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Admitting Diagnosis: Juandice - Coggle Diagram

- - - - Collaborative Interventions
        
        Low carb, low fat diet
        
        A low carb low fat diet helps reduce the stress on the pancreas and its related organs like the liver and gallbladder. By reducing fats and carbs we are reducing the workload of the affected organ allowing it to begin slowly draining the excess bilirubin.
        
        Prepare client for ERCP
        
        ERCP or Endoscopic retrograde cholangiopancreatography is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas.
      - Nursing Interventions
        
        Post sedation care and safety.
        
        Post ERCP the client will be recovering from the sedative effects of necessary medications, and an invasive procedure that required them to be NPO beforehand. Ensuring bed rails are up, call lights in place, bed alarms active, and continuous cardiac and oxygen monitoring we can reduce the clients fall risk and assess vital signs.
        
        Client Education
        
        As nurses we want to promote the understanding of the disease processes affecting our clients. This will help the clients to understand why we are performing such interventions and may reduce the likelihood of reoccurrence.
      - Teaching Topics
        
        Diet
        
        Teaching the Client about dietary choices they can make to reduce pain, and decrease the use of the pancreas to encourage healing should be a priority.
        
        Post ERCP complication
        
        ERCP complications include contracting infections such as pancreatitis, cholangitis, increasing the risk for hemorrhage and perforation.
      - SMART Goal
        
        The client will be evaluated on their dietary choices at each meal to determine whether teaching about appropriate food choices has been effective.
        
        Goal has been met. Client chooses meals that are low in fats and protein.
    - - Nursing Interventions
        
        Prophylactic Antibiotic Administration
        
        A blockage or back up of biliary secretions can cause a buildup of bacteria as well and can lead to infections of the descending and common bile ducts. This risk is increased with the ERCP procedure being performed as well
        
        Monitoring WBC count
        
        An elevated WBC count may be the first sign that an infection has begun. Monitoring and treating infections as early as possible will significantly improve patient outcomes.
      - Collaborative Interventions
        
        Encourage fluid intake
        
        With the help from UAP and patient family and friends we can consistently encourage them to drink water and stay hydrated to help aid in their recovery.
        
        Monitor BUN and Creatinine levels
        
        Clients receiving antibiotics for prolonged periods of time will need to be monitored for Kidney damage caused by nephrotoxic agents. Laboratory members can draw blood routinely and report the results to us directly.
      - Teaching Topics
        
        Adequate Hydration
        
        After being NPO pre ERCP the client should be encouraged to drink fluids to replenish fluids and will help dilute the kidneys during treatment with antibiotics.
        
        Signs and Symptoms
        
        Signs and Symptoms of infection are going to be pain and tenderness to the abdomen, could be red and swollen, and may have an increase in heart rate and temperature. The client needs to be aware of these complications so that they may return to the hospital if they occur.
      - SMART Goal
        
        For 48 hours post surgery the client will have Q12 hour WBC checks to proactively look for signs of infection.
        
        Goal is ongoing, as client is only 30 hours postop. WBC count continues to be within normal limits; will continue monitoring for signs of infection.