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Cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining. Cholecystitis is usually caused by a gallstone in the cystic duct, the duct that connects the gallbladder to the hepatic duct. The presence of gallstones in the gallbladder is called cholelithiasis. Cholelithiasis is the pathologic state of stones or calculi within the gallbladder lumen. A common digestive disorder worldwide, the annual overall cost of cholelithiasis is approximately $5 billion in the United States, where 75-80% of gallstones are of the cholesterol type, and approximately 10-25% of gallstones are bilirubinate of either black or brown pigment. In Asia, pigmented stones predominate, although recent studies have shown an increase in cholesterol stones in the Far East. Gallstones are crystalline structures formed by concretion (hardening) or accretion (adherence of particles, accumulation) of normal or abnormal bile constituents. According to various theories, there are four possible explanations for stone formation. First, bile may undergo a change in composition. Second, gallbladder stasis may lead to bile stasis. Third, infection may predispose a person to stone formation. Fourth, genetics and demography can affect stone formation. Risk factors associated with development of gallstones include heredity, Obesity, rapid weight loss, through diet or surgery, age over 60, Native American or Mexican American racial makeup, female gender-gallbladder disease is more common in women than in men. Women with high estrogen levels, as a result of pregnancy, hormone replacement therapy, or the use of birth control pills, are at particularly high risk for gallstone formation, Diet-Very low calorie diets, prolonged fasting, and low-fiber/highcholesterol/high-starch diets all may contribute to gallstone formation. Sometimes, persons with gallbladder disease have few or no symptoms. Others, however, will eventually develop one or more of the following symptoms; (1) Frequent bouts of indigestion, especially after eating fatty or greasy foods, or certain vegetables such as cabbage, radishes, or pickles, (2) Nausea and bloating (3) Attacks of sharp pains in the upper right part of the abdomen. This pain occurs when a gallstone causes a
blockage that prevents the gallbladder from emptying (usually by obstructing the cystic duct). (4) Jaundice (yellowing of the skin) may occur if a gallstone becomes stuck in the common bile duct, which leads into the intestine blocking the flow of bile from both the gallbladder and the liver. This is a serious complication and usually requires immediate treatment. The only treatment that cures gallbladder disease is surgical removal of the gallbladder, called cholecystectomy. Generally, when stones are present and causing symptoms, or when the gallbladder is infected and inflamed, removal of the organ is usually necessary. When the gallbladder is removed, the surgeon may examine the bile ducts, sometimes with X rays, and remove any stones that may be lodged there. The ducts are not removed so that the liver can continue to secrete bile into the intestine. Most patients experience no further symptoms after cholecystectomy. However, mild residual symptoms can occur, which can usually be controlled with a special diet and medication.
Porac Pampanga. He usually eats instant food and love eating foods which has condiment like “patis”. because of one of his siblings also had acquired this disease. . He had not experience any accident and injuries. Castro. Family Health and Illness History According to Mr. Mr. vinegar and soy sauce. His wife was the one who prepares him the breakfast and the snack.II. his ashtma just stopped when he start drinking alcohol beverages as he said. He is not also choosy on the food he eats because he really eat a lots. He also added that cholecystitis is prone to their family. his religious affiliation is Roman Catholic and he is married to Mrs. He always sleeps around 9 in the evening and wakes up at 6 in the morning. 1950 at Pulong Santol. Castro that the familial disease he knows that they have in their family was the hypertension that is on his father’s side. Brigida M. He also added that he had an ashtma when he was 7 years old that lasts when he is 21 years old. Aproniano Castro is a 56 year old male. Family Health and Illness History B. He is also the president of their jeepney’s association. Castro usually works for 10 to 12 hours a day usually around 7am to 7 pm. His father died because of heart attack and her mother died of natural cause. even though his job is prone to accident particularly vehicular accident. He has day-offs but uses this day in working as the president of the jeepney association. Castro been admitted into this hospital (Porac District Hospital). a Filipino citizen who resides at Pulong Santol. He was born on January 22. NURSING ASSESSMENT A. History of Past and Present Illness This is the second time Mr. He also love eating vegetable salads and fatty salty food. Regarding the finances about health he is using his wife’s PHILHEALTH card to compensate the finances needed. He is a jeepney driver bound in Porac-Angeles route. which is almost 3 years ago. He seldom drinks alcohol and smoke. On his first admission into this hospital he had undergone throidectomy operation. C. Personal History Mr.
Chest X-ray.According to Mr.130/90 RR-19 PR-84 Temp-36. Physical Examination Physical Assessment done by the attending physician reveals that patient is.21 . he was admitted last February 13.As for his present illness.Creatinine and ECG. 2006. BP. U/A. CBC. Castro. He just did not have his cholecystectomy done immediately due to financial problem.140/90 PR. His initial medication were H2bloc and Cefuroxime. Serrano.5 oC Physical Assessment done by the student reveals that patient is. 2005 for his operation. • afebrile • with pink palpebral conjunctiva • (+) dry lips • (+) paleness • (+) dryskin • decreased skin turgor • (-) bowel movement • (-) weakness Vital Signs taken and recorded as of February 15. • afebrile • with pink palpebral conjunctiva • (-) cyanosis • (+) NABS • non tender abdomen Vital Signs upon admission (February 13. When the money needed for his operation was enough he then goes to Porac District Hospital last February 13.85 RR. He was diagnosed and surgically operated by Dr. 2006) BP. BUN. Upon admission he had undergone some laboratory examination such as UTZ. he was admitted into this hospital because of cholecystitis. FBS. D. He was been diagnosed with cholecystitis with multiple cholelithiasis a month prior to admission due to severe epigastric pain and weight loss and was advised to remove his gallbladder. 2006 are as follows.
Temp.4 oC .36.
the gallbladder consists of an outer peritoneal coat (tunica serosa). and an inner mucous membrane coat (tunica mucosa).5 fluid ounces. and to the left. It is generally about 7. until it is needed in the digestive process.5 cm (1 in) in diameter at its thickest part. . The function of the gallbladder is to store bile.5 cm (about 3 in) long and 2. The wide end (fundus) points downward and forward. Structurally. upward. The gallbladder. D. In humans. preventing putrefaction. The purpose of bile is to. The body (corpus) and neck (collum) of the gallbladder extend backward. including fat-soluble vitamins: Vitamin A. it has a capacity varying from 1 to 1. by emulsifying fat into smaller droplets to increase access for the enzymes. help the Lipases to Work. a middle coat of fibrous tissue and unstriped muscle (tunica muscularis). sometimes extending slightly beyond the edge of the liver. Enable intake of fat. it is a pear-shaped membranous sac on the undersurface of the right lobe of the liver just below the lower ribs. ANATOMY AND PHYSIOLOGY Gallbladder. Digestion of fat occurs mainly in the small intestine. by pancreatic enzymes called lipases. and emulsifying fat. when functioning normally.III. rid the body of surpluses and metabolic wastes Cholesterol and Bilirubin. present in most vertebrates. empties through the biliary ducts into the duodenum to aid digestion by promoting peristalsis and absorption. and K. E. secreted by the liver and transmitted from that organ via the cystic and hepatic ducts. muscular organ that serves as a reservoir for bile.
PATHOPHYSIOLOGY Risk factor Heredity Obesity Rapid Weight Loss.IV. through diet or surgery Age Over 60 Bile must become supersaturated with cholesterol and calcium The solute precipitate from solution as solid crystals Crystals must come together and fuse to form stones Gallstones Obstruction of the cystic duct and common bile duct Sharp pain in the right part of abdomen Jaundice Distention of the gall bladder Venous and lymphatic drainage is impaired Proliferation of bacteria Localized cellular irritation or infiltration or both take place Areas of ischemia may occur Inflammation of gall bladder CHOLECYSTITIS .
Date Ordered: February 13. Date Ordered: February 13. Fasting Blood Sugar This is to measure the blood glucose levels. Complete Blood Count (CBC) This is to determine blood components and the response to inflammatory process and streptococcal infection. 10. 2006 Date Result In: February 13. 2006 Date Result In: February 13.9 g/l 5. DIAGNOSTIC AND LABORATORY PROCEDURE 1. 2006 Results: WBC RBC Lymphocyte Conclusion: WBC is slightly elevated based on the normal value of 4.8 mg/dl Conclusion: The result is within normal range based on the normal value of < 126 mg/dl. 2006 Results: 94.5 g/l 27 .V.3-10 g/l which confirms the presence of infection. 2.
Urinalysis data include color. and systematic disorders that alter urine composition. Creatinine This is the indicator of the renal function Date Ordered: February 13. bacteria.7 mg/dl. dietary intake of CHON and the level of protein metabolism Date Ordered: February 13. pH. and the presence of protein. ketones. . BUN This is an indicator of renal function and perfusion. 2006 Results: 1. casts and crystals.3. WBC’s. 2006 Results: 10. 2006 Date Result In: February 13.60-1. Leukocyte. Urinalysis Urinalysis yields a large amount of information about possible disorders of the kidney and lower urinary tract. RBC’s.0 mg/dl Conclusions: The result is within normal range based on the normal value of 0.glucose. 4. 5. bilirubin. esterase. 2006 Date Result In: February 13. specific gravity.7 Mg/dl Conclusions: The result is within normal range based on the normal value of mg/dl.
Date Ordered: February 10. 2006 Date Result In: February 10.negative Pus cells.0.yellow Specific Gravity.010 Sugar/ Albumin. 2006 Results: Color. .0.1 hpf Conclusions: The results are normal but there is a presence of pus cells in the urine which means that there is also the presence of infection.
expressi ons.RR.BP. Nursing Interventions After 4 hours 1.Assists in Is there a change differentiating cause on the patients. Pain information about scale disease b. steady. . intermittent. Reports complications.140/90 Nursing Diagnosis Acute pain related to inflammation and distortion of the gallbladder as evidenced by verbal reports of pain.. Scientific Explanations Due to the presence of stones in the gallbladder it causes some obstruction in the cystic duct which in turn causes a sharp acute pain on the right part of the abdomen. Acute Pain Cues S O . Patients Care a.(+) pallor . colicky). and character of pain (e.pain scale of 7/10 . Facial interventions. however.g.(+) muscle guarding . of pain. Control . of pain. and of pain effectiveness of e. patient will naturally assume least painful position. . RR progression/resolution. Objectives Rationale Evaluation .30 . c.difficulty in moving as manifested by facial grimaces . Promote bedrest. Observe and of nursing document intervention the location. BP development of d. allowing patient to assume position of comfort. and provides a.Cool surroundings 3.VI. patient will severity (0–10 report relieve scale).Bedrest in lowFowler’s position reduces intraabdominal pressure. Nursing Care Plan Preoperative NCP 1. 2.
which can relieve pain. Encourage use of relaxation techniques.Promotes rest. .environmental temperature. visualization. . deep-breathing exercises.Helpful in alleviating anxiety and refocusing attention. e. guided imagery. Administer analgesics as indicated aid in minimizing dermal discomfort. . 4. 5. may enhance coping.g.. 6. Provide diversional activities. Make time to listen to and maintain frequent contact with patient. redirects attention.Relief of pain facilitates cooperation with other therapeutic interventions. .
a. with decreased 3. dry mouth d. Provide skin and mouth care .Skin and mucous membranes are dry.2. Perform frequent oral hygiene Rationale . Evaluation Is there still the presence of. reduces risk of oral bleeding. Assess skin/mucous membranes. noting output less than Intake. will maintain adequate fluid volume as evidenced by moist mucous membranes and good skin turgor. Fluid Volume deficient Cues S O (+) pallor (+) body weakness (+) vomiting with poor skin turgor (+) dry skin (+) dry mouth Nursing Diagnosis Fluid Volume Deficient related to vomiting Scientific Explanations Because of vomiting excessive losses through normal routes occur thus causes Fluid Volume Deficient Objectives After series of NI the pt. poor skin turgor e. body weakness . Nursing Interventions 1. and capillary refill. .Decreases dryness of oral mucous membranes. increased urine specific gravity. peripheral pulses. 2. vomiting b.Provides information about fluid status/circulating volume and replacement needs. Maintain accurate record of I&O. dry skin c.
.. Encourage foods with high fluid content. . . Administer antiemetics. Ascertain patient’s beverage preferences. and set up a 24hr schedule for fluid intake.4. elasticity. prochlorperazine (Compazine) as ordered by the physician. because of vasoconstriction and reduced intracellular water. 6.Relieves thirst and discomfort of dry mucous membranes and augments parenteral replacement. e.Reduces nausea and prevents vomiting. .promotes hydration. Increase fluid intake 5.g.
thereby reducing sympathetic stimulation. 2. self-care. . disease condition diet treatment medication self-care needs - - a. Evaluation Does the patient understands and could recall all the teachings given? Is there a significant changes that occur on the patients knowledge regarding. Provide of nurse-patient explanations interaction the of/reasons for test patient will procedures and Verbalize preparation understanding needed. b. complications.Prevents/limits . and disease potential process/prognosis. . Nursing Interventions After an hour 1. of disease process. expression of concern. Discuss hospitalization and prospective treatment as indicated. d. possible side effects.Gallstones often recur. 3. Review prognosis. Review drug regimen. Objectives Rationale . treatment. c. Knowledge Deficit Cues S “pwede bang maulit ang sakit ko” as verbalized by the patient O Frequently asking question about his condition. prognosis. and discharge needs Scientific Explanations There is this presence of knowledge deficit due to some unfamiliar information that causes some confusion to the client that needs to be discussed. e. Effective communication and support at this time can diminish anxiety and promote healing.Information can decrease anxiety. necessitating long-term therapy.Provides knowledge base from which patient can make informed choices. Encourage questions.Post-operative NCP 3. treatment and diet With worried gaze Nursing Diagnosis Deficient knowledge related to condition. .
nuts. recurrence of gallbladder attacks. Instruct patient to avoid food/fluids high in fats (e. gravies. sucking distension/discomfort. cabbage. . spicy foods.. or smoking. .g. citrus). butter.Promotes gas 5. gas producers (e. pork). onions. on straw/hard candy.g. Suggest patient formation. which can limit gum increase gastric chewing. caffeine. or gastric irritants (e.4. ice cream. beans. fried foods.g... carbonated beverages). whole milk.
Nausea and Vomiting . dizziness.anti-infective . malaise.perioperative prophylaxis . dry mouth Nursing Consideration 1. not to be given in patients hypersensitive to drugs 3. Check for doctor’s order 2. Instruct patient to take drug with food 5. Perform ANST prior to admission 3. Drug Study Name of Drug GN: H2Bloc (Pepcidine) BN: Famotidine Date Ordered 02-13-06 Route/ Action Dosage and Frequency PO .headache.competitively bedtime inhibits action of histamine on the H2 at receptor sites of parietal cells. Advised patient to take drug once daily usually at bed time 6. 1. decreasing gastric acid secretion Indication -for short term treatment of duodenal ulcer Adverse Reaction . Should not be given if positive skin test 4.b. promoting osmotic instability . Advise patient to report any discomfort on the IV insertion site GN: Cefuroxime BN: Zinacef 02-13-06 IV 750 mg every 8o prior to OR (30 to 60 minutes before) . Slow IV push 5. Check for doctor’s order 2. Advise patient to report abdominal pain or blood in stools or is vomiting.a 2nd generation cephalosporin that inhibits cell-wall synthesis. Inform the patient about the possible side effect of the drug 4.Anti-ulcer 20 mg tab at . Inform the patient about the possible side effect of the drug 6.
Should not be given if positive skin test 4. Advise patient to report any discomfort on the IV insertion site 7. Check for doctor’s order 2. every 80 . Inform the patient about the possible side effect of the drug GN: Gentamicin Dulfate BN: Genticin 02-14-06 IV 80 mg amp. dry mouth Nursing Consideration 1. dizziness. headache. Monitor urine output.Nausea and Vomiting. dizziness 1.headache.Anti10 mg tab.Name of Drug GN: Clomipramine HCl BN: Placil Date Ordered 02-13-06 Route/ Action Dosage and Frequency PO . Slow IV push 5. depressants at 6 am Indication .inhibits protein synthesis .Anti-infective .endocarditis prophylaxis for GI or GU procedure or surgery . BUN and creatinine levels . Check for doctor’s order 2. Inform the patient about the possible side effect of the drug 6. specific gravity. malaise. Perform ANST prior to admission 3. U/A. not to be given in patients hypersensitive to drugs 3.for depression and chronic pain Adverse Reaction .
Advise patient to report any discomfort on the IV insertion site GN: MgSO4 02-14-06 IV 0. Monitor fluid intake and output 5. Should not be given if positive skin test 4. check magnesium level after repeated doses 4. Monitor renal function .Anti-infective 1 g amp.drowsiness. headache.03% 7ml every 120 -anti-convulsant -replaces magnesium and maintains magnesium level . Perform ANST prior to admission 3.endocarditis prophylaxis for GI or GU procedure or surgery Adverse Reaction .Name of Drug Date Ordered GN: Ampicillin 02-14-06 BN: Omnipen Route/ Action Dosage and Frequency IV . hypotension 1.magnesium supplementation . . Inform the patient about the possible side effect of the drug 6. Slow IV push 5. Use parenteral magnesium with extreme caution in patients with impaired renal function 2. dizziness Nursing Consideration 1.inhibits every 80 protein synthesis Indication .Nausea and Vomiting. Test knee jerk and patellar reflexes before each additional dose 3. Check for doctor’s order 2.
headache. and RR before and after giving the medication 2.dizziness.Name of Drug GN: Ketorolac Tromethamine BN: Toradol Date Ordered 02-14-06 Route/ Action Dosage and Frequency IV .short term management of moderately severe. PR. Check for doctor’s order 2. acute pain Adverse Reaction . Slow IV push 5. Advise patient to report any discomfort on the IV insertion site Anesthetic drug Name of Drug GN: Lidocaine HCl Date Ordered 02-14-06 Route IV Action Anesthetic drugs Adverse Reaction -lethargy. inflammatory every 60 . hypotension Nursing Consideration 1. Monitor patient for toxicity .inhibits prostaglandin synthesis Indication . sedation. Perform ANST prior to admission 3. flatulence.Anti30 mg amp. nausea and vomiting Nursing Consideration 1. Should not be given if positive skin test 4. Monitor BP. Inform the patient about the possible side effect of the drug 6.
causing the heart to contract. Medical/ Surgical Management 1. These measurement are not that accurate as body weight. cholangiography . 3. Ultrasounds are used to view internal organs of the abdomen such as the liver spleen.I&O measurement provide an other means of assessing fluid balance. however.The ECG is an essential tool in evaluating cardiac rhythm. Chest X-ray. 5. 8. 6. This data provide insight into the cause of imbalance such as decrease fluid intake or increase fluid loss. bile ducts. and kidneys and to assess blood flow through various vessels. and upper part of the small intestine. 4. 7.c.x-ray examination of the bile ducts using an intravenous (IV) dye (contrast).this is used to rule out respiratory causes of referred pain. 9. gallbladder. O2 Inhalation. because of relative risk of errors in recording. ultrasound (Also called sonography. Electrocardiography detects and amplifies the very small electrical potential changes between different points on the surface of the body as a myocardial cell depolarize and repolarize.an imaging technique of the liver. hepatobiliary scintigraphy . Intake and Output.) . intravenous (IV) fluids are used for replacement.when the fluid loss is severe or life threatening. 2. Intravenous Rehydration.a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs. Electrocardiogram.Oxygen therapies are used to provide more oxygen to the body into order to promote healing and health. percutaneous transhepatic cholangiography (PTC) . .a needle is introduced through the skin and into the liver where the dye (contrast) is deposited and the bile duct structures can be viewed by x-ray.
both horizontally and vertically. CT scans are more detailed than general x-rays. to remove a malignancy or to remove polyps. Cholecystectomy. then through the esophagus. A tube is then passed through the scope. 12.the insertion of a choledoscope into the common bile duct in order to directly visualize stones and facilitate their extraction. with or without cholelithiasis. and pancreas. including the bones.a procedure that allows the physician to diagnose and treat problems in the liver. muscles.a diagnostic imaging procedure using a combination of x-rays and computer technology to produce cross-sectional images (often called slices). and a dye is injected which will allow the internal organs to appear on an x-ray. 14. lighted tube. and organs. Cholecystotomy. The scope is guided through the patient's mouth and throat. endoscopic retrograde cholangiopancreatography (ERCP) . fat. computed tomography scan (CT or CAT scan) .10. 11.removal of the gallbladder. and duodenum. A long. This procedure may be performed to treat chronic or acute cholecystitis. A CT scan shows detailed images of any part of the body. of the body. This is performed when the patient cannot tolerate cholecystectomy. The physician can examine the inside of these organs and detect any abnormalities.the establishment of an opening into the gallbladder to allow drainage of the organ and removal of stones. The procedure combines x-ray and the use of an endoscope. . 13. Choledochoscopy. bile ducts. flexible. A tube is then placed in the gallbladder to established external drainage. gallbladder. stomach.
20 Temp.1 oC DAY 3 2/15/16 DISCHARGE 2/16/06 Nursing Problem Acute pain Fluid Volume Deficient Knowledge Deficit Vital Signs Dx & Lab Procedures CBC U/A FBS BUN Creatinine Medical & Surgical Management Chest X-ray 12-L ECG O2 inhalation D5LRS.130/90 PR.36.130/90 PR.2 oC BP.140/90 PR.36.36.83 RR.84 RR. 1Lx 30-31 gtts/min Drugs H2 Bloc .85 RR.19 Temp.140/90 PR.VII. Clients Daily Progress DAYS ADMISSION 2/13/06 * * BP. 1Lx 30-31 gtts/min D5NM.36.82 RR.4 oC * BP.21 Temp.21 Temp.5 oC * * * * * * * * * * * * * DAY 2 2/14/16 * * * BP.
.Cefuroxime Ketorolac Ampicillin Gentamicin MgSO4 Lidocaine Placil Diet NPO Clear liquid Soft Diet DAT Activity & Exercise FOB Sit on Bed Ambulation as Tolerated * * * * * * * * * * * * * * * * * * * * * * * * * First started and indicates the duration it was done and taken.
Encouraged patient to increase fluid intake 2. Encourage patient to avoid salty and fatty foods 4. 2006. Mefenamic Acid 500 mg cap 3 x day (am-1pm-8pm) for 1 week E T H foods - Instructed the patient to do exercise as tolerated such as walking Instructed the patient to continue the medication 1. . M DISCHARGE PLANNING Instructed the patient to continue medication as ordered 1.VIII. Advised the patient to a diet as tolerated but preferably avoiding salty fatty foods. Encourage patient to have enough rest O D and - Instructed to come back for follow-up check-up on February 23. Encouraged patient to eat foods rich in Vitamin and Nutritious 3. Cephalexin 500 mg cap 3 x day (8am-1pm-8pm) for 1 week 2. Thursday.
Mr. We should try to avoid foods which are rich in salt and fats. Just like on what our patient had experience he still has to collect money for the operation he had underwent causing them to have debt with different persons. This then causes inflammation of the gallbladder. but due to this blockage this toxic substances are not then being expelled and are just being stored in the bladder for a period of time. the patient had recovered at once he is no longer complaining of epigastric pain. U/A. He was admitted in Porac District Hospital and he was diagnosed of having a cholecystitis with multiple cholelithiasis based on the diagnostic procedure conducted in him like the CBC. X-ray and UTZ. Crea. . Let us not enjoy ourselves with the delicious food were eating that is rich in salts and fats but we should enjoy living because we have a healthy condition. Though there is a saying that ”Mas masarap pag bawal” which always pertains to the food were eating we should still be conscious on our health especially if we want to live longer and also to avoid those life-threatening diseases which not only shorten our life but causes us some financial problem. In order to lower the risk of having this kind of condition each and every one of us must be conscious in our diet. The following day we were given the chance to visit and assess our patient’s condition. Fortunately.IX. The treatment usually done is the cholecystectomy. FBS. What he was complaining is if he could already eat his food for he is on a liquid diet! And of course the pain of his operative site which is just normal for several days after undergoing the operation. Since cholecystitis is the inflammation of the gall bladder which is usually accompanied by gallstones or cholelithiasis these gallstones may block the way of toxic substances that really needs to go out. especially those foods which contains many seasonings. Conclusion Our patient. We are happy to say that most of our group mates witness the operation. BUN. Remember also the saying “Mahal ang magkasakit”. Due to the result the surgeon decided for a surgery to remove the gallbladder which is known as the cholecystectomy. Aproniano Castro has a chief complaint of epigastric pain. 12-L ECG.
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