CHOLECYSTECTOMY

Cholecystectomy



Case Study Report On Cholecystectomy

M.C. is a 62 year old retiree, admitted to your unit from the ETD. He is doubled-over, complaining of severe RUQ abdominal pain that radiates to his back. He is nauseated and has had a few episodes of vomiting at home. The pain is less intense if he walks around bent forward. The acute onset of pain started after eating a hot dog and french fries at a fast food stand. He reports having light-colored stools x 1 week. Urine is medium amber in color. Bowel sounds are audible x 4 quadrants, abdominal guarding noted with RUQ tenderness on palpation. Skin and sclera are slightly jaundiced. VS are 170/100; 126; 26; 99.9. (Soper 1992)1. What are Mr. C.'s clinical manifestations and how do you interpret the meaning of these findings?

RUQ abdominal pain - the gallbladder is located at the RUQ. when stone is lodged in the duct or stone moving through the ducts, spasms may result.

.nausea and vomiting, temperature of 99.9 - related to fever

intolerance to fat - onset of pain started after eating fatty foods such as hotdog and french fries.

light colored stool, medium amber colored urine and jaundice - obstruction of the bile duct by gallstones.

2. What laboratory studies and diagnostic studies need to be ordered for this client?

Ultrasound

WBC

Liver Function Test

Serum Bilirubin

Serum Amylase and Lipase

Serum electrolytes

Cardiac Enzymes

ERCP

Abdominal ultrasound reveals several retained stones in the common bile duct. M.C. is admitted to your floor and scheduled for an open cholecystectomy in the AM.3. Upon arrival to your unit, what are the nurse's assessment priorities?

check Vital signs

Assess pain

Assess for nausea and vomiting

review medical history

check physicians order or any special order

4. Given M.C. diagnosis, what laboratory values and diagnostic studies would be important to evaluate and why?

Result of Ultrasound - to diagnose the gallstones

ERCP - to visualize the gallbladder, cystic duct, common hepatic duct and the common bile duct; and also to take bile culture to identify infecting organism.

WBC (normal: 4300-10,800/mm3) - to evaluate proper dosage of antibiotic

Serum Bilirubin(normal: total 1.0mg/100ml) -to screen for or to monitor gall bladder dysfunction

Serum electrolytes (normal: K=3.5-5.0 meq/L; Mg=1.5-2.0 meq/L; Na=135-145 meq/L)- to ensure electrolytes balance

Cardiac Enzymes - to measure enzymes secreted by heart muscles

5. What data found in the assessment above are consistent with common bile duct obstruction and why?

skin and sclera are jaundiced

light colored stool

intolerance to fatty food

When the bile ducts become blocked, bile accumulates in the liver, and jaundice (yellow color of the skin) develops due to the accumulation of bilirubin in the blood.

6. List 4 pre-op preparations that need to be done and why?

NPO- restriction of fluids and food is to minimize potential risk of postop nausea and vomiting

.Consent for surgery - the patient must sign a voluntary and informed consent in the presence of a witness. This protects the patient, the suregeon, and the hospital and its employees.

typing and crossmatching of blood - in case of emergency blood transfusion due to surgery

.T-tube will be inserted - to drain excessive bile; ...