When assessing a client with cholelithiasis and acute cholecystitis, which findings might the nurse note during the health history and physical examination? Select all that apply.

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11ecbb05_c993_3188_b433_f57379db5e53_MD0009_00 Cardinal symptoms of acute cholecystitis from cholelithiasis include pain in the RUQ with referred pain to the right shoulder and scapula (Option E). Clients often report fatty food ingestion 1-3 hours before the initial onset of pain. Associated symptoms include low-grade fever, chills, nausea, vomiting, and anorexia (Option C). During an acute attack, inflammation of the mucous lining and wall of the gallbladder occurs as a result of gallstone(s) obstruction of the cystic bile duct. The inflammation and increased pressure in the gallbladder from the blocked bile duct results in Murphy's sign; palpation over the RUQ causes pain and inability to take a deep breath. Laboratory results show leukocytosis. (Option A) Flank pain radiating to the groin is seen with renal colic (ureteral stones). (Option B) It is not dietary protein but food with significant fat content (cheese, avocado, fried foods, hamburger) that signals the gallbladder to contract, emptying bile into the duodenum to help digestion. Gallstones normally harmlessly floating around the gallbladder are squeezed into the bile duct, causing the pain of biliary colic. Gallstones stuck further down the bile duct may become colonized by a bacterial infection (choledocholithiasis). (Option D) Initial onset of pain at the umbilicus is seen with acute appendicitis. Educational objective: Cardinal symptoms of acute calculous cholecystitis include pain in the RUQ and referred pain to the right shoulder and scapula a few hours after eating fatty foods. Associated symptoms include fever, chills, nausea, vomiting, and anorexia.

When Assessing a Client with Cholelithiasis and Acute Cholecystitis, Which