Medical AND Nursing Management OF Choledocholithiasis PDF

Preview

Summary

Download Medical AND Nursing Management OF Choledocholithiasis PDF

Description

MEDICAL AND NURSING MANAGEMENT OF CHOLEDOCHOLITHIASIS Medical Management Management of a patient with choledocholithiasis include:

Low-fat diet. Low-fat diet is prescribed to prevent attacks. Vitamin K administration. Vitamin K is given to manage the itching, jaundice, and bleeding tendencies due to vitamin K deficiency. NGT insertion. Insertion of NGT may be done during acute attacks. IV therapy. Intravenous therapy may be needed during acute attacks.

Pharmacologic Therapy Medications prescribed may include:

Ursodeoxycholic acid. Ursodeoxycholic acid dissolves radiolucent stones for 6 to 12 months and provides an alternative for patients who are poor surgical risks or who refuse surgery. • Antibiotic therapy. Antibiotics are administered during acute attacks.

Surgical Management Surgery, usually elective, is the treatment of choice for gallbladder and bile duct diseases.

Laparoscopic cholecystectomy. Visualization of the gallbladder is done to remove the stones lodged in the common bile duct. Cholecystectomy with operative cholangiography. Removal of the stones in the common bile duct is one of the most frequently performed surgeries. ERCP with sphincterotomy. This procedure is the treatment of choice for choledocholithiasis with obstruction or cholangitis due to obstruction.

Nursing Management

The patient who is to undergo surgical treatment of gallstones is often admitted to the hospital or same day surgery unit on the morning of surgery.

Nursing Assessment Assessment should focus on the respiratory status.

History. The nurse notes a history of smoking, previous respiratory problems, shallow respirations, a persistent or ineffective cough, and the presence of adventitious breath sounds. Nutrition. Nutritional status is evaluated through a dietary history and a general examination performed at the time of preadmission testing. Laboratory results. The nurse reviews previously obtained laboratory results to obtain information about the patient’s status.

Nursing Diagnosis Based on all the assessment data, the major nursing diagnoses for the patient who has choledocholithiasis and has undergone surgery may include the following:

Acute pain related to surgical incision. Impaired gas exchange related to high abdominal surgical incision. Impaired skin integrity related to altered biliary drainage after surgical intervention. Imbalanced nutrition, less than body requirements, related to inadequate bile secretion.

Nursing Care Planning & Goals The goals for the patient include:

Relief of pain. Adequate ventilation. Intact skin and improved biliary drainage. Optimal nutritional intake. Absence of complications.

Nursing Interventions Patient care for gallbladder and bile duct diseases focuses on supportive care and close postoperative observation.

Lung exercises. Before surgery, teach the patient to cough, deep breathe, expectorate, and perform leg exercises that are necessary after surgery. Patient education. Explain the procedures that will be performed before, during, and after surgery to help ease the patient’s anxiety and to help ensure his cooperation. Post-surgery monitoring. After surgery, monitor the patient’s vital signs for signs of bleeding, infection, or atelectasis. Incision site care. Evaluate the incision site for bleeding; serosanguinous drainage is common for the first 24 to 48 hours if the patient has a wound drain. T-tube care. After a choledochostomy, a T-tube drain is placed in the duct and attached to a drainage bag, so make sure that the drainage tube has no kinks and check that the connection tube from the Ttube is well secured to the patient to prevent dislodgement. T-tube drainage monitoring. Measure and record T-tube drainage daily, which has a normal amount of 200 to 300 ml. I&O monitoring. Monitor the patient’s intake and output. Pain management. Evaluate the location, duration, and character of the pain, and administer adequate pain medications, especially before activities that increase pain.

Evaluation The expected patient outcomes include:

Relief of pain. Adequate ventilation. Intact skin and improved biliary drainage. Optimal nutritional intake. Absence of complications.

Discharge and Home Care Guidelines The nurse should promote home and community-based care.

Medications. The nurse instructs the patient about medications that are prescribed and their actions. Symptoms to report. Inform the patient and the family about symptoms that should be reported to the physical, including jaundice, dark urine, pale-colored stools, pruritus, and signs of inflammation and infections, such as pain or fever. Drainage tube management. The nurse instructs the patient and the family of the proper care of the drainage tube and the importance of reporting promptly any changes in the amount and characteristics of the drainage. Follow up appointments. The nurse emphasizes the importance of keeping follow-up appointments and reminds the patient and the family of the importance of participating in health promotion activities and recommended health screening.

Documentation Guidelines The focus of documentation include:

Client’s description of response to pain. Acceptable level of pain. Respiratory rate, character of breath sounds, frequency, amount, and appearance pf secretions, and presence of cyanosis. Conditions that may interfere with oxygen supply. Characteristic of skin damage. Impact of condition on personal image and lifestyle. Caloric intake. Individual cultural and religious restrictions, personal preferences. Plan of care. Teaching plan.

Client’s responses to treatment, teaching, and actions performed. Attainment or progress toward desired outcome. Modifications to plan of care....