assessment and management of patients with biliary/pancreas...
TRANSCRIPT
Assessment and Management of Patients
With Biliary/Pancreas Disorders
Shu-Yi (Emily) Wang, PhD, RN, CNS
Denver School of Nursing
Liver, Biliary System, and Pancreas
Figure 39-4, pp. 931
Gall bladder (GB) stoneIntrahepatic duct (IHD) stoneCommon bile duct (CBD) stone
Gastro-colic reflexDuodenal-colic reflex
Belching: expulsion of gas from the stomach through the monthFlatulence: expulsion of gas from the rectum
ERCP
NPO 8 hrsLocal anesthetic gargle or spray---gag reflex returnedAtropine given: ↓secretion; Glucagon given: relax smooth muscleObserve S/S perforation: pain, bleeding, unusual difficult swallowing, rapidly elevate temp
Nonsurgical Techniques for Removing Gallstones
Common Hepatic DuctCommon Bile Duct
Traditional Cholecystectomy
Care of the T-tubeKeep below GBAssess drainage & outputAssess odor & inspect skinNever irrigate or aspirateWhen allowed to eat
Care of wound
Laparoscopic Cholecystectomy
Pathogenic Process of Acute Pancreatitis
Pain: LLQPost-hepatic jaundice
Multiple Sumps after Pancreatic Surgery
Triple-lumen tubes consist of ports that provide tubing for irrigation, air venting and drainage
Pancreatoduodenectomy (Whipple’s Procedure)
End result of resection of carcinoma of the head of the pancreas or the ampulla of VaterThe common duct is sutured to the end of the jejunum, and the remaining portion of the pancreas and the end of the stomach are sutured to the side of the jejunum
Figure 44-16, pp. 1126