Cholecystitis
• Is an inflammation of the gallbladder. The
gallbladder is the small sac-like organ located in
the upper right side of the abdomen, just
below the liver.
• 2 types
- Acute cholecystitis
- Chronic cholecystitis
Pathophysiology
Diagnostic/Lab Tests
• Blood tests.
• Imaging tests
• A hepatobiliary iminodiacetic acid
(HIDA)
Treatment Regimen
• Antibiotics for fighting infection oral
dissolution therapy using medications to help
dissolve gallstones (this is typically a last
resort, reserved for individuals who cannot
undergo surgery) pain relievers for controlling
pain during treatment.
• Chronic cholecystitis requires the removal of
the gallbladder surgically.
Surgery
• Gallbladder surgery is generally done
laparoscopically.
Diet and Nutrition
• Upon recovery, eating five to six smaller meals
a day is recommended. This allows the bile in
your digestive tract to normalize.
• Stick to a low-fat diet with lean proteins, such
as poultry or fish.
• Avoid fatty meats, fried food, and any high-fat
foods, including whole milk products.
Exercise
• Two to three hours per week of recreational
physical activity like running, jogging, playing
tennis, walking briskly reduced the risk of
gallstones by 31 percent.
Exercise after cholecystectomy
• Start slowly, by walking several times a day with a
low pace. This could be around the yard, block, or
even just around your home. Increase the
duration and pace every day, according to your
body.
• Avoid strenuous activity, like moving, carrying or
lifting heavy objects for 10 to 14 days, or as
directed by your doctor.
Prevention and Prognosis
Prevention: A person can reduce the risk of cholecystitis and
cholelithiasis by taking the following steps to prevent
gallstones:
• Lose weight slowly. Rapid weight loss can increase the risk
of gallstones. If you need to lose weight, aim to lose 1 or 2
pounds (0.5 to about 1 kilogram) a week.
• Maintain a healthy weight. To achieve a healthy weight,
reduce calories and increase your physical activity. Maintain
a healthy weight by continuing to eat well and exercise.
• Choose a healthy diet. Diets high in fat and low in fiber may
increase the risk of gallstones. To lower your risk, choose a
diet high in fruits, vegetables and whole grains.
Prevention and Prognosis
Prognosis: Less than half of patients with
gallstones become symptomatic. The mortality
rate for an elective cholecystectomy is 0.5% with
less than 10% morbidity. The mortality rate for
an emergent cholecystectomy is 3%-5% with
30%-50% morbidity. Following cholecystectomy,
stones may recur in the bile duct.
Nursing
diagnoses
and
Intervention
Acute pain related to Biological injuring agents:
obstruction/ductal spasm, inflammatory process, tissue
ischemia/necrosis
• Observe and document location, severity (0–10 scale), and
character of pain (steady, intermittent, colicky).
• Note response to medication, and report to physician if pain is not
being relieved
• Promote bedrest, allowing patient to assume position of comfort.
• Use soft or cotton linens; calamine lotion, oil bath; cool or moist
compresses as indicated.
• Control environmental temperature.
• Encourage use of relaxation techniques. Provide diversional
activities.
• Make time to listen to and maintain frequent contact with patient.
• Maintain NPO status, insert and/or maintain NG suction as
indicated.
Risk for Imbalanced Nutrition: Less Than Body Requirements
related to Self-imposed or prescribed dietary restrictions,
nausea/vomiting, dyspepsia, pain
• Weigh as indicated.
• Consult with patient about likes and dislikes, foods that cause distress, and
preferred meal schedule.
• Provide a pleasant atmosphere at mealtime; remove noxious stimuli.
• Assess for abdominal distension, frequent belching, guarding, reluctance
to move.
• Ambulate and increase activity as tolerated.
• Consult with dietitian or nutritional support team as indicated.
• Advance diet as tolerated, usually low-fat, high-fiber. Restrict gas-
producing foods (onions, cabbage, popcorn) and foods or fluids high in fats
(butter, fried foods, nuts).
• Monitor laboratory studies: BUN, prealbumin, albumin, total protein,
transferrin levels.
• Provide parenteral and/or enteral feedings as needed.
Risk for Deficient Fluid Volume related to Excessive losses
through gastric suction; vomiting, distension, and gastric
hypermotility
• Maintain accurate record of I&O, noting output less than intake,
increased urine specific gravity. Assess skin and mucous membranes,
peripheral pulses, and capillary refill.
• Monitor for signs and symptoms of increased or continued nausea or
vomiting, abdominal cramps, weakness, twitching, seizures, irregular
heart rate, paresthesia, hypoactive or absent bowel sounds, depressed
respirations.
• Eliminate noxious sights or smells from environment.
• Perform frequent oral hygiene with alcohol-free mouthwash; apply
lubricants.
• Use small-gauge needles for injections and apply firm pressure for
longer than usual after venipuncture.
• Assess for unusual bleeding: oozing from injection sites, epistaxis,
bleeding gums, ecchymosis, petechiae, hematemesis or melena.
• Keep patient NPO as necessary.
• Insert NG tube, connect to suction, and maintain patency as indicated.
Anxiety (severe) related to situational crisis and stress
AMB too much talking; restlessness secondary to
upcoming surgery
• Established NPI
• Monitor vital signs
• Observe Behaviours
• Notes reports of insomnia
• Reviewed Coping skills in post.
• Established therapeutic relationship, conveying
empathy and unconditional positive regard. Note SN
needs to be aware of own feelings of anxiety or
uneasiness exercising core.
• Provided accurate information about the situation .
• Provided comfort measures (e.g calm and quiet
environment, warm bath or backrub
Deficient knowledge related to Lack of
knowledge/recall
• Explain reasons for test procedures and preparations as needed.
• Review disease process and prognosis. Discuss hospitalization and prospective
treatment as indicated. Encourage questions, expression of concern.
• Review drug regimen, possible side effects.
• Discuss weight reduction programs if indicated
• Instruct patient to avoid food/fluids high in fats (pork, gravies, nuts, fried foods,
butter, whole milk, ice cream), gas producers (cabbage, beans, onions,
carbonated beverages), or gastric irritants ( spicy foods, caffeine, citrus).
• Review signs and symptoms requiring medical intervention: recurrent fever;
persistent nausea and vomiting, or pain; jaundice of skin or eyes, itching; dark
urine; clay-colored stools; blood in urine, stools, vomitus; or bleeding from
mucous membranes.
• Recommend resting in semi-Fowler’s position after meals.
• Suggest patient limit gum chewing, sucking on straw and hard candy,
or smoking.
• Discuss avoidance of aspirin-containing products, forceful blowing of nose,
straining for bowel movement, contact sports.
• Recommend use of soft toothbrush, electric razor.
