Hi, welcome to our series on the gallbladder.
I'm gonna teach you what you need to know about caring for patients preoperatively or before surgery.
So, at this point, we've decided that gallbladder's gotta go.
We've got a cholecystectomy ordered for your patient.
So, what are the four most important treatment goals?
Well, the priority is supportive and symptom management,
but I wanna group them into four categories for you.
First up, pain control.
That's really important to your patient and to their quality of life during this time.
Second category, empiric antibiotics for control of actual or potential infection.
So, we're gonna make sure we treat them, hopefully prevent an infection,
or treat one that may have already begun.
Third, we're gonna maintain fluid and electrolyte balance,
and the fourth is managing nausea and vomiting,
which is a big reason why they may be having fluid and electrolyte imbalances.
I chose to start with pain control because most of your patients would appreciate you starting with pain control.
Now, on an NCLEX question, this is considered a psychosocial need,
but we're not talking about an NCLEX question.
Right now we're talking about your priorities when you're caring for a patient before surgery.
So, this is about keeping them comfortable
because remember, our goals are support and symptom management.
So, it's a three-pronged approach.
We can talk about keeping them NPO,
we can look at giving them anticholinergic medications, or we can look at opioids.
Now, let's break those down a little bit. If the patient stays NPO or nothing by mouth,
that means there's not gonna be any food stimulating that gallbladder and subsequent spasms.
So, the patient may or may not be NPO.
That's a decision that will be made by the healthcare provider,
depending on the length of time that the patient's gonna have to wait for surgery.
Anticholinergic medications are not considered traditional pain medications,
but in this case, they really will help minimize the patient's level of pain.
See, anticholinergics will decrease GI secretions
and will also counteract that smooth muscle spasm that's causing the pain.
So, while it's not like an opioid, which directly relieves pain,
anticholinergics will decrease the opportunity for the patient to experience pain.
Less GI secretions and it will help deal with that smooth muscle spasm that's causing the pain.
So, we've looked at the first priority of pain control.
The next priority is talking about antibiotics.
Now, empiric coverage includes Gram-negative enteric organisms.
That's what we're looking to treat.
So, I've got some examples of IV antibiotics listed there for you.
Ceftriaxone, metronidazole, you got piperacillin tazobactam, or ticarcillin clavulanate.
So, these are examples of antibiotics that may be used.
Now, I don't think it's really important that you memorize each of these medications.
I just wanted you to see examples of antibiotics that are typically or commonly used.
So, we've talked about pain control, we've talked about antibiotics,
now we will look at how we maintain fluid and electrolyte balance.
See, the patient may require IV fluids especially with NPO status or if they're vomiting.
So, if we're not allowing them to take anything in by mouth
or they can't keep food down because they're vomiting,
they may likely require IV fluids so they do not get dehydrated.
Now, if the patient's at home, we recommend what type of oral fluids
they should be taking so that we help them prevent becoming dehydrated.
So, pain, antibiotics, fluid and electrolyte management, and last, nausea and vomiting.
Now, no one wants to feel nauseous and nobody likes to deal with vomiting.
The anticholinergic medications will help deal with some of that
because you have fewer GI secretions.
So, with less GI secretions, it may help with the nausea.
It will also minimize that gallbladder stimulus so that NPO might also be effective in helping us with that.
Now, medications may be needed in addition to the anticholinergic medications.
So, we have medications that specifically address nausea,
but if all else fails, we can place an NG tube
if we just can't seem to get that nausea or vomiting under control.
That will decompress the stomach and decrease the gallbladder stimulation.
So, managing nausea and vomiting can be just as important to the patient's quality of life,
as it is managing the pain.
Now, I want to share with you a story from my own life.
It was about my dad. He was diagnosed with gallbladder disease.
He had the risk factors that you would expect.
He was diabetic and he had hepatobiliary disease, so he was kinda prime for this to happen.
Now, they went and did his evaluation on a Friday,
but he wasn't gonna have the surgery until Monday.
He was stable, his vital signs were fine, didn't really seem like this should be a big deal.
But see, my dad also had rheumatoid arthritis and he took pretty high power NSAIDs,
non-steroidal anti-inflammatories for that arthritis pain.
Well, because he didn't feel good, people with gallbladder disease have that dyspepsia and anorexia
and they're restless and they can't get comfortable
and they're nauseated, he didn't really wanna eat anything
and he didn't even want to drink anything.
So, he didn't, but he took just enough fluid to take his high power NSAIDs.
Well, by Monday morning, he was in acute renal failure.
It happened quickly, it came on over the weekend,
and his kidneys literally never recovered for the rest of his life.
Eventually, he ended up on dialysis and it all started from gallbladder disease,
not being hydrated, and ended up really damaging his kidneys because of the NSAIDs.
So, always know, when you're talking to your patients,
remind them that NSAIDs can be particularly difficult on kidneys
and if you are dehydrated, it can be lethal to your kidneys.