Nursing Concept Map
Cholecystitis - Week 8
Pathophysiology = RT
The cause of gallstones is unknown.
They develop when the balance that
keeps cholesterol, bile salts, and
calcium in solution is changed so that
these substances precipitate. In
patients with gallstones, the bile
secreted by the liver is supersaturated
with cholesterol (lithogenic bile). The
bile in the gallbladder then becomes
supersaturated with cholesterol and
precipitation of cholesterol occurs in
the gallbladder. Other components of
bile that precipitate into stones are
bile salts, bilirubin, calcium, and
protein. (Harding, 2020, p. 999)
Signs & Symptoms = AEB
Initial symptoms of cholecystitis:
* acute pain and tenderness in the
right upper quadrant, pain may be
accompanied by nausea and
vomiting, restlessness, and
diaphoresis; Abd distended
* Fever, chills, and jaundice
* Inflammation results in
leukocytosis and fever;
*Jaundice, icteric sclera
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(Harding, 2020)
Risks for Developing Nursing Diagnosis
Gangrenous cholecystitis, subphrenic * Acute Pain related to obstruction
abscess, pancreatitis, cholangitis of the ducts by stones as evidenced
(inflammation of biliary ducts), biliary
cirrhosis, fistulas, and rupture of the by reporting pain at the abdomen
gallbladder, which can cause bile * Deficient Knowledge related to
peritonitis
Unfamiliarity with information
resources as evidenced by request
for information and questions on
Disease Process
the disease process.
Diagnostics Medications
 Alkaline phosphatase, • IV fluid; Antiemetics
ALT, and AST • Analgesics;Anticholinergics
 Direct and indirect • Antibiotics (for secondary Nursing Interventions
bilirubin levels, and infection)
 Urinary bilirubin • Fat-soluble vitamins (A, D, * Administer pain meds as ordered
levels E, and K) * Administer meds for relieving
nausea and vomiting,
* Maintain fluid & electrolyte
balance, nutrition
Education * Oral hygiene, care of nares,
accurate I & O monitor
1. Remove the bandages on the puncture sites the day after * Observe for signs of obstruction
surgery and you can shower. of the ducts by stones include
2. Notify your HCP if any of the following s/s occurs: Redness, jaundice; clay-colored stools; dark,
swelling, bile-colored drainage or pus from any incision; Severe foamy urine; steatorrhea; fever;
abdominal pain, nausea, vomiting, fever, chills and increased WBC count.
3. You can gradually resume normal activities. * Assessment for infections: vital
4. Return to work within 1 wk of surgery. signs, fever with chills jaundice may
5. You can resume your usual diet, but a low-fat diet is usually indicate choledocholithiasis
better tolerated for several weeks after surgery.