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.Joe Harrison, a 62-year-old bank executive, presents to the emergency room with severe abdominal pain.

1. If the common bile duct is obstructed by a gallstone, an additional procedure called an endoscopic retrograde cholangiopancreatography (ERCP) may be performed. During an ERCP, an endoscope is used to examine the ducts of the gallbladder, pancreas, and liver. The endoscope has a small camera and light on the end, allowing the doctor to see inside the body and locate the obstruction. The doctor can then use special instruments to remove the gallstone and relieve the obstruction.

The nurse should provide the following written and verbal instructions before discharge:

• Pain management: Explain how to take pain medication as prescribed, what to do if the pain is not relieved, and the importance of reporting any adverse effects of pain medication.
• Incision care: Explain how to care for the surgical incisions, such as keeping the area clean and dry, changing dressings as needed, and looking for signs of infection.
• Activity restrictions: Explain any activity restrictions, such as lifting heavy objects, driving, or returning to work, and how long they will last.
• Diet: Explain any dietary restrictions or modifications, such as avoiding fatty or greasy foods and eating a low-fat diet, and when the patient can resume a normal diet.
• Follow-up care: Explain when and where the patient should follow up with their healthcare provider, how to schedule appointments, and what to expect at their follow-up visit.

2. Markedly elevated levels of serum amylase and lipase are typically seen in acute pancreatitis. Amylase and lipase are digestive enzymes produced by the pancreas, and when the pancreas is inflamed or damaged, these enzymes leak into the bloodstream. The elevation in these enzyme levels indicates pancreatic inflammation and damage.

The pale, bulky stools are a result of the lack of pancreatic enzymes, which aid in the digestion and absorption of fats. The dark tea-colored urine is caused by the presence of bilirubin, which is a waste product that is normally excreted in bile. In acute pancreatitis, the obstruction of the common bile duct can cause bilirubin to accumulate in the bloodstream and be excreted in the urine, causing it to become darker.

Based on the Criteria for Predicting the Severity of Pancreatitis, Mr. Harrison’s mortality risk is intermediate. The criteria take into account several factors, including age, comorbidities, and laboratory values, to predict the severity of pancreatitis and the patient’s risk of mortality.

The nurse should implement the following interventions related to hypocalcemia:

• Administer calcium supplements as prescribed.
• Monitor for signs and symptoms of hypocalcemia, such as tetany, numbness and tingling in the extremities, and muscle cramps.
• Monitor for signs and symptoms of hypomagnesemia, as hypocalcemia can occur in conjunction with hypomagnesemia.
• Provide education to the patient and family about the importance of calcium and magnesium supplementation and potential adverse effects.