I.

INTRODUCTION

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.

II.

NURSING ASSESSMENT
A. Personal History

Mr. Aproniano Castro is a 56 year old male, a Filipino citizen who resides at Pulong
Santol, Porac Pampanga.

He was born on January 22, 1950 at Pulong Santol, his

religious affiliation is Roman Catholic and he is married to Mrs. Brigida M. Castro. He

is a jeepney driver bound in Porac-Angeles route. He is also the president of their
jeepneys association. Mr. Castro usually works for 10 to 12 hours a day usually around
7am to 7 pm. He always sleeps around 9 in the evening and wakes up at 6 in the morning.
His wife was the one who prepares him the breakfast and the snack. He has day-offs but
uses this day in working as the president of the jeepney association. He usually eats
instant food and love eating foods which has condiment like patis, vinegar and soy
sauce. He also love eating vegetable salads and fatty salty food. He is not also choosy on
the food he eats because he really eat a lots. He seldom drinks alcohol and smoke.
Regarding the finances about health he is using his wifes PHILHEALTH card to
compensate the finances needed. Family Health and Illness History
B. Family Health and Illness History
According to Mr. Castro that the familial disease he knows that they have in their
family was the hypertension that is on his fathers side. His father died because of heart
attack and her mother died of natural cause. He also added that cholecystitis is prone to
their family, because of one of his siblings also had acquired this disease.
C. History of Past and Present Illness
This is the second time Mr. Castro been admitted into this hospital (Porac District
Hospital). On his first admission into this hospital he had undergone throidectomy
operation, which is almost 3 years ago. He had not experience any accident and injuries,
even though his job is prone to accident particularly vehicular accident. He also added
that he had an ashtma when he was 7 years old that lasts when he is 21 years old, his
ashtma just stopped when he start drinking alcohol beverages as he said.

As for his present illness, he was admitted into this hospital because of cholecystitis,
he was admitted last February 13, 2006. 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.

He just did not have his

cholecystectomy done immediately due to financial problem. When the money needed
for his operation was enough he then goes to Porac District Hospital last February 13,
2005 for his operation. He was diagnosed and surgically operated by Dr.
Serrano.According to Mr. Castro. Upon admission he had undergone some laboratory
examination such as UTZ, Chest X-ray, U/A, CBC, FBS, BUN,Creatinine and ECG. His
initial medication were H2bloc and Cefuroxime.
D. Physical Examination
Physical Assessment done by the attending physician reveals that patient is;
afebrile
with pink palpebral conjunctiva
(-) cyanosis
(+) NABS
non tender abdomen
Vital Signs upon admission (February 13, 2006)
BP- 130/90
RR-19
PR-84
Temp-36.5 oC
Physical Assessment done by the student reveals that patient is;
afebrile
with pink palpebral conjunctiva
(+) dry lips
(+) paleness
(+) dryskin
decreased skin turgor
(-) bowel movement
(-) weakness
Vital Signs taken and recorded as of February 15, 2006 are as follows;
BP- 140/90
PR- 85
RR- 21

Temp- 36.4 oC

III.

ANATOMY AND PHYSIOLOGY

Gallbladder, muscular organ that serves as a reservoir for bile, present in most

vertebrates. In humans, it is a pear-shaped membranous sac on the undersurface of the

right lobe of the liver just below the lower ribs. It is generally about 7.5 cm (about 3 in)
long and 2.5 cm (1 in) in diameter at its thickest part; it has a capacity varying from 1 to
1.5 fluid ounces. The body (corpus) and neck (collum) of the gallbladder extend
backward, upward, and to the left. The wide end (fundus) points downward and forward,
sometimes extending slightly beyond the edge of the liver. Structurally, the gallbladder
consists of an outer peritoneal coat (tunica serosa); a middle coat of fibrous tissue and
unstriped muscle (tunica muscularis); and an inner mucous membrane coat (tunica
mucosa).
The function of the gallbladder is to store bile, secreted by the liver and transmitted
from that organ via the cystic and hepatic ducts, until it is needed in the digestive process.
The gallbladder, when functioning normally, empties through the biliary ducts into the
duodenum to aid digestion by promoting peristalsis and absorption, preventing
putrefaction, and emulsifying fat. Digestion of fat occurs mainly in the small intestine, by
pancreatic enzymes called lipases. The purpose of bile is to; help the Lipases to Work, by
emulsifying fat into smaller droplets to increase access for the enzymes, Enable intake of
fat, including fat-soluble vitamins: Vitamin A, D, E, and K, rid the body of surpluses and
metabolic wastes Cholesterol and Bilirubin.

IV.
PATHOPHYSIOLOGY
Risk factor
Heredity
Obesity
Rapid Weight Loss, 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

Inflammation of gall bladder

CHOLECYSTITIS

Areas of
ischemia may
occur

V.

DIAGNOSTIC AND LABORATORY PROCEDURE

1. Complete Blood Count (CBC)
This is to determine blood components and the response to

inflammatory process and streptococcal infection.

Date Ordered: February 13, 2006
Date Result In: February 13, 2006
Results:
WBC

10.9 g/l

RBC

5.5 g/l

Lymphocyte

27

Conclusion:
WBC is slightly elevated based on the normal value of 4.3-10 g/l which
confirms the presence of infection.
2. Fasting Blood Sugar
This is to measure the blood glucose levels.
Date Ordered: February 13, 2006
Date Result In: February 13, 2006
Results:
94.8 mg/dl
Conclusion:
The result is within normal range based on the normal value of < 126
mg/dl.

3. Creatinine
This is the indicator of the renal function
Date Ordered: February 13, 2006
Date Result In: February 13, 2006
Results:
1.0 mg/dl
Conclusions:
The result is within normal range based on the normal value of 0.60-1.7
mg/dl.
4. BUN
This is an indicator of renal function and perfusion, dietary intake of
CHON and the level of protein metabolism
Date Ordered: February 13, 2006
Date Result In: February 13, 2006
Results:
10.7 Mg/dl
Conclusions:
The result is within normal range based on the normal value of mg/dl.
5. Urinalysis
Urinalysis yields a large amount of information about possible disorders of
the kidney and lower urinary tract, and systematic disorders that alter urine composition.
Urinalysis data include color, specific gravity, pH, and the presence of protein, RBCs,
WBCs, bacteria, Leukocyte, esterase, bilirubin,glucose, ketones, casts and crystals.

Date Ordered: February 10, 2006

Date Result In: February 10, 2006
Results:
Color- yellow
Specific Gravity- 0.010
Sugar/ Albumin- negative
Pus cells- 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.

VI.

Patients Care
a. Nursing Care Plan

Preoperative NCP
1. Acute Pain
Cues
S

O
- pain scale
of 7/10
- difficulty in
moving as
manifested
by facial
grimaces
- (+) pallor
- (+) muscle
guarding
- RR- 30
- BP- 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.

Objectives

Nursing
Interventions
After 4 hours
1. Observe and
of nursing
document
intervention the location,
patient will
severity (010
report relieve
scale),
of pain.
and character of
pain (e.g.,
steady,
intermittent,
colicky).
2. Promote
bedrest,
allowing patient
to assume
position of
comfort.

3. Control

Rationale

Evaluation

- Assists in
Is there a change
differentiating cause
on the patients;
of pain, and provides
a. Pain
information about
scale
disease
b. RR
progression/resolution,
c. BP
development of
d. Reports
complications, and
of pain
effectiveness of
e. Facial
interventions.
expressi
ons.
- Bedrest in lowFowlers position
reduces intraabdominal
pressure; however,
patient will naturally
assume least
painful position.
- Cool surroundings

environmental
temperature.

aid in minimizing
dermal discomfort.

4. Encourage
use of
relaxation
techniques, e.g.,
guided
imagery,
visualization,
deep-breathing
exercises.
Provide
diversional
activities.

- Promotes rest,
redirects attention,
may enhance coping.

5. Make time to
listen to and
maintain
frequent contact
with
patient.

- Helpful in alleviating
anxiety and refocusing
attention,
which can relieve
pain.

6. Administer
analgesics as
indicated

- Relief of pain
facilitates cooperation
with other
therapeutic
interventions,

2. 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. will
maintain
adequate fluid
volume as
evidenced by
moist mucous
membranes and
good skin turgor,

Nursing
Interventions
1. Maintain
accurate record
of I&O, noting
output less than
Intake, increased
urine specific
gravity. Assess
skin/mucous
membranes,
peripheral
pulses, and
capillary
refill.

Rationale

Evaluation

- Provides
information
about fluid
status/circulating
volume and
replacement
needs.

Is there still the

presence of;
a. vomiting
b. dry skin
c. dry
mouth
d. poor skin
turgor
e. body
weakness

2. Perform
frequent oral
hygiene

- Decreases
dryness of oral
mucous
membranes;
reduces
risk of oral
bleeding.

3. Provide skin
and mouth care

- Skin and
mucous
membranes are
dry, with
decreased

4. Increase fluid
intake

elasticity,
because of
vasoconstriction
and reduced
intracellular
water.
- promotes
hydration.

5. Ascertain
patients
beverage
preferences, and
set up a 24hr schedule for
fluid intake.
Encourage foods
with high
fluid content.

- Relieves thirst
and discomfort
of dry mucous
membranes
and augments
parenteral
replacement.

6. Administer
antiemetics, e.g.,
prochlorperazine
(Compazine) as
ordered by the
physician.

- Reduces nausea
and prevents
vomiting.

Post-operative NCP
3. Knowledge Deficit
Cues
S
pwede bang
maulit ang
sakit ko as
verbalized by
the patient
O
-

Frequently
asking
question
about his
condition,
treatment
and diet
With
worried
gaze

Nursing
Diagnosis
Deficient
knowledge
related to
condition,
prognosis,
treatment,
self-care, 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.

Objectives

Nursing
Interventions
After an hour
1. Provide
of nurse-patient explanations
interaction the
of/reasons for test
patient will
procedures and
Verbalize
preparation
understanding
needed.
of disease
process,
2. Review
prognosis, and disease
potential
process/prognosis.
complications. Discuss
hospitalization
and prospective
treatment as
indicated.
Encourage
questions,
expression of
concern.
3. Review drug
regimen, possible
side effects.

Rationale
- Information can
decrease anxiety,
thereby reducing
sympathetic
stimulation.
- Provides knowledge
base from which
patient can make
informed choices.
Effective
communication and
support
at this time can
diminish anxiety and
promote healing.

- Gallstones often
recur, necessitating
long-term therapy.
- Prevents/limits

Evaluation
-

a.
b.
c.
d.
e.

Does the
patient
understands
and could
recall all
the
teachings
given?
Is there a
significant
changes
that occur
on the
patients
knowledge
regarding;
disease
condition
diet
treatment
medication
self-care
needs

4. Instruct patient
to avoid
food/fluids high
in fats (e.g.,
whole milk, ice
cream, butter,
fried foods, nuts,
gravies,
pork), gas
producers (e.g.,
cabbage, beans,
onions,
carbonated
beverages), or
gastric irritants
(e.g., spicy
foods, caffeine,
citrus).

recurrence of
gallbladder attacks.

- Promotes gas
5. Suggest patient formation, which can
limit gum
increase gastric
chewing, sucking distension/discomfort.
on straw/hard
candy, or
smoking.

b. Drug Study
Name of Drug

Date
Ordered

GN: H2Bloc
(Pepcidine)
BN:
Famotidine

02-13-06

GN:
Cefuroxime
BN: Zinacef

02-13-06

Route/
Action
Dosage and
Frequency
PO
- Anti-ulcer
20 mg tab at - competitively
bedtime
inhibits action
of histamine on
the H2 at
receptor sites of
parietal cells,
decreasing
gastric acid
secretion

IV
750 mg
every 8o
prior to OR
(30 to 60
minutes
before)

- anti-infective
- a 2nd
generation
cephalosporin
that inhibits
cell-wall
synthesis,
promoting
osmotic
instability

Indication

Adverse
Reaction

Nursing Consideration

-for short term

treatment of
duodenal ulcer

- headache,
dizziness,
malaise, dry
mouth

1. Check for doctors order

2. not to be given in patients
hypersensitive to drugs
3. Inform the patient about the
possible side effect of the drug
4. Instruct patient to take drug
with food
5. Advised patient to take drug
once daily usually at bed time
6. Advise patient to report
abdominal pain or blood in
stools or is vomiting.

- perioperative
prophylaxis

- Nausea and
Vomiting

1. Check for doctors order

2. Perform ANST prior to
admission
3. Should not be given if
positive skin test
4. Slow IV push
5. Inform the patient about the
possible side effect of the drug
6. Advise patient to report any
discomfort on the IV insertion
site

Name of Drug

Date
Ordered

GN:
Clomipramine
HCl
BN: Placil

02-13-06

GN:
Gentamicin
Dulfate
BN: Genticin

02-14-06

Route/
Action
Dosage and
Frequency
PO
- Anti10 mg tab,
depressants
at 6 am

IV
80 mg amp,
every 80

- Anti-infective
- inhibits
protein
synthesis

Indication

Adverse
Reaction

Nursing Consideration

- for depression
and chronic pain

- headache,
dizziness,
malaise, dry
mouth

1. Check for doctors order

2. not to be given in patients
hypersensitive to drugs
3. Inform the patient about the
possible side effect of the drug

- endocarditis
prophylaxis for
GI or GU
procedure or
surgery

- Nausea and
Vomiting,
headache,
dizziness

1. Check for doctors order

2. Perform ANST prior to
admission
3. Should not be given if
positive skin test
4. Slow IV push
5. Inform the patient about the
possible side effect of the drug
6. Advise patient to report any
discomfort on the IV insertion
site
7. Monitor urine output, specific
gravity, U/A, BUN and
creatinine levels

Name of Drug

Date
Ordered

GN: Ampicillin 02-14-06

BN: Omnipen

GN: MgSO4

02-14-06

Route/
Action
Dosage and
Frequency
IV
- Anti-infective
1 g amp,
- inhibits
every 80
protein
synthesis

IV
0.03% 7ml
every 120

-anti-convulsant
-replaces
magnesium and
maintains
magnesium
level

Indication

Adverse
Reaction

Nursing Consideration

- endocarditis
prophylaxis for
GI or GU
procedure or
surgery

- Nausea and
Vomiting,
headache,
dizziness

1. Check for doctors order

2. Perform ANST prior to
admission
3. Should not be given if
positive skin test
4. Slow IV push
5. Inform the patient about the
possible side effect of the drug
6. Advise patient to report any
discomfort on the IV insertion
site

- magnesium
supplementation

- drowsiness,
hypotension

1. Use parenteral magnesium

with extreme caution in patients
with impaired renal function
2. Test knee jerk and patellar
reflexes before each additional
dose
3. check magnesium level after
repeated doses
4. Monitor fluid intake and
output
5. Monitor renal function

Name of Drug
GN: Ketorolac
Tromethamine
BN: Toradol

Date
Ordered
02-14-06

Route/
Action
Dosage and
Frequency
IV
- Anti30 mg amp, inflammatory
every 60
- inhibits
prostaglandin
synthesis

Indication
- short term
management of
moderately
severe, acute pain

Adverse
Reaction
- dizziness,
sedation,
headache,
flatulence,
nausea and
vomiting

Nursing Consideration
1. Check for doctors order
2. Perform ANST prior to
admission
3. Should not be given if
positive skin test
4. Slow IV push
5. Inform the patient about the
possible side effect of the drug
6. 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,
hypotension

Nursing Consideration
1. Monitor BP, PR, and RR before and
after giving the medication
2. Monitor patient for toxicity

c. Medical/ Surgical Management

1. Chest X-ray- this is used to rule out respiratory causes of referred pain.
2. Intake and Output- I&O measurement provide an other means of
assessing fluid balance. This data provide insight into the cause of
imbalance such as decrease fluid intake or increase fluid loss. These
measurement are not that accurate as body weight, however, because of
relative risk of errors in recording.
3. Electrocardiogram- The ECG is an essential tool in evaluating cardiac
rhythm.

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, causing the heart to
contract.
4. O2 Inhalation- Oxygen therapies are used to provide more oxygen to the
body into order to promote healing and health.
5. Intravenous Rehydration- when the fluid loss is severe or life
threatening, intravenous (IV) fluids are used for replacement.
6. ultrasound (Also called sonography.) - a diagnostic imaging technique
which uses high-frequency sound waves to create an image of the
internal organs. Ultrasounds are used to view internal organs of the
abdomen such as the liver spleen, and kidneys and to assess blood flow
through various vessels.
7. hepatobiliary scintigraphy - an imaging technique of the liver, bile ducts,
gallbladder, and upper part of the small intestine.
8. cholangiography - x-ray examination of the bile ducts using an
intravenous (IV) dye (contrast).
9. 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.

10. endoscopic retrograde cholangiopancreatography (ERCP) - a procedure

that allows the physician to diagnose and treat problems in the liver,
gallbladder, bile ducts, and pancreas. The procedure combines x-ray and
the use of an endoscope. A long, flexible, lighted tube. The scope is
guided through the patient's mouth and throat, then through the
esophagus, stomach, and duodenum. The physician can examine the
inside of these organs and detect any abnormalities. A tube is then
passed through the scope, and a dye is injected which will allow the
internal organs to appear on an x-ray.
11. computed tomography scan (CT or CAT scan) - a diagnostic imaging
procedure using a combination of x-rays and computer technology to
produce cross-sectional images (often called slices), both horizontally
and vertically, of the body. A CT scan shows detailed images of any part
of the body, including the bones, muscles, fat, and organs. CT scans are
more detailed than general x-rays.
12. Cholecystectomy- removal of the gallbladder. This procedure may be
performed to treat chronic or acute cholecystitis, with or without
cholelithiasis, to remove a malignancy or to remove polyps.
13. Cholecystotomy- the establishment of an opening into the gallbladder to
allow drainage of the organ and removal of stones. A tube is then placed
in the gallbladder to established external drainage. This is performed
when the patient cannot tolerate cholecystectomy.
14. Choledochoscopy- the insertion of a choledoscope into the common bile
duct in order to directly visualize stones and facilitate their extraction.

VII.

Clients Daily Progress

DAYS

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, 1Lx 30-31
gtts/min
D5NM, 1Lx 30-31
gtts/min
Drugs
H2 Bloc

ADMISSION
2/13/06

DAY 2
2/14/16

*
*

*
*

BP- 130/90
PR- 84
RR- 19
Temp- 36.5 oC

BP- 140/90
PR- 82
RR- 21
Temp- 36.2 oC

DAY 3
2/15/16

DISCHARGE
2/16/06

BP- 140/90
PR- 85
RR- 21
Temp- 36.4 oC

BP- 130/90
PR- 83
RR- 20
Temp- 36.1 oC

*
*
*
*
*
*
*
*

*
*
*

Cefuroxime
Ketorolac
Ampicillin
Gentamicin
MgSO4
Lidocaine
Placil

NPO
Clear liquid
Soft Diet
DAT
Activity & Exercise
FOB
Sit on Bed
Ambulation as Tolerated

*
*
*
*
*
*
*

*
*
*
*
*
*
*

Diet

* First started and indicates the duration it was done and taken.

*
*
*
*
*
*

VIII.

DISCHARGE PLANNING

Instructed the patient to continue medication as ordered

1. Cephalexin 500 mg cap 3 x day (8am-1pm-8pm) for 1 week
2. Mefenamic Acid 500 mg cap 3 x day (am-1pm-8pm) for 1 week

Instructed the patient to do exercise as tolerated such as walking

Instructed the patient to continue the medication

1. Encouraged patient to increase fluid intake

2. Encouraged patient to eat foods rich in Vitamin and Nutritious

foods
3. Encourage patient to avoid salty and fatty foods
4. Encourage patient to have enough rest
O

Instructed to come back for follow-up check-up on February 23, 2006,

Thursday.

Advised the patient to a diet as tolerated but preferably avoiding salty

and
fatty foods.

IX. Conclusion
Our patient, Mr. Aproniano Castro has a chief complaint of epigastric pain.
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, U/A, 12-L ECG, FBS, BUN, Crea, X-ray and UTZ. Due to the
result the surgeon decided for a surgery to remove the gallbladder which is known as
the cholecystectomy. We are happy to say that most of our group mates witness the
operation. The following day we were given the chance to visit and assess our
patients condition. Fortunately, the patient had recovered at once he is no longer
complaining of epigastric pain. 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, 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. This then causes inflammation of the gallbladder. The treatment
usually done is the cholecystectomy.
In order to lower the risk of having this kind of condition each and every one
of us must be conscious in our diet. We should try to avoid foods which are rich in
salt and fats, especially those foods which contains many seasonings. 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.

Remember also the saying Mahal ang

magkasakit. 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. 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.

X. BIBLIOGRAPHY
Books
Joyce M. Black,PhD, RN, CPSN, CWCN & Jane Hokanson Hawks, DNSc, RN, BC,
Medical- Surgical Nursing 7th edition, pg.1302-1314.
Nursing 2004 Drug Handbook, 24th edition
Doenges, Moorhouse, & Murr, Nurses pocket guide 9th edition.
Online Resources
www.facs.org
http://tjsamson.client.web-health.com/webhealth/topics/GeneralHealth/generalhealthsub/generalhealth/liver&gallbladder/what_gall
bladder.html
http://www.emedicine.com/emerg/topic97.htm
http://www.emedicine.com/radio/topic163.htm
http://www.healthsystem.virginia.edu/uvahealth/adult_liver/chole.cfm
http://www.emedicine.com/EMERG/topic98.htm
Microsoft Encarta 2004
Nursing Care Plan Content CD-ROM