Open Cholecystectomy WHAT YOU SHOULD KNOW: Open Cholecystectomy (Inpatient Care) Care Guide

Open Cholecystectomy Aftercare Instructions Open Cholecystectomy Discharge Care Open Cholecystectomy Inpatient Care Open Cholecystectomy Precare En Espanol Open cholecystectomy (koe-le-sis-TEK-toe-mee) is surgery to treat gallbladder and bile duct diseases. These diseases include cholecystitis (swelling of the gallbladder) and cholelithiasis (stones in the gallbladder or bile ducts). The gallbladder is a pear-shaped organ found under your liver on the right side of your upper abdomen (stomach). It stores bile that comes from the liver and helps in the digestion of food. Bile is carried by the bile duct to the intestines. If left untreated, gallstones or biliary sludge may block the flow of bile. This can cause more swelling, infection, and abdominal pain.

With open cholecystectomy, the gallbladder is removed through an incision (cut) in the abdomen. Sometimes, your caregiver will do open surgery after having problems during a laparoscopic cholecystectomy. Laparoscopic cholecystectomy is surgery that uses several small incisions and special

instruments to remove your gallbladder. With open cholecystectomy, your symptoms may be relieved and further damage to other organs prevented. CARE AGREEMENT: You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment. RISKS:

The bile duct, nerves, blood vessels, muscles, and other organs near the gallbladder may be damaged. You can get an infection or bleed too much. Your signs and symptoms may not go away. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening. Without treatment, the symptoms of cholecystitis and cholelithiasis may get worse. The bile flow may get blocked or the gallbladder tissue may die. The gallbladder may burst and spill bile and blood inside the abdomen. This may lead to serious medical problems, such as peritonitis (infection of abdominal wall membrane) and sepsis (blood infection). Ask your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE: Before your surgery:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen. Enema: You may need to have an enema before your surgery. This is liquid put into your rectum to help empty your bowel. IV: An IV (intravenous) is a tube placed in your vein that is used to give you medicine or liquids.

Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed. General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery. Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink because this will block the flow of urine. In most cases, caregivers will remove the catheter as soon as possible to help prevent infection. Nasogastric (NG) tube: A nasogastric tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty. You may need a NG tube if your stomach gets too full or if you throw up a lot after surgery. You may also need it if you cannot use your mouth to eat. An NG tube may also be used to help get your bowels working. Food or medicine may be given through your NG tube. Tests:
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Abdominal ultrasound: An abdominal ultrasound is a test to see inside your abdomen. Sound waves are used to show pictures of your gallbladder and abdomen on a TV-like screen. This allows your caregiver to check for stones and other problems. Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once. Computerized tomography scan: This is also called a CT or CAT scan. An x-ray machine uses a computer to take pictures of your abdomen to look for problems and abnormal changes.

ERCP: ERCP is also called endoscopic retrograde cholangiopancreatography. This test is done during an endoscopy to find stones, tumors, or other problems. Dye is put into the endoscopy tube. The dye helps your pancreas and bile ducts show up better on xrays. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish, dyes, or any medicines. If you have stones, they may be removed during ERCP. Gallbladder scintigraphy: This is also called a HIDA scan. This procedure uses a radioactive chemical or tracer to help the gallbladder show up clearly on a special screen. The tracer is injected into your IV. Percutaneous bile aspiration: This procedure is used to remove bile from your gallbladder using a thin, long needle. The sample of bile will be sent to a lab for tests. This procedure can also be used to decrease your symptoms. X-rays: Before surgery, caregivers may want to have an x-ray (picture) of your abdomen to see any other problems.

During your surgery: After you go to sleep, your body will be moved into position for your surgery. Your skin is cleaned with soap and water and covered with sheets. An incision (cut) is made in your abdomen to reach the gallbladder. Once it is seen, the blood vessels attached to it are tied off and cut. It is removed carefully, making sure not to damage the liver. Your caregiver checks for bleeding and the other damage to organs nearby. Your caregiver may place a drain (small tube) to let fluid flow out from your abdomen. The incision is closed with sutures (stitches) and covered with a bandage. After your surgery: You may be taken to a recovery room, where you will stay until you are fully awake. Caregivers will watch you closely for problems. Do not attempt to get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages covering your incision keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your incision.

Activity: Caregivers may help you get out of bed to walk on the same day of surgery, or the day after. Ask caregivers if there are exercises that you may do while in bed. Exercise helps blood move through your body and may help prevent blood clots from forming. Your caregiver will tell you when it is okay to get out of bed. Call your caregiver before getting up for the first time. If

you feel weak or dizzy while standing up, sit or lie down right away, and call your caregiver.

Deep breathing and coughing: This breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake even if you wake up during the night.
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Hold a pillow tightly against your incision (cut) when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough. You may be asked to use an incentive spirometer. This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.

Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet. Medicines: You may need any of the following:
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Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria. Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time. Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait until the pain is

very bad to ask for your pain medicine. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
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Patient controlled analgesia: You may get pain medicine from a special pump. You can receive the pain medicine through an IV or an epidural line. This is called patient controlled analgesia (PCA) or patient controlled epidural analgesia (PCEA). Your caregivers set up the PCA pump to give you small amounts of pain medicine. The PCA pump has a cord coming from it, with a push button on the end. When you feel pain and push the button, you will give yourself pain medicine. To keep you from getting too much medicine, there is a limit on how often you can get the medicine. Do not let anyone else push the button for you. Your pump may give you a constant dose of pain medicine, as well as the medicine that you give yourself. If your pain is still bad even with using the PCA, let your caregivers know. Stool softeners: You may be given stool softeners to soften your bowel movements, making them easier to pass.

Monitoring: Caregivers may check for pulses on your arms or wrists. This helps caregivers learn if you have problems with blood flow after your surgery. You may also have any of the following:
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Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first. Intake and output: For intake and output (I and O), caregivers will keep track of the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3 liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2 liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need to have more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.

Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.

Oxygen: You may need to get oxygen through a plastic mask or nasal cannula. A nasal cannula is a pair of short, thin tubes that are placed inside your nose. Tell your caregiver if the mask or prongs bother you, or if your nose gets dry. Ask your caregiver before taking off your oxygen mask, or removing your nasal cannula. Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or elastic wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming. Tubes and drains:
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Nasogastric (NG) tube: A nasogastric tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty. You may need a NG tube if your stomach gets too full or if you throw up a lot after surgery. You may also need it if you cannot use your mouth to eat. An NG tube may also be used to help get your bowels working. Food or medicine may be given through your NG tube. Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining. T-Tube: A thin rubber tube may come out of your abdomen after surgery. This tube drains bile onto a bandage or into a small bag. The T-tube is removed when the amount of bile draining is already very little.

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