Question

Evelyn Bean, 52 years of age, is admitted to the same-day surgery unit for an elective laparoscopic cholecystectomy. The patient presents with jaundice of the skin and sclera. The patient’s urine is dark and the patient stated that she has clay-colored stools. She stated she has occasional colicky pain in her right upper quadrant of her abdomen radiating to her back. The patient had preadmission testing 1 week ago and the results are on the patient’s chart. The record of patient education and an informed written consent are also on the chart. (Learning Objectives 2 and 3) a. What additional procedure will be performed if the common bile duct is obstructed by a gallstone? b. The nurse in the same day surgery unit provides the discharge instructions to the patient and family before the patient goes for surgery so the patient is fully awake to receive the instructions and ask questions. What written and verbal instructions should the nurse provide?

Answer 1

LAPAROSCOPIC CHOLECYSTECTOMY: Removal of the gall bladder by laproscopy. Laparoscopic cholecystectomy is performed through several small incisions. The laproscope which is a small tube inserted into the abdomen through a tiny cut made just below the navel.

BILIARY DUCT OBSTRUCTION: A biliary obstruction is a blockage of the bile ducts. The bile ducts carry bile from the liver and gall bladder through the pancreas to the duodenum ( a part of the small intestine). The gall bladder releases bile which helps in a)digestion b) fat absorption and c) clear the waste products in the liver.

CAUSES: The main cause of biliary obstruction is the presence of stones in the gall bladder. The other causes are a) inflammation of the bile ducts b) trauma c) cysts d) pancreatitis e) an injury related to gall bladder or liver surgery f) cirrhosis and g) severe liver damage.

SYMPTOMS OF BILIARY OBSTRUCTION: a) light-colored stools b) dark urine c) jaundice ( yellowish eyes or skin) c) pain in the upper right side of the abdomen d) itching e) nausea f) weight loss and g) fever.

WHAT ADDITIONAL PROCEDURE WILL BE PERFORMED IF THE BILE DUCT IS OBSTRUCTED BY A GALL STONE?   ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) : is both a diagnostic and therapeutic procedure which involves the use of an endoscope and X-ray to remove small stones from the bile duct and also helps to place a stent inside the duct to restore the bile flow.

DISCHARGE INSTRUCTIONS TO THE PATIENT AND TO THE FAMILY: PATIENT INFORMATION: A well-informed patient is essential for achieving outcomes and are less likely to experience anxiety. There is limited time to explain patient about their preoperative preparation, surgical procedure, anaesthesia and post-operative recovery. It is therefore important that verbal instructions are reinforced on a number of occasions including a) primary care b) surgical outpatient clinic c) preoperative assessment d) admission and d) discharge. Verbal instructions should always be accompanied by clear written information. The nurse should provide information such as A) Not to drive for 3 days post- surgery or until no longer taking pain medicine and are able to step on the brake pedal without hesitation. B) wash the skin around the incision daily by using soap and water in view to reduce infection. C) Eat regular diet D) Watch for the other symptoms like a) fatigue b) pain around the incision site c) diarrhoea or constipation d) loss of appetite e) fever f) pus from the incision site and g) edema and redness on the surgical area. E) Appropriate analgesia with written instructions should be give to the patient. F) A discharge summary should they require medical assistance and senior nurse overnight.