MEDICAL SURGICAL NURSING

LESSON PLAN ON
CHOLECYSTITIS
SUBMITTED TO, SUBMITTED BY,

SUBMITTED ON,
 IDENTIFICATION DATA

• Name of the student teacher : Ms. Priyanka R. Deorukhkar.

• Course : First Year M.Sc. Nursing
• Subject : Medical Surgical Nursing
• Unit :
• Topic :Cholecystitis.
• Date :
• Venue :
• Time :
• Number of students : 03
• Method of teaching : Lecture cum discussion
• A.V. Aids : Black board, power point, chart, palm plates.
• Previous knowledge of students : A group having less knowledge regarding cholecystitis.
 GENERAL OBJECTIVES
After completion of this lesson plan students will beable to learn about cholecystitis in-detailed.

SPECIFIC OBJECTIVES
After completion of this lesson plan students will be able to;
• Introduce the cholecystitis.
• Define cholecystitis.
• Enlist the types of the cholecystitis.
• Know the incidence of cholecystitis.
• Explain the aetiology of cholecystitis.
• Enlist the signs and symptoms of cholecystitis.
• Explain the pathophysiology of cholecystitis.
• Describe the diagnostic evaluation of cholecystitis.
• Explain medical management of cholecystitis.
• Know the surgical management of cholecystitis.
• Explain the nursing management of cholecystitis.
• Describe the complications of cholecystitis.
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2min Introduce the • INTRODUCTION:
topic
Cholecystitis is the medical name for inflammation of the
gallbladder. The gallbladder assists in the digestive process by storing
and releasing the substance called bile into the small intestine, which
helps break down food. Cholecystitis is most often the result of an
obstruction within a duct in the gallbladder.

• DEFINITION:
2min Define
Lecture cum Palmplate Define
cholecystitis
Cholecystitis is defined as an inflammation of the gallbladder that discussion cholecystitis?
occurs most commonly because of an obstruction of the cystic duct
from cholelithiasis.
The inflammatory condition of Gall Bladder is called as Cholecystitis.

Enlist the • TYPES:

Lecture cum chart What are the
5min types of
1. Acute cholecystitis: discussion types of
cholecystitis
Acute cholecystitisis a sudden inflammation of the gallbladder cholecystitis?
that causes severe abdominal pain.

There are two types of acute cholecystitis;

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A.) Calculous cholecystitis: -

Calculous cholecystitis is the most common, and usually less serious,

type of acute cholecystitis. It accounts for around 95% of all cases.
Calculous cholecystitis develops when the main opening to the
gallbladder, the cystic duct, gets blocked by a gallstone or a substance
known as biliary sludge. Biliary sludge is a mixture of bile, a liquid
produced by the liver that helps digest fats, and small cholesterol and
salt crystals. The blockage in the cystic duct causes bile to build up in
the gallbladder, increasing the pressure inside it and causing it
to become inflamed. In around 1 in every 5 cases, the inflamed
gallbladder also becomes infected by bacteria.

B.) Acalculous cholecystitis: -

Acalculous cholecystitis is a less common, but usually more serious,

type of acute cholecystitis. It usually develops as a complication of a
serious illness, infection or injury that damages the gallbladder.
Acalculous cholecystitis can be caused by accidental damage to the
gallbladder during major surgery, serious injuries or burns, sepsis,
severe malnutrition or HIV/AIDS.
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2. Chronic Cholecystitis:

-Chronic Cholecystitis is long- standing swelling and irritation of the

gallbladder.
-It almost always results from gallstones and from prior
attacks of acute cholecystitis.
-Chronic cholecystitis is characterized by repeated attacks of pain
(biliary colic) that occur when gallstones periodically block the cystic
duct.
-In chronic cholecystitis, the gallbladder is damaged by repeated
attacks of acute inflammation, usually due to gallstones, and may
become thick-walled, scarred, and small.

-The gallstones may block the opening of the gallbladder into the
cystic duct or block the cystic duct itself. The gallbladder usually also
contains sludge. If scarring is extensive, calcium may be deposited in
the walls of the gallbladder, causing them to harden (called porcelain
gallbladder).
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2min Know the • INCIDENCE: Lecture cum Power What is the
incidence of discussion point incidence of
cholecystitis Although the incidence of acute cholecystitis is unknown, about cholecystitis?
120,000 Americans are treated for acute cholecystitis annually. At age
65, 25% of women and 12% of men will have gallstone disease.
Approximately 10% of all patients with symptomatic gallstones will
develop cholecystitis.
4min Explain the Lecture cum Black What are the
• ETIOLOGY: discussion
etiology of board causes of
cholecystitis Cholecystitis occurs when your gallbladder becomes inflamed. cholecystitis?
Gallbladder inflammation can be caused by;

1.Gallstones:
-Most often, cholecystitis is the result of hard particles that
develop in your gallbladder (gallstones).
-Gallstones can block the tube (cystic duct) through which bile flows
when it leaves the gallbladder. Bile builds up, causing inflammation.

2.Tumor:
-A tumor may prevent bile from draining out of
yourgallbladder properly, causing bile build-up that can lead to
cholecystitis.
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3.Bile duct blockage:

-Kinking or scarring of the bile ducts can cause blockages that
lead to cholecystitis.

4.Infection:
- AIDS and certain viral infections can trigger gallbladder
inflammation.

5.Blood vessel problems:

- A very severe illness can damage blood vessels and decrease
blood flow to the gallbladder, leading to cholecystitis.
3min Enlist the Lecture cum Power Enlist the signs
signs and • SIGNS AND SYMPTOMS: discussion point and symptoms of
symptoms of cholecystitis?
cholecystitis • Severe pain in your upper right or centre abdomen

• Pain that spreads to your right shoulder or back

• Tenderness over your abdomen when it's touched

• Nausea

• Vomiting

• Fever
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6min Explain the Lecture cum Power Explain the
pathophysiologyof • PATHOPHYSIOLOGY: discussion point pathophysiology
cholecystitis Due to the etiological factors of cholecystitis?

Chemical irritation of the obstructed gallbladder.

The protective glycoprotein mucus layer is disrupted.

Prostaglandins contribute to inflammation.

Gallbladder dysmotility.

Increased intraluminal pressure compromise blood flow to

the mucosa.

Later in the course bacterial contamination may develop

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5min Describe the Lecture cum Power What is the
diagnostic • DIAGNOSTIC EVALUATION: discussion point diagnostic
evaluation of evaluation of
cholecystitis cholecystitis?
- History collection (Family history)
- Physical examination: -
Murphy's sign is elicited in patients with acute cholecystitis
by asking the patient to take in and hold a deep breath while
palpating the right subcostal area. If pain occurs on
inspiration, when the inflamed gallbladder comes into
contact with the examiner's hand, Murphy's sign is positive.
- Blood test: -
i. Complete blood count (CBC).
ii. Liver function test.
- CT Scan: -
(The CT scan uses X-rays to produce very detailed pictures
of abdomen, to view your gallbladder and liver. This will
help them visualize stones and duct obstructions.)
- A HIDA scan, an injection of a small amount of radioactive
material can help identify abnormal contractions or
obstructions of your gallbladder and bile ducts.
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- Endoscopic retrograde
cholangiopancreatography involves using an endoscope (a
long, flexible tube inserted down the throat), dye, and an X-
ray to thoroughly examine the organs and find defects or
problems.
- In a percutaneous transhepatic cholangiography, doctor
will insert contrast dye into the liver with a needle. This
allows doctor to see bile ducts on X-ray.
- Magnetic Resonance Cholangiopancreatography
(MRCP): - This type of MRI shows details of your liver,
gallbladder, bile ducts, structures and ducts of the pancreas
as well. It can show gallstones, inflammation or blockage of
the bile ducts and gallbladder and if there is any
inflammation of the pancreas.

5min Explain the Lecture cum Power What is the

medical discussion point medical
management • MEDICAL MANAGEMENT: management of
of cholecystitis?
cholecystitis Management may involve controlling the signs and symptoms
and the inflammation of the gallbladder;
1. Fasting. The patient may not be allowed to drink or eat at first in
order to take the stress off the inflamed gallbladder; IV fluids are
prescribed to provide temporary food for the cells.
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2.Supportive medical care. This may include restoration
pf hemodynamic stability and antibiotic coverage for gram-
negative enteric flora.

3. Gallbladder stimulation. Daily stimulation of gallbladder

contraction with IV cholecystokinin may help prevent the
formation of gallbladder sludge in patients receiving TPN.

• Pharmacologic Therapy:

1. Antibiotic therapy. Levofloxacin and Metronidazole for

prophylactic antibiotic coverage against the most common
organisms.
2. Promethazine or Prochlorperazine may control nausea
and prevent fluid and electrolyte disorders.
3. Oxycodone or Acetaminophen may control inflammatory
signs and symptoms and reduce pain.
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5min Know the • SURGICAL MANAGEMENT: Lecture cum Power Explain the
surgical discussion point surgical
management management of
of 1. Cholecystectomy,is usually performed by making tiny cholecystitis?
cholecystitis cuts (incisions) through the abdomen to insert a
laparoscope (tiny camera) to see inside the abdomen and
surgical instruments to remove the gallbladder. The
gallbladder is usually removed within 24 to 48 hours of
admission if you have a confirmed case of acute
cholecystitis.
2. Draining the gallbladder to treat and prevent the spread
of infection. This procedure, called percutaneous
cholecystostomy, is usually reserved for those who are
too ill to undergo surgery.
3. Removing gallstones in the area blocking the common
bile duct. This procedure, done by an endoscopist,
called endoscopic retrograde
cholangiopancreatography (ERCP), is reserved for
patients with a suspected or confirmed blocked common
bile duct, and can clear the duct of stones and sludge.
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6min Explain the • NURSING MANAGEMENT: Lecture cum Palmplate What is the
nursing discussion nursing
management Management of cholecystitis include the following: management of
of cholecystitis?
cholecystitis
Nursing Assessment -
• Integumentary system. Assess skin and mucous
membranes.
• Circulatory system. Assess peripheral pulses and capillary
refill.
• Bleeding. Assess for unusual bleeding: oozing from
injection sites, epistaxis, bleeding gums, petechiae,
ecchymosis, hematemesis, or melena.
• Gastrointestinal system. Assess for abdominal distension,
frequent belching, guarding, and reluctance to move.

Nursing Diagnosis -
Based on the assessment data, the major nursingdiagnosis for the
patient may include;
• Acute pain related to the inflammatory process.
• Risk for imbalanced nutrition related to self-imposed
dietary restrictions and pain.
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Nursing Care Planning & Goals –

The major goals for the patient include:

• Relieve pain and promote rest.
• Maintain fluid and electrolyte balance.
• Prevent complications.
• Provide information about disease process, prognosis, and
treatment needs.

Nursing Interventions-

Treatment of cholecystitis depends on the severity of the condition and

the presence or absence of complications.
• Pain assessment. Observe and document location, severity
(0-10 scale), and character of pain.
• Activity. Promote bedrest, allowing the patient to assume a
position of comfort.
• Diversion. Encourage use of relaxation techniques, and
provide diversional activities.
• Communication. Make time to listen and to maintain
frequent contact with the patient.
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• Calories. Calculate caloric intake to identify nutritional

deficiencies or needs.
• Food planning. Consult the patient about likes and dislikes,
foods that cause distress, and preferred meal schedules.
• Promote appetite. Provide a pleasant atmosphere at
mealtime and remove noxious stimuli.
• Laboratory studies. Monitor laboratory studies: BUN, pre-
albumin, albumin, total protein, transferrin levels .

Evaluation-

Expected patient outcomes are;

• Pain relieved.
• Homeostasis achieved.
• Complications prevented/minimized.
• Disease process, prognosis, and therapeutic regimen
understood.
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3min Describe the • COMPLICATIONS: Lecture cum Handout What are the
complications discussion complications of
of Cholecystitis can progress to gallbladder complications, such as: cholecystitis?
cholecystitis

• Empyema. An empyema of the bladder develops if the

gallbladder becomes filled with purulent fluid.
• Gangrene. Gangrene develops because the tissues do not
receive enough oxygen and nourishment at all.
• Cholangitis. The infection progresses as it reaches the bile
duct.
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2min Summarised SUMMARY
the topic
cholecystitis In this lesson plan we have discussed, regarding definition of
cholecystitis, types, causes, incidence of cholecystitis, pathophysiology,
signs and symptoms, diagnostic evaluation and in management,
medical management, surgical management and nursing management
of cholecystitis and their complications.

2min
CONCLUSION

After this lesson plan, I have concluded that cholecystitis is

the inflammation of gallbladder due to the obstruction from existing
bile. This can be prevented by modifying the life style. It can be easy to
diagnose and easy to manage. If diagnosed early then it is cured by
medicines.
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