A Case Study on Choledocholithiasis

8/16/2019 A Case Study on Choledocholithiasis

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A Case Study on

Choledocholithiasis

Submitted by:

Jaelynn Faith OmbinaAngelika Isona

Warline R. Hyberts

Kenneth Pagasianhristelle adiente



Table of Contents

ha!ter I Introdu"tion

ha!ter II Ob#e"ti$e

ha!ter III Patient%s &ata

ha!ter I' (enogram

ha!ter ' History o) Illness

ha!ter 'I &e*nition o) om!lete

&iagnosis

ha!ter 'II &e$elo!mental +ilestone

ha!ter 'III Physi"al Assessment

ha!ter I, Anatomy and Physiology

ha!ter , -tiology and Sym!tomatologyha!ter ,I Patho!hysiology

ha!ter ,II &o"tor%s Order

ha!ter ,III &iagnosti" and aboratory Result

ha!ter ,I' &rug Study

ha!ter ,' +edi"al Surgi"al +anagement

ha!ter ,'I &is"harge Planning/ Health

0ea"hing

ha!ter ,'II 1ursing are Plan

ha!ter ,'III Prognosis



ha!ter ,I, Re)eren"es

ha!ter ,, A"kno2ledgement

Introduction

holedo"holithiasis re)ers to the !resen"e o) gallstones2ithin the "ommon bile du"t. A""ording to the 1ational Healthand 1utrition -3amination Sur$ey 41HA1-S III56 o$er 78 millionAmeri"ans are estimated to ha$e gallbladder disease 4de*ned as

the !resen"e o) gallstones on transabdominal ultrasound or ahistory o) "hole"yste"tomy5. Among those 2ith gallbladderdisease6 the e3a"t in"iden"e and !re$alen"e o) "holedo"holithiasisare not kno2n6 but it has been estimated that 9 to 78 !er"ent o)!atients ha$e "holedo"holithiasis at the time o) "hole"yste"tomy62ith the in"iden"e in"reasing 2ith age.

In Western "ountries6 most "ases o) "holedo"holithiasis arese"ondary to the !assage o) gallstones )rom the gallbladder intothe "ommon bile du"t. Primary "holedo"holithiasis 4i.e.6 )ormationo) stones 2ithin the "ommon bile du"t5 is less "ommon. Primary"holedo"holithiasis ty!i"ally o""urs in the setting o) bile stasis4e.g.6 !atients 2ith "ysti" *brosis56 resulting in a higher !ro!ensity)or intradu"tal stone )ormation. Older adults 2ith large bile du"tsand !eriam!ullary di$erti"ular are at ele$ated risk )or the

)ormation o) !rimary bile du"t stones. Patients 2ith re"urrent or!ersistent in)e"tion in$ol$ing the biliary system are also at risk6 a!henomenon seen most "ommonly in !o!ulations )rom -ast Asia.



0he "auses o) !rimary "holedo"holithiasis o)ten ae"t the biliarytra"t diusely6 so !atients may ha$e both e3trahe!ati" andintrahe!ati" biliary stones. Intrahe!ati" stones may be"om!li"ated by re"urrent !yogeni" "holangitis.

(allstones in Southeastern Asia 4-3tra!olated Statisti"s5:e3tra!olated !re$alen"e is 968;<68=8> Po!ulation -stimated ?sedis @67=B6C;7.

Objectives 0his "ase study 2il l hel! and ser$e us to enhan"e

our kno2ledge to understand Choledocholithiasis byassessing6 analyDing and inter!reting the "olle"ted data. 0his 2illin turn gi$e us a better idea o) ho2 2e "ould gi$e !ro!er nursing"are making the right e$aluation and right inter$ention to our"lients 2ith this "ondition> And so that 2e may a!!ly them on our

)uture e3!osures as students and e$entually as nurses. We alsodid this "ase study as !art o) our reEuirement in our "lini"ale3!osure.

• &e*ne holedo"holithiasis by identi)ying their signs andsym!toms6 as 2ell as its "lini"al mani)estations.

• A"Euire baseline data.

• AnalyDe the signs and sym!toms and "lini"al mani)estation

eli"ited by the !atient and other !roblems that the !t. mayde$elo! so that the student nurse may !rioritiDe theses



!roblem to be able to render "are in a systemati" and logi"alorder.

• Illustrate the !atho!hysiology o) the !t. "ondition and

interrelate 2ith it.

• A!!ly a!!ro!riate nursing inter$ention and shallot aid the

student nurses !rodu"es "om!etent and reliable !lan o) "areto hel! the !atient health and medi"al understanding assu"h "onditions.

• &e$elo! s!e"i*" nursing "are !lan6 measure and attainable6

realisti" and time bounded.

• Re"ommend a!!ro!riate dis"harge !lanning the !atients so

that the !t. 2ill de$elo! kno2ledge and understanding athome )or )aster re"o$ery.

Patient’s Data

PERSONA DATA

Patients 1ame: +rs. ing

Age: <C

(ender: Female

irth &ate: January B6 BC;;

i$il Status: +arried

O""u!ation: 1one

ity Address: OsmeGa6 om!ostella PR?7

1ationality: Fili!ino



Religion: Roman atholi"

-du"ational Attainment: ollege ?ndergraduate

Sour"e: Patient%s hart

CINICA!AD"ITTIN# DATA

&ate o) admission: =/B@/78B

0ime o) admission: B:78 P+

Hos!ital: &a$ao +edi"al S"hool Foundation

Ward: Surgi"al

Room 1o: <7= =

Attending Physi"ian:&r. 'elas"o

Admitting &iagnosis: holedo"holithiasis

$ITA SI#NS ON E%R% AD"ISSION

&ate o) Admission: A!ril B@6 78B

0ime: B:78 P+

0em!erature: <.B &egrees elsius

Pulse Rate: ;@ !m

Res!iratory Rate: 78 "!m

lood Pressure: B78/@8 mm/Hg

Height: B=< "m

Weight: ;.9 kg



#eno&ra'



(istory of Illness

A)ter establishing ra!!ort 2ith the !atient6 I asked about her age

and 2hat brought her to the hos!ital. 0he !atient $erbaliDed that

she is <C years o) age and began to e3!erien"e !ain roughly t2omonths !rior admission but did not !ay it any mind. On +ar"h @6

78B6 she e3!erien"ed !ain in the ba"k so she 2ent to thehos!ital )or another "he"ku!. As the days 2ent by6 the !ainseemed to be getting 2orse6 so on A!ril B@6 78B she de"ided to

go ba"k to the hos!ital and 2as admitted.



When I asked about her li)estyle and her eating habits6 the !atient

$erbaliDed that she used to eat )atty )oods6 es!e"ially in her

"ollege days. When I asked her i) she has any allergies tomedi"ations and i) she e$er had any surgi"al !ro"edure done

be)ore6 the !atient stated 1o. 0he !atient is ha!!ily married.She has one son and o2ns a sarisari store. 0he !atient $erbaliDed

she is $ery grate)ul to (O& that the surgery 2ent 2ell.

Social (ealth (istory

Patient does not "onsume al"oholi" be$erages. She stays homema#ority o) her time 2ith )amily. Her )amily are $ery "lose and

s!ends time 2ith ea"h other on Sundays6 2hile going to "hur"h.

)a'ily (istory

0he !atient%s )amily does not e3hibit any history o) Hy!ertension6&iabetes +ellitus6 Asthma6 an"er6 Angina6 Abdominal Pain6 Flank

Pain6 Heat and old6 Heada"he.

De*nition of Co'+lete

Dia&nosis



B. holedo"holithiasis is the !resen"e o) at least one gallstonein the "ommon bile du"t. 0he stone may be made u! o) bile!igments or "al"ium and "holesterol salts.Re)eren"e: https://www.nlm.nih.gov/medlineplus/ency/article/000274.htm

7. holedo"holithiasis denotes the !resen"e o) gallstone 2ithinthe bile du"ts 4"ommon he!ati" du"t and/or "ommon biledu"t5.Re)eren"e: http://radiopaedia.org/articles/choledocholithiasis

<. holedo"holithiasis is a disease o) the "ommon bile du"t

2hi"h )orms at the #un"tion o) the "ysti" du"t )rom thegallbladder and the "ommon he!ati" du"t 4)rom li$er5.

Re)eren"e: http://www.myvmc.com/diseases/common-bile-duct-stone-choledocholithiasis-cholangitis-obstructive-jaundice/

Nursin& Theories

Environ'ental Theory

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Florence Nightingale

1ursing is an a"t o) utiliDing the en$ironment o) the !atient to assist him inhis re"o$ery that in$ol$es the nurses initiati$e to "on*gure en$ironmentalsettings a!!ro!riate )or the gradual restoration o) the !atients health6 and

that e3ternal )a"tors asso"iated 2ith the !atients surroundings ae"t li)e onbiologi" and !hysiologi" !ro"ess and his de$elo!ment.

Rationale:

?s nurses need to gi$e "are and "om)ort to our !atient be"ause Floren"e1ightingale belie$ed that the en$ironment has a big !arti"i!ation )or )asterre"o$ery o) the !atient. Similar to our !atient6 ing6 she surrounds hersel) ina good en$ironment so that she 2as able to a"hie$e )aster re"o$ery not only2ith the hel! o) the health "are team but as 2ell as the en$ironment.

Nursin& Need theory

Virginia Henderson

0he 1ursing 1eed 0heory 2as de$elo!ed by 'irginia A. Henderson. 0o de*nethe uniEue )o"us o) the nursing !ra"ti"e6 the theory )o"uses on theim!ortan"e o) in"reasing the !atient%s inde!enden"e to hasten their

!rogression in the hos!ital.

Rationale:

As nurses6 2e not only !ro$ide "are )or our !atients but en"ourage the!atient%s ability to "are )or himsel). 0his "an only be attained by !romotingthe !atient%s inde!enden"e. 0his theory 2as a!!lied 2ith our !atient6 ing62ho #ust "ame )rom ha$ing a ma#or o!eration done6 hole"yste"tomy6 and2as limited in mo$ement due to !ain )rom surgery6 by assisting her intrans)erring )rom bed to "hair but allo2ing her to use her arms and legs as

2ell. In due time6 she 2ill gain ba"k her strength and be able to do things onher o2n again.

Care, Cure, Core Nursin& Theory

Lydia Hall



are6 "ure and "ore are the three %s o) ydia Hall6 2here "are is the sole)un"tion o) nurses. 0he ure and ore are shared 2ith other members o) thehealth "are team.

Rationale:

?s nurses gi$e thera!euti" "are and !ro$ide )or tea"hing and learninga"ti$ities to our !atient. We ha$e a goal6 an inter$ention and !lanning )or the!atient%s "are in order )or him/her to get 2ell. 0his in"ludes gi$ing medi"ationand other means o) treatments. We !ro$ide thera!euti" "are by edu"atingour !atient 2ith their health6 !ro!er sel)"are and by di$erting the !atient%sattention )rom their !ain to re"o$ery. One 2ay 2e a""om!lish this is by!ro$iding entertainment and 2ellmeaning "on$ersations.



Develo+'ental

"ilestone

Eri-son.s Sta&e of Psychosocial Develo+'ent

Erikson’s (1959) theory of psychosocial development has eight distinct stages. Like

Freud Erikson assumes that a crisis occurs at each stage of development. For Erikson

(19!") these crises are of a psychosocial nature #ecause they involve psychological

needs of the individual (i.e. psycho) conflicting $ith the needs of society (i.e. social).

%ccording to the theory successful completion of each stage results in a healthy

personality and the ac&uisition of #asic virtues. 'asic virtues are characteristic

strengths $hich the ego can use to resolve su#se&uent crises.

Failure to successfully complete a stage can result in a reduced a#ility to complete

further stages and therefore a unhealthier personality and sense of self. hese stages

ho$ever can #e resolved successfully at a later time.

Stage &es"ri!tion Result Justi*"ation



Inti'acy vs%Isolation

LoungAdulthood

4ages B@ to =8

yrs.5

We begin to

share

oursel$es more

intimately 2ithothers. We

e3!lore

relationshi!s

leading to2ard

longer term

"ommitments

2ith someone

other than a)amily

member.

Su""ess)ul

"om!letion o)

this stage "an

lead to

"om)ortablerelationshi!s

and a sense o)

"ommitment6

sa)ety6 and

"are 2ithin a

relationshi!.

A$oiding

intima"y6

)earing

"ommitment

and

relationshi!s

A"hie$ed Patient ing is

<C years oldand married.

She is $ery

mu"h ha!!y asa mother o)only son. She

de"ided to o2n

and run asmall sarisari

store6 to be

able to "are )orher son 2hile

also earning anin"ome.



"an lead to

isolation6

loneliness6 and

sometimesde!ression.

Su""ess in this

stage 2ill lead

to the $irtue

o) love.

/ohlber&.s Theory

0he signi*"an"e o) this theory is )o"used on the moral

de$elo!ment o) an indi$idual. +o$ing )rom an orientation o)

sel*shness o) the la2 and order stage6 2ithout !assing throughthe good boy/girl stage. 0his theory hel!s us understand that

morality starts )rom the early "hildhood years and "an be ae"ted

by se$eral )a"tors.




on$entional

+orality a2and Order

0he stage

2here mostadoles"ents

and adult

)rame theirmoral beha$iorand

understand the

im!ortan"e o)others and the

basi" !rin"i!les

o) agen"y !arto) the so"iety

hasestablished

$alues thatshould di"tate

moral

beha$ior.

A"hie$ed Patient is a

hands onmother. She

"hose to tea"h

her only songood $aluesand good

moral 2hi"h

"an "ontributegoodness in

the so"iety.

(avi&hurst’s Develo+'ental Tas- Theory

0his theory suggests si3 stages o) li)e: the in)an"y o) early

"hildhood 2hi"h lasts )rom in)an"y to early "hildhood. 0hese are



babies 2ho are #ust learning to 2alk and talk and *guring out the

2orld around them. +iddle "hildhood6 lasts )rom ages to age B7.

&uring this time6 "hildren be"ome more sel)suM"ient as they goto s"hool and make )riends. Adoles"en"e6 2hi"h lasts )rom age B<

to age B@6 "omes 2ith hormonal "hanges and learning aboutha$ing a li)e !artner. -arly adulthood6 lasts )rom age BC to age <8

2hi"h in$ol$es *nding an o""u!ation6 as 2ell as *nding that li)e!artner. +iddle age6 lasts )rom age <8 to age 8. 0his is the time

2hen most !eo!le start a )amily and settle into their adults li$es.

ater maturity lies around the age o) 8. &uring this time !eo!lead#ust to li)e a)ter 2ork and begin to !re!are themsel$es )or

death.


+iddle Age4<8 yrs. old5

+aintaining

e"onomi"li$ing and

!er)orming

"i$i" so"ialres!onsibility

Relating to

s!ouse as a!erson and

ad#usting to

!hysiologi"al

"hanges

A"hie$ed +rs. ing has a

ha!!y )amilyand li$es under

one roo) 2ith

her mother N)ather. She is a

)ull time mom

and 2i)e. Shealso runs her

$ery o2n sari

sari store.



Physical Assess'ent#eneral Survey0

Assessment 2as done in B:=8 P+ o) A!ril 786 78B at &+SFhos!ital re"o$ery room

$ital Si&ns0

Patient is lying in a su!ine !osition and "ons"ious6 2eak anda!!ears slightly "hilling6 )ully "o$ered 2ith a blanket. With I'F!lain P1SS B to run at B88"" 37 "y"le.

CEP(AOCA1DA0 From head to toe ins!e"tion6 2e obser$edthe !atient%s 2illingness to "oo!erate during entire !eriod o)assessment. She is able to stand but she "annot !er)orm e3traa"ti$ity.

S/IN0 0he "lient%s skin is uni)orm in "olor6 no s"ars notedunblemished and no !resen"e o) any )oul odor. He has a good skinturgor and skin%s tem!erature is 2ithin normal limit

(AIR0 0he !atient%s s"al! is lighter than the "olor o) his skin and hasno areas o) tenderness. 0he hair is e$enly distributed thi"k and it haslittle 2hite hair no !resen"e o) li"e6 no s"ars noted or !a!ules.

"O1T(0 0he li!s o) the "lient are uni)ormly !ink> moist6symmetri" and ha$e a smooth te3ture. 0here is no dis"oloration o) the enamels6 no retra"tion o) gums6 !inkish in "olor o) gums. 0hebu""al mu"osa o) the "lient a!!eared as uni)ormly !ink> moist6so)t6 glistening and 2ith elasti" te3ture. 0he tongue o) the "lient is"entrally !ositioned. It is !ink in "olor6 moist and slightly rough.

0here is a !resen"e o) thin 2hitish "oating. 0he smooth !alates



are light !ink and smooth 2hile the hard !alate has a moreirregular te3ture. 0he u$ula o) the "lient is !ositioned in themidline o) the so)t !alate.

NOSE0 0he !atient nose "olor is same as )a"esymmetri"ala!!earan"e the nose is at the "enter no redness in the nasalmu"osa no rashes noted no nodules u!on !al!ation.

E2E0 Hair is e$enly distributed. 0he "lient%s eyebro2s are

symmetri"ally aligned and sho2ed eEual mo$ement 2hen asked

to raise and lo2er eyebro2s. -yelashes a!!eared to be eEually

distributed and "urled slightly out2ard. 0here 2as no !resen"e o)

dis"harges6 no dis"oloration and lids "lose symmetri"ally 2ith

in$oluntary blinks.EAR0 0he Auri"les are symmetri"al and has the same "olor 2ithhis )a"ial skin. 0he auri"les are aligned 2ith the outer "anthus o)eye. When !al!ating )or the te3ture6 the auri"les are mobile6 *rmand not tender. 0he !inna re"oils 2hen )olded. &uring theassessment o) Wat"h ti"k test6 the "lient 2as able to hear ti"kingin both ears.

NEC/ : 0he ne"k is in the "enter same 2ith )a"ial skin no

de)ormities noted no nodules noted u!on !al!ation

T(ORA30 0heres no sign o) de)ormities no dis"oloration. 0he"hest 2all is inta"t 2ith no tenderness and masses. 0here%s a )ulland symmetri" e3!ansion and the thumbs se!arate 7< "m duringdee! ins!iration 2hen assessing )or the res!iratory e3"ursion. 0he"lient mani)ested Euiet6 rhythmi" and eortless res!irations. 0hes!ine is $erti"ally aligned. 0he right and le)t shoulders and hi!sare o) the same height.

(EART0 0here 2ere no $isible !ulsations on the aorti" and!ulmoni" areas. 0here is no !resen"e o) hea$es or li)ts u!onaus"ultation

A4DO"EN0 0he abdomen o) the "lient .is no dis"oloration 0heabdomen has a symmetri" "ontour. at or rounded symmetri"al



bilaterally be"ause o) the !resen"e o) in"ision and o! sitedressing

1PPER E3TRE"ITIES0 Able to !er)orm )ull RO+ not s2elling or

inammation noted no dis"oloration% (ood skin turgor no nodulesnoted no rashes noted> ha$e same siDe and length "oordinatedmo$ement no !resent o) tremor.

NAIS0 no dis"oloration no de)ormities6 nails are "lean no s"arnoted no nodules noted u!on !al!ation.

INSPECTION AND PAPATION O) O5ER E3TRI"ITIES0 0hee3tremities are symmetri"al in siDe and length. 0he mus"les arenot !al!able 2ith the absen"e o) tremors. 0hey are normally *rm

or sho2ed smooth6 "oordinated mo$ements. 0here 2as no!resen"e o) bone de)ormities6 tenderness and s2elling. 0here 2asno s2elling6 tenderness and #oints mo$e smoothly.E#S0 Feet no dis"oloration6 no de)ormities6 no rashes noted6 nonodules u!on !al!ation. normal dee! tendon ree3 u!on!er"ussion normal.

#ERITO1RINAR20 Patient $erbaliDed she has normal hairdistribution and no !resen"e o) body li"e in the genitalia. We

don%t in"lude the genitals !art o) our !atient be"ause 2e res!e"tthe de"ision and maintain the !ri$a"y o) the !atient. 0hemenstruation o) our !atient is normal < = days shes stated. Andtheres no !resen"e o) burning sensation 2hen she urinates.



Anato'y andPhysiolo&y

Lour digesti$e system is uniEuely "onstru"ted to !er)orm itss!e"ialiDed )un"tion o) turning )ood into the energy you need tosur$i$e and !a"kaging the residue )or 2aste dis!osal. 0o hel! youunderstand ho2 the many !arts o) the digesti$e system 2orktogether6 here is an o$er$ie2 o) the stru"ture and )un"tion o) this"om!le3 system.



+outh

0he mouth is the beginning o) the digesti$e tra"t> and6 in )a"t6digestion starts here 2hen taking the *rst bite o) )ood. he2ingbreaks the )ood into !ie"es that are more easily digested6 2hilesali$a mi3es 2ith )ood to begin the !ro"ess o) breaking it do2ninto a )orm your body "an absorb and use.

-so!hagus

o"ated in your throat near your tra"hea 42ind!i!e56 theeso!hagus re"ei$es )ood )rom your mouth 2hen you s2allo2. ymeans o) a series o) mus"ular "ontra"tions "alled !eristalsis6 theeso!hagus deli$ers )ood to your stoma"h.

Stoma"h

0he stoma"h is a hollo2 organ6 or "ontainer6 that holds )ood2hile it is being mi3ed 2ith enDymes that "ontinue the !ro"ess o)breaking do2n )ood into a usable )orm. ells in the lining o) thestoma"h se"rete a strong a"id and !o2er)ul enDyme that areres!onsible )or the breakdo2n !ro"ess. When the "ontents o) thestoma"h are suM"iently !ro"essed6 they are released into thesmall intestine.





0he gallbladder stores and "on"entrates bile6 and then releases itinto the duodenum to hel! absorb and digest )ats.

olon 4large intestine5

0he "olon is a )oot long mus"ular tube that "onne"ts the smallintestine to the re"tum. 0he large intestine is made u! o) the"e"um6 the as"ending 4right5 "olon6 the trans$erse 4a"ross5 "olon6the des"ending 4le)t5 "olon6 and the sigmoid "olon6 2hi"h"onne"ts to the re"tum. 0he a!!endi3 is a small tube atta"hed tothe "e"um. 0he large intestine is a highly s!e"ialiDed organ that isres!onsible )or !ro"essing 2aste so that em!tying the bo2els iseasy and "on$enient.

Stool6 or 2aste le)t o$er )rom the digesti$e !ro"ess6 is !assedthrough the "olon by means o) !eristalsis6 *rst in a liEuid stateand ultimately in a solid )orm. As stool !asses through the "olon62ater is remo$ed. Stool is stored in the sigmoid 4Ssha!ed5 "olonuntil a mass mo$ement em!ties it into the re"tum on"e or t2i"ea day. It normally takes about < hours )or stool to get throughthe "olon. 0he stool itsel) is mostly )ood debris and ba"teria.

0hese ba"teria !er)orm se$eral use)ul )un"tions6 su"h assynthesiDing $arious $itamins6 !ro"essing 2aste !rodu"ts and)ood !arti"les6 and !rote"ting against harm)ul ba"teria. When thedes"ending "olon be"omes )ull o) stool6 or )e"es6 it em!ties its"ontents into the re"tum to begin the !ro"ess o) elimination.

Re"tum

0he re"tum 4atin )or straight5 is an @in"h "hamber that"onne"ts the "olon to the anus. It is the re"tums #ob to re"ei$estool )rom the "olon6 to let the !erson kno2 that there is stool tobe e$a"uated6 and to hold the stool until e$a"uation ha!!ens.

When anything 4gas or stool5 "omes into the re"tum6 sensors senda message to the brain. 0he brain then de"ides i) the re"tal"ontents "an be released or not. I) they "an6 the s!hin"ters rela3and the re"tum "ontra"ts6 dis!osing its "ontents. I) the "ontents"annot be dis!osed6 the s!hin"ter "ontra"ts and the re"tuma""ommodates so that the sensation tem!orarily goes a2ay.



Anus

0he anus is the last !art o) the digesti$e tra"t. It is a 7in"h long"anal "onsisting o) the !el$i" oor mus"les and the t2o anals!hin"ters 4internal and e3ternal5. 0he lining o) the u!!er anus iss!e"ialiDed to dete"t re"tal "ontents. It lets you kno2 2hether the"ontents are liEuid6 gas6 or solid. 0he anus is surrounded bys!hin"ter mus"les that are im!ortant in allo2ing "ontrol o) stool.

0he !el$i" oor mus"le "reates an angle bet2een the re"tum andthe anus that sto!s stool )rom "oming out 2hen it is not su!!osedto. 0he internal s!hin"ter is al2ays tight6 e3"e!t 2hen stool entersthe re"tum. It kee!s us "ontinent 2hen 2e are aslee! orother2ise una2are o) the !resen"e o) stool. When 2e get an urgeto go to the bathroom6 2e rely on our e3ternal s!hin"ter to hold

the stool until rea"hing a toilet6 2here it then rela3es to releasethe "ontents.

The #allbladder



0he &allbladder is a !earsha!ed6 hollo2 stru"ture lo"ated underthe li$er and on the right side o) the abdomen. Its !rimary)un"tion is to store and "on"entrate bile6 a yello2bro2n digesti$eenDyme !rodu"ed by the li$er. 0he gallbladder is !art o) thebiliary tra"t6 2hi"h are the organs and ducts that "reate andstore bile and release it into the duodenum 4the small intestine5.

0he gallbladder ser$es as a reser$oir )or bile 2hile it%s not beingused )or digestion. 0he gallbladders absorbent lining"on"entrates the stored bile. When )ood enters the smallintestine6 a hormone "alled "hole"ystokinin is released6 signalingthe gallbladder to "ontra"t and se"rete bile into the smallintestine through the "ommon bile du"t.

0he bile hel!s the digesti$e !ro"ess by breaking u! )ats. It alsodrains 2aste !rodu"ts )rom the li$er into the duodenum6 a !art o)

the small intestine.

An e3"ess o) "holesterol6 bilirubin6 or bile salts "an "ausegallstones to )orm. (allstones are generally small6 hard de!ositsinside the gallbladder that are )ormed 2hen stored bile"rystalliDes. A !erson 2ith gallstones 2ill rarely )eel anysym!toms until the gallstones rea"h a "ertain siDe6 or i) the



gallstone obstru"ts the bile du"ts. Surgi"al remo$al o) thegallbladder 4"hole"yste"tomy5 is the most "ommon 2ay to treatgallstones.

0he "ysti" du"t #oins the gallbladder to the bile du"t and is one o)the im!ortant stru"tures needing !ro!er identi*"ation anddi$ision during a standard "hole"yste"tomy. 0he "ysti" du"t mayrun a straight or a )airly "on$oluted "ourse. Its length is $ariable

and usually ranges )rom 7 to = "m. Around 78 o) "ysti" du"tsare less than 7 "m. Hen"e there may be $ery little s!a"e to !ut"li!s or ligatures. 0rue absen"e o) the "ysti" du"t is e3tremely rareand i) the du"t is not seen is more likely to be hidden. 0he "ysti"du"t is usually 7T< mm 2ide. It "an dilate in the !resen"e o)!athology 4stones or !assed stones5. 0he normal bile du"t is alsoaround 9 mm and hen"e "an look like a mildly dilated "ysti" du"t.



In general6 a "ysti" du"t larger than 9 mm 4or the need to use a$ery large "li! to "om!letely o""lude the du"t5 should arouse asus!i"ion o) mistaken identity 2ith the bile du"t be)ore it is"li!!ed or ligated.

0he "ysti" du"t #oins the gallbladder at the ne"k and this anglemay be )airly a"ute. Also the mode o) #oining may be smoothta!ering or abru!t. On the bile du"t side its mode o) union sho2ssigni*"ant $ariations. Sin"e su"h $ariations are not un"ommon itmay not be sa)e to try and disse"t the "ysti" du"t to its #un"tion2ith the bile du"t. It is im!ortant to remember that e$en in thelo2 insertion $ariety the "ysti" du"t rarely goes behind duodenumand there)ore a du"tal stru"ture !assing behind the duodenum ismore likely to be the bile du"t itsel). &ouble "ysti" du"ts are

des"ribed but are e3"eedingly rare and there)ore t2o du"talstru"tures entering the gallbladder should al2ays be $ie2ed 2ithsus!i"ion. Also the "ysti" du"t does not ha$e $essels tra$eling onits sur)a"e 2hereas the bile du"t has su"h $isible $essels.

hole"ystitis 4koluhsis0I-tis5 is inammation o) the gallbladder.

Lour gallbladder is a small6 !earsha!ed organ on the right side o)



your abdomen6 beneath your li$er. 0he gallbladder holds digesti$euid thats released into your small intestine 4bile5.

In most "ases6 gallstones blo"king the tube leading out o) yourgallbladder "ause "hole"ystitis. 0his results in a bile buildu! that"an "ause inammation. Other "auses o) "hole"ystitis in"lude biledu"t !roblems and tumors. I) le)t untreated6 "hole"ystitis "an leadto serious6 sometimes li)ethreatening "om!li"ations6 su"h as agallbladder ru!ture. 0reatment )or "hole"ystitis o)ten in$ol$esgallbladder remo$al

Etiolo&y

PR-&ISPOSI1(

FA0OR

PR-S-10/AS-1

0

RA0IO1A- J?S0IFA0IO1

Female

Womenbet2een 78

8 years o)

age are t2i"eas likely to

de$elo!

gallstonethan men.

-strogen

in"reases"holesterol

le$els in bile

and de"reasegallbladder

mo$ement>

both o) 2hi"h"an lead to

gallstone

0he !atient is

)emale.



)ormation.

Age: <C Lears

Old

+any o) the

body%s

system and!rote"ti$e

me"hanism

be"ome lesseM"ient 2ith

age.

ody systemand

!ro"esses

be"omesluggish.

0he !atient is

<C years old.

Ra"e: Asian

Asians aremore

geneti"ally!redis!osed

to ha$ing

!igmentedstones

"om!ared to

those li$ing inWestern

ountries.

Our !atient isFili!ino.

Patient 2ith

diabetesgenerally

ha$e high



&iabetes

+ellitus ,le$els o) )atty

a"ids "alled 0rigly"eride.

0hese )attya"idsin"rease the

risk )or

gallstone)ormation.

0he !atient

has nodiabetes.

PR-IPA0A0I1(

FA0OR

PR-S-10/AS-1

0

RA0IO1A- J?S0IFIA0IO1

Pregnan"y ,-3"ess

estrogen )rom!regnan"yin"reases risk

o) gallstone

)ormation.

0he !atient isnot !regnant.

Pills

irth "ontrol!ills a!!ears

to in"rease

"holesterolle$els in bile6

resulting in

the de"rease

o) gallbladdermo$ement>

both o) 2hi"h

"an lead togallstone

)ormation.

0he !atient is

using birth

"ontrol !ills.

Ra!idWeight

oss 3 0he body

metaboliDes)at during

2eight loss6

2hi"h "auses

1o ra!id2eight loss

2as noted by

the !atient.



the li$er to

se"rete e3tra"holesterol

into the bile6

"ontributingto gallstone)ormation.

Pain

Obesity most

likely tends toredu"e the

amount o)

bile salt in

bile6 resulting

in more"holesterol

build u!.

Obesity

de"reasesgallbladder

em!tying.

0he !atient is

obese.

Pain

Pain that is

lo"aliDed tothe

e!igastrium

or R?U6sometimes

radiating to

the right

s"a!ular ti!

be"ause o))orming o)

stone in thegallbladder.

0he !atient$erbaliDed that

the !ain is

!resent in theR?U o) the

abdomen and

radiates to the

ba"k o) the

shoulder.



hills

When the

"ommon biledu"t be"omes

"logged by a

gallstone6there isblo"kage o)

bile to the

"ommon biledu"t.

Our !atient

$erbaliDed

that it is $ery"old.

1ausea and

'omiting

Sym!toms

and

"om!li"ations

result )romee"ts

o""urring2ithin the

gallbladder or

)rom stonesthat es"a!e

the

gallbladder to

lodge in the&.

0he !atient

al2ays $omits



Sy'+to'atolo&y

SL+P0O+S PR-S-10/AS-10 RA0IO1A- J?S0IFIA0IO1

Pain in the

R?U that

radiates to

the ba"k o) the shoulder

Pain that is

lo"aliDed to

thee!igastrium

or right u!!er

Euadrant6

sometimesradiating to

0he !atient$erbaliDed that

the !ain is

!resent in the

R?U o) theabdomen and



the right

s"a!ular ti!be"ause o)

)orming o)

stone in thegall bladder

radiate to the

ba"k o) theshoulder

1ausea N'omitting

Sym!toms

and

"om!li"ationsresult )rom

ee"ts

o""urring

2ithin the

gallbladder or)rom stones

that es"a!ethe

gallbladder to

lodge in the&.

0he !atient

al2ays $omits

Jaundi"e

,1ot !resent

2ith our

!atient

&ark ?rine , 1ot !resent2ith our

!atient



Fe$er

,1ot !resent

2ith our!atient

hills

When the

"ommon bile

du"t "loggedby a gall stone

there 2as a

blo"kage o)

bile in the"ommon bile

du"t

Our !atientsaid

that it%s $ery

"old



Patho+hysiolo&y



Doctor’s Order+-&IA OR&-R SH--0

Patient 1ame: +rs. ing

Age: <C years old

(ender: Female

Admission &ate: A!ril B@6 78B

&ate and 0ime &o"tor%s Order Rationale

P B78/@8 mmHg

PR ;@ b!m

RR 78 "!m

0 <.BV"

W0 ;. kg

H0 B=< "m

'SE=

I'F P1SS B B88/hr.

Right arm.

SF

0o ha$e a baseline

data.

0o re!la"e uidbalan"e !atient is1PO or "an%t drinkany uid.

0o redu"e the)ormation o) thestone.



A!ril BC6 78B

0ramadol

-RP

I'F P1SS B B88""/hr

,RAL )or the lungs

Anesthesia !reo!

Am!ima3

lood test used toe$aluate youro$erall health anddete"t a 2ide rangeo) disorder.

Our !atient ise3!erien"ing !ain6

0ramadol is ananalgesi" 2hi"hrelie$es !ain.

Is the te"hniEue

that uses 3ray to$ie2 !atient ing%sbile and !an"reati"du"t.

0o re!la"e uid orhydration )or our!atient.

Is an imaging testthat uses radiationto look at the lungso) our !atient.

Is to !ro$ide)rame2ork )or"onsidering "ardia"risk o) non"ardia"surgery in a $arietyo) the !atient and



=/BC/B

=/BC/B

/78/B

1PO !ost midnight

I'F P1SS B B88""/hr

-RP today.

0rane3ami".

Ome!raDole.

+eto"lo!ramide.

S/P -RP.

ba"k to the room.

1PO =hrs.

'SE<8 on"e stable.

o!erati$e.

0reatment )or)ollo2ing in)e"tion.

0o !re$ent nauseaand $omiting.

Re!la"ement o)uid.

is the te"hniEues

that uses ,ray to$ie2 !atient6 andbile !an"reati".

Pre$ent e3"essi$enausea and$omiting.

0o !re$ente3"essi$e bleeding.

is used to treat



Am!ima3

?&A

Ome!raDole

0rane3ami" A"id

nausea and$omiting.

done -RP.

Pre$ent nausea and$omiting a)ter the!ro"edure.

)or monitoring.

antiba"terial.

0o hel! dissol$estones )rom the&.

Pre$ent e3"essi$ebleeding.

to treat nausea and$omiting.

Dia&nostic and ab

Results1ame: +rs. ing Physi"ian: &r. 'elas"o

&ate: A!ril B@6 78B Room: <7= T =



H-+IA H-+IS0RL

0est 1ame Result ?nit RangeRe)eren"e

Rationale Justi*"ation

S(P0/A0 X B97 u/ 8.88<=88

Remarks: Sam!le run t2i"e"ontrol in range.

OO& H-+IS0RL

0est Results ?nit 1ormal'alue

Rationale

Sodium B<9. mmol/ B<9B=@ ?sed to

dete"t

abnormal"on"entrat

ion o) the

urine.Potassium <.9; mmol/ <.99.< 0his test

measuresthe

amount o) !otassium

in uid

!rotein.al"ium B.B9 mmol/ B.B<B.B9 Is ordered

to s"reen

)or

diagnose.hlorine mmol/ C9B8@ Is used to

dete"t

abnormal

"on"entration o)



"hloride.+agnesium mmol/ 8.;=8.CC ?sed to

measurethe le$el

o)magnesium in the

blood.

H-+A0OO(L

0est Result 1orm

al

'alues

lini"al Indi"ation

Hemoglobin B7B B78

B98

+easures the amount o)

Hemoglobin in your bloodhemoglobin is a !rotein in

your red blood "ells and

used to dete"t lo2

hemoglobin and des"ribe asbeing anemi"6 nutritional

iron !oly"ythemia et".

Hemato"rit 8.< 8.<@8.=8

0he ratio o) the $olume o)red blood "ells to the total

$olume o) blood.

&e"reased6leeding6 bone marro2

1utritional !roblems.

When in"rease OP&"ongenital heart disease or

se$ere dehydration.



-rythro"ytes =.78 =.8

.8

Red blood "ells 4Rs56 also

"alled erythrocytes6 are themost "ommon ty!e o) blood

"ell and the $ertebrae

organisms !rin"i!al meanso) deli$ering o3ygen 4O75 tothe body%s tissues.

&e"rease "hroni" heart)ailure si"kle "ell anemia.

S!hero"ytosis6 High FibrogenAnemia.

euko"ytes .B 9.8

B8.8

A "olorless "ell that

"ir"ulates in the blood andbody uids and is in$ol$ed in

"ountera"ting )oreign

substan"es and disease.

&e"reased

• eukemia

• 0uber"ulosis

• Hy!er!lenism

http://www.mayoclinic.org/diseases-conditions/leukemia/basics/definition/con-20024914

http://www.mayoclinic.org/diseases-conditions/leukemia/basics/definition/con-20024914



+' @9 @8

B88

+H 7C 7;<7

+H <= <7<

1eutro!hil 8.9 8.=9

8.9Neutro+hil 4also kno2n

as neutro+hils oro""asionally neutrocytes5

are the most abundant ty!e

o) granulo"ytes and the mostabundant 4=8 to ;95 ty!e

o) 2hite blood "ells in most

mammals. 0hey )orm anessential !art o) the innate

immune system.



• &e"rease:

• ?l"ers

• Abs"esses 4"olle"tionso) !us5

• Rashes

• Wounds that take a

long time to heal.

ym!ho"ytes 8.<9 8.78

8.<9

A )orm o) small leuko"yte

42hite blood "ell5 2ith asingle round nu"leus6

o""urring es!e"ially in the

lym!hati" system.

&e"rease

0he number o) lym!ho"ytes"an tem!orarily de"rease

during

• ertain $iral in)e"tions

4su"h as inuenDa andhe!atitis5

• Fasting

• 0imes o) se$ere

!hysi"al stress

• ?se o) "orti"osteroids

4su"h as !rednisone5

• hemothera!y and/or



radiation thera!y )or

"an"er

+ono"yte 8.8 8.878.8

"onocytes are a ty!eo) 2hite blood "ells6

or leukocyte. 0hey are the

largest ty!e o) leuko"yte6and dierentiates into: ma"r

o!hages>

dendriti" "ells> and )oam"ells. As a !art o)

the $ertebrate innateimmune system mono"ytes

also inuen"e the !ro"esso) ada!ti$e immunity.

&e"rease:

When mono"ytes de"reasein)e"tions in"lude ulike

sym!toms6

"oughing6sore throat6

"hills and )e$er6

)reEuent urination.

-osino!hil 8.8< 8.87

8.=

-osino!hils are a ty!e o)

disease*ghting 2hite blood"ell.

&e"rease

hroni" myelogenous



leukemia6 hurgStrauss

syndrome6 rohns disease6

&rug allergy6 -osino!hili"

leukemia6 Hay )e$er6

Hodgkins lym!homa

4Hodgkins disease5

aso!hil 8.88 8.88

8.8B4aso+hil is a ty!e o) 2hite

blood "ell. 0hey are the least"ommon o) the granulo"ytes6

re!resenting about 8.9 to B

o) "ir"ulating 2hite blood"ells. ut they are the

largest granulo"ytes. 0hey

are res!onsible )orinammatory rea"tions

during immune res!onse o)

a"ute and "hroni" allergi"

diseases.

&e"reased

in ana!hyla3is6asthma6

ato!i" dermatitis

hay )e$er



0hrombo"ytes 7<9 B98=98 Platelets6 also

"alled thro'bocytes 4thromb Y "yte6 blood

"lot "ell56 are a

"om!onent o) blood2hose )un"tion is tosto! bleeding by

"lum!ing and "lotting

blood $essel in#uries. &e"reased

ruising easily.

0iny red s!ots6 or!ete"hiae6 under the

skin.

?nusual bleeding )rom

the gums or nose.

A lot o) or longlasting

bleeding )rom a small

"ut or in#e"tion site.

lood in the urine6

2hi"h may look !ink6red or bro2n

blood in the stool or

bla"k"olored stool.

'omiting blood orsomething that lookslike "oee grounds.

'aginal bleeding that

is dierent )rom andlasts longer than the



normal menstrual

!eriod.

onstant heada"he6

blurred $ision or"hange in le$el o)"ons"iousness.

?RI1ALSIS

Para'etersRan&e 1nit

ResultReference

Ran&e

ResultsReference

Rationale

Physi"al

-3aminationolor i&ht

2ello6 0he "olor o)

the urine is

hel!)ul in

!redi"ting the"on"entration

o) the

s!e"imen.larity Clear ?se)ul in

!redi"ting the

!resen"e o)

the"ontaminants

su"h as "ells

or mu"us.Che'ical

Analysis!H 7%8 ?rine !H le$el

test is a testthat analyDes

the a"idity or

alkalinity.



S!e"i*" (ra$ity 9%8: Is a measure

o) the"on"entration

o) the solute in

the urine.(lu"ose Ne&ative 0est measures

the le$el o)

glu"ose or

sugar in yoururine.

Protein 1egati$e A !rotein urine

test measures

the amount o)

the !rotein inthe urine.

1rine)lo6cyto'etryW < 8

B;/u

B

8<

Is hel! to

diagnose and

in)e"tion.R B 8

B;/u88<

0o "he"k i)there 2as

bleeding.-!ith ells < 8

B;/uB8<

?sed in guidedtissue

regeneration.ast 8

B/u

8 8

8<

?rinary "asts

are tiny tubesha!ed

!arti"les that

"an be )ound2hen urine is

e3amined

under the

mi"ros"o!e.a"teria BB9 8

7;@/u

7B 8

98

0o "he"k 2hat

s!e"i*"



ba"teria.

Dru& Study

S1TA"ICIIN

+u"us 0hread 0o identi)y i)

there 2as a

serious

"ondition thatmedi"al

needs.rystal Is the rationale

)or urinary

alkaliDation in

!atient.





For "hildren abo$e <8 Kg: <;9 to ;98 mg to be used at regular

inter$als.

?n"om!li"ated gonorrhea

Adult: 7.79 g o) Sultami"illin along 2ith !robene"id B g.

+ode o) A"tion: hemi"al -e"t: Inhibits beta la"tamases in

!eni"illinresistant mi"roorganisms and it a"ts against sensiti$e

organisms during the stage o) a"ti$e multi!li"ation by inhibitingbiosynthesis o) "ell 2all mu"o!e!tide 0hera!euti" -e"t: Kills

sus"e!tible ba"teria Oral Onset: unkno2n Peak: 7 hr &uration: @

hr

Indi"ation: ?n"om!li"ated gonorrhea6 Otitis media6 Res!iratory

tra"t in)e"tion

ontraindi"ation: hy!ersensiti$e to drug or any other !eni"illins6use "autiously in !atients 2ith other drug allergies 4es!e"ially to

"e!halos!orins5 be"ause o) !ossible "rosssensiti$ity and in those

2ith mononu"leosis be"ause o) high risk o) ma"ulo!a!ular rash

Side -e"ts: 1S: thrombo!hlebitis6 $ein irritation (I: nausea6$omiting6 diarrhea glossitis6 stomatitis6 bla"k hairy tongue6

entero"olitis Hematologi": anemia6 thrombo"yto!enia6 !ur!ura6eosinoo!hilia6 leuko!enia6 agranulo"ytosis Skin: !ain at in#e"tion

site Other: hy!ersensiti$ity rea"tions6 ana!hyla3is6 o$ergro2th o)

nonsus"e!tible organisms

1ursing Res!onsibilities:

B. Assess hy!ersensiti$ity to drug or other !eni"illins

7. Assess !atient%s in)e"tion be)ore starting thera!y<. Obtain s!e"imen )or "ulture and sensiti$ty

Re)eren"es/Sour"e: +osby%s 1ursing &rug Re)eren"e 788B





hy!erse"retory "onditions 4su"h as Zollinger-llison syndrome5>

&uodenal ul"er> (astri" ul"er> Heartburn on 7 or more days !er

2eek> Posterior laryngitis

ontraindi"ations: ontraindi"ated in !atients hy!ersensiti$e to

the drug or any o) its "om!onents. In !regnant 2omen6 use"autiously. In breast)eeding 2omen6 use "autiously> it%s unkno2n

i) the drug a!!ears I breast milk. In "hildren ages 7 to B years6drug may be used to treat (-R&6 erosi$e eso!hagitis6 and )or

maintenan"e o) healing in erosi$e eso!hagitis 4tablets and

"a!sules only5.

&rug Intera"tions: Am!i"illin esters6 iron deri$ati$es6

keto"onaDole: +ay de"rease absor!tion. (i$e se!arately.

larithromy"in: +ay in"rease le$el o) either drug. +onitor !atient)or drug to3i"ity. &iaDe!am6 !henytoin6 2ar)arin: +ay de"rease

he!ati" "learan"e o) these drugs6 !ossibly leading to in"reased

le$els. +onitor !atient "losely. Su"ral)ate: +ay delay absor!tionand redu"e ome!raDole bioa$ailability. Se!arate administration

times by <8 minutes or more.

Ad$erse -e"ts: diDDiness6 heada"he6 abdominal !ain6

"onsti!ation6 diarrhea6 atulen"e6 nausea6 $omiting6 ba"k !ain6

"ough6 rash

1ursing Res!onsibilities:

B Assess !atient%s "ondition be)ore starting thera!y andregularly therea)ter to monitor drug%s ee"ti$eness.

7 e alert )or ad$erse rea"tions and drug intera"tions.< I) ad$erse (I rea"tion o""urs6 monitor !atient%s hydration.= Assess !atient%s and )amily%s kno2ledge o) drug thera!y

9 (i$e tablets or "a!sules <8 minutes be)ore meals> !o2der)or oral sus!ension B hour be)ore meals.

?se 7 tbs o) 2ater to mi3 B !a"ket o) !o2der )or oralsus!ension> don%t use any other liEuids or )ood

; o2er doses aren%t needed )or !atient%s 2ith renal or he!ati"im!airment



@ -3!lain im!ortan"e o) taking drug e3a"tly as !res"ribed.C Warn !atient not to "rush or "he2 tablets or "a!sules.B8-3!lain to !atient ho2 to re"onstitute !o2der )or oral

sus!ension: -m!ty !a"ket "ontents into a small "u!

"ontaining 7 tbs!. o) 2ater> stir 2ell and drink immediately.Re*ll "u! 2ith 2ater and drink.

References/Sources: Springhouse Nurse’s Drug Guide !!"

pg#$%

TRA"ADO

(eneri" 1ame: 0ramadol

rand 1ame: ?ltram6 ?ltram -R

Indi"ations: arbamaDe!ine 40egretol6 0egretol ,R6 -Euetroarbatrol5redu"es the ee"t o) tramadol by in"reasing itsina"ti$ation in the body. Uuinidine 4Uuinaglute6 Uuinide35 redu"es



the ina"ti$ation o) tramadol6 thereby in"reasing the "on"entrationo) tramadol by988. ombining tramadol 2ithmonoamineo3idase inhibitors 4)or e3am!le6 Parnate5 or sele"ti$eserotonin inhibitors 4SSRIs6 )or e3am!le6 uo3etine ProDa"[5 may

result in se$ere side ee"ts su"h as seiDures or a "ondition "alledserotonin syndrome.

ontraindi"ations: 0ramadol may in"rease "entral ner$ous systemand res!iratory de!ression 2hen "ombined 2ith al"ohol6anestheti"s6 nar"oti"s6 tranEuiliDers or sedati$e hy!noti"s.

A"tions: 0ramadol is used in the management o) mode rate tomode rate se$ere !ain. -3tended release tablets are used)or moderate to moderately se$ere "hroni" !ain in adults 2ho

reEuire "ontinuous treatment )or an e3tended !eriod.

Side ee"ts: 0ramadol is generally 2ell tolerated6 and side ee"tsare usually transient. ommonly re!orted side ee"ts in"ludenausea6 "onsti!ation6 diDDiness6 heada"he6 dro2siness6 and$omiting. ess "ommonly re!orted side ee"ts in"lude it"hing6s2eating6 dry mouth6 diarrhea6 rash6 $isual disturban"es6 and$ertigo. Some !atients 2ho re"ei$ed tramadol ha$e re!ortedseiDures. Abru!t 2ithdra2al o) tramadol may result in an3iety6

s2eating6 insomnia6 rigors6 !ain6 nausea6 diarrhea6 tremors6 andhallu"inations.

1ursing Res!onsibilities:B. Assess ty!e6 lo"ation6 and

intensity o) !ain be)ore and 7< hr 4!eak5 a)ter administration.7. Assess P N RR be)ore and !eriodi"ally during

administration. Res!iratory de!ression has not o""urred 2ithre"ommended doses.

<. Assess bo2el )un"tion routinely. Pre$ention o) "onsti!ation

should be instituted 2ith in"reased intake o) uids and bulkand 2ith la3ati$es to minimiDe "onsti!ating ee"ts.

=. Assess !re$ious analgesi" history. 0ramadol is notre"ommended )or !atients de!endent on o!ioids or 2hoha$e !re$iously re"ei$ed o!ioids )or more than B 2k> may"ause o!ioid 2ithdra2al sym!toms.



9. Prolonged use may lead to !hysi"al and !sy"hologi"alde!enden"e and toleran"e6 although these may be milderthan 2ith o!ioids. 0his should not !re$ent !atient )romre"ei$ing adeEuate analgesia. +ost !atients 2ho re"ei$e

tramadol )or !ain d not de$elo! !sy"hologi"al de!enden"e. I) toleran"e de$elo!s6 "hanging to an agonist may be reEuiredto relie$e !ain.

. 0ramadol is "onsidered to !ro$ide more analgesia than"odeine 8 mg but less than "ombinedas!irin98mg/"odeine 8 mg )or a"ute !osto!erati$e !ain.

;. +onitor !atient )or seiDures.@. +ay o""ur 2ithin re"ommended dose range. Risk in"reased

2ith higher doses and in!atients taking antide!ressants4SSRIs6 tri"y"li"s6 or +ao inhibitors56 o!ioid analgesi"s6 orother drugs that de"rease the seiDure threshold.

C. O$erdose may "ause res!iratory de!ression and seiDures.1alo3one 41ar"an5may re$erse some6 but not all6 o) thesym!toms o) o$erdose. 0reatment should be sym!tomati"and su!!orti$e. +aintain adeEuate res!iratory e3"hange.

B8. -n"ourage !atient to "ough and breathe dee!ly e$ery 7hr to !re$ent atela"tasis and !neumonia.

"ETOCOPRA"IDE



rand 1ame: Plasil

(eneri" 1ame: +eto"lo!ramide

Indi"ation: !re$ention o) "hemothera!yindu"ed emesis6treatment o) !ostsurgi"al and diabeti" gastri" stasis6 )a"ilitation o) small bo2el intubations in radiogra!hi" !ro"edures6 managemento) eso!hageal reu36 treatment and !re$ention o) !osto!erati$enausea and $omiting 2hen nasogastri" su"tioning is undesirable

&rug lassi*"ation: Antiemeti"s

+e"hanism o) A"tion: it blo"ks do!amine re"e!tors and makes the(I "ells more sensiti$e to a"etyl"holine6 leading to in"reased (Ia"ti$ity and ra!id mo$ement o) )ood through the u!!er (I tra"t.

&osage: 0ab Adult: Btab tid6 Syr Adult: B8 ml tid6 "hildren: 9B= yr7.99 mg tid6 <9 yr 7mg bid

S!e"ial !re"aution: !atients 2ith history o) de!ression6 diabeti"

!atients6 !regnan"y and la"tation "hildren and geriatri" !atients

Pregnan"y risk "ategory:

Ad$erse rea"tion: 1S: dro2siness6 e3tra!yramidal rea"tions6restlessness6 an3iety6 de!ression6 irritability6 tardi$e dyskinesia



': arrhythmias6 hy!ertension6 hy!otension (I: "onsti!ations6diarrhea6 dry mouth6 nausea -ndo: gyne"omastia

ontraindi"ated to: hy!ersensiti$ity6 !ossible obstru"tion or

hemorrhage6 history o) seiDure disorders6 !heo"hromo"ytoma6Parkinson%s disease

Form: solution 4oral "on"entrate56 syru! 4sugar )ree56 tablet6am!ule

1ursing res!onsibilities:B. Assess "lient )or abdominal !ain distention6 bo2el sound7. Assess "lient )or e3tra!yramidal rea"tions<. +onitor )or tardi$e dyskinesian

TRANE3A"IC ACID

rand 1ame: Hemostan

(eneri" 1ame: 0rane3ami" A"id

Indi"ations: antihemorrhagi" and anti*brinolyti" )or ee"ti$ehemostasis in $arious surgi"al and "lini"al "ases6 in traumati"in#uries6 !osttooth e3tra"tion and other dental !ro"edures.



&rug lassi*"ation: Antihemo!hili" Agent

+e"hanism o) A"tion: Forms a re$ersible "om!le3 that dis!la"es!lasminogen )rom *brin resulting in inhibition o) *brinolysis6 it

also inhibits the !roteolyti" a"ti$ity o) !lasmin

&osage: a!sule: 798 T 988 mg tidEid. In#e"tions: 798988mg I+6or by slo2 I' in# bid tid. &uring or a)ter o!eration6 9887988mg i)ne"essary by I' dri!.

S!e"ial !re"aution: 1ot ad$isable to use )or !rolonged !eriods in!atients !redis!osed to thrombosis. 1ot re"ommended )or!ro!hyla3is during !regnan"y and be)ore deli$ery. O!thalmi"e3am be)ore and during thera!y reEuired i) !atient is treated

beyond se$eral days> "aution in !atients 2ith "ardio$as"ular6renal6 "erebro$as"ular disease.

Pregnan"y risk "ategory:

Ad$erse rea"tion: (I disorders: nausea6 $omiting. 1S: anore3ia6heada"he im!aired renal insuM"ien"y6 hy!otension 2hen I'in#e"tion is too ra!id.

ontraindi"ation: !atients !redis!osed to thrombosis. Pro!hyla3isduring !regnan"y and be)ore deli$ery.

Form: B88mg/ml 4B8 m5 in#e"tion> 988mg tablet

1ursing Res!onsibility:B. &osage modi*"ation reEuired in !atients 2ith renal

im!airment7. Wat"h out )or any signs o) bleeding

Re)eren"e/Sour"es:htt!s://222.s"ribd."om/do"/78B<=8CB7/0rane3ami"A"iddrugstudy



1RSODEO32C(OIC ACID

rand:

(eneri" 1ame: ?rsodiol6 ?&A

lassi*"ation:

Indi"ations: 1ote: ra"keted in)ormation in the indi"ations se"tion

re)ers to uses that are not in"luded in ?.S !rodu"t labeling

+e"hanism o) A"tion: Anti"holelithi"QAlthough the e3a"t

me"hanism o) ursodiols anti"holelithi" a"tion is not "om!letelyunderstood6 it is kno2n that 2hen administered orally ursodiol is

"on"entrated in bile and de"reases biliary "holesterol saturation

by su!!ressing he!ati" synthesis and se"retion o) "holesterol6 andby inhibiting its intestinal absor!tion. 0he redu"ed "holesterol



saturation !ermits the gradual solubiliDation o) "holesterol )rom

gallstones6 resulting in their e$entual dissolution.

Ad$erse -e"ts: ?rsodiol in"reases bile o2. In "hroni" "holestati"li$er disease6 ursodiol a!!ears to redu"e the detergent !ro!erties

o) the bile salts6 thus redu"ing their "ytoto3i"ity. Also6 ursodiolmay !rote"t li$er "ells )rom the damaging a"ti$ity o) to3i" bile

a"ids 4e.g.6 litho"holate6 deo3y"holate6 and "henodeo3y"holate562hi"h in"rease in "on"entration in !atients 2ith "hroni" li$er

disease.

Pre"autions to onsider

rosssensiti$ity and/or related !roblems

Patients sensiti$e to other bile a"id !rodu"ts may be sensiti$e to

ursodiol also \8B] \B<].

ar"inogeni"ity/0umorigeni"ity

Studies in rats 2ith intrare"tal instillation o) litho"holi" a"id and

other metabolites o) ursodiol and "henodiol did not sho2e$iden"e o) tumorigeni"ity6 e3"e!t 2hen these substan"es 2ere

administered in "on#un"tion 2ith a "ar"inogeni" agent.

-!idemiologi" studies suggest that bile a"ids might be in$ol$ed inthe !athogenesis o) human "olon "an"er in !atients 2ho ha$e

undergone a "hole"yste"tomy> ho2e$er6 "on"lusi$e e$iden"e is

la"king. \8B] \89]

Pregnan"y/Re!rodu"tion

Pregnan"yQAdeEuate and 2ell"ontrolled studies ha$e not been done in

humans \89].

Studies in rats at doses 78 to B88 times the human dose6 and in

rabbits at doses 9 times the human dose6 ha$e not sho2n that

http://www.drugs.com/mmx/ursodeoxycholic-acid.html#citec00167701












ursodiol "auses ad$erse ee"ts in the )etus.

F&A Pregnan"y ategory .

reast)eedingIt is not kno2n 2hether ursodiol is distributed into breast

milk \89] \B<]. Ho2e$er6 !roblems in humans ha$e not beendo"umented.

Pediatri"sA!!ro!riate studies on the relationshi! o) age to the ee"ts o)

ursodiol 2hen used as an anti"holelithi" ha$e not been !er)ormed

in the !ediatri" !o!ulation. Ho2e$er6 studies !er)ormed to date in

"hildren and in)ants 2ith "holestati" li$er disease and biliaryatresia ha$e not demonstrated !ediatri"ss!e"i*" !roblems that

2ould limit the use)ulness o) ursodiol in "hildren. \<<] \<=] \=8]

(eriatri"s

A!!ro!riate studies on the relationshi! o) age to the ee"ts o)

ursodiol ha$e not been !er)ormed in the geriatri" !o!ulation.Ho2e$er6 geriatri"ss!e"i*" !roblems that 2ould limit the

use)ulness o) this medi"ation in the elderly are not e3!e"ted. \B<]

&rug intera"tions and/or related !roblems

0he )ollo2ing drug intera"tions and/or related !roblems ha$e

been sele"ted on the basis o) their !otential "lini"al signi*"an"e4!ossible me"hanism in !arentheses 2here a!!ro!riate5Qnot

ne"essarily in"lusi$e 4^ _ ma#or "lini"al signi*"an"e5:

Re)eren"e/Sour"es: htt!://222.drugs."om/mm3/ursodeo3y"holi"a"id.html







http://www.drugs.com/mmx/ursodeoxycholic-acid.html












+edi"al N Surgi"al+anagement

ERCP <Endosco+ic Retro&rade Cholan&io=Pancreato&ra+hy>-RP is a !ro"edure that enables your !hysi"ian to e3amine the

!an"reati" and bile du"ts. A bendable6 lighted tube 4endos"o!e5



about the thi"kness o) your inde3 *nger is !la"ed through your

mouth and into your stoma"h and *rst !art o) the small intestine

4duodenum5. In the duodenum a small o!ening is identi*ed4am!ulla5 and a small !lasti" tube 4"annula5 is !assed through the

endos"o!e and into this o!ening. &ye 4"ontrast material5 isin#e"ted and ,rays are taken to study the du"ts o) the !an"reas

and li$er.

PROCED1RE

Lou lie on your side on a "ou"h. 0he do"tor 2ill ask you to s2allo2the *rst se"tion o) the endos"o!e. +odern endos"o!es are Euite

thin 4thinner than an inde3 *nger5 and Euite easy to s2allo2. 0he

do"tor then gently !ushes it do2n your eso!hagus into yourstoma"h and duodenum.

0he do"tor looks do2n the endos"o!e $ia an eye!ie"e or on a 0'monitor 2hi"h is "onne"ted to the endos"o!e. Air is !assed do2n

a "hannel in the endos"o!e into the stoma"h and duodenum to

make the lining easier to see. 0his may make you )eel )ull and

2ant to bel"h.

0he endos"o!e also has a side "hannel do2n 2hi"h $arioustubes or instruments "an !ass. 0hese "an be mani!ulated by the

do"tor 2ho "an do $arious things. For e3am!le:

In#e"t a dye into the bile and !an"reati" du"ts. ,ray !i"tures

taken immediately a)ter the in#e"tion o) dye sho2 u! the detail o)the du"ts. 0his may sho2 narro2ing 4stri"ture56 stu"k gallstones6

tumors !ressing on the du"ts6 et".

0ake a small sam!le 4bio!sy5 )rom the lining o) the duodenum6

stoma"h6 or !an"reati" or bile du"t near to the !a!illa. 0he bio!sy



sam!le "an be looked at under the mi"ros"o!e to "he"k )or

abnormal tissue and "ells.

I) the ,rays sho2 a gallstone stu"k in the du"t6 the do"tor "an2iden the o!ening o) the !a!illa to let the stone out into the

duodenum. A stone "an be grabbed by a basket or le)t to be!assed out 2ith the stools 4)e"es5.

I) the ,rays sho2 a narro2ing or blo"kage in the bile du"t6 the

do"tor "an !ut a stent inside to o!en it 2ide. A stent is a small

2iremesh or !lasti" tube. 0his then allo2s bile to drain into the

duodenum in the normal 2ay. Lou 2ill not be a2are o) a stent6

0he endos"o!e is gently !ulled out 2hen the !ro"edure is

*nished. An -RP "an take anything )rom <8 minutes to o$er an

hour6 de!ending on 2hat is done.

C(OEC2STECTO"2

hole"yste"tomy 4kohluhsis0-Ktuhme5 is a surgi"al !ro"edure

to remo$e your gallbladder Q a !earsha!ed organ that sits #ust

belo2 your li$er on the u!!er right side o) your abdomen. Lourgallbladder "olle"ts and stores bile Q a digesti$e uid !rodu"ed in

your li$er.

hole"yste"tomy may be ne"essary i) you e3!erien"e !ain )rom

gallstones that blo"k the o2 o) bile. hole"yste"tomy is a"ommon surgery6 and it "arries only a small risk o) "om!li"ations.

In most "ases6 you "an go home the same day o) your

"hole"yste"tomy.

hole"yste"tomy is most "ommonly !er)ormed by inserting a tiny

$ideo "amera and s!e"ial surgi"al tools through )our smallin"isions to see inside your abdomen and remo$e the gallbladder.

&o"tors "all this la!aros"o!i" "hole"yste"tomy. In some "ases6





Treat'ent 0reating gallstones in the bile du"t )o"uses on relie$ing the

blo"kage. 0hese treatments may in"lude:

• stone e3tra"tion• )ragmenting stones 4lithotri!sy5

• surgery to remo$e the gallbladder and stones

4"hole"yste"tomy5

• surgery that makes a "ut into the "ommon bile du"t to

remo$e stones or hel! them !ass 4s!hin"terotomy5

• biliary stenting

0he most "ommon treatment )or gallstones in the bile du"t is

biliary endos"o!i" s!hin"terotomy 4-S5. &uring a -S !ro"edure6

a balloon or basketty!e de$i"e is inserted into the bile du"t and

used to e3tra"t the stone or stones. About @9 !er"ent o) bile du"t

stones "an be remo$ed 2ith -S 4Attasaranya et al.6 788@5.



I) a stone does not !ass on its o2n or "annot be remo$ed 2ith

-S6 do"tors may use lithotri!sy. 0his !ro"edure is designed to

)ragment stones so they "an be "a!tured or !assed easily.

Patients 2ith gallstones in the bile du"t and gallstones still in the

gallbladder may be treated 2ith "hole"yste"tomy 4gallbladder

remo$al5. While !er)orming the surgery6 your do"tor 2ill also

ins!e"t your bile du"t to "he"k )or remaining gallstones.

I) stones "annot be remo$ed "om!letely or you ha$e a history o)

gallstones "ausing !roblems but do not 2ish to ha$e your

gallbladder remo$ed6 your do"tor may !la"e biliary stents 4tinytubes to o!en the !assage5. 0hese 2ill !ro$ide adeEuate drainage

and hel! !re$ent )uture "holedo"holithiasis e!isodes. 0he stents

"an also !re$ent biliary se!sis 4inammation5 and in)e"tion.

Dischar&e Plannin& ?(ealth Teachin&

" edi"ine

Ad$i"e !atient to "ontinue taking his !res"ribed

medi"ations su"h as: Sultami"illin and 0ramadol.

E n$ironmental and -3er"ise

+aintain a Euiet and !leasant en$ironment to

!romote rela3ation. Pro$ide "lean and "om)ortable en$ironment.

-n"ourage 2alking e$ery day.



T reatment

ontinue home medi"ations. 0ea"h !atient about 2ound "are. -n"ourage !atient to take multi$itamins )or

immunity.

( ealth 0ea"hing

Pro$ide 2ritten and oral instru"tion about 2ound

"are6 a"ti$ity6 diet re"ommendations6 medi"ationand )ollo2 u! $isits.

Instru"t !atient to limit his a"ti$ity )or 7= to =@ hrs.

a)ter dis"harge.

O ut Patient Follo2 ?!

Patient 2ill be ad$ised to go ba"k in the hos!ital in a

s!e"i*" date to ha$e )ollo2Tu! "he"ku! a)ter

dis"harge. onsult do"tors )or are any !roblems or "om!li"ation

en"ountered.

D iet

-n"ourage !atient to in"rease !rotein intake )or

tissue re!air. Ad$i"e !atient to eat smallerthannormal amount o)

at mealtime.

S !iritual

-n"ourage !atient to "ommuni"ate 2ith (od. -n"ourage !atient to "ommuni"ate 2ith other

!eo!le.

1ursing are PlanDATEAND

ASSESS"ENT

N1RSIN#DIA#NOSI

NE

PANNIN# I"PE"ENTATION!

E$A1ATION



TI"E S ED

INTER$ENTION

A!ril BC678B@:88 A+

Sub#e"ti$e:

Patient$erbaliDed

&sakit ilihokakong kilid

sa tuo#'

Ob#e"ti$e:

• Pains"aleo) @

• (ene

raliDed2eaknessnoted

• Restlessnessnoted

• &iM"ulty

slee!ingnoted

A"ute !ainrelated tosurgi"alin"ision

se"ondaryto"hole"yste"tomy

O(1

I 0I'-

P-R-P

0?A

PA

0 0-R1

At the end o) 7=hours o) my"are6 !atient 2illbe relie$ed )rom

!ain ase$iden"ed by:

a.5 'erbaliDing !ains"ale o) <or belo2

b.5 be ableto mo$emore2ithoutdis"om)o

rt

B.5 -stablishra!!ort 2ith!atient.R: (ain trust

)or"oo!eration.

7.5 +onitor 'S.R: 0o ha$ebaselinedata.

<.5 Pro$ide!ri$a"y to!atient.R: Res!e"t)orindi$idual%sstatus.

=.5 0ea"h!atient todo !ro!erhand2ashing.R: Pre$ents!read o)mi"roorganisms.

9.5 1oteres!onse tomedi"ationand re!ort

to!hysi"ians i) !ain is notbeingrelie$ed.R: Se$ere!ain notrelie$ed byroutinemeasuresmayindi"atede$elo!ing"om!li"ation or need)urtherinter$ention.

.5 Promotebed restallo2ing!atient to

(OA +-0:At the end o)= hours o) myshi)t6 !atient

2as able to$erbaliDe!ain s"ale o)< and be ableto mo$e2ithout"om!lainingo) !ain.



assume!osition o)"om)ort.R: Redu"esirritationand bed

sores.;.5 Instru"t!atient notto tou"h thein"ision.R: A$oidin)e"tion.

@.5 Instru"t!atient todo B9 minRO+e3er"ises.R:

Strengthenmus"les.Im!ro$eblood"ir"ulation.

DATEANDTI"E

ASSESS"ENT

N1RSIN#DIA#NOSI

S

NEED

PANNIN# I"PE"ENTATION!INTER$ENTION

E$A1ATION

A!ril BC678B@:88 A+

Sub#e"ti$e:

Patient$erbaliDed&Sige

(atandog

akong kilid)

nahadlok ko

*asin (a

unsa#'

Ob#e"ti$e:

• 'erbaliDation o)!roblem

• (rima"e

&e*"ientkno2ledgeabout sel)"area"ti$itiesrelated toin"ision"are.

A

0I'I

0 L

-,-

RIS-

PA

0

A)ter the endo) my shi)t6!atientshould:

a.5 'erbaliDeunderstandingo) sel)"areroutine.

b.5 A$oidina!!ro!riatea"tionsthatmay"auseirritation or

B.5 -stablishra!!ort.R: (ain trustand"oo!eration.


<.5 0ea"h !atient!ro!erhand2ashingte"hniEue.

R: Pre$ents!read o)mi"roorganisms.

=.5 &is"uss 2iththe !atientho2 to )ollo2sel)"areroutine.

(OA +-0:At the end o)shi)t6 !atient)ullyunderstoodsim!lete"hniEues o)!ro!er sel)"are anddemonstrateditinde!endently

by !er)ormingsel)"areroutines ande3er"ises.



)a"easobser$ed

• ohe

rent

0-R1

in)e"tion.

R: 0o hel!!atient "o!eeasier6 ste!by ste!.

9.5 Instru"t!atient to

eat !ro!erdiet.R: +aintaingood health.

.5 Pro$ide!ri$a"y )orthe !atient.R: Res!e"tindi$idual%sstatus.

;.5 -n"ourage!atient totake sim!le

e3er"ise.R: Hel!e3ibilityand mus"lestrength.

@.5 Instru"t!atient totake a rest)reEuently.R: 0omaintaingood moodand ha$e

!ea"e o)mind.

C.5 Pro$ide "leanand )reshen$ironment.R: Promotemental2ellness.

DATEAND

TI"E

ASSESS"ENT

N1RSIN#DIA#NOSI

S

NE

ED


E$A1ATION

A!ril BC678B@:88 A+

Sub#e"ti$e:

&Naga+kul*a

ko *asig

(agka

pro*le(a

akong

Fear/An3iety relatedto la"k o)understanding o)

S-FP-

A)ter 7=hours o) my"are6 !atient2ill be able toidenti)y to!re$ent orredu"e risk o)

B.5 -stablishra!!ortR: (ain trustand"oo!eration.

7.5 0ea"h !atient!ro!er

(OA +-0:A)ter = hours o)nursinginter$ention the!atient 2as ableto a"hie$etimely 2ound



opera#

Ob#e"ti$e:

• Fa"ialgrima

"enoted

• oherent

• Patient is"oo!erati$e togi$ein)or

mationrelated toher"ondition

diagnosis6diagnosti"tests6 andtreatments

R-P

0IO

1

S-FO1-

P 0

PA

0 0-R1

in)e"tions ase$iden"ed by:

a.5 A"hie$etimely

2oundhealing

b.5 Free)romsignsandsym!toms o)in)e"tion

hand2ashingte"hniEueR:Hand2ashingis the singlemost

ee"ti$e 2ayto !re$entin)e"tion.

<.5 Instru"t on!ro!er 2ound"are.R: For *rstline o)de)enseagainst "ross"ontamination.

=.5 -n"ourage to

eat $itamin ri"h )oods likedark lea)ygreens6 !easand !a!aya.R: 'itamin hel!s boostimmunesystem.

9.5 Pro$ide!ri$a"y )orthe !atient.R: Res!e"t

indi$idual%sstatus.

.5 Wash!un"ture site2ith mildsoa! and2ater.R: A$oidin)e"tion that"an "ause!ain.

;.5 -n"ourage!atient toe3er"ise andnot to stay inbed ma#orityo) time.R: Hel!e3ibility andmus"lestrengthening.

healing and )ree)rom signs andsym!toms o)in)e"tion.



@.5 Instru"t!atient to eat!ro!er diet.R: A"EuireadeEuatenutrition.

C.5 Instru"t!atient toslee! at least@ hours.R: Slee!!romotesgood moodand 2ellbeing.

DATE

ANDTI"E

ASSESS"E

NT

N1RSIN#

DIA#NOSIS

N

EED

PANNIN# I"PE"ENTATION!

INTER$ENTION

E$A1ATION

A!ril BC678B@:88 A+

Sub#e"ti$e:

&,ag

gag(ay

lang

(aino(

nako na

tu*ig#'

Ob#e"ti$e:

• B88ml!re$iousshi)t:?rineout!ut islessthannorm

al4<8ml/hr5

• ?rine"olorisdee!orang

Risk )orele"trolyteimbalan"erelated tode"reasein bodilyuid.

1?

0RI

0IO1A

+-

0AOI

PA 0 0-R1

At the end o)my shi)t6 the!atient 2ill beable tomaintainele"trolytebalan"e ase$iden"ed by:

a.5 AdeEuateurinaryout!ut

b.5 (oodskintrugor



<.5 Instru"t!atient todrink 2ater.R: A$oiddehydration.

=.5 +onitor I'Fluids.R: +easureintake andout!ut.

9.5 ollaborate2ith!hysi"ians in

the uidthera!y.R: 0o ha$e agoodmani)estationo) a !atientillness.

.5 0est skinturgor.

(OA +-0:At the end o)my shi)t6 !atient2as able tomaintainele"trolytebalan"e ase$iden"ed by:

a.5 (oodskinturgor.

b.5 Stable'S.

".5 1ormal?rinaryout!ut o) <8ml/hr.



e

• &ryness o) skinnoted

• &ryness o) li!snoted

• &ee!nesso)eyesnoted

R: he"khydration.

;.5 Pro$ide!atient!ri$a"y.R: Res!e"t

indi$idual%[email protected] Obser$e )or

signs o)dehydration.R: 0o a"Euirebaseline data

C.5 Administermedi"ation.R: For )astre"o$ery.

DATEANDTI"E

ASSESS"ENT

N1RSIN#DIA#NOSI

S

NEED


E$A1ATION

A!ril BC678B@:88 A+

Sub#e"ti$e:

&-ala ko’y

gana

(ukaon') as$erbaliDedby the!atient.

Ob#e"ti$e:

• Pallornoted

• Weaknessnoted

• Fatigue

• &idnoteatbreak)ast

Risk )orimbalan"enutritionless thanbodyreEuirements relatedto la"k o)

a!!etite.

1?

0RI

0IO1

A

+-

0AOI

PA 0 0-R1

A)ter 7=hours o) "are6!atient 2illin"reasea!!etite ase$iden"ed by:

a.5 -atingherne3tmeal

b.5 -atingsmallsna"ksinbet2eenmeals



<.5 -n"ourage!atient to eat!ro!er diet.R: A"Euirenutritionalneeds.

=.5 Instru"t!atient torest.R: Promotegood moodand 2ellbeing.

9.5 0ea"h !ro!erhygiene.R: Risk )or"ross"ontamination.

(OA +-0:A)ter = hours o)nursinginter$ention6!atient$erbaliDed:

a.5 I ate hal)o) mymeal )orlun"h.

b.5 I ammoreeager toeat.



PrognosisRI0-RIA POOR

4B5FAIR475

(OO&4<5

J?S0IFIA0IO1

&uration o)

Illness

7 &ays be)ore

o!eration

Onset o)

Illness It takes time

)or her to go to

the hos!italand kno2 the

*ndingsPre"i!itating

Fa"tors

om!lian"e 1e$er re)use

to take

medi"ationPredis!osing

Fa"tors She is <C high

risk to ha$e

de$elo!gallstones

Age High risk tode$elo!

gallstonedisease.



-n$ironment She has a $ery

su!!orti$e)amily6

relati$es and

ha$e a gooden$ironment.

Re)eren"eshtt!://222.u!todate."om/"ontents/"holedo"holithiasis"lini"almani)estationsdiagnosisandmanagement

htt!s://222.nlm.nih.go$/medline!lus/en"y/arti"le/8887;=.htm

htt!://radio!aedia.org/arti"les/"holedo"holithiasis

htt!://222.my$m"."om/diseases/"ommonbiledu"tstone"holedo"holithiasis"holangitisobstru"ti$e#aundi"e/

htt!://222.drugs."om/mm3/ursodeo3y"holi"a"id.html

htt!s://222.s"ribd."om/do"/78B<=8CB7/0rane3ami"A"iddrugstudy

S!ringhouse 1urse%s &rug (uide 788@ !g.C7B

+osby%s 1ursing &rug Re)eren"e 788B

htt!://222.healthline."om/humanbodyma!s/gallbladder

http://www.uptodate.com/contents/choledocholithiasis-clinical-manifestations-diagnosis-and-management







https://www.scribd.com/doc/201340912/Tranexamic-Acid-drug-study








https://www.scribd.com/doc/201340912/Tranexamic-Acid-drug-study



A"kno2ledgement

In the !ro"ess o) !utting this resear"h together6 2e 2ould like tothank *rst and )oremost6 our !atient and her )amily )or trusting usand !ro$iding us 2ith the in)ormation needed )or our "ase study>the &+SF 1ursing Sta6 )or making us )eel 2el"ome and aiding us2ith 2hate$er 2e needed in learning by allo2ing us to a"Euire

more in)ormation )rom our !atient%s diagnosis> and to our belo$eddean6 +rs. renda +orales R.1 +.16 our "lini"al instru"tors6 +r.Ri"hard &ionisio R.1. and +iss Prin"ess Re"abe R.1. 2ho ha$erelentlessly en"ouraged us to gi$e our best and guiding usthroughout the "ourse. 0his e3!erien"e has hastened our skills inassessing our !atients6 2riting u! 1ursing are Plans6 a"Euiringthe skill to dete"t the signs and sym!toms o) the disease be)ore it)urther de$elo!s into a stage 2here surgi"al management isne"essary +ost im!ortantly 2e no2 ha$e a mu"h more inde!th

Documents

A Case Study on Choledocholithiasis