Question

John Smith is a 65-year-old retiree who is admitted to your unit from the emergency department (Ed). On arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. John indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid back as a deep, sharp, boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but "none as bad as this." He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. John experienced an acute onset of pain after eating fried fish and chips at a fast-food restaurant earlier today. He is not happy to be in the hospital and is grumpy that his daughter insisted on taking him to the emergency department for evaluation. After orienting him to the room, you perform your physical assessment. The findings are as follows: He is awake, alert, and oriented × 3, and he moves all extremities well. He is restless, constantly shifting his position, and complains of fatigue. Breath sounds are clear to auscultation. Heart sounds are clear and crisp, with no murmur or rub noted and with a regular rate and rhythm. Abdomen is flat, slightly rigid, and very tender to palpation throughout, especially in the RUQ; bowel sounds are present. He reports having light-colored stools for 1 week. The patient voids dark amber urine but denies dysuria. skin and sclera are jaundiced. Admission vital signs are blood pressure 164/100, pulse of 132 beats/min, respiration 26 breaths/min, temperature of 100° F (37.8° C), spo2 96% on 2 L of oxygen by nasal cannula. Preoperative Laboratory Test Results • WBC 11,900/mm3 • Hgb 14.3 g/dL • Hct 43% • Platelets 250,000/mm3 • ALT 200 units/L • AST 260 units/L • ALP 450 units/L • Total bilirubin 4.8 mg/dL • PT/INR 11.5 sec/1.0 • Amylase 50 units/L • Lipase 23 units/L • Urinalysis Negative .

If he had a laparoscopic cholecystectomy, which discharge instruction would the nurse advise the patient: (explain the rational for the correct choice). a. Keep the incision areas clean and dry for at least a week b. Report he need to take pain medication for shoulder pain c. Report any bile-colored or purulent drainage from the incisions d. Expect some postoperative nausea and vomiting for a few days

Answer 1

c The patient who undergoes laparoscopic cholecystectomy is discharged soon after the surgery,so homecare is important.The patient should be explained about the need to report the following signs and symptoms such as redness,swelling,bile-coloured drainage or pus from any incision,as tis may indicate obstruction.hence c is the correct option.

option b is noticed immediately following the surgery this referredf pain to the shoulder because of the Carbondioxide that was not released or absorbed by the body.The CO2 can irritate the phrenic nerve and the diaphragm ,causing some difficulty breathing.