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NORTHWESTERN UNIVERSITY
College of Allied Health Sciences
Department of Nursing
Laoag City

Alternative Learning Activities

CHOLECYSTITIS WITH CHOLELITHIASIS

In partial fulfillment of the Course Requirements in Care of Clients with life threat condition,
Acute Ill / Multiple Organ Problems, High Acuity and Emergency Situation, Acute and Chronic
(NCM 118)

Presented to:
Aprile D. Rabbon, MAN
Genevieve C. Agodon, MAN
Glenn B. Lagdao, RN
Clinical Instructors

Presented by:
Agosto, Yzah Angelika D.
Batangan, Lycka Dee Zyrill S.
Battle III, Michael A.
Cacal, Elizabeth Kyla B.
Gaviola, Jose Marie T.
Lazo, Kristene Claire O.
Mangrobang, Janelle Louraine S.
Raguindin, Crystal L.

BSN IV B - Group 2
First Semester A.Y. 2021-
2022
 Table of Contents

Page

I) Case scenario 1

II) Introduction 3

III) Pathophysiology 7

IV) Discharge Planning 10

V) Related Nursing Theory 12

VI) Review of Related Literature/Studies 13

VII) References 16
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NORTHWESTERN UNIVERSITY
College of Allied Health Sciences
Department of Nursing
Laoag City

I. CASE SCENARIO

A 45-year-old woman presents to the emergency department with persistent right

upper abdominal pain radiating to her right shoulder, nausea, vomiting and sweating. She

gives a rating of 8 on a 10-point pain scale. Upon the nurse’s assessment, the vital signs

are: blood pressure 130/80 mmHg, heart rate 115 BPM, respiratory rate 17 BPM, and

temperature of 37.6°C. The physical examination reveals marked tenderness to palpation

in the right upper quadrant and a positive Murphy’s sign. It is noted that the pain began

several hours prior, and she does not remember any precipitating factor or trauma that

would cause such pain. She does recall having intermittent, less severe episodes of

abdominal discomfort over the previous year. When asked to take in and hold a deep

breath while performing a deep palpation by the nurse, the patient stops breathing in and

winces with a ‘catch in her breath’ because it is painful. She stated she takes antacids to

help with the discomfort, but it does not help with her recurrent pain. There is no

history of chest pain, heartburn, lower abdominal pain, diaphoresis, or dizziness. It is also

noted she takes combined oral contraceptives and has a history of obesity and non-insulin

dependent diabetes.

With these manifestations and diagnosis, diagnostic procedures were required.

The physician prescribed Demerol 50 mg PO every 3 to 4 hours as needed for the pain, as

well as Prochlorperazine 5 mg PO 3 to 4 times a day for her nausea and vomiting.

Laboratory orders of Complete blood count (CBC), C-reactive protein (CRP), and

Erythrocyte sedimentation rate (ESR) tests were ordered, and results were as follows:

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NORTHWESTERN UNIVERSITY
College of Allied Health Sciences
Department of Nursing
Laoag City

LABORATORY TEST RESULTS REFERENCE RANGE

COMPLETE BLOOD COUNT
White Blood Cell Count 14.3 3.7-11.0 x 10^3/uL
Red Blood Cell Count 4.22 3.85-5.22 x 10^6/uL
Hemoglobin 11.9 11.5-15.0 g/dL
Hematocrit 39.0 34.8%-46%
Mean Corpuscular Volume 88 78.0-100.0fL
Mean Corpuscular 30.6 26.0-32.0 pg
Hemoglobin
Mean Corpuscular Hemoglobin 33.6 31.0-35.5 g/dL
Concentration
Red Cell Distribution Width 13.8 11.5%-15.5%
Platelet Count 397 150-400 x 10^3/uL
Mean Platelet Volume 10.8 8.7-12.5 fL
C-reactive protein 27 <10 mg/L
Erythrocyte Sedimentation Rate 43 1-20 mm/h

A physician also ordered a transabdominal ultrasound of her gallbladder which

revealed visible thickening of the gallbladder wall and gallstones. There was

pericholecystic fluid accumulation as well. Because of this, the physician ordered an

urgent laparoscopic cholecystectomy.

Post-surgery management included teachings of proper incision care, nutrition

and diet therapy such as low-fat diet, avoiding heavy lifting for 4 to 6 weeks, and

paracetamol 500mg PO every 4 to 6 hours for pain, as needed.

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NORTHWESTERN UNIVERSITY
College of Allied Health Sciences
Department of Nursing
Laoag City
II. INTRODUCTION

OBJECTIVES:

At the end of the activity, the following will be achieved:

 Student nurses will gain more understanding and knowledge about cholecystitis and

cholelithiasis.

 Student nurses will be able to share the important details of the disease and

prevention, to their: family, relatives, friends and even neighbors.

 Student nurses will be of help in lowering down the cases of this disease in their

respective communities.

Cholelithiasis develops when calculi, or gallstones, form in the gallbladder.

These are hard, pebble-like cholesterol and bilirubin compounds. The gallbladder is a

tiny, pear-shaped organ that sits underneath the liver. It holds bile, a fluid generated by

the liver that aids in digestion. Bile is required for digestion when foods containing fat

are consumed.

Cholecystitis occurs when bile accumulates in the gallbladder, causing pressure

and inflammation. Gallstones that clog the duct are the most prevalent cause, however it

can happen for a variety of causes. Gallstones that obstruct the tube coming out of the

gallbladder usually cause cholecystitis. This causes bile accumulation, which can cause

inflammation. Other causes of cholecystitis include bile duct obstruction, tumors, severe

sickness, and some infections. Cholecystitis, if left untreated, can progress to significant,

even life-threatening consequences, such as gallbladder rupture. Gallbladder removal is

a common treatment for cholecystitis.

The two types of cholecystitis are: acute cholecystitis and chronic cholecystitis.

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NORTHWESTERN UNIVERSITY
College of Allied Health Sciences
Department of Nursing
Laoag City
Calculous cholecystitis is the most prevalent type of acute cholecystitis which is usually

less dangerous. It accounts for around 95% of all cases. When the cystic duct, the main

entry to the gallbladder, is obstructed by a gallstone or biliary sludge, calculous

cholecystitis develops. Biliary sludge is made up of bile, a liquid produced by the liver

that aids in the digestion of lipids, as well as tiny cholesterol and salt crystals. Bile

builds up in the gallbladder due to a blockage in the cystic duct, increasing the pressure

inside and causing inflammation. Acalculous cholecystitis is a kind of acute

cholecystitis that is less prevalent but usually more dangerous. It usually occurs because

of gallbladder damage caused by a significant disease, infection, or injury. Accidental

gallbladder damage during major surgery, traumatic traumas or burns, sepsis, severe

starvation, or HIV/AIDS can all induce acalculous cholecystitis.

STATISTICAL DATA

GLOBAL

EPIDEMIOLOGY

Frequency An estimated 10-20% of Americans have gallstones, and as many as

one third of these people develop acute cholecystitis. Cholecystectomy for either

recurrent biliary colic or acute cholecystitis is the most common major surgical

procedure performed by general surgeons, resulting in approximately 500,000 operations

annually. Cholelithiasis, the major risk factor for cholecystitis, has an increased

prevalence among people of Scandinavian descent, Pima Indians, and Hispanic

populations, whereas cholelithiasis is less common among individuals from sub-Saharan

Africa and Asia. Mortality/Morbidity Most patients with acute cholecystitis have a

complete remission within 14 days. However, 25-30% of patients either require surgery

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NORTHWESTERN UNIVERSITY
College of Allied Health Sciences
Department of Nursing
Laoag City
or develop some complication. Patients with acalculous cholecystitis have a mortality

rate ranging from 10-50%, which far exceeds the expected 4% mortality rate observed in

patients with calculous cholecystitis.

Race Pima Indian and Scandinavian people have the highest prevalence of

cholelithiasis and, consequently, cholecystitis. Populations at the lowest risk reside in

sub-Saharan Africa and Asia. In the United States, white people have a higher

prevalence than black people. Sex Gallstones are 2-3 times more frequent in females

than in males, resulting in a higher incidence of calculous cholecystitis in females.

Elevated progesterone levels during pregnancy may cause biliary stasis, resulting in

higher rates of gallbladder disease in pregnant females. Acalculous cholecystitis is

observed more often in elderly men. The incidence of cholecystitis increases with age.

The physiologic explanation for the increasing incidence of gallstone disease in the

elderly population is unclear. The increased incidence in elderly men has been linked to

changing androgen-to-estrogen ratios.

NURSING IMPLICATIONS

Nursing Education

This will help to provide students and clinical instructors with supplemental information

on the topic of cholecystitis with cholelithiasis, in an effort to equip them with

knowledge that will help them to deliver quality patient care and continued development

of the nursing profession.

Nursing Practice

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NORTHWESTERN UNIVERSITY
College of Allied Health Sciences
Department of Nursing
Laoag City
This will help health care providers determine effective best practices, improve on old

and current studies, discover new treatments, procedures, and protocols, and create new

methodology—all of which will be of particular benefit to patients experiencing

cholecystitis with cholelithiasis.

Nursing Research

This will serve as a guide for future researchers—students, clinical instructors, and

healthcare providers, to improve upon current best practices. It will provide the future

generation with the information needed to develop new tests for diagnosis, treatments,

and protocols.

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 SYMPTOMATOLOGY

(Can be Acute or Chronic)

III. PATHOPHYSIOLOGY
Case Specific
 Murphy’s Sign – Pathognomic Sign
Modifiable Risk Factors  Pain (Typically localized to the right upper quadrant of the abdomen that radiates to
the right shoulder or scapula)
 Abdominal Pain and Cramping after Eating – especially large and fatty foods
LIFESTYLE  Fever above 38.0°C (fever may not be present in older adults and usually doesn’t
 Excessive smoking – increases risk of developing gallstones. occur in people with chronic cystitis)
 Alcohol abuse – can cause bile buildup  Nausea / Vomiting
 Physical Inactivity – lower work activity, higher prevalence of  Sweating
cholesterol gallstones.  Dark colored urine
 Obesity – elevated production and secretion of cholesterol.  Clay colored feces
 Rapid weight loss – liver secretes extra cholesterol into the bile  Loss of appetite
 Rapid weight gain – due to higher cholesterol level in the bile
 Prolonged consumption of certain drugs (i.e. Ceftriaxone
(intrabilliary debris), Octreotide (inhibition of gallbladder
emptying), Thiazide diuretics (increases biliary cholesterol
Non-Modifiable Risk
saturation), Hormone replacement [estrogen therapy](increases
hepatic secretion of biliary cholesterol), oral contraceptives Factors
(increases cholesterol levels) DIAGNOSTIC EVALUATION/TOOLS
DIET  Age (40 years and older)
 Excessive calorie intake – leads to more cholesterol in bile and – increased cholesterol A) PHYSICAL ASSESSMENT
reduced gallbladder emptying release into bile
 Gender: Female Vital Signs:
 Refined carbohydrates intake – increases gallstone risk by
(pregnancy) – Blood Pressure: 140/90 mmHg
increasing insulin secretion which can increase cholesterol
 Ethnicity/Races like: Heart Rate: 22 bpm
concentration in bile
Native American, Temperature: 38.3°C
 Low fiber in the diet – can decrease the intestinal transit time,
increases the production of bile acids and bile cholesterol levels. Hispanic, Chilean Indians,
European – have genetic General Appearance:
 Prolonged fasting – decreases gallbladder movement
predisposition to high  Patient appears to be in severe distress due to severe
ASSOCIATED CONDITIONS
cholesterol in bile abdominal pain.
 Crohn’s Disease – ileum inflammation causes bile salts to not be
absorbed, resulting in cholesterol build up and bile formation.  Family history of the
disease – mutation in gene Cardiovascular
 Diabetes Mellitus – High triglycerides, gallbladder stasis hepatic
insulin resistance may increase risk of gallstones controls cholesterol fr  Abnormal blood pressure (140/90 mmHg)
 Hyperlipidemia – high cholesterol, cholesterol crystals form, may liver to bile duct
Gastrointestinal
b  Localized pain in the upper right quadrant
 Nausea / vomiting

B) MEDICAL DIAGNOSIS
DISEASE PROCESS  Ultrasound : uses sound waves to take images
of gallbladder. It is the gold-standard to look for
[Type here] gallstones because it is simple and non-invasive.
Ultrasound is very good at highlighting gallstones within
Nausea / Bile stagnates in the gallbladder the gallbladder, as well as features, such as thickened
Vomiting gallbladder wall, that point to inflammation of the
gallbladder (acute cholecystitis).

Pigment solute precipitate as solid crystals
Gallstones Crystal clump together and form stones
Gallbladder contracts after intake of fat to release bile
Upon contraction, a stone is moved and becomes impacted on the cystic duct
Lumen is obstructed by stones
 Complete Blood Count (CBC): If there is inflammation
caused by gallstones, the white blood cell count, C-
reactive protein, and ESR will be elevated. The patient will
often have a fever.
 Liver function tests (LFTs): Although these tests are not
done specifically for gallstone disease, this test can show
inflammation in the gallbladder in the enzyme levels of the
liver. Other combinations of liver tests are arranged if
gallstones fall out of the gallbladder and are blocking the
bile duct, which can lead to jaundice.
 Computed tomography (CT): This test uses X-rays to
construct detailed images of the abdominal organs. CT can
give additional information on the bile ducts and liver,
which may be affected by gallstone disease.

 HIDA scan (cholescintigraphy): Radioactive material

called hydroxy iminodiacetatic acid (HIDA) is injected
Bile stasis into the patient. The material is taken up by the gallbladder
and shows how the gallbladder is functioning. This test is
useful when the ultrasound result is inconclusive,
especially if there is acute inflammation of the gallbladder
Chemical reaction inside gallbladder triggers the
and the outlet of the gallbladder is blocked. It is also
release of inflammatory enzymes beneficial when the gallbladder is diseased but there are no
stones present (acalculous cholecystitis).
(Prostaglandins)
 Magnetic resonance cholangiopancreatography (MRCP):
Pictures of the biliary tree (liver, gallbladder and bile
Fluids leak into gallbladder Inflammation of the gallbladder ducts) are produced in detail using magnetic resonance
imaging. It is of particular use to look at the bile ducts for
signs of stones that have escaped from the gallbladder and
are blocking the bile duct, which can lead to jaundice.
Edema Biliary Colic (RUQ pain)  Endoscopic retrograde cholangiopancreatography
(ERCP): In this procedure, a tube is placed down the
patient’s throat, into the stomach, then into the small
intestine. Dye is injected and the ducts of the gallbladder,
Increased Intraluminal pressure  Sweating
liver, and pancreas can be seen on X-ray. of the bile).
and distention of the gallbladder;  Fever
 Hypertension gallstone has blocked the bile duct
Constriction of blood vessels  (+) Murphy’s Sign causing pancreatitis (inflammation of the pancreas),
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If not treated:
PROGNOSIS:
 A continued increase in
intraluminal pressure of the
gallbladder will cause a rupture
and spread of indigenous
microorganisms into the
peritoneal cavity, leading to
sepsis and eventual death.
 A continued lack of
blood supply to the gallbladder
will lead to necrosis, gangrene
and empyema, and perforation of
the gallbladder, leading to sepsis
and eventual death.
BAD PROGNOSIS
jaundice or cholangitis (infection of the bile).
C) NURSING DIAGNOSIS (NANDA)
If treated:
 Acute Pain
 Risk for Fluid Volume Deficit
 Risk for Imbalanced Nutrition: Less than body
 Surgery, proper diet, and
Requirement
compliance to medications
GOOD PROGNOSIS
MANAGEMENT SPECIFIC TO THE
SIGNS/SYMPTOMS
Medical Management
 Physical and psychological modification. Maintain a
healthy weight with exercise and diet.
 Dietary Modification. Avoiding high fat and low
fiber intake.
Surgical Management
 Laparoscopic Cholecystectomy. Considered the gold
standard for surgical treatment of gallstone disease.
It is a minimally invasive surgery to remove the
gallbladder. Generally less pain, scarring and shorter
recovery time.
Pharmacological Management
 Pain Control Medications. Demerol (drug of choice)
to relieve severe pain and promote spasms of biliary
duct.
Ex/ Generic Name: Meperidine Hydrochloride
Brand Name: Demerol
Classification: Opiod Analgesics
Mechanism of Action: Binds with opioid receptors
in the CNS, altering perception of and emotional
response to pain.
Desired Effect: Relieve moderate to severe pain.
Nursing Responsibilities:
1. Advise patient to get up slowly when rising
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Drug Classification: Gallstone solubilizing agent  from a sitting or lying position.

Mechanism of Action: It reduces elevated liver enzyme levels by facilitating bile flow through the liver and protecting liver cells. The mainRationale: mechanism isTo reduce the risk of injury from fall
anticholelithic. 
Desired effects: The drug decreases the absorption of cholesterol and is used to dissolve (cholesterol) gallstones in patients as an alternativecaused by dizziness
to a surgical procedure or lightheadedness.
to remove the gallstones.
Nursing responsibilities:  Medical Surgical Nursing Management 2. Monitor respiratory rate.
1. Tell the patient to take this medicine with or immediately after food.  Rationale: To check for respiratory depression.
Medical
Rationale:Management
For faster absorption of the drug j 3. Instruct patient for possible side effects:
 2. Tell the patient to avoid
Pharmacologic foods
Therapy. that are highof
Combinations in antibiotic,
calories oranalgesics,
cholesterol. 
anticholinergics, antiemetics, oral bile acid
Rationale:
therapy To avoid
and pain gastric
control irritation/ gastric upset
drugs. Nausea: avoid unnecessary movements and rest
 3. DoPhysical
not take and
antacid preparationsmodification.
Psychological at the same time as this
Maintain medicine. 
a healthy weight by continuing to eat well and exercise. Vomiting: Advise patient to drink clear or ice-
ToRationale:
achieve aTo avoidweight,
healthy indigestion
reduceremedies
caloriesthat
andcan stop Ursodeoxycholic
increase acid from working properly.
your physical activity. cold drinks and to eat bland foods.
 4. Tell the pt. Modification.
Dietary when taking Ursodeoxycholic
Avoid high fat and acid
low asin
a liquid medicine,
fiber may make
increase the sure to gallstones.
risk of shake the bottle well before you pour out a dose. Constipation: Encourage dietary fiber and
 Rationale: For faster absorption
Cholecystectomy. Procedureoffor
theremoving
drug the gallbladder and performed with the abdomen distended by an increase fluid intake.
5. If the of
injection pt. carbon
forgets to take a dose,
dioxide, whichtakeliftsone
theasabdominal
soon as you remember
wall unless
away from theit is nearlyand
viscera timeprevents
for your injury
next dose. Do not take two doses at the same time to make up.
to the
Rationale: andTo avoid missed dose or overdose of this drug 4. Ensure accuracy when administrating drug.
peritoneum other organs.
 Laparoscopic cholecystectomy. The only patients who will receive medical dissolution are generally those Rationale: To avoid dosing errors.
 Analgesics and Anticholinergics. Dicyclomine (Bentyl) during acute attacks.
who are nonobese patients with very small cholesterol gallstones and a functioning gallbladder. The anticholinergics relax the smooth muscle, preventing biliary contraction and pain.
 Ex/ Generic name: Dicyclomine
Percutaneous Cholecystostomy. Draining the gallbladder to treat and prevent the spread of infection.  Antiemetics. Treatment for severe nausea and
 Endoscopic retrograde cholangiopancreatography (ERCP). Removing gallstones in the area blocking the vomiting caused by trapped bile that backs up into
Brand name:
common Bentyl
bile duct.
the gallbladder.
Pharmacological Management
Classification: Anticholinergic Agents Ex/ Generic Name: Prochlorperazine
 Antibiotics Therapy. Ciprofloxacin, Meropenem, Imipenem/Cilastatin, ampicillin/sulbactam. Brand Name: Compazine
piperacillin/tazobactam
Mechanism of Action: varies with
Inhibits thedrug
actionAntibiotic regimenon
of acetylcholine is postganglionic,
focused on those appropriate for
parasympathetic receptors, parasympatheticClassification:
typical bowel
muscarinic Anti-emetic
muscarinic receptors, decreasing GI motility. Drug possesses
flora.
localAntibiotics given to manage
anesthetic properties infection
that may along
be partly with bowel
responsible rest, intravenous hydration, correction of electrolyte
for spasmolysis. Mechanism of Action: Blocks the D2 dopamine
imbalances, and pain management with follow-up care.
Ex/ Generic Name: Ciprofloxacin receptors in the brain.
Desired Effect: It helps to reduce the symptoms of stomach and intestinal cramping. This medication works by slowing the natural movements of the gut and by relaxing the muscles in the stomach
Brand Name: Cipro XR
and intestines. Desired Effect: Relieve severe nausea and vomiting
Drug Classification: Antibiotics Nursing Responsibilities:
Mechanism of action: It inhibits bacterial DNA synthesis mainly by blocking DNA gyrase; bactericidal.
Nursing Responsibilities:  1. Position patient carefully after administration.
Desired effect: Used to treat bacterial infection such as chest infection urine infection, prostatitis, digestive
infection, bone and joint infection and some sexually disease infection. Rationale: To prevent aspiration.
1. Tell the patient when
Nursing Responsibilities: to take drug and stress importance of doing so on time and at evenly spaced intervals and to report all adverse reactions.
2. Monitor vital signs.
1. Advise the patient not to crush, split, or chew the tablets. Rationale: To avoid hyperthermia and elevated
Rationale:ToToavoid
Rationale: avoidalteration
missing or of overdosing
the absorptionthe or
drugs
stability of the medicine and may cause local irritant effect or blood pressure.
unacceptable taste.
3. Advise patient to protect skin from direct sun
2.2.Advice
Advisepatient not tototake
the patient with milk
increase fluid or juice. Only with water.
intake
Rationale: To prevent the delay of absorption and it can reduce the drug function. rays and use sunscreen.
3.Rationale:
Do not double up missed
To prevent dose. Advice the patient to take as soon as they remember.
constipation
Rationale: To prevent photosensitivity
Rationale: To avoid overdosing of this drug reactions.
4. Advice patient to apply sunscreen when going out.
3. Exercise caution in hot weather.  10 | P a g e
Rationale: To prevent photosensitivity reactions
5. Encourage increase fluid intake to the patient
Rationale:ToDicyclomine
Rationale: may increase
reduce or minimize urine risk of heatstroke by decreasing sweating
crystals

 4.Oral
If drug
bileproduces drowsiness
acid therapy and light headedness,
- Ursodeoxycholic supervision
acid; Nonsurgical of ambulation
method to dissolveand other safety precautions are warranted.
gallstones.
Ex/ Generic Name: Ursodeoxycholic acid
Rationale:Brand Name:
To ensure theActigall,
safety ofUrso Forte
the patient.
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IV. DISCHARGE PLANNING

Goals and Objectives Discharge Care Nursing Interventions

Plan
The goals and objectives of Skin Care - Instruct patient with homecare
Laparoscopic instruction regarding incision
Cholecystectomy discharge
care are: Rationale: Promote independence
 To achieve timely in care and reduces risk of
wound healing complications.
without - Keep dressing clean and dry for 48
complications. hours and change dressing as often
 To provide home as needed.
care instruction of Rationale: to reduce the risk of
incision and dressing infection.
 To emphasize the
importance of low Advice client that they may shower
fat diet, eating small after 48 hours without immersion or
frequent meals and swimming for at least 2 weeks.
gradual
reintroduction of
food or fluids
containing fats over
4 to 6 month period.
 To identify signs and
symptoms requiring
notification of
healthcare.
 To improve and
maintain activity
intolerance.

Medication - Advice the patient to take low dose

Paracetamol as needed for low to
mild pain only.
Rationale: Paracetamol can cause
an ulcer in the stomach or gut if
taken for prolonged time or in big
doses. It can also cause heart and
kidney failure in very big doses.
Environment - Encourage the family members to
provide a peaceful, clean, stress-
free, and well-ventilated
environment conducive to a fast
recovery and healthy living.

Treatment - Promote bed rest, and in low

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fowler’s position
Rationale: Bed rest in low fowler’s
position reduces intra-abdominal
pressure.
- Encourage use of relaxation
techniques
Rationale: promote rest, redirects
attention, may enhance coping
- Instruct patient to do exercise as
tolerated such as walking.
Rationale: to achieve optimal
independence for self-care and
reduce energy consumption during
activity.
Nutrition and Diet - Advice client to start with clear
Therapy liquids to prevent nausea, vomiting
and constipation such as soup, Jell-
O, juices, popsicles, and carbonated
beverages. Then advance to a
regular low-fat diet.
- Remind patient to avoid fatty foods
such as hamburgers, whole milk,
and cheese.
Rationale: foods high in
cholesterol and fats can lead to
irritation, stone formation, and
episodes of cholecystitis.
Health Education - Advise patient not to lift any heavy
object for 4 to 6 weeks.
- Advise to seek medical advice from
health care provider in case of
complication.
Teach the family members about
engaging with the patient to
improved outcomes and help the
patient adhere to treatment and
recommendations and to help
prevent the need for readmission.
Follow Up - Advise significant other or client to
comply with the recommended
medical follow-ups to check for his
condition’s improvement.
- Rationale: to ensure the client is
moving forward with the prescribed
treatment plan.

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V. RELATED NURSING THEORY

This case was guided by the Care, Cure, Core Theory of Lydia E. Hall, also

known as the Three Cs of Lydia E. Hall. These three interlocking circles, the care, core,

and cure, represent the patient and nursing function aspects.

According to Alligood (2018), the care circle represents the patient's body, the

cure circle represents the disease that affects the patient's physical system, and the core

circle represents the person's inner feelings and management. The three circles alter in

size and overlap depending on the patient's stage of the disease. A nurse works in all

three circles, albeit to varying degrees.

In this case, the patient was diagnosed with cholecystitis with cholelithiasis. The

care, cure, and core theory will assist the nurse in providing the patient with the care that

she or he needs. Upon the patients' hospitalization, healthcare personnel, particularly

nurses, are the ones who will aid and accompany them throughout their stay. During the

care phase, the nurse will assist the patient with daily routines such as bathing and

toileting. Meanwhile, in the cure phase, the nurse applies medical knowledge to the

person's therapy, including administering drugs, intravenous fluids, and even

independent nursing care for the patients' symptoms. The nurse addresses the patient's

social and emotional requirements during the core phase to provide efficient

communication and a comfortable setting. The core phase can also aid in the

enhancement of the nurse-patient relationship.

According to Hall, professional nursing care hastens recovery, and as less

medical care is required, more professional nursing care and teaching are necessary. In

addition, she emphasizes the autonomous function of nurses.

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VI. REVIEW OF RELATED LITERATURE / RELATED STUDIES

RELATED LITERATURE

Cholecystitis is a condition in which your gallbladder gets inflamed. Inflammation

of the gallbladder can be caused by:

 Gallstones. Cholecystitis is most commonly caused by hard particles that form in

your gallbladder (gallstones). Gallstones can clog the cystic duct, which is the

conduit via which bile exits the gallbladder. Bile accumulates, producing irritation.

 Tumor. A tumor may prevent bile from draining correctly from your gallbladder,

resulting in bile accumulation and cholecystitis.

 Blockage of the bile duct. The bile ducts can become kinked or scarred, resulting

in obstructions and cholecystitis.

 Infection. Inflammation of the gallbladder can be caused by AIDS and other viral

diseases.

 Problems with blood vessels. A severe disease can cause blood vessel damage

and a reduction in blood flow to the gallbladder, resulting in cholecystitis.

Cholelithiasis is usually caused by an excess of cholesterol in the bile stored in

the gallbladder. Cholesterol solidifies and hardens into stone-like things. Increased body

weight and age are linked to higher amounts of cholesterol in the bile. As a result,

gallstones are more prone to form in women, fat persons, and the elderly. Some

gallstones form as a result of too much bilirubin in the bile, which is a waste product of

the liver and a component of bile. Pigment stones are gallstones that form as a result of

an excess of bilirubin. The types of gallstones are:

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 CHOLESTERTOL STONES - These are usually yellow-green. They are

the most common, making up 80% of gallstones.

 PIGMENT STONES - These are smaller and darker stones that are made

of bilirubin.

 MIXED STONES - Lytic enzymes from the bacteria and leukocytes

hydrolyze bilirubin conjugates and fatty acids. As a result, over time,

cholesterol stones may accumulate a substantial proportion of calcium

bilirubinate and other calcium salts, producing mixed gallstones.

RELATED LITERATURE

Cholelithiasis: Causitive factors, clinical manifestations and Management (Pimpale, et

al., 2019)

In this study, symptomatic or asymptomatic patients were diagnosed

ultrasonically in India. The demographic and etiological factors, the clinical

manifestations of Cholelithiasis and its surgical management with its postoperative

complications were evaluated. Pain was the most common presentation of

cholelithiasis. All patients had pain, as it was an inclusion criterion with 66.30%

patients having dyspepsia. The ultrasound revealed 7.6% of patients with solitary stones

and 92.40% with multiple stones present in the study. All patients in the study

underwent surgery. Cholelithiasis is commonly seen in females presenting with

abdominal pain and dyspepsia. Multiple gallstones are common and laparoscopic

cholecystectomy is the best surgical management with 6.57% of conversion rate to open

cholecystectomy, with lesser complications.

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Acute calculus cholecystitis : Review of current best practices. (Gomes, et al.,

2017)

In this study, a review of current best practices to allow surgical teams to develop

practical bedside decision-making strategies. The aim of performing a less demanding

procedure on the patient as well as have a lower frequency of complications.

Management of associated common bile duct stones treatment wise depends on the

level of surgical expertise, equipment, and the availability of multidisciplinary facilities

at each hospital. Laparoscopy is the suggested best treatment and first approach for

cholecystectomy because it is almost guaranteed to have advantages over open surgery.

In some cases, percutaneous cholecystostomy may be used as a lifesaving maneuver.

Lastly, the possibility of choledocholithiasis should be kept in mind and its therapeutic

alternatives considered. Recognizing the basic antimicrobial use for prophylactic and

therapeutic purpose principles is also important.

Operative Management of Cholecystitis and Cholelithiasis. (Perez & Pappas,

2019)

According to Perez and Pappas (2019), minimally invasive surgery has

revolutionized the way patients with these conditions are managed. It is a safe and

effective therapy that also results in reduced wound-related complications in

comparison to open cholecystectomy. Laparoscopic cholecystectomy is one of the most

commonly performed abdominal surgeries in the United States.

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VII. REFERENCES

Sherly Abraham|Haidy G. Rivero|Irina V. Erlikh|Larry F. Griffith|Vasantha K.

Kondamudi. (2014, May 15). Surgical and Nonsurgical management of
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Terrie, Y. C., Pharm, B., & RPh Clinical Pharmacist/Freelance Medical Writer

Haymarket, Virginia. (2020, December 18). A review of cholelithiasis and
cholecystitis for pharmacists. U.S. Pharmacist – The Leading Journal in
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Cholecystitis & cholelithiasis - PPT video online download. (2017, July 11). SlidePlayer
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Gallstones (Cholelithiasis): Practice essentials, background, pathophysiology. (2021,

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Cholecystitis cholelithiasis-presentation. (n.d.). Share and Discover Knowledge on

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Cholecystitis and cholelithiasis. (n.d.). Share and Discover Knowledge on

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Patrick J. Bacaj, H. James Williams, 2020. (2020, September 11). SAGE
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Simore Afamefuna Candidate Philadelphia College of Osteopathic Medicine School of

Pharmacy Suwanee, Georgia Shari N. Allen, BCPP Assistant Professor of
Pharmacy Practice Philadelphia College of Osteopathic Medicine School of
Pharmacy Suwanee, Georgia. (2013, March 20). Gallbladder disease:
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pathophysiology-diagnosis-and-treatment

Tests to diagnose gallstone disease. (n.d.). Cleveland

Clinic. https://my.clevelandclinic.org/health/diagnostics/12026-tests-to-
diagnose-gallstone-disease.

Tanaja, J., 2021. Educational Case: Gallstones, Cholelithiasis, and Cholecystitis -

Alexander R. Gross, Patrick J. Bacaj, H. James Williams, 2020. [online] SAGE
Journals. Available at:
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Gross, A., Bacaj, P. and Wiliams, J., 2021. Educational Case: Gallstones, Cholelithiasis,
and Cholecystitis - Alexander R. Gross, Patrick J. Bacaj, H. James Williams,
2020. [online] SAGE Journals. Available at:
<https://journals.sagepub.com/doi/full/10.1177/2374289520951902?
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4D1BqdE0> [Accessed 23 September 2021].

Cholecystitis Nursing Care Management and Study Guide. (2017, February 9).
Nurseslabs. https://nurseslabs.com/cholecystitis/#medical_management

Alligood, M. (2018). Nursing Theorists and their work. (9 th Edition). Elsevier

(Singapore) Pte. Ltd.

Gomes, C. A., Junior, C. S., Di Saverio, S., Sartelli, M., Kelly, M. D., Gomes, C. C.,
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calculous cholecystitis: Review of current best practices. World journal of
gastrointestinal surgery, 9(5), 118–126. https://doi.org/10.4240/wjgs.v9.i5.118

Perez, A., & Pappas, T. N. (2019). Operative Management of Cholecystitis and

Cholelithiasis. In Shakelford’s Surgery of the Alimentary Tract, 2 Volume Set
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Pimpale, R., Katakwar, P., & Akhtar, M. (2019). Cholelithiasis: causative factors,
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