NSG 3800 EXAM 3 COMPREHENSIVE
QUESTIONS WITH VERIFIED PRACTICE
SOLUTIONS
●● Cholecystitis patho/etiology
Answer: Persistent irritation to gallbladder wall from cholelithiasis
(stones)
Diabetes & obesity contribute
Untreated can lead to increased risk of cancer & sepsis
●● Calculous cholecystitis vs Acalculous cholecystitis
Answer: calculous has stones
acalculous has no stones
●● Acalculous theory
Answer: Speculation/theory cause is alterations in fluids & electrolytes;
alterations in regional blood flow in visceral circulation
Bile stasis & increased viscosity of bile are also thought to play a role
Occurs after major surgical procedures (makes diagnosis difficult at
times)
Severe trauma
,Burns
Other associated factors
Torsion
TPN
Cystic duct obstruction
Primary bacterial infections of gallbladder
Multiple blood transfusions
●● Cholecystitis ERCP (diagnosis)
Answer: Endoscopic retrograde cholangiopancreatography
Allows direct visualization of structures
Examines hepatobiliary system via side-viewing fiberoptic endoscope
Multiple position changes required during the procedure to pass
endoscope.
Patient in left semi-prone position
Preparation & Procedure
NPO 6-8 hours prior to procedure
Moderate sedation
Need someone to drive them home
,observe for s/s of perforation or infection s/p procedure
No ice chips until gag reflex is back
●● Cholelithiasis s/s
Answer: RUQ pain
Jaundice
Dark colored urine
Grey/clay looking stool
biliary colic after eating heavy meal
Vit A,D,E, & K deficiency
●● Cholelithiasis nutrition considerations
Answer: AVOID
eggs
cream
pork
fried food
cheese
rich dressings
gas-forming veggies (broccoli)
ETOH
, ●● Cholelithiasis medication
Answer: Ursodeoxycholic acid (inhibits synthesis and secretion of
cholesterol, thereby desaturating bile)
●● Cholelithiasis nursing management
Answer: post-op care
- low fowlers
-fluids via IV
- NGT to decompress abdomen
- soft diet after bowel sounds return
- monitor for s/s of hemorrhage, peritonitis, infection
- water and fluids after gag reflex has returned
●● Post-op wound care for cholelithiasis
Answer: Check puncture site daily for signs of infection.
Wash puncture site with mild soap and water.
Allow special adhesive strips on the puncture site to fall off. Do not pull
them off.
●● If the liver is not working properly, what proteins will be low?
Answer: Fibrinogen
Prothrombin
Factor V, VII, IX, X, XI, XII
QUESTIONS WITH VERIFIED PRACTICE
SOLUTIONS
●● Cholecystitis patho/etiology
Answer: Persistent irritation to gallbladder wall from cholelithiasis
(stones)
Diabetes & obesity contribute
Untreated can lead to increased risk of cancer & sepsis
●● Calculous cholecystitis vs Acalculous cholecystitis
Answer: calculous has stones
acalculous has no stones
●● Acalculous theory
Answer: Speculation/theory cause is alterations in fluids & electrolytes;
alterations in regional blood flow in visceral circulation
Bile stasis & increased viscosity of bile are also thought to play a role
Occurs after major surgical procedures (makes diagnosis difficult at
times)
Severe trauma
,Burns
Other associated factors
Torsion
TPN
Cystic duct obstruction
Primary bacterial infections of gallbladder
Multiple blood transfusions
●● Cholecystitis ERCP (diagnosis)
Answer: Endoscopic retrograde cholangiopancreatography
Allows direct visualization of structures
Examines hepatobiliary system via side-viewing fiberoptic endoscope
Multiple position changes required during the procedure to pass
endoscope.
Patient in left semi-prone position
Preparation & Procedure
NPO 6-8 hours prior to procedure
Moderate sedation
Need someone to drive them home
,observe for s/s of perforation or infection s/p procedure
No ice chips until gag reflex is back
●● Cholelithiasis s/s
Answer: RUQ pain
Jaundice
Dark colored urine
Grey/clay looking stool
biliary colic after eating heavy meal
Vit A,D,E, & K deficiency
●● Cholelithiasis nutrition considerations
Answer: AVOID
eggs
cream
pork
fried food
cheese
rich dressings
gas-forming veggies (broccoli)
ETOH
, ●● Cholelithiasis medication
Answer: Ursodeoxycholic acid (inhibits synthesis and secretion of
cholesterol, thereby desaturating bile)
●● Cholelithiasis nursing management
Answer: post-op care
- low fowlers
-fluids via IV
- NGT to decompress abdomen
- soft diet after bowel sounds return
- monitor for s/s of hemorrhage, peritonitis, infection
- water and fluids after gag reflex has returned
●● Post-op wound care for cholelithiasis
Answer: Check puncture site daily for signs of infection.
Wash puncture site with mild soap and water.
Allow special adhesive strips on the puncture site to fall off. Do not pull
them off.
●● If the liver is not working properly, what proteins will be low?
Answer: Fibrinogen
Prothrombin
Factor V, VII, IX, X, XI, XII
