Cholecystitis and Cholangitis 55
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Cholecystitis and Cholangitis
1. Admit to:
2. Diagnosis: Bacterial cholangitis
3. Condition:
4. Vital signs: q4h. Call physician if BP systolic >160, <90; diastolic. >90, <60;
P >120, <50; R>25, <10; T >38.5
C
5. Activity: Bed rest
6. Nursing: Inputs and outputs
7. Diet: NPO
8. IV Fluids: 0.5-1 L LR over 1h, then D5 1 NS with 20 mEq KCL/L at 125 cc/h.
NG tube at low constant suction. Foley to closed drainage.
9. Special Medications:
-Ticarcillin or piperacillin 3 gm IV q4-6h, and either metronidazole (Flagyl) 500
mg q8h or cefoxitin (Mefoxin) 1-2 gm IV q6h.
-Ampicillin 1-2 gm IV q4-6h and gentamicin 100 mg (1.5-2 mg/kg), then 80
mg IV q8h (3-5 mg/kg/d) and metronidazole 500 mg IV q8h.
-Ticarcillin/clavulanate (Timentin) 3.1 g IV q4-6h (single agent).
-Imipenem/cilastatin (Primaxin) 1.0 gm IV q6h (single agent).
-Piperacillin/tazobactam (Zosyn) 3.375 IV q6h.
-Ampicillin/sulbactam (Unasyn) 1.5-3.0 gm IV q6h.
10. Symptomatic Medications:
-Meperidine (Demerol) 50-100 mg IV/IM q4-6h prn pain.
-Hydroxyzine (Vistaril) 25-50 mg IV/IM q4-6h prn with meperidine.
-Omeprazole (Prilosec) 20 mg PO bid.
-Heparin 5000 U SQ q12h.
11. Extras: CXR, ECG, RUQ Ultrasound, HIDA scan, acute abdomen series. GI
consult, surgical consult.
12. Labs: CBC, SMA 7&12, GGT, amylase, lipase, blood C&S x 2. UA,
INR/PTT.
Acute Pancreatitis
1. Admit to:
2. Diagnosis: Acute pancreatitis
3. Condition:
4. Vital signs: q1-4h, call physician if BP >160/90, <90/60; P >120, <50; R>25,
<10; T >38.5
C; urine output < 25 cc/hr for more than 4 hours.
5. Activity: Bed rest with bedside commode.
6. Nursing: Inputs and outputs, fingerstick glucose qid, guaiac stools. Foley to
closed drainage.
7. Diet: NPO
8. IV Fluids: 1-4 L NS over 1-3h, then D5 1 NS with 20 mEq KCL/L at 125
cc/hr. NG tube at low constant suction (if obstruction).
