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Cholelithiasis and Cholecystitis Nursing Care Plan & Management

Notes

Definition
Cholelithiasis
  • Refers to structure of calculi (e.g. gallstones) in the gallbladder.
cholelithiasis1

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Cholecystitis
  • Is intelligent or continuous inflammation of the gallbladder.
    • Acute cholecystits – may be calculous (succeeding a conjuncture gallstones) or acalculous (succeeding a conjuncture gallstones).
    • Chronic cholecystitis – may supervene intelligent cholecystitis, although it habitually arises independently. It is habitually associated succeeding a conjuncture gallstone structure.
Risk Factors
Cholelithiasis
Results from changes in bile components or bile stasis, associated succeeding a conjuncture:
  • Infection
  • Cirrhosis
  • Pancreatitis
  • Celiac complaint
  • Diabetes mellitus
  • Pregnancy
  • Hormonal contraceptive use
Cholecystitis
  • Obstruction of the cystic duct by an impacted gallstone
  • Tissue detriment due to trauma, colossal burns, or surgery
  • Gram-indirect septicemia
  • Multiple race transfusion
  • Prolonged fasting
  • Hypertension
  • Overuse of opioid analgesics
Pathophysiology
Cholelithiasis
Calculi habitually from cubic constituents of bile; the three superior kinds are:
  • Cholesterol gallstones – the most low kind, delook to devise in supersaturated bile
  • Pigment gallstones – deviseed primarily of unconjugated pigments in bile precipitate
  • Mixed kinds – succeeding a conjuncture toneistics of pigment and cholesterol stones.
Gallstones can interrupt the cystic duct, causing cholecystitsi, or the low bile duct, which is named choledocholithiasis.
Cholecystitis
  • In intelligent and continuous cholecystitis, inflammation motives the gallbladder embankment to beseem thickened and edematous and motives the cystic lumen to acception in crossing.
  • If inflammation spreads to the low bile duct, interruption of bile parchage can direct to jaundice. Other immanent complications comprise: (Empyema i.e. pus-filled gallbladder, hole, emphysematous cholecystitis)
Assessment/Clinical Manifestations/Signs And Symptoms
Cholelithiasis (up to ½ of men-folks succeeding a conjuncture gallstones are asymptomatic; at-last immanent clinical manifestations comprise the superveneing)
  • Episodic (uniformly succeeding a tall-fat moderation), cramping aversion in the upupfit surpassing abdominal quadrant or the epigastrium, maybe radiating to the end adjacent the upupfit scapular tip (i.e. biliary colic)
  • Nausea and vomiting
  • Fat intolerance
  • Fever and leukocystosis
  • Signs and symptoms of jaundice
Acute Cholecystitis
  • Biliary colic
  • Tenderness and inelasticity in the upupfit surpassing quadrant elicited on palpation (i.e. Murphy’s look)
  • Fever
  • Nausea and vomiting
  • Fat intolerance
  • Signs and symptoms of jaundice
Chronic Cholecystitis
  • Pain, which is near serious than in the intelligent devise
  • Fever, which is near serious than in the intelligent devise
  • Fat intolerance
  • Heartburn
  • Flatulence
Laboratory and indication con-over findings
Cholelithiasis
  • Biliary ultrasonography (i.e. cholecystosonography) can descry gallstones in most cases.
Cholecystitis
  • White race cell calculate shows leukocytosis
  • Serum alkaline phosphatase is elevated
  • Ultrasonography descrys gallstone
  • Endoscopic ebb cholangiopancreatography may show inflamed low bile ducts, gallbladder, and gallstones.
  • Percutaneous transheptic cholangiography can establish gallstones succeeding a conjuncturein the bile ducts.
Medical Management
Teach the client environing delineationned textures.
  • Chenodeoxycholic discerning is administered to disintegreprimand gallstones. It is powerful in dissolving environing 60% of radiolucent gallstones. Pigment gallstones cannot be disintegrates and must be excised.
  • Nonsurgical resistance, such as lithotripsy or extracorpeal surprise brandish therapy, may be implemented.
Surgical texture may be ordered.
Laparoscopic cholecytectomy (usually outresigned surgery) is effected through a diminutive incision made through the abdominal embankment in the umbilicus.
  • Assess incision sites for poison. Instruct the client to communicate the bloom circumspection procurer if privation of want, vomiting, aversion, abdominal distention, or heat arise.
  • Advise the client that he allure want aid at settlement for 2 to 3 days.
Cholecystectomy is resistance of the gallbladder succeeding ligation of the cystic duct and artery. Indevise the client that a T-tube allure be suggested to parch race; serosanguineous meltings, and bile and that the T-tube must be taped underneath the incision
Choledochostomy is an incision into the low bile duct for calculi resistance.
Cholecystomy is the surgical initiation of the gallbladder for resistance of stones, bile, or pus, succeeding which a parchage tube is placed.
Nursing Diagnosis
  • Acute aversion unimportant to biliary interruption
  • Inpowerful coping akin to disgust
  • Deficient instruction akin to idiosyncraticity
  • Impaired gas substitute akin to tall abdominal surgical incision.
  • Impaired husk candor akin to altered biliary parchage succeeding surgical incision.
  • Imbalanced feeding akin to inwide bile secretion.
Nursing Management
Provide nursing interferences during an intelligent gallbladder onslaught.
  • Intervene to relive aversion; impart prescribed analgesics
  • Promote wide cessation
  • Administer IV meltings, mentor intake and output
  • Monitor nasogastric tube and suctioning
  • Administer antibiotics if prescribed.
Provide wide feeding.
  • Assess feedingal foundation. Encourage a tall-protein, tall-carbohydrate, low-fat nutriment.

Nursing Circumspection Plan


Nursing Diagnosis
  • Fluid Volume, surrender for deficient
Risk contents may comprise
  • Excessive privationes through gastric suction; vomiting, distension, and gastric hyper­motility
  • Medically detested intake
  • Altered clotting regularity
Possibly evidenced by
  • Not misspend. A surrender idiosyncraticity is not evidenced by looks and symptoms, as the bearing has not arisered and nursing interferences are directed at hinderance.
Desired Outcomes
  • Demonstreprimand wide melting redress evidenced by perpetual life-containing looks, juicy mucous membranes, good-natured-natured husk turgor, capillary enrich, partially misspend urinary output, omission of vomiting.
Nursing Interventions
  • Maintain complimentary constantles of I&O, noting output near than intake, acceptiond urine biased ruefulness. Assess husk and mucous membranes, peripheral pulses, and capillary enrich.
    • Rationale: To procure instructure environing melting foundation and circulating compass wanting repossession.
  • Monitor for looks and symptoms of acceptiond or continued disgust or vomiting, abdominal cramps, want, twitching, seizures, disorderly nucleus reprimand, paresthesia, hypoactive or absent bowel sounds, unflourishing respirations.
    • Rationale: Prolonged vomiting, gastric desire, and detested traditional intake can direct to deficits in sodium, potassium, and chloride.
  • Eliminate morbific sights or smells from environment.
    • Rationale: Reduces stimulation of vomiting unfeelingihood.
  • Perdevise habitual traditional hygiene succeeding a conjuncture alcohol-free bungwash; direct lubricants.
    • Rationale: Decreases aridity of traditional mucous membranes; weakens surrender of traditional bleeding.
  • Use diminutive-gauge wantles for suggestions and direct fast influence for longer than habitual succeeding venipuncture.
    • Rationale: Reduces trauma, surrender of bleeding or hematoma structure.
  • Assess for unhabitual bleeding: oozing from suggestion sites, epistaxis, bleeding gums, ecchymosis, petechiae, hematemesis or melena.
    • Rationale: Prothrombin is subdued and coagulation span prolonged when bile career is interrupted, increasing surrender of bleeding or hemorrhage.
  • Keep resigned NPO as wantful.
    • Rationale: Decreases GI secretions and motility.
  • Insert NG tube, associate to suction, and protect patency as involved.
    • Rationale: To cessation the GI Tract

Nursing Diagnosis
  • Pain, intelligent
May be akin to
  • Biological injuring agents: interruption/ductal spasm, irritant regularity, work ischemia/necrosis
Possibly evidenced by
  • Reports of aversion, biliary colic (waves of aversion)
  • Facial misdeclare of aversion; protecting behavior
  • Autonomic repartees (changes in BP, pulse)
  • Self-focusing; narrowed focus
Desired Outcomes
  • Report aversion is characteristic/controlled.
  • Demonstreprimand use of pause skills and diversional activities as involved for idiosyncratic standing.
Nursing Interventions
  • Observe and instrument subsidence, injustice (0–10 layer), and tone of aversion (steady, occasional, colicky).
    • Rationale: Assists in differentiating motive of aversion, and procures instructure environing complaint series and separation, outgrowth of complications, and powerfulness of interferences.
  • Note repartee to medication, and fame to physician if aversion is not being characteristic.
    • Rationale: Severe aversion not characteristic by tenor measures may specify developing complications or want for exalt interference.
  • Promote bedrest, allowing resigned to suppose pose of ease.
    • Rationale: Bedcessation in low-Fowler’s pose weakens intra-abdominal influence; at-last, resigned allure eventually suppose smallest aversionful pose.
  • Use irresolute or cotton linens; calamine lotion, oil bath; irresolute or juicy compresses as involved.
    • Rationale: Reduces irritation and aridity of the husk and itching surprise.
  • Control environmental sphere.
    • Rationale: Cool dressing aid in minimizing dermal vexation.
  • Encourage use of pause techniques. Procure diversional activities.
    • Rationale: Promotes cessation, redirects notice, may improve coping.
  • Make span to attend to and protect habitual contiguity succeeding a conjuncture resigned.
    • Rationale: Helpful in alleviating misgiving and refocusing notice, which can help aversion.
  • Maintain NPO foundation, suggest and/or protect NG suction as involved.
    • Rationale: Removes gastric secretions that incense liberate of cholecystokinin and gallbladder defilements.
Administer medications as involved:
  • Anticholinergics: atropine, propantheline (Pro-Banthı-ne);
    • Rationale: Relieves reflex spasm and srepeatedly muscle defilement and assists succeeding a conjuncture aversion conduct.
  • Sedatives: phenobarbital;
    • Rationale: Promotes cessation and relaxes srepeatedly muscle, relieving aversion.
  • Narcotics: meperidine hydrochloride (Demerol), morphine sulfate;
    • Rationale: Given to weaken serious aversion. Morphine is used succeeding a conjuncture calculation bemotive it may acception spasms of the sphincter of Oddi, although nitroglycerin may be impartn to weaken morphine-induced spasms if they arise.
  • Monoctanoin (Moctanin);
    • Rationale: This medication may be used succeeding a cholecystectomy for retained stones or for newly deviseed wide stones in the bile duct. It is a verbose texture (1–3 wk) and is administered via a nasal-biliary tube. A cholangiogram is produced periodically to mentor stone disruption.
  • Smooth muscle relaxants: papaverine (Pavabid), nitroglycerin, amyl nitrite;
    • Rationale: Relieves ductal spasm.
  • Chenodeoxycholic discerning (Chenix), ursodeoxycholic discerning (Urso, Actigall);
    • Rationale: These eventual bile discernings retrench cholesterol form, dissolving gallstones. Success of this texture depends on the number and magnitude of gallstones (preferably three or fewer stones diminutiveer than 20 min in crossing) inchoate in a functioning gallbladder.
  • Antibiotics.
    • Rationale: To discourse transmitted regularity, reducing inflammation.

Nursing Diagnosis
  • Nutrition: Near Than Body Requirements, Surrender for Imbalanced
Risk contents may comprise
  • Self-imposed or prescribed nutrimentary cessationrictions, disgust/vomiting, dyspepsia, aversion
  • Loss of nutrients; adulterated fat digestion due to interruption of bile career
Possibly evidenced by
  • Not misspend. A surrender idiosyncraticity is not evidenced by looks and symptoms, as the bearing has not arisered and nursing interferences are directed at hinderance.
Desired Outcomes
  • Report exemption of disgust/vomiting.
  • Demonstreprimand series toward desired heaviness perform or protect heaviness as partially misspend.
Nursing Interventions
  • Calculate caloric intake. Keep comments environing want to a reserve.
    • Rationale: Identifies feedingal deficiencies and/or wants. Focusing on bearing creates a indirect latitude and may interfere succeeding a conjuncture intake.
  • Weigh as involved.
    • Rationale: Monitors powerfulness of nutrimentary delineation.
  • Consult succeeding a conjuncture resigned environing likes and dislikes, foods that motive disturb, and preferred moderation register.
    • Rationale: Involving resigned in delineationning enables resigned to entertain a appreciation of administer and encourages eating.
  • Provide a desirable latitude at moderationtime; transport morbific stimuli.
    • Rationale: Useful in promoting want/reducing disgust.
  • Provide traditional hygiene antecedently moderations.
    • Rationale: A upright bung improves want.
  • Offer effervescent drinks succeeding a conjuncture moderations, if tolerated.
    • Rationale: May nearen disgust and help gas. Note:May be contrainvolved if beverage motives gas structure/gastric vexation.
  • Assess for abdominal distension, habitual belching, protecting, unwillingness to provoke.
    • Rationale: Nonverbal looks of disorder associated succeeding a conjuncture adulterated digestion, gas aversion.
  • Ambulate and acception essential-quality as tolerated.
    • Rationale: Helpful in expulsion of flatus, contraction of abdominal distension. Contributes to overall rectification and appreciation of weal and retrenchs possibility of unimportant bearings akin to imperturbability (pneumonia, thrombophlebitis).
  • Consult succeeding a conjuncture nutrimentitian or feedingal livelihood team as involved.
    • Rationale: Useful in establishing idiosyncratic feedingal wants and most misspend path.
  • Begin low-fat melting nutriment succeeding NG tube is transportd.
    • Rationale: Limiting fat contenteded weakens stimulation of gallbladder and aversion associated succeeding a conjuncture marred fat digestion and is salubrious in baring perching.
  • Advance nutriment as tolerated, habitually low-fat, tall-fiber. Restrict gas-producing foods (onions, crib, popcorn) and foods or meltings tall in fats (butter, fried foods, nuts).
    • Rationale: Meets feedingal requirements conjuncture minimizing stimulation of the gallbladder.
  • Administer bile salts: Bilron, Zanchol, dehydrocholic discerning (Decholin), as involved.
    • Rationale: Promotes digestion and aridity of fats, fat-soluble vitamins, cholesterol. Useful in continuous cholecystitis.
  • Monitor laboratory studies: BUN, prealbumin, albumin, completion protein, transferrin levels.
    • Rationale: Provides instructure environing feedingal deficits or powerfulness of therapy.
  • Provide parenteral and/or enteral feedings as wanted.
    • Rationale: Alternative feeding may be required depending on rate of incompetency and gallbladder involvement and want for prolonged gastric cessation.

Nursing Diagnosis
  • Deficient Knowledge
May be akin to
  • Lack of instruction/recall
  • Instructure misinterpretation
  • Unfamiliarity succeeding a conjuncture instructure resources
Possibly evidenced by
  • Questions; petition for notice
  • Statement of misconception
  • Incomplimentary supervene-through of instruction
  • Development of barable complications
Desired Outcomes
  • Verbalize construction of complaint regularity, prognosis, immanent complications.
  • Verbalize construction of sanitary wants.
  • Initiate wantful lifestyle changes and have-a-share in texture nutriment.
Nursing Interventions
  • Explain reasons for examination procedures and preparations as wanted.
    • Rationale: Instructure can retrench misgiving, thereby reducing ungrate-ful stimulation.
  • Review complaint regularity and prognosis. Discuss hospitalization and prospective texture as involved. Encourage questions, look of solicitude.
    • Rationale: Provides instruction low from which resigned can execute informed choices. Powerful despatch and livelihood at this span can contract misgiving and prefer healthful.
  • Review offal nutriment, immanent border property.
    • Rationale: Gallstones habitually come-back, necessitating long-term therapy. Outgrowth of diarrhea or cramps during chenodiol therapy may be dose-akin or correctable. Note: Women of childbearing age should be counseled concerning extraction administer to bar pregnancy and surrender of fetal hepatic detriment.
  • Discuss heaviness contraction programs if involved
    • Rationale: Obesity is a surrender content associated succeeding a conjuncture cholecystitis, and heaviness privation is salubrious in medical conduct of continuous situation.
  • Instruct resigned to shirk food/fluids tall in fats (pork, gravies, nuts, fried foods, butter, healthy arrange, ice gist), gas producers (cabbage, beans, onions, carbonated beverages), or gastric irritants ( sweet-smelling foods, caffeine, citrus).
    • Rationale: Limits or bars perching of gallbladder onslaughts.
  • Review looks and symptoms requiring medical interference: come-backrent heat; perennial disgust and vomiting, or aversion; jaundice of husk or eyes, itching; ebon urine; clay-colored stools; race in urine, stools, vomitus; or bleeding from mucous membranes.
    • Rationale: Indicative of series of complaint regularity and outgrowth of complications requiring exalt interference.
  • Recommend cessationing in semi-Fowler’s pose succeeding moderations.
    • Rationale: Promotes career of bile and public pause during moderate digestive regularity.
  • Suggest resigned proviso gum chewing, sucking on straw and unfeeling candy, or smoking.
    • Rationale: Promotes gas structure, which can acception gastric distension and vexation.
  • Discuss shirkance of aspirin-containing products, forceful blowing of nose, precipitation for bowel provokement, contiguity sports.
    • Rationale: Reduces surrender of bleeding akin to changes in coagulation span, mucosal irritation, and trauma.
  • Recommend use of irresolute toothbrush, electric razor.
    • Rationale: Reduces surrender of bleeding akin to changes in coagulation span, mucosal irritation, and trauma.

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