Question

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Concept Map-Choledocholithiasis Mr. Tony Burk is a 60y/o retiree admitted to your unit from the emergency room. Upon arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. The patient states that he has had severe upper right quadrant pain that radiates to his back, and he is more comfortable walking bent forward than lying down in bed. He admits to having bouts of abdominal pain in the past month but "none as bad as this". He states he feels only slightly nauseated but has experienced but has experienced nausea and vomiting during previous episodes. He states that he experienced this latest episode after eating fish and chips at a fast food restaurant. His daughter insisted he go to the hospital and has accompanied him to the floor. Assessment findings are: AAO X 3 and moves all extremities well. Moves restlessly and continuously; complains of notable fatigue. Heart sounds clear bilaterally in both anterior and posterior chest. Heart sounds clear without adventitious sounds, heart rate regular, all pulses +3 bilaterally. Abdominal guarding noted with exquisite tenderness to light palpation over the right side, especially the upper right quadrant. He has sharp respiratory arrest with palpation of the upper right quadrant. Patient reports light colored stools over the past week. Voids medium amber urine; denies pain or discomfort with voiding. Skin and sclera are slightly jaundiced. Vital signs on admission are: B/P 164/100, P 132, R 26, and T. 99.4 1. State the structures that are in the upper right quadrant of the abdomen 2. List two organs that can be palpated in the upper right quadrant 3. Discuss the significance of the vital signs. Revised 9/19 Tot

Answer 1

1. Structures in the right upper quadrant

Abdomen can be divided into four quadrants. They are Right upper quadrant, Right lower quadrant, Left upper quadrant, Left lower quadrant. ( It can be divided into 9 quadrants by three horizontal and vertical lines also).

Structures in the right upper quadrant includes:

1. The gallbladder

2. Right portion of the liver

3. Right kidney

4. Part of colon and intestine

5. small section of the stomach

Right upper quadrant contains very important organs such as kidney, portion of the liver and gallbladder.

2. Two organs that can be palpated in the right upper quadrant are;

* the gallbladder : a distended mass can felt in case of cholecystitis, inflammation of gallbladder, pancreatic cancer)

* a portion of the liver: a mass can be felt in case of hepatomegaly ( enlargement of liver) due to hepatic tumour or hepatitis.

3. Significance of vital signs

Vital signs are a set of vital or important measurements of ap patient's condition taken regularly to assess the state of body functions. Vital signs are temperature, pulse,respiration,and Blood pressure. Significant variations are indications of disease condition or major physiological or pathological changes in the body.

Mr.Tony's vital signs indicates;

* BP : 164/ 100mm of Hg . It shows Hypertension or high blood pressure.

* Pulse: 132. It shows tachycardia or the abnormally increased heart beat.

* Respiration: 26. Respiratory rate also shows increased rate. More than 20 breaths per minute indicates tachypnoea.

* Temperature: 99.4. Patient's temperature is in normal limits.