Professional Documents
Culture Documents
Chole Lithia Sis
Chole Lithia Sis
Using NANDA, NIC, and NOC Provide appropriate preoperative teaching for the planned
Chart 22–1 shows links between NANDA nursing diagnoses, procedure. Discuss the possibility of open cholecystectomy
NIC, and NOC when caring for a client with cholelithiasis or even when a laparoscopic procedure is planned. Teach postop-
cholecystitis. erative self-care measures to manage pain and prevent compli-
cations. If the client will be discharged with a T-tube, provide
Home Care instructions about its care (see Box 22–4). Discuss manifesta-
Teaching varies, depending on the choice of treatment options tions of complications to report to the physician. Stress the im-
for cholelithiasis and cholecystitis. If surgery is not an option, portance of follow-up appointments.
teach about medications that dissolve stones, their use and ad- Following cholecystectomy, a low-fat diet may be initially
verse effects (diarrhea is a common side effect), and maintain- recommended. Refer the client and food preparer to a dietitian
ing a low-fat, low-carbohydate diet if indicated. Include an ex- to review low-fat foods. Higher fat foods may be gradually
planation about the role of bile and the function of the added to the diet as tolerated.
gallbladder in terms that the client and family can understand.
PLANNING AND IMPLEMENTATION about ways to reduce her fat intake while keeping her weight sta-
Mr. Corbin plans and implements the following interventions for ble.She verbalizes understanding of initial activity restrictions and
Mrs. Red Wing. resumption of normal activities. Mrs. Red Wing states,“It wasn’t as
bad as I thought it would be at first.” She has an appointment to
• Teach about the gallbladder and the function of bile.
see her surgeon in 1 week.
• Discuss pre- and postoperative care, including self-care follow-
ing discharge. Critical Thinking in the Nursing Process
• Promote mobility as soon as allowed after surgery. 1. What is the rationale for a low-fat diet with cholelithiasis?
• Teach home care of stab wounds and recognition of signs of
Discuss nutritional practices as they relate to the medical
infection.
problem and Mrs. Red Wing’s culture.
• Review specific high-fat foods to avoid and ways to maintain
2. How would your discharge teaching for Mrs. Red Wing differ if
her weight.
she had had an open cholecystectomy instead of a laparo-
• Provide analgesia as needed postoperatively. Teach appropri-
scopic cholecystectomy?
ate analgesic use after discharge.
3. Design a nursing care plan for Mrs. Red Wing for the nursing
EVALUATION diagnosis: Fatigue.
Mrs. Red Wing is discharged the morning after her surgery. She is
afebrile, has no signs of infection, and is able to appropriately care See Evaluating Your Response in Appendix C.
for her stab wounds. She identifies signs of infection and talks
THE CLIENT WITH CANCER extension to the liver, and metastasize via the blood and
OF THE GALLBLADDER lymph system.
At the time of diagnosis, the cancer usually is too advanced
to treat surgically. Ninety-five percent of clients with primary
Gallbladder cancer is rare, primarily affecting people over cancer of the gallbladder die within 1 year. Radical and exten-
age 65. Women are more likely to develop the disorder. Man- sive surgical interventions may be performed, but the progno-
ifestations of gallbladder cancer include intense pain and a sis is poor regardless of treatment (Tierney et al., 2001). Nurs-
palpable mass in the RUQ of the abdomen. Jaundice and ing care is palliative, focusing on maintaining comfort and
weight loss are common. Gallbladder cancers spread by direct independence to the extent possible.
LIVER DISORDERS
The liver is a complex organ with multiple metabolic and reg- Bilirubin is a breakdown product of hemoglobin, released
ulatory functions. Optimal liver function is essential to health. when RBCs are broken down and destroyed. This insoluble
Because of the significant amount of blood in the liver at all form of bilirubin (unconjugated bilirubin) is metabolized by
times, it is exposed to the effects of pathogens, drugs, toxins, the liver into a soluble form (conjugated bilirubin), which is
and possibly malignant cells. As a result, liver cells may be- then eliminated in bile. The liver also metabolizes carbohy-
come inflamed or damaged, or cancerous tumors may develop. drates, proteins, and fats. Most drugs are metabolized in the
liver, and substances such as alcohol and many toxins are
detoxified. It is these metabolic functions and bile elimination
THE CLIENT WITH HEPATITIS that are disrupted by the inflammation of hepatitis. See Chapter
19 for more information about the liver.
Hepatitis is inflammation of the liver. It is usually caused by a Viral Hepatitis
virus, although it may result from exposure to alcohol, drugs
At least five viruses are known to cause hepatitis: hepatitis A
and toxins, or other pathogens. Hepatitis may be acute or
virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV),
chronic in nature. Cirrhosis, discussed in the next section, is a
the hepatitis B-associated delta virus (HDV), and hepatitis E
potential consequence of severe hepatocellular damage.
virus (HEV). These viruses differ from one another in mode of
transmission, incubation period, the severity and type of liver
PATHOPHYSIOLOGY AND MANIFESTATIONS damage they cause, and their ability to become chronic or de-
The essential functions of the liver are multiple. One of its pri- velop a carrier (asymptomatic) state. Table 22–2 identifies
mary functions is the metabolism and elimination of bilirubin. unique features of the primary hepatitis viruses. Two additional