1. 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)
- What additional procedure will be performed if the common bile duct is obstructed by a gallstone?
- 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?
2. Joe Harrison, a 62-year-old bank executive, presents to the emergency room with severe abdominal pain. He describes the pain as excruciating, and indicates it is located in the mid epigastrium with radiation into his back. The patient states he has not eaten anything in the past 24 hours, but 2 days ago attended a wedding dinner and consumed a large meal and about 4 to 5 alcoholic beverages. Mr. Harrison admits to being a “social drinker,” ingesting 2 to 3 alcoholic beverages several days a week. Based on his clinical presentation and history, Mr. Harrison is admitted with a diagnosis of rule-out pancreatitis. (Learning Objectives 4 and 5)
- Blood and urine samples are sent to the lab, and the results indicate that the serum amylase and lipase are markedly elevated. How do these findings correlate to the diagnosis of acute pancreatitis?
- The nurse notes that Mr. Harrison’s stool is pale and bulky, while his urine is a dark tea color. Correlate these findings to the pathophysiology of acute pancreatitis.
- Mr. Harrison’s WBC is 18,500, and his serum glucose is 325. His LDH is 300 IU/L and the AST is 120 U/mL. Based on the Criteria for Predicting the Severity of Pancreatitis, what is Mr. Harrison’s mortality risk?
- Mr. Harrison develops hypocalcemia secondary to the acute pancreatitis. What nursing interventions should the nurse implement related to this complication?