Question

Evelyn Bean is 52 years of age and is a female patient who is admitted to the same day surgery unit for an elective laparoscopic cholecystectomy. The patient presents with jaundice of the skin and sclera. The patient's urine is dark and the patient stated that she has clay-colored stools. She stated she has occasional colicky pain in her right upper quadrant of her abdomen radiating to her back. The patient had preadmission testing one week ago and the results are on the patient's chart. The record of patient education and an informed written consent are also on the chart. 30. What additional procedure will be performed if the common bile duct is obstructed by a gallstone? 31. The nurse in the same day surgery unit provides the discharge instructions to the patient and family before the patient goes for surgery so the patient is fully awake to receive the instructions and ask questions. What written and verbal instructions should the nurse provide?

Answer 1

1) Gall bladder a small pear shaped organ located under the liver at right upper quadrant of the abdomen. The function of gall bladder includes storing bile, that is produced from liver.Bile is important to digest fat present in the diet. Gall stones are solid ,ass forms as a result of excess deposition of cholesterol. Gall stone may block common bile duct. The symptoms ranges from pain in upper quadrant,nausea ,vomiting,dark urine, clay color stools and jaundice.

Laparoscopic gallbladder removal refers to procedure assisted with removal of gall bladder using video assisted device. An incision is made in the belly button and a port is created. Abdomen is filled with gas to create space in the abdomen for the surgery. A small camera is inserted through the port and the gall bladder is excised using instruments.

Additional procedure needed to treat CBD obstruction is Endoscopic Retrograde cholangiopancreatography a procedure involves in upper GI endoscopy and x rays to treat gall stones. The procedure is done under sedatives. A anesthetic based gargle is provided to to numb the oral cavity. Periodical monitoring of vital signs id done. A small flexible catheter is inserted through scope and a special contrast medium is injected followed by series of x ray studies to locate any obstruction in common bile duct,pancreatic duct. In case of gall stones it is break into pieces and removed. A temporary stents are placed to prevent bile leakage.

2) The nurses health teaching for a patient undergone elective lap cholecystectomy includes the following, to monitor skin incision area for any redness and purulent discharge,wash the surgical site with mild soap and water, Avoid spicy food for few days,Watch for yellowish discoloration of skin,fever accompanied with chills,pain of higher threshold, swelling in the incision area, bleeding in rectum. Explain the patient regarding followups and medication name,dosage,route and frequency.