NSG 3800/3850 Exam 4 UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS
Cholecystitis s/s - CORRECT ANSWER Pain
Tenderness
Rigidity/RUQ abdomen that may radiate to midsternal area or right shoulder/back
Cholecystitis patho/etiology - CORRECT 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 - CORRECT ANSWER calculous
has stones
acalculous has no stones
Acalculous theory - CORRECT 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) - CORRECT 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 - CORRECT 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 - CORRECT ANSWER AVOID
eggs
cream
pork
fried food
cheese
, rich dressings
gas-forming veggies (broccoli)
ETOH
Cholelithiasis medication - CORRECT ANSWER Ursodeoxycholic acid (inhibits
synthesis and secretion of cholesterol, thereby desaturating bile)
Cholelithiasis nursing management - CORRECT 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 - CORRECT 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? - CORRECT
ANSWER Fibrinogen
Prothrombin
Factor V, VII, IX, X, XI, XII
Protein C & S
Antithrombin
these help blood clot
QUESTIONS AND CORRECT ANSWERS
Cholecystitis s/s - CORRECT ANSWER Pain
Tenderness
Rigidity/RUQ abdomen that may radiate to midsternal area or right shoulder/back
Cholecystitis patho/etiology - CORRECT 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 - CORRECT ANSWER calculous
has stones
acalculous has no stones
Acalculous theory - CORRECT 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) - CORRECT 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 - CORRECT 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 - CORRECT ANSWER AVOID
eggs
cream
pork
fried food
cheese
, rich dressings
gas-forming veggies (broccoli)
ETOH
Cholelithiasis medication - CORRECT ANSWER Ursodeoxycholic acid (inhibits
synthesis and secretion of cholesterol, thereby desaturating bile)
Cholelithiasis nursing management - CORRECT 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 - CORRECT 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? - CORRECT
ANSWER Fibrinogen
Prothrombin
Factor V, VII, IX, X, XI, XII
Protein C & S
Antithrombin
these help blood clot
