Galltone Case

Introduction
A 65-year-old man, Mr. Black was taken to emergency ward complaining of severe abdominal pain from his upper right abdomen to his mid back as sharp and boring pain after ingestion of fatty rich foods. Mr. Black was felt nauseated at that time but did not vomit and stated that he had a similar attack in the past month, but ‘none as bad as this’. Mr. Black had an abdomen ultrasound to reveal Mr. Black to suffer from cholelithiasis, a formation of gallstones in the gallbladder that blocks the bile duct which led to acute pain, nausea and vomiting (Strasser, S. 2013, December 10). An additional diagnosis was performed using endoscopic retrograde cholangiopancreatography (ERCP) to release and break the stones. After the procedure, more
2013, July 25). Bile is mainly of water, cholesterol, salts and blood pigments. Gallstones occur when excessive cholesterol in the bile became hardened and gallbladder failure to discharge the stones (Ratini, M. 2014, December 3). There are 3 most common stones; mixed stones, made of cholesterol and salts capable of developing in batches; cholesterol stones formed due to excessive cholesterol, thus the yellowish colored stones which can grow to substantial size enough to block the bile duct and finally pigment stones, consist of blood pigments, a greenish-brown in color comes in smaller sizes but often numerous in quantity (Strasser, S 2013, December 10). Approximately 15% of people over the age of 50 and over have gallstones in the gallbladder of which 70% do not have a symptom (Strasser, S 2013, December 10). People at risk are those who are obese, with a family history of gallstones (Ratini, M. 2014, December 3). However, women are most commonly at risk due to a significant increase in cholesterol level, for example, pregnant women and/or on birth control pills, on hormone replacement
Black admitted to the ward post-ERCP procedure, the patient would be under sedation. When patient yet to regain full conscious state patient is regard as a fall risk. Patient acute pain is placed in semi-fowler position for comfort by releasing pressure on the gallbladder (LeMone, P., Burke, K., & Bauldoff, G. 2011). Vital signs such as temperature, heart rate, blood pressure, respiratory rate, oxygen saturation are monitored frequently for 24 to 48 hours, any deviation from baseline must be escalated to the health care professional. For Mr Black’s situation, a rise in temperature is an indication of infection whereas a drop will mean bacterial infection (Liddle, C. 2013). It is expected that patient will experience numbness of the throat, especially difficulty in swallowing after the procedure (Mangahas, K. V., Lady.