Cholecystitis Nursing NCLEX Pathophysiology, Symptoms (T-Tube & Cholecystostomy)

hey everyone it's Sarah registered nurse RN comm and today we're going to talk about coal cystitis and as always whenever you're done watching this YouTube video you can access the free quiz that will test you on this condition so let's get started what is coal cystitis well to help us understand this condition let's break this word apart the word coal means bile this means membranous sack and itis means inflammation so we're dealing with inflammation of a membranous sac that holds bile well what structure in the body does that the gall bladder Sokol cystitis is inflammation of the gallbladder now the helped us understand this condition we need to talk about the role of the gallbladder your gallbladder is a very unique looking structure it's like rotund and pear-shaped and green and it's found on the right side of the body just beneath the liver which is very fitting because the liver and the gallbladder work together they both share their love for a substance called bile the liver actually creates the bile and it will leave the liver go down into the hepatic duct and into the gallbladder where it's stored and concentrated now what is vile well bile is a important substance that helps us digest fats like those fat soluble vitamins like DEA and K and it also is a vehicle for a substance called bilirubin to exit our body through the stool so first let's talk about how bile works to digest fats well whenever you eat a meal the food goes into your stomach and your stomach will partially digest it and whenever it leaves the stomach the food will be called kind because now it's like this thick semi pulpy substance that has gastric juices and fats in it so it's gonna leave the stomach go down there the small intestine and it's going to hit the duodenum and here in the duodenum you have a duct that's going to since that fat in that time and whenever it senses that it causes the gallbladder to contract and release bile down through the cystic duct down through the common bile duct and then into the duodenum to assist with digesting those fats now whenever you have an issue with the gallbladder and let's say this bile can't leave the gallbladder to get down there maybe there's some type of obstruction may be from a gallstone or the gallbladder just isn't working due to some major trauma going on with the patient well the fat that's in that time will not be digested instead the patient will excrete it out so whenever you look at the stool it will be like this greasy fatty looking stool called steatorrhea and that's one thing you want to look at in patients who have cholecystitis especially chronic cholecystitis because their gallbladder is so inflamed the bile is not getting there so instead of digesting fats they're just excreting it out and another thing that bile does that I pointed out earlier is that it's a vehicle for allowing bilirubin to exit our body through the stool so let's talk a little bit about Billy Ruben well Billy Ruben is a substance that's created whenever you have the breakdown of old worn out red blood cells and it's like this brown orangish color and what it does because it exits our body through the stool it gives your stool that brownish color so if we have let's say another gall bladder problem like your gall bladder is inflamed with this well the bile isn't being able to get down here into the small intestine so isn't the Billy Ruben so the patient can have jaundice where that Billy Ruben isn't leaving the body it's actually leaking into the tissue so you could see the sclera of the eyes turning that yellowish orange the skin also the stool will look like colored clay color because it won't have that brown tint because of that bilirubin that wouldn't normally exited the body plus the urine can be dark in color as well now let's around the cause of coal cystitis what can inflame our gallbladder well one of the main causes is some type of obstruction we're either talking about an obstruction in the cystic duct where bile just can't get out and it stays in the gallbladder which is not good or gall stones and gall stones is usually one of the main causes of coal cystitis and you want to know the risk factors of a patient developing gall stones which are being female obese older age like over 40 a family history of gall stones being pregnant or having an ethnicity of being a Native American or Mexican American and another cause of coal cystitis would be termed a calculus which means without a stone presenting and this occurs when the gall bladder just isn't working properly so there's dysfunction of that gall bladder it's not contracting like it should and releasing the bile now this tends to occur in patients who are severely sick usually in the hospital they've had maybe a burn a massive trauma or they've had sepsis or they've even been on TPN for a really long time and this gall bladder isn't doing what it should so whether it's like an obstruction preventing this bile from leaving or the gall bladder just isn't contracting whatever the cause this bile is staying stagnant in this gall bladder it's getting thick and whenever that happens it increases pressure in the gall bladder which in flames and damages the gall bladder wall and causes it to swell and whenever this happens this inflammation can lead to serious complications it can cause hepatitis it can cause infection in the livers bile ducts it can inflame the pancreas it can lead to sepsis and it can even lead to the gallbladder tearing open now let's talk about the signs and symptoms of coal societies most patients are going to have nausea and vomiting and nausea vomiting can be so severe that they will need a nasogastric tube inserted with GI decompression where what that means is that we will remove the stomach contents with low intermittent suction so this gall bladder isn't stimulated and we'll give them anti-nausea medication as well and that can help with the nausea and vomiting and with this nausea and vomiting a lot of patients become dehydrated so one of the big things that you'll be doing as a nurse per physician order will be administering IV fluids to help hydrate them also patients are going to have pain and the pain can be very intense and we'll want to administrate pain medication and this abdominal pain can be epigastric and one unique characteristic of it is that the pain is going to radiate to the right scapula the right shoulder blade and why is that well that's where that gallbladder is so if it's inflamed they can fill that over there and a thing about this pain is that it can get worse after a patient consumes a heavy greasy meal so be watching out for those signs and symptoms because that really indicates that hey something's up with that gall bladder also patients can have a positive Murphy sign and just like I've said throughout all my lectures if you ever see something that's named after someone and it's a sign type of sign and symptom always remember that because it's probably going to be on your test so what is a positive Murphy sign well how you elicit this is you would lay the patient back tell them to breathe out then you're gonna tell them to breathe in and while they're breathing in you're gonna palpate underneath the ribs midclavicular lee which is where the gallbladder is and you're gonna tell them to breathe in and while they're doing that you're feeling and you're gonna watch their breathing and as they breathe in and do they stop do they pause their breathing due to pain because this gallbladder is inflamed and if they do pause let's stop the breathing that's a positive Murphy sign also patients can have bloating in their abdomen they can have a fever increase heart rate and patients who have had chronic cholecystitis they've had this for a while it gets better comes back gets better comes back they can have that jaundice and that's from that bilirubin bilirubin isn't exiting the body through the bio because it can it's really just hanging out in the gallbladder they can have dark urine where the bilirubin is leaking into the urine like colored stools and the steatorrhea and that was because the bile is not getting there to that duodenum to help digest the fats now when your patient is presenting with all these signs and symptoms as a nurse what could you expect the physician to order to help diagnose that this indeed is coal societies well they can order an abdominal ultrasound where they go and look at this area of the abdomen see what's going on with the gallbladder they can also order what's called a Haida scan and this is where they inject a radioactive tracer into a patient's veins and it will in a sense light up this whole area once they go under this special camera and they can assess what's going on with the gallbladder also a CT scan can be ordered as well now let's talk about our role as the nurse for a patient who has cholecystitis and highlight those important concepts you need to know for exams about this condition and to do that we are going to remember the word gallbladder because that will help guide us in remembering those important concepts so first G for GI rest whenever you have a patient who has an inflamed gallbladder you don't want it to be stimulated and to increase that inflammation so the patient will be NPO nothing by mouth until they're recovered and a lot of patients will have that nausea and vomiting as I've talked about earlier and if it's severe they'll have that NG tube with GI decompression so as the nurse you want to maintain that low intermittent suction whatever the physician orders and monitor what's being removed and provide routine mouth care especially if your patients been vomiting and whenever they're recovering their nutrition will be advanced physicians order and usually they'll start out with clears and you'll see how they tolerated that did they have nausea and vomiting did they have that epigastric pain that radiated you want to be looking for all those signs and symptoms and then they'll be upgraded to full liquids and then a soft bland diet and so forth and again just monitor how the patient tolerates that next is a for analgesics and antiemetics patients with Coulson sadhus are going to be in a lot of pain and probably have a lot of nausea so you'll want to give IV medication whatever the physician ordered to help treat that pain and nausea and assess their pain and their nausea routinely and evaluate that effectiveness of that medication then elf or low-fat diet when recovered whenever a patient has recovered from cholecystitis a lot of patients if it's severe they will get a cholecystectomy where they actually remove the gallbladder and we're going to talk about that here in a moment so you'll want to tell them to avoid having a diet that's really high in fat so don't want to avoid greasy foods spicy foods and gassy foods and some examples of gassy foods are like onions cauliflower beans and broccoli then the next L is large-bore IV for fluids as I pointed out earlier patients are going to have nausea and vomiting they're most likely going to be dehydrated and we're worried about them becoming too dehydrated and having electrolyte imbalances so we will administer fluids per the MD order to help maintain their fluid status and electrolytes because if they've been throwing up they've been losing a lot of electrolytes and fluids can help supplement that next B for breathing in stopped by patient this deals with that positive Murphy sign and I wanted to include this in this mnemonic so you will remember this for exams and this is where that breathing is stopped by the patient during palpation of the gallbladder due to pain and the skull bladder will be inflamed and as you can see here on the right in this picture this is approximately where the palpation point will be l4 labs as a nurse we want to monitor our patients lab results as they're ordered by the physician so some labs will be looking at that maybe order are like electrolytes make sure that they're falling within normal range there Billy Reuben level and not only can you look at the level but you can just look at your patient and see if they're billy Reubens hi are they having jaundice dark urine clay colored stools also what's their white blood cell count is it really high and their renal function are they becoming too dehydrated looking at that bu in and creatinine some other things not listed here you could look at their liver enzymes see maybe if they're developing a complication from this cholecystitis where you're having inflammation of the liver look at their pancreatic enzymes maybe they're getting pancreatitis again another complication from this condition a for antibiotics for infection many patients will be started on an IV antibiotic so you'll be administering that heard the physician's order and you'll be monitoring your patient for any adverse reactions to the antibiotic and how they're responding to it D for drain care and we're talking about a col cystoscopy tube also called a C tube now this is different from a t tube which I'm going to talk about here in a moment and a t tube is placed sometimes after the patient has their gallbladder removed in its place in the bile duct AC tube is placed through the abdominal wall into the gall bladder and this is for some patients who can't immediately have surgery to remove their gall bladder due to cholecystitis so they will have this type of drain and what it will do is it'll drain fluid from the gall bladder so it's gonna drain all that infected bile from the gallbladder and help it heal and some things you want to remember about this drain is that you want to keep the drainage bag lower than the insertion site so at or below waist level so gravity can help remove that infected bile you'll also want to empty that bag regularly note the color it should be yellowish brownish greenish and note the amount make sure it's draining properly and per the physician order you may need to flush the tubing to keep it patent and if the patient goes home you'll want to teach them that if the physician has ordered that and you'll want to make sure that you change the dressing regularly and teach the patient how to do this and to keep that skin dry and clean because bile is very harsh on the skin then d4 deterioration signs and symptoms what are some things that you want to be looking out for that could indicate treatment is not helping and the patient is actually getting worse well they have mental status changes their heart rate is high tachycardic they have a drop in their blood pressure hypotension which could indicate sepsis they have an elevated temperature their white blood count is really high or their stool has changed now it is steatorrhea where it's that greasy fatty stool or their stool is now light-colored they've developed jaundice or they're having increased nausea and vomiting and they're having increasing right upper quadrant abdominal pain and now we have the last two parts of our pneumonic and they're going to deal with the treatment for cholecystitis so e is for ERCP and this stands for endoscopic retrograde cholangiopancreatography and that's what we call anything your CP because that's a big long word and what this is is this will remove gall stones from that bile duct and if we can remove gall stones bile can drain out and that can help the gall bladder and what how this is done is an endoscope is inserted through the mouth and into the stomach to the small intestine to the bile duct and you can see that with this illustration here and then are for removal of the gallbladder and the proper term for this procedure is cholecystectomy a neck t'me means cutting out so they're cutting out the membranous sac the holds bile so they're removing the gallbladder now you may be wondering okay where is this bile that leaves the liver going to be stored well the Bible will now actually drain from the liver via the bile duct into the duodenum continuously and this procedure can be performed laparoscopically or open most today are leper scopic and as the nurse you want to monitor your patient for infection after this procedure looking at the incisions making sure they look good and how's their vital signs how are they doing and be aware that patients who have the laparoscopic procedure can have shoulder pain where the carbon dioxide was not absorbed by the body so some things you can help the patient deal with this as help them get into a side laying position with their knees bent some heat therapy can help on the shoulders or analgesics also you want to make sure that your patient is ambulating early after surgery so they don't get any complications they're coughing and deep breathing they're splitting their incision especially if they have the open surgery using that incentive spirometer and you want to provide t-tube care if they have this and some things you want to remember about the t tube for exams is that it works as a drain and it can be used for testing where dye is injected into the tube and an x-ray is taken to see if there are any more stones so it'll like light up the biliary tree and they can assess how everything looks like for example in this picture right here now the t tube is t-shaped hence why we call it a t tube and the top part of the T is actually placed in the bile duct as you can see in this illustration over here and this will drain the bile while that duct is healing after surgery because there's gonna be a lot of swelling in there now most patients will have a drainage bag where it will drain from the tube and collect in the bag and then sometimes they will just put a sterile cap over that end of the drain and some patients will go home with it and then they'll have it removed later on things you want to remember as the nurse is that you want to keep that tubing and drainage bag below the insertion site so at or below waist level so it can drain properly and make sure it's actually drain it's not kinked and that the patient is in semi Fowler's position because this will help with draining that bile now you may have to flush or clamp the tubing at some points but you must have a physician's order to do this in addition you're going to be emptying and measuring the drainage and you want to look at the color and look at how much you have emptied there should be no more than 500 CCS a day or emails a day of drainage that you're emptying that would be abnormal and you'd want to notify the position the first couple days of posts off after a tee tube the drainage will be bloodiest tinge and then it will start to look greenish brownish color but make sure you look at that amount that it is putting out you'll also want to monitor the skin surrounding the insertion site of the tube because bile like I said earlier is really harsh on the skin and if you do have an order to clamp the tube sometimes physicians will want you to clamp the tube one hour before meals and one hour after meals and this is so bile can enter the small intestine to help with fat digestion instead of just leaving all through the tee tube and that tubing into the collection bag we actually want it to go through the duodenum and digest the fats of the patients eating so a big thing you want to remember is that during those periods when that tube is clamped you want to assess how that patient is tolerating that tube actually being clamped and report any signs and symptoms that the patient may be having regarding nausea and vomiting they start having that or abdominal pain okay so that wraps up this review over coal societies

Channel: RegisteredNurseRN

Views: 823,155

Keywords: cholecystitis, cholecystitis nursing, cholecystitis examination, cholecystitis pathophysiology, cholecystitis symptoms, t-tube drain after cholecystectomy, t-tube drain, t-tube for cholecystitis, t-tube cholecystectomy, t-tube nursing care cholecystitis nclex, cholecystostomy, cholecystostomy tube nursing, cholecystectomy, gallbladder, gallbladder inflammation, gallbladder inflammation nursing, gallbladder nclex, gallbladder attack, gallbladder pain, gallbladder symptoms

Id: nyBV18sHNSg

Length: 21min 41sec (1301 seconds)

Published: Thu Sep 26 2019