Nr 325 Chapter 43 Liver, Pancreas, And Biliary Tract Problem

Nr 325 Chapter 43 Liver Pancreas And Biliary Tract Problems Clinic

NR 325 Chapter 43 Liver, Pancreas, and Biliary Tract Problems – Clinical Situations Read the following case studies. Circle the correct answer. CASE STUDY: Liver Biopsy Veronica is scheduled for a liver biopsy. The staff nurse assigned to care for Veronica is to accompany her to the treatment room. 1. Before a liver biopsy, the nurse should check to see that: a. A compatible donor blood is available. b. Coagulation studies have been completed. c. Vital signs have been assessed. d. All of the above have been done. (Blood must be compatible with the patient’s to prevent a transfusion reaction. Due to bleeding risks, coagulation studies should have been completed before liver biopsy. Standard percutaneous liver biopsy observations include monitoring the patient’s vital signs every 15 minutes for the first two hours, then every 30 minutes for two hours and then hourly for the rest of the remaining period. This protocol is reasonable when one considers that 61% of complications occur within the first two hours.) 2. The nurse begins preparing Veronica for the biopsy by assisting her to the correct position, which is: a. Jackknife, with her entire back exposed. b. Recumbent, with her right upper abdomen exposed. (Percutaneous Liver biopsy procedure uses needle inserted between 6th and 7th or 8th and 9th intercostal spaces on the right side to obtain specimen of hepatic tissue.) c. Lying on her right side, with the left upper thoracic area exposed. d. Supine, with the left lateral chest wall exposed. 3. The nurse knows that the biopsy needle will be inserted into the liver between the: a. Third and fourth ribs. b. Fourth and fifth ribs. c. Sixth and seventh ribs. d. Eight and ninth ribs. 4. Immediately before needle insertion, Veronica needs to be instructed to: a. Breathe slowly and deeply so that rib cage expansion will be minimized during needle insertion. b. Inhale and exhale deeply several times then exhale and hold her breath at the end of expiration until the needle is inserted. c. Pant deeply and continue panting during needle insertion so pain perception will be minimized. d. Take a deep inspiration and not breathe for 30 to 40 seconds so that the area for needle insertion can be determined; she should then resume normal breathing for the remainder of the procedure. 5. After the biopsy, the nurse assists Veronica to: a. High-Fowler’s position, in which she can effectively take deep breaths and cough. b. Ambulate while splinting her incision. c. Assume the Trendelenburg position to prevent post biopsy shock. d. The right side-lying position with a pillow placed under the right costal margin. (Keep patient lying on right side to splint puncture site.) CASE STUDY: Paracentesis Wendy is scheduled for a paracentesis because of ascites formation subsequent to cirrhosis of the liver. 1. Before the procedure, the nurse obtains several drainage bottles. She knows that the maximum amount of fluid to be aspirated at one time is: a. 1L. b. 2L. c. 3L. d. 4L. (Therapeutic paracentesis refers to the removal of maximum amount of fluid of 4L to reduce intra-abdominal pressure and relieve the associated dyspnea, abdominal pain, and early satiety.) 2. The nurse helps Wendy to assume the proper position for a paracentesis, which is: a. Recumbent so that the fluid will pool to the lower abdomen. b. Laying on her left side so that fluid will not exert pressure on the liver. c. Semi-Fowler’s to avoid shock and provide the most comfort. d. Upright with her feet resting on a support so that the puncture site will be readily visible. (Clients who have ascites are typically more comfortable sitting up.) 3. After the paracentesis, Wendy should be observed for signs of vascular collapse, which include all of the following except: a. Bradycardia (Fluid volume deficit can occur due to increased fluid excretion by the kidneys or excessive diaphoresis which leads to tachycardia, not bradycardia.) b. Hypotension. c. Oliguria. d. Pallor. CASE STUDY: Cholecystectomy Brenda, a 33-year-old obese mother of four, is diagnosed as having acute gallbladder inflammation. She is 5 feet tall and weighs 190 lb. The physician decides to delay surgical intervention until Brenda’s acute symptoms subside. 1. Brenda’s initial course of treatment would probably consist of: a. Analgesics and antibiotics. b. Intravenous fluids. c. Nasogastric suctioning. d. All of the above. (Pain management using analgesics is critical during an acute episode of cholecystitis. Morphine may be initially given for pain management. Vomiting associated with cholecystitis may lead to metabolic alkalosis and chloride shift. Administering NaCl will help compensate the shift in chloride levels. Inserting NG Tube experiencing severe vomiting will help decompress the stomach and minimize gallbladder stimulation.) 2. After her acute attack, Brenda was limited to low-fat liquids. As foods are added to her diet, she needs to know that she should avoid: a. Cooked fruit. b. Eggs and cheese. c. Lean meats. d. Rice and tapioca. 3. Brenda is being medicated with chenodeoxycholic acid. The nurse needs to tell Brenda that the drug may not be effective if it is taken in conjunction with: a. Dietary cholesterol. b. Estrogens. c. Oral contraceptives. d. Any of the above. Because Brenda’s symptoms continue to recur, she is scheduled for gallbladder surgery. 1. Brenda has signed a consent form for removal of her gallbladder and ligation of the cystic duct and artery. She is scheduled to undergo a: a. Cholecystectomy. b. Cholecystostomy. c. Choledochotomy. d. Choledocholithotomy. 2. Postoperative nursing observation includes assessing for: a. Indicators of infection. b. Leakage of bile into the peritoneal cavity. c. Obstruction of bile drainage. d. All of the above. 3. Brenda needs to know that fat restriction is usually lifted after the biliary ducts dilate to accommodate bile once held by the gallbladder. This takes about: a. 1 week. b. 2 to 3 weeks. c. 4 to 6 weeks. d. 2 months. CASE STUDY: Alcoholic or Nutritional Cirrhosis Nathan, a 50-year-old physically disabled veteran, has lived alone for 30 years. He has maintained his independence despite chronic back pain resulting from a war injury. He has a long history of depression and limited food intake. He drinks 6 to 10 bottles of beer daily. He was recently admitted to a veteran’s hospital with a diagnosis of alcoholic or nutritional cirrhosis. He was asymptomatic for ascites. 1. On assessment, the nurse notes early clinical manifestations of alcoholic or nutritional cirrhosis, which include all of the following except: a. Pain caused by liver enlargement. b. A sharp edge to the periphery of the liver. c. A liver decreased in size and nodular. d. A firm liver. 2. An abnormal laboratory finding for Nathan is a: a. Blood ammonia level of 35 mg/dL. b. Serum albumin concentration of 4.0 g/dL. c. Total serum bilirubin level of 0.9 mg/dL. d. Total serum protein level of 5.5 g/dL. 3. Nathan is 5 feet 8 inches tall and weighs 154 lb. The physician recommends 50 cal/kg for weight gain. Nathan’s daily caloric intake would be approximately: a. 2,200 calories. b. 2,800 calories. c. 3,500 calories. d. 3,800 calories. 4. A recommended daily protein intake for Nathan to gain weight is: a. 31 to 44 g. b. 41 to 54 g. c. 51 to 64 g. d. 61 to 74 g. 5. The physician recommends a sodium-restricted diet. The nurse expects the suggested sodium intake to be approximately: a. 250 to 500 mg/24 h. b. 500 to 1,000 mg/24 h. c. 2,000 to 2,500 mg/24 h. d. 3,000 to 3,500 mg/24 h.

Paper For Above instruction

The compilation of clinical case studies regarding liver, pancreas, and biliary tract problems provides critical insights into complex management and treatment strategies. These cases emphasize the importance of thorough pre-procedure assessments, appropriate patient positioning, vigilant post-procedure care, and tailored nutritional management to ensure patient safety and optimal outcomes. This essay synthesizes the essential considerations for each condition, highlighting procedural protocols, nursing interventions, and patient education necessary in managing these hepatic, pancreatic, and biliary disorders effectively.

Management of Liver Biopsy

The liver biopsy is a pivotal diagnostic procedure for evaluating hepatic pathology. Pre-procedure preparations are crucial, particularly ensuring coagulation studies are complete, as these assess bleeding risk, which is heightened in liver diseases. The availability of compatible donor blood is also vital in case transfusion becomes necessary. Vital signs monitoring is essential to detect early signs of complications, such as hemorrhage or shock. Patient positioning for the procedure typically involves lying on the right side with the upper abdomen exposed, facilitating proper access to the liver through the intercostal spaces—usually between the sixth and seventh or the eighth and ninth ribs. Instruction on breath-hold during needle insertion ensures minimal movement and reduces injury risk. Post-procedure, maintaining the patient in the right-side position with a pillow under the costal margin supports bleeding control by applying pressure to the puncture site and prevents peritoneal irritation. Continuous monitoring of vital signs and observing for signs of bleeding or other complications is mandatory in the immediate hours following the biopsy.

Paracentesis in Managing Ascites

Paracentesis serves as both a diagnostic and therapeutic intervention for ascites secondary to liver cirrhosis. Limiting fluid removal to a maximum of 4 liters at a time prevents hypovolemic shock and electrolyte imbalances. The patient is typically positioned upright or semi-Fowler’s to allow adequate fluid pooling and ease access to the abdomen. Post-procedure observations focus on detecting vascular collapse, a life-threatening complication characterized by hypotension, oliguria, pallor, and tachycardia. Recognizing that bradycardia is not associated with vascular collapse due to hypovolemia is important, as tachycardia is the typical response. Maintaining vigilant monitoring for signs of shock, managing fluid and electrolyte status, and providing comfort are essential components of postoperative care in paracentesis patients.

Surgical Interventions for Gallbladder Pathology

Cholecystectomy remains the definitive treatment for acute or chronic gallbladder disease such as cholecystitis. Initial management focuses on pain control with analgesics, often opioids like morphine, and antibiotics to combat infection. Intravenous fluids support hydration and electrolyte balance, while nasogastric suctioning assists in decompressing the stomach during severe vomiting episodes. Dietary modifications following an attack include avoiding high-fat foods such as eggs, cheese, and greasy meats. The medication chenodeoxycholic acid, used to dissolve gallstones, requires caution when taken with dietary cholesterol, estrogens, or oral contraceptives, as these can diminish its efficacy. Postoperative care involves monitoring for infection, bile leakage, and biliary obstruction. When the biliary ducts dilate, usually within 2 to 3 weeks, patients can gradually resume a normal or low-fat diet, improving digestion and nutrient absorption.

Chronic Liver Disease and Nutritional Management

Nathan’s case exemplifies the progression and management of alcoholic or nutritional cirrhosis. Early signs include hepatomegaly, a sharp-edged liver, and nodularity indicative of advancing fibrosis. Laboratory findings such as elevated blood ammonia and decreased serum albumin reflect hepatic dysfunction; however, Nathan’s labs appear within normal ranges, emphasizing the importance of clinical correlation. Nutritional support involves caloric intake of approximately 50 calories per kilogram of body weight, translating to about 2,800 calories daily for Nathan based on his weight. Protein intake is vital for hepatic regeneration and preventing catabolism; recommended intakes range from 41 to 54 grams daily. Sodium restriction is equally important to manage edema and ascites, with an intake around 500 to 1,000 mg per day being appropriate for early stages. Implementing dietary modifications and addressing alcohol cessation are critical to slowing disease progression and improving quality of life.

Conclusion

Effective management of liver, pancreatic, and biliary disorders demands comprehensive understanding of procedural precautions, vigilant monitoring, and personalized nutritional plans. Education on patient positioning, recognition of post-procedure complications, and tailored diets are integral to patient safety. These case studies underscore the collaborative role of healthcare providers in optimizing outcomes through evidence-based practices, meticulous assessment, and proactive interventions. As advances in medical technology and pharmacotherapy continue, holistic and patient-centered approaches remain pivotal in managing complex hepatic and biliary conditions efficiently and compassionately.

References

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