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Such stones usually from the gall bladder; for this reason, they are called gallstones. Gallstone formation is a common occurrence , with autopsy studies indicating their presence in approximately 15% of adults, most of whom have no indication of their presence or asymptomatic. Peak occurrence is seen in obese females who are past the age of 40. The process of gallstone formation is called cholelithiasis. The major constituents of normal bile are water, various inorganic ions, bile salts, cholesterol, lecithin, and conjugated bilirubin. Since cholesterol I s a lipid, it has low water solubility. How ever, bile salts and lecithin combine with cholesterol to form large, water soluble complexes. When a change in bile permits low-solubility bile components to come out of the solution, they are said to precipitate out of the bile and as they do, they form a small crystals on the gall bladder s mucosal surface. Overtime , these enlarge to produce grossly visible stones that may exceed 1 cm in diameter.several or many stones commonly form instead of only one or two. In North America, 80- 90% of gallstones are formed precipitated cholesterol. The remainder are predominantly composed of calcium bilirubinate, the calcium salt of the heme-derived pigment bilirubin. These stones are known Hospitalization is often the result of the complications arising from the presence of a stone in the as pigment stones. In the United States, the incidence rate for gallstones is approximately 40% in individuals older than 60 years. In individuals undergoing cholecystectomy for symptomatic cholelithiasis, 8-15% of patients younger than 60 years have CBD stones, compared to 15-60% of patients older than 60 years. (http://emedicine.medscape.com/article/172216-overview) In the Philippines, there were 131 males (18%) and 609 (82%) females, with a female ratio male 4.6:1. Benign lesions comprised 99% (mean age 36), mostly chronic cholelithiasis (97%) and acute cholelithiasis which constituted 15 cases only (2%), malignant lesions comprised only 7 cases for example 1% of all lesions (mean age 65). http://www.thedoctorsdoctor.com/diseases/gallbladder_chronic_cholelithiasis.htm#epidemiol ogy
Current Trends Magnesium Intake May Cut Risk of Gallstones, February 22, 2008 Consumption of a diet rich in magnesium appears to reduce the risk of symptomatic gallstone disease, according to findings from a US study of over 42,000 men.Dietary consumption of magnesium has been declining over the years, lead author Dr. Chung-Jyi Tsai and colleagues note, due in part to the over processing of foods.Magnesium deficiency is known to cause elevated triglyceride levels and decreased HDL cholesterol levels, both of which may raise the risk of gallstones. Still, the long-term effect of magnesium consumption level on the risk of gallstones in humans was not known.
The results of treating the first 10 patients with this instrument reveal that large stone burdens as well as small stones (23 mm) of any composition can be removed if the gallbladder is of sufficient size to accommodate the six-pronged basket. pulling calculi into a high-speed blade that fragments stones to predominantly under 500 microns. A fluid vortex is generated. access was lost in one case. mumps. According to her this is the first time she consulted a doctor regarding her disease. One day prior to admission. Mrs. General physical assessment The patient is in lying position.The percutaneous rotary lithotrite: a new approach to the treatment of symptomatic cholecystolithiasis The principle of the instrument is that of a liquidizer with an impeller that emulsifies stones. In knowing the details of the disease. Mrs. When she was at the elementary level she experienced having the following childhood illness like chickenpox. we will be able to share our knowledge to other people particularly to those people with this condition. she advised for admission. knowledge and attitude to be an efficient and effective care provider. She had no allergies in foods and any drugs HISTORY OF PRESENT ILLNESS Eight months prior to admission Mrs. Reasons for choosing such case for presentation The reason why we have chosen this case is for us to enhance our understanding regarding Cholecystolithiasis and to gather factual data and current trends in regards to this condition. Ursodeoxycholic acid was administered from 3 to 12 months to five patients with either residual stones or aggregates. and measles. X consult at OPD where abdominal ultrasound requested. X started to experience epigastric pain. . One major complication occurred. All patients (except the patient who underwent surgery) resumed light activity in 3-4 days and strenuous activity and full diet within 3 weeks. She is pale and weak in appearance but able to respond during our conversation. Nine of 10 procedures were completed. At repeat oral cholecystography. The percutaneous rotary lithotrite introduces a new concept to fragmentation and percutaneous removal of gallstones. The hospital stay ranged from 48 to 72 hours. the gallbladder was visualized after 3-6 weeks in eight of the nine patients. This will enable us to improve our skill. HISTORY OF PAST ILLNESS The patient did not complete her immunization as she verbalized that there are no available vaccine for immunization at that time. X is persisted regarding to her condition. Rotation times of 7-39 minutes were required.
X has a good relationship and it shows that they have problem regarding their income status because their daily income is not enough to sustain their medical needs They also gave financial assistance to their friends. Mental status Upon our assessment with Mrs. All family members obtain a healthy relationship with one another.5 Temperature 36. But then eye contact was established during interview. She moves free.4 36. . She is conscious and well oriented with the time and place where she was. They adopt the attitude of each family member. the patient shows no signs of mental illness. 2010 Time 8am 10am 2pm Blood pressure 120/80 120/80 140/80 Blood pressure 140/90 130/90 130/90 Pulse rate 64 63 64 Pulse rate 64 64 69 Respiratory rate 19 18 19 Respiratory rate 19 21 20 Temperature 36.5 36.5 36. Analysis Based on the assessment above and the data we gathered. 2010 Time 8am 10am 2pm July 16. She knows the place where she was and the reasons why she undergo an operation as she verbalized ooperahanakokasitatangglinnilayungapdoko. Her facial expressions are appropriate with her feelings and mood conversation. Cognitive abilities Mrs. She can able to respond and cooperate. She wears loose light clothing which is appropriate in weather.7 Urine output Urine output Areas of assessment 1.5 36. sit and perform any movement before the operation. Appearance and movement Mrs. Interpretation She has a good family background. Her husband is the one who answers our questions. X She is not well attentive. X was in sitting position In a manner comfortable for her. Economic resource are also important t sustain the basic necessities like foods that a man needs to achieved a health lifestyle. Social status Analysis Based on the data gathered. whenever we ask her about their names of her brothers and sisters she didn t know it. (source: Weber Janet. paratinakasingsumasakityungtiyan at likodko . She is well groomed.July 15. she can walk. relatives and neighbors in the family. X is concern of herself and to her family. Mrs. Nurse handbook on Health assessment) 2.
Because of her surgical incision. X had the ability to manage stress by means of expressing her thoughts and feelings willingly. The symptoms include self destructive action. Feelings and able to communicate with others. It seems like her condition affects her emotional status because the pain that she felt. Erb. Berman and Snyder) 4. withdrawal or distrust friends and family. Her emotional affected and she needs more emotional support and health teachings for pain Management. Her feeling of fear is due to her health condition because she was thinking of the complications and consequences that might happen when she will eat foods in high cholesterol and she will able to maintain her proper diet.(Source: Fundamentals of nursing by Kozier. Sense of sight She can t read newspaper without wearing her eyeglasses. As she verbalized nungnaospitalakoditonagingibayungpanlasakokaysanungnasabahayako . X had a good conversation with us. Berman and Snyder) 3. She is aware that she must take suitable diet to her condition. impaired cognitive functioning. emotional deregulations and or maladaptive behavior. Before the patient described moderate to severe pain. After the operation she told us angsakitngsugatko . She appropriately responds to her present conditions worrisome at times. Sensory perception Sense of taste Mrs. Auditory Activity Needs repetitions of verbal command. Analysis Mrs. short temper. Despite of that. she rated it 9/10. she was able to cope up with that kind of situation. Emotional status Mrs. (Source: Fundamentals of nursing by Kozier. and argumentative inability to concentrate glaze or far away statement and disorganized speech and erratic. X was able to determine various taste during mealtime. We asked her to rate the pain she was felling at that moment. Interpretation She has capabilities of expressing her emotions. Erb.Interpretation Mental illness is characterized by distress. Sense of smell She distinguishes pleasant and unpleasant odors. Analysis . Emotional wellness involves the ability to recognize accept and express feelings and to accept ones limitation. Pain sensation When the first day of our interview the patient verbalized masakitangtiyanko That is her complaint to us her pain scale is 8/10 before the operation then the day after her operation the patient verbalized masakitangsugatko . She also told us tat she was irritated by the noxious odor in the hospital especially in the comfort room.
2010 Time 8am 10am 2pm 8am 10am 2pm Temperature 36. she cannot tolerate ambulating long distance walking.5 36. Interpretation The normal stability of a person is that a person able to move freely without and feeling of pain and can ambulate by herself. it appears that she had activity intolerance that results to limited movements because she has undergone a surgical procedure. and she needs assistance to transfer to another place. Interpretation .7 July 16. Respiratory Status Date July 15. X sensory perception. she feels pain when standing.5 36. we have found that a normal sensory reaction of our body because she was able to rate the pain in her incision area. after the operation we observed that she had limited movement. 2010 Time 8am 10am 2pm 8am 10am 2pm Respiratory Rate/cpm 19 18 19 19 21 20 July 16. This implies that her condition affects her respiration. (Source: Nursing Fundamentals by Daniels) 7. Analysis Mrs. X before the operation we had observed free movements and she have any activity intolerance due to the pain she was feeling at the right upper quadrant of her abdomen area.5 36.2 degree Celsius is the normal body temperature. Erb.4 36. Interpretation 36. Body temperature Date July 15. Motor Stability On our first visit to Mrs.Regarding Mrs. Berman and Snyder) 6. X the data above showed that she has a normal body temperature. Her Abnormal breathing is due to her incision site and pain.5 36. X has abnormal breathing pattern and she did not complain any difficulty of breathing.5 to 37. 2010 Analysis Mrs. 2010 Analysis Upon assessing Mrs.(Source: Fundamentals of nursing by Kozier. she is also warm to touch due to environment factors like humid environment. X motor stability is normal. 5.
Interpretation She has a good nutritional status with complete dietary supplements.The average breaths per minutes of the individual have 12-20 there is no obstruction and abnormal breath sound present with good and equal inspiration and expiration.Underweight 18. Circulation Status Date July 15. (Health assessment 5th edition by Janet Weber) 8. Sleep and rest pattern Because the pain felt in the incision site.normal weight 24.5. She was a bit upset because she cannot sleep even at night.. (AdellePilleteri. the patient had an abnormal activity of circulatory status.obesity >40 extreme obesity Analysis The patient is obese based on the result of her body mass index (BMI).83 <18.9 . 2010 Analysis Based on the data above. As a form of relaxation. X finds it difficult to sleep inside the hospital.5 . noisy environment and insufficient ventilation Mrs. Interpretation An average adult has 60-100 cpm and the normal blood pressure is 120/80mmHg.9 .191 lbs Height.24. she usually sleeps during day hours.9-29. 2010 Time 8am 10am 2pm 8am 10am 2pm Pulse Rate 64 63 64 64 64 69 Blood Pressure 120/80 120/80 140/80 140/90 130/90 130/90 July 16. Mother and child nursing) 10. Analysis .(Health assessment 5th edition by Janet Weber) 9. she consume 2-4 hours of rest day.9 overweight 30-39. Nutritional Status W eight.5 6 BMI= Weight in kg Height in m2 BMI = 30.
(Source: Mother and child nursing by Pelliteri) 13. X has a normal skin and appendages state she has no signs of skin problem and deformities >The patient has dry and clean dressing. Her normal cycle last for % days she consumed 2-3 pads per day. soft and elastic. Her incision site is in the right upper quadrant. Interpretation An average woman has a mature reproductive status. Interpretation Skin is warm. She is not able to get enough sleep at night in the hospital. Her bowel elimination is once a day. Analysis The patient elimination status is normal.. (Nursing fundamentals by Rick Daniels) 11. She sleeps ^ hours per day this may affect the recovery process. No lesions. The normal menarche period should be at the age of 10-16. Elimination status She usually urinates 3 times a day.Mrs. X sleep pattern is normal. Her scalp has no flakes. A normal stool is color brown and well formed and urine is clear to yellowish in color. State of skin and appendages Upon assessing her integument we have inspected minimal scars without presence of lesions. once in the morning and twice in the evening. X has a normal reproductive status because she can bear child. odor or edema. She had a urine output ranging 1300cc tea like colored urine upon assessment. Her intravenous fluid is located at right metacarpal vein 5% Dextrose in lactated Ringers 1L regulated at 30 drops per minutes. (Pediatric Nursing by Nick L. Color is uniformed no flaking of the scalp. Analysis Mrs. Interpretation Average person sleeps at least 8 hours every night and has a balance relaxation time.(Health assessment 5th edition by Janet Weber) . Potts et. wounds. discolorations. Analysis It shows that Mrs. mass and lump and have a fair . She also experienced dysmenorrheal during her menstruation. Interpretation Normal bowel movement of a person must be 1-2 times a day and a voiding # times a day with 12001500cc ml per day. Her hair is free from infestations and black in color.al) 12. Reproductive status Her first menstruation or menarche was at the age of 16 and has a regular 28 day cycle. Body hair is moderate with uniformed distribution. dry.
1 ± 10.4 mg/dl . Diagnostic /laboratory procedure Blood chemistry Date ordered and date results 02/22/2010 Indication/ purpose To monitor the bilirubin level in the blood results Normal values Bilirubin 2.03-1 mg/dl Analysis and interpretation of results Hyperbilirubinemia Bilirubin level is elevated above normal range .9 G/L Analysis and interpretation of results Elevated WBC Indicates a significant finding of Infection or inflammation.DIAGNOSTIC AND LABORATORY PROCEDURES Diagnostic /laboratory procedure Date ordered and date results Indication/ purpose results Normal values Blood chemistry 02/22/2010 To diagnose damage bile canaliculi and duct cells Alkaline Phosphatase 10-30 U/L 103 U/L Analysis and interpretation of results Elevated alkaline Phosphatase suggestive of a damaged bile canaliculi and duct cells which releases alkaline phosphatase. Diagnostic /laboratory procedure Date ordered and date results Indication/ purpose results Normal values CBC 02/22/2010 To confirm infection WBC 17.4 G/L 4.
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