URDANETA CITY UNIVERSITY

San Vicente West, Urdaneta City, Philippines-2428

COLLEGE OF ARTS AND SCIENCES

Name: Cruz Mary Ruth D. Date: April 29, 2022

Course and Year Level: BSN-3 Code: N110
Block: 1 Subject: MS

Assessment and Management of Patients with Biliary Disorders

CRITICAL THINKING:

1. A 77-year-old man underwent a right total hip replacement. His clinical course was initially
stable but on day 4 postoperatively he became nauseated and began vomiting. He also
complained of right upper quadrant pain and was hypotensive and tachycardic. His urine output
has decreased to 10 mL/hr. What are the initial priorities of care for this patient? Abdominal
ultrasound and abdominal CT scan were performed and revealed marked thickening of the
gallbladder wall and pericholecystic effusion but no gallstones were identified. He was
determined to have acalculous cholecystitis. What would be the initial treatment the nurse
would expect to implement? If the patient continued to deteriorate with worsening pain and
signs of systemic inflammation and hypovolemia, what additional interventions should the nurse
be prepared to implement?

Answer:

What are the initial priorities of care for this patient?

 Assessment should focus on the patient’s respiratory status. If the traditional surgical approach
is planned, the high abdominal incision required during surgery may interfere with a full
respiratory excursion.

What would be the initial treatment the nurse would expect to implement?

 In calculous cholecystitis, a gallbladder stone obstructs bile outflow. Bile remaining in the
gallbladder initiates a chemical reaction; autolysis and edema occur; and the blood vessels in
the gallbladder are compressed, compromising its vascular supply.

If the patient continued to deteriorate with worsening pain and signs of systemic inflammation and
hypovolemia, what additional interventions should the nurse be prepared to implement?

 If the patient’s condition deteriorates, surgical intervention is delayed just until the acute
symptoms subside (usually within a few days). There is no need to delay surgery pending an
improvement in nutritional status, and deciding on a laparoscopic approach is not a lengthy
process.

2. A 58-year-old man presents to the emergency department with complaints of severe mid-
epigastric pain. He is also nauseated and vomiting. His vital signs reveal hypotension and
tachycardia and he is febrile. His history is significant for alcohol abuse and hypertension. What
laboratory and imaging studies do you expect to be performed? His CT scan revealed pancreatic
necrosis and multiple fluid collections. An evidence-based approach for managing infected
pancreatic necrosis was implemented. What first-line intervention would you expect to be
implemented in this case? What classification of pancreatitis is this patient experiencing?

Answer:

What laboratory and imaging studies do you expect to be performed?

• X-ray studies of the abdomen and chest may be obtained to differentiate pancreatitis from other
disorders that may cause similar symptoms and detect pleural infusion. Ultrasound and contrast-
enhanced computed tomography scans are used to identify an increased diameter of the pancreas and
detect pancreatic cysts, abscesses, or pseudocysts and also CT scan
 URDANETA CITY UNIVERSITY
San Vicente West, Urdaneta City, Philippines-2428
COLLEGE OF ARTS AND SCIENCES

Name: Cruz Mary Ruth D. Date: April 29, 2022

Course and Year Level: BSN-3 Code: N110
Block: 1 Subject: MS

What first-line intervention would you expect to be implemented in this case?

• First is the percutaneous image-guided catheter drainage (PCD). Endoscopic drainage (ED) and
retroperitoneal mucosectomy. Percutaneous drainage is the most frequently used first-line intervention
in the management of necrotizing pancreatitis.

- What classification of pancreatitis is this patient experiencing?

• The patient experiencing pancreatic necrosis.

3. A 55-year-old woman has been experiencing upper abdominal pain for several weeks. She
believes that she has gallbladder disease but is concerned because her mother died from
pancreatic cancer. She visits her physician who prescribes a CT scan and initial laboratory
screening studies. Which laboratory tests would you expect to be assessed? The CT scan
revealed no masses but did show dilatation of the pancreatic duct. The woman grew more
concerned due to her family history even though her initial laboratory tests were normal. Her
physician shared her concern and prescribed an MRI, which revealed a small mass at the head of
the pancreas. The woman was referred to a surgeon who began an assessment to determine if
the patient was a candidate for potentially curative resection. What testing is needed to assess if
the mass was cancerous and if it may have metastasized? The patient is determined to be a
candidate for surgery. List two postoperative nursing interventions that can be effective in
preventing complications. What education will the nurse provide the patient to enhance
comfort, nutrition, and quality of life after discharge?

Answer:

Which laboratory tests would you expect to be assessed?

• MRI and computed tomography are used to identify the presence of pancreatic tumors. ERCP is also
used in the diagnosis of pancreatic carcinoma. Cells obtained during ERCP are sent to the laboratory for
examination.

What testing is needed to assess if the mass was cancerous and if it may have metastasized?

• Although percutaneous biopsy is a valuable diagnostic tool, it has some potential drawbacks: a false–
negative result if small tumors are missed and seeding of cancer cells along the needle track.

List two postoperative nursing interventions that can be effective in preventing complications. What
education will the nurse provide the patient to enhance comfort, nutrition, and quality of life after
discharge?

• Pain management and attention to nutritional requirements are important nursing measures to
improve the level of comfort. Skincare and nursing measures are directed toward relief of pain and
discomfort associated with jaundice, anorexia, ad profound prominences from pressure. Patient-
controlled analgesia should be considered for the patient with severe, escalating pain.