In The Name of God. Advanced Concept of Nursing- II UNIT- V Advance Nursing Management of GIT diseases. Cholecystitis.

Transcription

1 In The Name of God (A PROJECT OF NEW LIFE HEALTH CARE SOCIETY, KARACHI) Advanced Concept of Nursing- II UNIT- V Advance Nursing Management of GIT diseases. Cholecystitis. Shahzad Bashir RN, BScN, DCHN,MScN (Std.DUHS) Instructor New Life College of Nursing Updated on June 08, 2016

2 Objectives: By the end of this presentation, the students will be able to: 8/22/2016 Define cholecyctitis. Discuss the pathophysiology of cholecystitis. List the types of cholecystitis. Identify the clinical features of cholecystitis. Elaborate the investigations of cholecystitis. Explain the medical and nursing management of cholecyctitis. Cite nursing diagnosis of cholecyctitis. 2

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6 Gallbladder When food enters the duodenum, the gallbladder contracts and the sphicter of Oddi relaxes (valve in the common bile duct), allowing bile to enter the intestine. Cholecystitis - inflammation of gallbladder usually develops in assoc. with gallstones. But can occur from bacterial invasion or biliary spasm. Jaundice, bile obstruction not common. Blockage of bile flow from GB Gallbladder becomes fibrotic and contracted, which result in decreased motility and deficient absorption. 3x4 pear shaped hollow organ underside of liver Cholilithiasis- over time the concentration of bile in the gallbladder may result in insoluble stones, especially if bile contains high amounts of cholesterol. 6

7 Conti. Cholesterol stones form and block drainage of bile from gallbladder, which causes spasm, GB becomes inflamed, edematous and distended. This congestion leads to changes in GB circulation which eventually causes necrosis. Bacterial growth also develops. 7

8 Gallbladder Function- storage depot for bile Cholecystitis- inflammation of the gallbladder wall, acute infection Cholelithiasis - presence of gallstones

9 Cholecystitis Inflammation of gallbladder is called as cholecystitis. Two types of cholecystitis. 8/22/2016 Acute cholecystitis Chronic cholecyctitis 9

10 Acute cholecystitis Acute cholecystitis is acute inflammation of gallbladder. It is precipitated 90% of time by gallstones obstruction of neck or cystic duct. Acalculous cholecystitis describes acute gallbladder inflammation in the absence of obstruction by gallstones. For example: Surgical procedure, sever trauma, severe burns etc. 8/22/

11 Clinical features 8/22/2016 Right upper quadrant pain Pain radiates to right scapula and right shoulder Fever Anorexia Tachycardia Diaphoresis Nausea & vomiting Jaundice 11

12 Pathophysiology (Calculus Cholecystitis) 8/22/2016 A gallbladder stone obstructs bile outflow. Bile remaining in the gallbladder initiates a chemical reaction. It causes autolysis and edema The blood vessels in the gallbladder are compressed, compromising its vascular supply. Gangrene of gallbladder with perforation may result. Bacteria play a minor role in acute Cholecystitis.i.e. Enterococci, Staphylococci, E. coli

13 Pathophysiology (Acalculus Cholecystitis) 8/22/2016 Acalculous Cholecystitis describes acute gallbladder inflammation in the absence of obstruction by gallstones. Acalculous Cholecystitis occurs after major surgical procedures, severe trauma, or burns It results from alterations in fluids and electrolytes and in regional blood flow in the visceral circulation.

14 Cholecystitis: Pathophysiology The most common cause is cholelithiasis; obstructing the cystic and or common bile ducts. Can be acute or chronic Bile is used for digestion of fats. It s produced in the liver and stored in the gallbladder. When the concentration of bilirubin in the blood increases to greater than 2mg/dl, jaundice occurs. Acute- gallstones partially/completely obstruct CBD Chronic Cholecystitis- results from inefficient emptying of bile by gallbladder and gallbladder muscle wall disease persists. Chronic- may be caused by or lead to formation of gallstones (cholelithiasis)

15 Investigations Ultrasonography The use of ultrasound is based on reflected sound waves. 8/22/2016 Ultrasonography can detect calculi in the gallbladder or a dilated common bile duct. To detect gallstones with 95% accuracy. 15

16 Cholescintigraphy 8/22/2016 Cholescintigraphy is used successfully in the diagnosis of acute cholecystitis A radioactive agent (Technitum 99-M) is administered intravenously It is taken up by the hepatocytes and excreted rapidly through the biliary tract The biliary tract is then scanned, and images of the gallbladder and biliary tract are obtained 16

17 Nursing Diagnosis 8/22/2016 Altered nutrition: less than body requirement related to inadequate bile secretion Deficient knowledge related to dietary modifications, medications, self care activities Acute pain related to inflammation of gallbladder Impaired skin integrity related to vomiting Risk for infection Knowledge deficit 17

18 Nursing Interventions S/P Cholecystectomy Lap vs. Open Cholecystecomy LOC Vital signs Pulmonary Hygiene (cough deep breath, ambulate, turn and position incentive spirometer) Splinting to reduce pain Pain management Monitor wound incision /S/S of infection Monitor T-tube drainage (initially bloody, then greenbrown bile) T-tube initially may drain >400ml/day then should gradually decrease

19 Care of the T-tube Report sudden increases in drainage or amounts exceeding 1000ml/day Keep drainage bag below level of GB Inspect surrounding skin Maintain flow by gravity Never irrigate, clamp or aspirate without order Clamp 1 to 2 hours AC and PC Monitor and document the client s response to food

20 Nursing Interventions: Patient Education Dietary counseling: Low fat diet Weight reduction Fat-soluble vitamins and bile salts to enhance absorptions and aid digestion Avoid gas-forming foods Smaller more frequent meals Activity precautions 4-6 weeks Care of T-tube

21 References Brunner, L. S., Suddarth, D. S., & Smeltzer, S. C. (2008). Brunner & Suddarth's textbook of medicalsurgical nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins. Porth, MC. (6th ED). Pathophysiology. (2002). Philadelphia. USA. Lippincott Willams& Willkins, A Wolters Kluwer Company McPhee, J. S., & Papadakis, A. M. (2011). Current Medical Diagnosis and Treatment. (50th ED). Chicago. USA: Mc Graw Hill