Question

write a nursing care plsn the following case study using the rubric

Case Study, Assessment and Management of Patients With Biliary Disorders

1. Evelyn Bean, 52 years of age, 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 1 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. (Learning Objectives 2 and 3)

NURSING CARE PLAN RUBRIC

Do not write the NCP using a grid format… use an essay format/ bullet point using the numbers of this rubric.

All NCP will be graded according to the following rubric.

1) Definition of the medical diagnosis __________10

etiology/pathophysiology

2) Common signs and symptoms ___________5

3) Potential complications ___________5

4) Head to toe physical assessment you are to write one….use the data in the case if there is none you create it as if this was your patient. NOT a to do list!

__________10

5) Diagnostic and lab studies ___________5

normal values

expected abnormalities

6) ALL NANADA Nursing diagnoses __________10

7) Develop 3 NANDA priority nursing diagnoses __________10

8) State a patient plan AND goal for each of the __________10

priority nursing diagnosis

9) Write interventions for each of __________10

priority nursing diagnosis

10) Write scientific rationales for you you ___________5

interventions

11) Write evaluation of your interventions __________10

your plan or make changes

12) List of typical medications __________10

category

usual dosage

side effects

patient teaching

Answer 1

1. Biliary disorder is disease of bile duct, gall bladder and other structure involved in the production and transportation of bile.

  Etiology

• Hereditary
• Age here patient has 52 year
• High fat diet
• Common biliary disorders are cholelithiasis and choleycystitis.
• Choley lithiasis is occur due to change in bile composition.

Pathophysiology

Biliary disorder occur as a result of extahepatic obstruction and intrahepatic obstruction. Gallstones occur as a result if bile supersaturated with cholesterol or calcium.

Signs and symptoms

• ​​​​​​​​​​​​​​Murphy's sign (choleycystitis )
• ​​​​​​​Jaundice (skin and eyes )
• Abdominal pain (upper right side of abdomen and radiating to back)
• Nause and vomiting
• Anorexia
• Fatigue
• Fever

Complications

• obstruction
• Cholangitis
• Liver abscess
• Fistula
• Carcinoma
• 4.Here patient have jaundice on skin and sclera, pain on right upper quadrant radiating to chest. Dark coloured urine and clay coloured stool. These symptoms suggested patient has choleycystitis.

Lab study

• Alanine aminotransferase (ALT)and aspartate aminotransferase(AST) are used to evaluate choleycystitis.
• AST (normal 10-40unit ) and ALT (7-56 unit )
• Bilirubin (normal 0.2-0.3mg/dl)
• WBC (normal 4000-11000mmol3)

Diagnostic test

• Biliary ultrasonography
• abdominal x-ray study
• CT and MRI
• Hepatobiliary scintigraphy

Nursing careplan

1. ​​​​​Acute pai related to biliary spasm
2. Risk for deficient fluid related to vomiting
3. Risk for imbalance nutrition less than body requirement related to inadequate intake of food.
4. Knowledge deficit related to inadequate knowledge related to disease process.
5. Risk for injury related to medication and procedure.

Nursing interventions and rationale

pain

• Asses the location, severity of pain to get baseline data.
• Provide comfort measures such as back rub and positioning to enhance rest.
• Administred pain medication as ordered to relieve pain

Risk for imbalanced fluid volume

• Assess hydration status to assess baseline data
• Insert nasogastric tube to relieve vomiting, distension and remove gastric juices contains choleycystokinin which causes painful contraction of gallbladder
• Administer IV fluids and electrolyte to maintain hydration.

Evaluation

• ​​​​​​​Patient gets relief from pain
• Patient maintain adequate hydration