Nursing care of patient common bile duct stone with septicemia

Abstract

Introduction: Common bile duct stones. Nowadays, Common bile duct stones. Nowadays, it’s can be found more and become a health and economic problem of the population in the country. The most common problems caused by gallstones are acute cholecystitis, ascending cholangitis, and pancreatitis. Most patients with common bile duct stones are asymptomatic and some have symptoms similar to those of intestinal or gastritis. The diagnosis is hard, leading to the likelihood of severe symptoms, septicemia, and 2-3% of deaths per year. 

Objectives of the study: To improve skills in assessing and caring for patients with common bile duct stones to avoid more serious complications and prevent death from complications.

Methods: This is a case study of a patient with common bile duct stones and septicemia for 1 specific case at the Surgery Intensive Care Unit (ICU) Building of Ang Thong Hospital, conducting studies between December 2021 and January 2022.

Result: A case study of a Thai female patient is 71 years old, admitted to Ang Thong Hospital on May 25, 2021, at the Accident and Emergency Department. 2-3 days ago, the patient had epigastric pain, diarrhea 2-3 times, no nausea, and no vomiting after taking mineral salt was better. On May 25, an hour before coming to the hospital, the patient had fainting and chills. In the emergency department, she had a fever of 40.2 degrees Celsius, BP 88/58 mmHg, PR /120 times/min, and RR 30 times/min. The doctor diagnosed septic shock and treated by load 0.9% NSS 1500 cc and Levophed 4:250 start at 10 cc/hr, keep BP > 90/60 mmHg and take ceftriaxone 2 gm IV OD, the patient has oxygen sat 83%, Shortness of breath RR 30 times/min. Therefore, the doctor intubated ventilator No 7.5, depth 22 cm. And then send the patient to the female internal medicine building on bird respirator NPO. The doctor examined the body and found that the patient had severe pain under the right ribcage. Therefore, the patient is sent for an ultrasound upper abdomen, the result is diffuse dilatation of bilateral IHDs and CBD without demonstrable cause of obstruction, Further CT is suggested. The doctor considered sending a CT upper abdomen, the result is A 1.7 oval iso-hyperdensity lesion at distal CBD (distal CBD stone) causing biliary system obstruction (intrahepatic duct 1 cm. and CBD 1.8 cm) and swelling ampullar of vater Distended gallbladder from biliary obstruction without stone or mass or cholecystitis and consulting with a surgeon for moving to the surgery ICU set OR for ERCP with EST with Balloon extraction with stent 1 pieces on ventilator Vital sign stable off Levophed, breathing more comfortably, and wean off ETT. The patient was able to eat food and was transferred from the surgery ICU to the female surgery building and was returned home safely. The patient was hospitalized for a total of 8 days. After that, the doctor made an appointment to see him again in two weeks for the blood test for LFT, CBC, the results were normal.