Chapter 11

1. Symptoms of gallbladder disease often resemble those of other GI diseases. Which group of symptoms suggests cholecystitis?

Pain in the right upper quadrant that radiates to the right shoulder or back, positive Murphy’s sign, and low-grade fever would suggest cholecystitis.

2. What diagnostic tests can be used to confirm a diagnosis of cholecystitis?

Diagnostic tests for cholecystitis include ultrasound, which can reveal gallstones or inflammation of the gallbladder, and a hepatobiliary iminodiacetic acid (HIDA) scan, which evaluates gallbladder function. Blood tests such as liver function tests and a complete blood count (CBC) may also be performed to assess for inflammation and infection.

3. Why are G.B.’s symptoms triggered by eating and/or eating fatty foods?

Symptoms are triggered by eating fatty foods because fatty foods stimulate the release of cholecystokinin (CCK), which causes the gallbladder to contract and release bile. In individuals with gallbladder disease, such as cholecystitis, the bile duct may become obstructed by gallstones, leading to inflammation and pain.

4. Which best describes the role of the gallbladder?

The gallbladder stores, concentrates, and secretes bile.

5. True or False: Family history is the ONLY risk factor for cholecystitis seen in G.B.’s case. If other risk factors are present, please list them.

False. Other risk factors for cholecystitis in G.B.’s case include obesity, previous gestational diabetes, and her symptoms worsening after consuming fatty foods.

6. What are some potential treatment options for G.B.?

Treatment options for cholecystitis may include pain management, antibiotics to treat infection, and dietary modifications. In severe cases or recurrent episodes, surgical removal of the gallbladder (cholecystectomy) may be necessary.

7. The physician decides that the best course of action for G.B. is a laparoscopic cholecystectomy. What does this procedure entail? What kind of postoperative instructions will you give to G.B.?

Laparoscopic cholecystectomy is a minimally invasive surgical procedure to remove the gallbladder. It involves making small incisions in the abdomen and inserting a camera and specialized surgical instruments to visualize and remove the gallbladder. Postoperative instructions may include pain management, activity restrictions, dietary modifications (low-fat diet initially), and monitoring for signs of complications such as infection or bile duct injury.

GI Case Study 2 Answers

1. What are the signs and symptoms of peptic ulcer disease?

Signs and symptoms of peptic ulcer disease include abdominal pain, often described as burning or gnawing in nature, typically occurring between meals or during the night. Other symptoms may include nausea, vomiting (sometimes with blood), bloating, feeling full after small meals, and unintentional weight loss.

2. What risk factors does Samara present with?

Samara presents with risk factors for peptic ulcer disease such as frequent use of NSAIDs (ibuprofen), which can irritate the stomach lining, and symptoms suggestive of an upper GI bleed, such as vomiting blood (hematemesis).

3. What other MAJOR complications can occur with peptic ulcer disease?

Major complications of peptic ulcer disease include perforation, where the ulcer creates a hole through the wall of the stomach or duodenum, leading to leakage of stomach contents into the abdominal cavity; and gastric outlet obstruction, where swelling or scarring from the ulcer blocks the passage of food from the stomach into the small intestine.

4. What are the interventions if these major complications occur?

Immediate surgical intervention may be necessary if major complications such as perforation or gastric outlet obstruction occur. Perforation requires surgical repair of the hole in the stomach or duodenum, while gastric outlet obstruction may require procedures such as endoscopic dilation or surgical correction to relieve the blockage.

5. Should the nurse suggest to the health care provider that these two home medications should be added to her admission orders? Why or why not?

The nurse should suggest discontinuing NSAIDs (ibuprofen) from Samara’s admission orders, as NSAIDs can exacerbate peptic ulcer disease. However, Ortho Tri-Cyclen Lo can remain on her medication list as it is not associated with exacerbating peptic ulcers.

6. Which lab results are abnormal and what is the significance of the abnormal results?

Abnormal lab results include hemoglobin (Hgb) of 11g/dL and hematocrit (Hct) of 34%, indicating mild anemia likely due to chronic blood loss from the upper GI bleed. Additionally, the white blood cell count (WBC) of 11,800 cells/mm3 is elevated, suggesting an inflammatory response, possibly due to the ulceration and inflammation seen on EGD.

7. What are the nursing responsibilities after Samara has the EGD?

Nursing responsibilities after Samara’s EGD include monitoring for signs of complications such as bleeding or perforation (e.g., abdominal pain, worsening hematemesis), providing comfort measures for any discomfort related to the procedure, and ensuring Samara remains on bedrest as ordered to minimize the risk of further bleeding.

8. After returning to the nursing unit from diagnostic testing, Samara asks to try some saltine crackers and ginger ale. How should the nurse respond to Samara’s request?

Initially, the nurse should withhold solid foods and clear liquids until it is determined whether Samara’s GI tract is actively bleeding or stable. However, if Samara’s condition is stable and there are no contraindications, the nurse can offer small sips of clear fluids initially, such as water or ice chips, and gradually progress to bland foods like saltine crackers and ginger ale if tolerated.

9. Identify three nursing diagnoses appropriate on admission for Samara. Prioritize each nursing diagnosis and provide the rationales for each selected nursing diagnoses and its priority number.

Nursing diagnoses appropriate for Samara on admission include the following:

Acute Pain related to gastric ulceration and inflammation (Priority: 1) – Priority is given to managing Samara’s pain to ensure her comfort and promote rest, which aids in healing.

Risk for Deficient Fluid Volume related to vomiting and potential upper GI bleed (Priority: 2) – Priority is given to addressing fluid volume deficits to prevent complications such as hypovolemic shock.

Anxiety related to hospitalization, uncertainty about illness, and impact on work responsibilities (Priority: 3) – While important, addressing Samara’s physical needs takes precedence over psychological support in this acute care setting.

10. Develop a teaching plan for these medications and explain to Samara rationales for diet and health care follow-up.

The teaching plan for Samara’s discharge medications includes the following:

• Omeprazole: Explanation of its role in reducing stomach acid production, which helps to heal and prevent ulcers.
• Calcium carbonate: Instruction on its use for relieving symptoms of indigestion or heartburn.