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Medical/ Surgical Management

1 .Chest X-ray- this is used to rule out respiratory causes
of referred pain.
2.Intake and Output
I&O measurement provide an other means of assessing
fluid balance. This data provide insight into the cause
of imbalance such as decrease fluid intake or increase
fluid loss. Thesemeasurement are not that accurate as
body weight, however, because of relative risk of errors in
recording.
3.Electrocardiogram- The ECG is an essential tool in
evaluating cardiacrhythm. Electrocardiography detects
and amplifies the very smallelectrical potential changes
between different points on the surface of the body as a
myocardial cell depolarize and repolarize, causing the
heart tocontract.
4.O2 Inhalation- Oxygen therapies are used to provide
more oxygen to the body into order to promote healing
and health.
5.Intravenous Rehydration
when the fluid loss is severe or lifethreatening,
intravenous (IV) fluids are used for replacement.
6.ultrasound (Also called sonography.) - a diagnostic
imaging techniquewhich uses highfrequency sound waves to create an image of theinternal
organs. Ultrasounds are used to view internal organs of
theabdomen such as the liver spleen, and kidneys and to
assess blood flowthrough various vessels.

7.hepatobiliary scintigraphy - an imaging technique of the

liver, bile ducts,gallbladder, and upper part of the small
intestine.
8.cholangiography x
ray examination of the bile ducts using anintravenous (IV)
dye (contrast).
9.percutaneous transhepatic cholangiography (PTC)
a needle isintroduced through the skin and into the liver
where the dye (contrast) isdeposited and the bile duct
structures can be viewed by x-ray.

10.endoscopic retrograde cholangiopancreatography

(ERCP) - a procedurethat allows the physician to diagnose
and treat problems in the liver,gallbladder, bile ducts, and
pancreas. The procedure combines x-ray andthe use of an
endoscope. A long, flexible, lighted tube. The scope
isguided through the patient's mouth and throat, then thro
ugh theesophagus, stomach, and duodenum. The
physician can examine theinside of these organs and
detect any abnormalities. A tube is then passed through
the scope, and a dye is injected which will allow
theinternal organs to appear on an x-ray.

11.computed tomography scan (CT or CAT scan) - a

diagnostic imaging procedure using a combination of xrays and computer technology to produce cross-sectional
images (often called slices), both horizontallyand
vertically, of the body. A CT scan shows detailed images of
any partof the body, including the bones, muscles, fat, and
organs. CT scans aremore detailed than general x-rays.
12.Cholecystectomy- removal of the gallbladder. This
procedure may
be performed to treat chronic or acute cholecystitis, with o
r withoutcholelithiasis, to remove a malignancy or to
remove polyps.
13.Cholecystotomy- the establishment of an opening into
the gallbladder toallow drainage of the organ and removal
of stones. A tube is then placedin the gallbladder to
established external drainage. This is performedwhen
the patient cannot tolerate cholecystectomy.
14.Choledochoscopy- the insertion of a choledoscope into
the common bileduct in order to directly visualize stones
and facilitate their extraction.

VIII.DISCHARGE PLANNINGM-Instructed the patient to conti

nue medication as ordered
1. Cephalexin 500 mg cap 3 x day (8am-1pm-8pm) for
1 week
2. Mefenamic Acid 500 mg cap 3 x day (am-1pm-8pm) for
1 week E-Instructed the patient to do exercise as tolerated
such as walkingT-Instructed the patient to continue the me
dication.
1. Encouraged patient to increase fluid intake
2. Encouraged patient to eat foods rich in Vitamin
and Nutritiousfoods
3. Encourage patient to avoid salty and fatty foods
4. Encourage patient to have enough rest
O-Instructed to come back for follow-up check-up on Febru
ary 23, 2006,Thursday.
D
- Advised the patient to a diet as tolerated but preferably a
voiding saltyandfatty foods.

Books
Joyce M. Black,PhD, RN, CPSN, CWCN & Jane Hokanson
Hawks, DNSc, RN, BC,Medical- Surgical Nursing 7 th
edition, pg.1302-1314. Nursing 2004 Drug Handbook, 24
th editionDoenges, Moorhouse, & Murr, Nurses pocket
guide 9 th edition.

Online Resources
www.facs.orghttp://tjsamson.client.web-health.com/webhealth/topics/GeneralHealth/generalhealthsub/generalheal
th/liver&gallbladder/what_gall bladder.htmlhttp://www.eme
dicine.com/emerg/topic97.htmhttp://www.emedicine.com/r
adio/topic163.htmhttp://www.healthsystem.virginia.edu/uv
ahealth/adult_liver/chole.cfmhttp://www.emedicine.com/E
MERG/topic98.htmMicrosoft Encarta 2004 Nursing Care
Plan Content CD-ROM