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Understanding Cholecystitis and how to care for it... Nursing Care Plan

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Cholecystitis

Pathophysiology
Cholecystitis is the inflammation of the gallbladder, which holds bile, a digestive juice, that is released into the small intestine. When the path (bile duct) between the gallbladder and small intestine is blocked, bile becomes trapped, builds up and causes inflammation. Surgical removal of the gallbladder is commonly required.

Etiology
The cause of obstruction of the bile duct may vary. The majority of cases are caused by gallstones (calculi) that get trapped in the bile duct. Biliary sludge is the mixture of bile, cholesterol and salt that can build up and form a blockage. Other obstructions may develop from infection, tumors, or edema from compression of the blood vessels.
Desired Outcome
Patient will be free of pain and resume and maintain optimal diet and nutrition.
Cholecystitis Nursing Care Plan
Subjective Data:
Nausea
Loss of appetite
Severe abdominal pain, RUQ or center
Objective Data:
Fever
Vomiting
Jaundice (severe cases)
Abnormal labs
Clay-colored stools
Nursing Interventions and Rationales
Assess vital signs
Monitor for signs of cardiopulmonary stress and signs of infection
Tachycardia
Fever

Assess Gastrointestinal status

Look– for distention
Listen– for frequent belching
Feel– for abdominal rigidity and palpable gallbladder, note tenderness

Initiate IV access and administer fluids
IV access will be required for medication administration and for anesthesia if surgery or diagnostic procedures are being performed. Patient will need to be on bowel rest program and IV hydration is essential.
Assess and manage pain
Severe pain is the most common and worrisome symptom. Patients may report pain that radiates from the RUQ to the back
Administer medications
Assist with positioning, place in semi-Fowler’s following meals to aid in digestion
Promote bedrest for comfort

Administer medications
Monitor for effectiveness
Monitor for side effects / adverse reactions

Antibiotics (levofloxacin, cephalosporins, metronidazole) – in cases of infection and for prophylaxis during surgery or procedures
Antiemetics (ondansetron, promethazine) – to control nausea and prevent electrolyte imbalances
Analgesics (oxycodone, acetaminophen)- to manage pain
Cholecystokinin may be given to prevent gallbladder sludge in patients receiving TPN

Monitor diagnostic testing
Labs
Imaging (Ultrasound, CT, MRI, x-rays)
Labs: labs may not always be reliable, but the following are often noted:
AST/ALT – may be elevated due to liver dysfunction in cases of obstruction
Elevated bilirubin may indicate common bile duct obstruction/liver dysfunction
Urinalysis- can be used to rule out pyelonephritis and renal calculi as source of pain
Pregnancy test should be done on all women of childbearing age to prevent fetal demise
Imaging: Ultrasound is the diagnostic choice as it allows visualization of acute disease without excessive radiation exposure
Ultrasound
CT, MRI- may be done for more detailed evaluation or when ultrasound is inconclusive

Prepare patient for diagnostic procedures:
ERCP (Endoscopic Retrograde Cholangiopancreatography) – allows visualization of the biliary system to help diagnose and treat problems with the bile and pancreatic ducts.
HIDA scan (Hepatobiliary Iminodiacetic Acid)- performed by injecting a radioactive dye into the bloodstream and visualizing the flow through a special camera placed on the abdomen

Place patient on clear liquids only for 6-12 hours prior to procedure
Withhold NSAIDS and anticoagulants prior to procedure to avoid excess bleeding and interference with the test
Assist patient with ambulation after the tests as medication (often morphine) given during the procedure may cause drowsiness

Nutrition and Lifestyle education

Obesity is often related to gallbladder disease- encourage diet and exercise to control weight
Avoid foods high in fat such as pork, gravies, fried foods, butter
Avoid gas producing foods such as cabbage, beans, carbonated drinks
Limit or avoid gastric irritants such as alcohol, coffee, tea, caffeine

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