NURS 290 STUDY GUIDE

THE CLIENT WITH CHOLECYSTITIS THE CLIENT WITH CHOLECYSTITIS 1. A client has undergone a laparoscopic cholecystectomy. Which of the following instructions should the nurse include in the discharge teaching? 1. Empty the bile bag daily. 2. If you become nauseated, breathe deeply into a paper bag. 3. Keep adhesive dressings in place for 6 weeks. 4. Report bile-colored drainage from any incision. 4. There should be no bile-colored drainage coming from any of the incisions postoperatively. A laparoscopic cholecystectomy does not involve a bile bag. Breathing deeply into a paper bag will prevent a person from passing out due to hyperventilation; it does not alleviate nausea. If the adhesive dressings have not already fallen off, they are removed by the surgeon in 7 to 10 days, not 6 weeks. 2. A 40-year-old client is admitted to the hospital with a diagnosis of acute cholecystitis. The nurse should contact the physician to question which of the following orders? 1. I.V. fluid therapy of normal saline solution to be infused at 100 mL/hour until further orders. 2. Administer morphine sulfate 10 mg I.M. every 4 hours as needed for severe abdominal pain. 3. Nothing by mouth (NPO) until further orders. 4. Insert a nasogastric tube and connect to low intermittent suction. 2. A nurse should question the order for morphine sulfate because it is believed to cause biliary spasm. Thus, the preferred opioid analgesic to treat cholecystitis is meperidine (Demerol). Elderly clients should not be given meperidine because of the risk of acute confusion and seizures in this population. An alternative pain medication will be necessary. I.V. fluid therapy is used to maintain fluid and electrolyte balance that may result from NPO status and gastric suctioning. NPO status and gastric decompression prevent further gallbladder stimulation. 3. A client is admitted to the hospital with a diagnosis of cholecystitis from cholelithiasis. The client has severe abdominal pain, nausea, and has vomited several times. Based on these data, which nursing diagnosis would have the highest priority for intervention at this time? 1. Anxiety related to severe abdominal discomfort. 2. Deficient fluid volume related to vomiting. 3. Pain related to gallbladder inflammation. 4. Imbalanced nutrition: Less than body requirements related to vomiting. 3. The priority for nursing care at this time is to decrease the client's severe abdominal pain. The pain, which is frequently accompanied by nausea and vomiting, is caused by biliary spasm. Opioid analgesics are given to relieve the severe pain and spasm of cholecystitis. Relief of pain may decrease nausea and vomiting and thereby decrease the client's likelihood of developing further complications, such as deficient fluid volume and imbalanced nutrition. There are no data to suggest that the client is anxious. 4. A client's stools are light gray in color. The nurse should assess the client further for which of the following? Select all that apply. 1. Intolerance to fatty foods. 2. Fever. 3. Jaundice. 4. Respiratory distress. 5. Pain at McBurney's point. 6. Peptic ulcer disease. 1, 2, 3. Bile is created in the liver, stored in the gallbladder, and released into the duodenum giving stool its brown color. A bile duct obstruction can cause pale colored stools. Other symptoms associated with cholelithiasis are right upper quadrant tenderness, fever from inflammation or infection, jaundice from elevated serum bilirubin levels, and nausea or right upper quadrant pain after a fatty meal. Pain at McBurney's point lies between the umbilicus and right iliac crest and is associated with appendicitis. A bleeding ulcer produces black, tarry stools. Respiratory distress is not a symptom of cholelithiasis. 5. A client who has been scheduled to have a choledocholithotomy expresses anxiety about having surgery. Which nursing intervention would be the most appropriate to achieve the outcome of anxiety reduction? 1. Providing the client with information about what to expect postoperatively. 2. Telling the client it is normal to be afraid. 3. Reassuring the client by telling her that surgery is a common procedure.