Republic of the Philippines

Tarlac State University

College of Science
Department of Nursing
Lucinda Campus, Brgy. Ungot, Tarlac City Philippines 2300
Accredited Level 3 Status by the Accrediting Agency of Chartered Colleges and
Universities in the Philippines (AACUP), Inc.

SURGERY WARD
S/P CHOLECYSTECTOMY SECONDARY TO
CHOLECYSTITIS WITH CHOLELITHIASIS
NCM 116 CLINICAL LABORATORY
Clinical Case Study
MAY 19, 2022

Submitted by:

Ariola, Ma. Daniela

Baldueza, Ann Eugene
Baligod, Bernadette
Carreon, Kenneth
Concepcion, Cazzandra Mae
Dagohoy, Francis Josh
De Lazo, Patricia Lae
Dela Cruz, Erica Mae
Estigoy, Harriet
Guiao, Celine Angela
Macalino, Allysa
Mangacu, Jeric
Sunga, Keithlyn Nicole
Vicente, Cindy Liz

Group 1 BSN 3-2

Submitted to:
Mrs. Maria Theresa T. Mendoza, PHRN, LPT, USRN
Clinical Instructor
 TABLE OF CONTENTS
I. INTRODUCTION-------------------------------------------------------------------------------------------------- 6
II. NURSING PROCESS --------------------------------------------------------------------------------------------- 11
A. ASSESSMENT----------------------------------------------------------------------------------------------------- 11
1. PERSONAL DATA------------------------------------------------------------------------------------------- 11
2. FAMILY HISTORY OF HEALTH AND ILLNESS-------------------------------------------------- 12
3. HISTORY OF PAST ILLNESS---------------------------------------------------------------------------- 13
4. HISTORY OF PRESENT ILLNESS---------------------------------------------------------------------- 13
5. PHYSICAL ASSESSMENT-------------------------------------------------------------------------------- 14
6. LABORATORY AND DIAGNOSTIC PROCEDURE------------------------------------------------ 30
7. ANATOMY AND PHYSIOLOGY------------------------------------------------------------------------ 35
8.PATHOPHYSIOLOGY------------------------------------------------------------------------------------- 37
B. PLANNING---------------------------------------------------------------------------------------------------------- 39
C. IMPLEMENTATION--------------------------------------------------------------------------------------------- 47
1. DRUGS---------------------------------------------------------------------------------------------------------- 47
2. MEDICAL MANAGEMENT------------------------------------------------------------------------------ 53
3. SURGICAL MANAGEMENT----------------------------------------------------------------------------- 54
4. DIET------------------------------------------------------------------------------------------------------------- 55
5. ACTIVITY/EXERCISE------------------------------------------------------------------------------------- 55
6. NURSING MANAGEMENT------------------------------------------------------------------------------- 57
D. EVALUATION----------------------------------------------------------------------------------------------------- 63
III. CONCLUSION----------------------------------------------------------------------------------------------------- 65
IV. RECOMMENDATION------------------------------------------------------------------------------------------- 65
V. REVIEW OF RELATED LITERATURES AND STUDIES---------------------------------------------- 66
VI. BIBLIOGRAPHY-------------------------------------------------------------------------------------------------- 67

2
CASE SCENARIO

Patient TM is a 58-year-old primary school teacher who has been taking her classes online since
the pandemic began. The patient is fond of eating fatty foods and has no time to exercise because
of paperwork. She has hypertension and hypercholesterolemia, which she manages with statins and
amlodipine. She was taken to the hospital by her husband at about 8:00AM with acute abdominal
pain. The patient was seen and examined by the ER-MD with the RNOD, the doctor ordered to
start D5LRS IV Fluid (31 drops). Patient TM said that the discomfort originates in the RUQ and
radiates to the right shoulder during the examination. Her system review revealed that she has
abdominal pain (8/10), which began after eating a large meal the night before and it was
accompanied by nausea, vomiting, and a fever. Her physical exam also revealed positive Murphy's
sign. She was given ketorolac for pain and the ER-MD ordered Stat Abdominal Sonogram. Her lab
results are as follows, CBC; Leukocytes = 12,000 cells/mcL, Hemoglobin = 15 mg/dL, Platelets =
220,000-cells/mcL; Erythrocyte Sedimentation Rate (ESR) = 35 mm/h; C-Reactive Protein (CRP)
Test = 90 mg/L; Blood Chemistry; CR = 0.8 mg/dL, BUN = 16 mg/dL, Na = 140 mEq/L, K = 4.9
mEq/L, Bilirubin = 2.4 mg/dL, ALP = 160 IU/L, AST= 45 IU/L, ALT = 60 IU/L and Cholesterol
Test; LDL = 155 mg/dL, HDL = 32 md/dL.
The result of her ultrasound confirmed severe acute cholecystitis with cholelithiasis.
After giving the ketorolac, Mrs. TM verbalizes mild relief of pain. At 9:00AM patient TM was
transferred to the surgical ward.

SURGERY WARD: Patient TM looks weak with a GCS score of 15/15. Eye opening 4/4, Verbal
response of 5/5, and Motor response 6/6 and her latest pain score is 3/10, 10 being the highest.
Received the MD’S orders:

Patient was admitted under Dr. Carreon, for Open Cholecystectomy tom @10:30 am.

The operating room was notified. The patient was also referred to Dr. Mangacu for
anesthesia including preoperative preparations. Cardiopulmonary clearance notes from
Dr. Dagohoy have been received that patient TM may undergo the contemplated
procedure without cardiac monitoring.

3
 Use Record Number: 4567
Family Name: Patient TM
Owner Name: Patient TM
PRE-OPERATIVE Date of Birth: 06/08/1964
CHECKLIST Age: 58
Sex: F
Room No: 101
DATE – April 21, 2022
SCHEDULED OPERATION – Cholecystectomy- YES N/A
10:30AM
WARD – OR Ward
CONSENT FORM – Signal 
– Witnessed Ann Eugene C.
Baldueza, RN
IDENTIFICATION BAND CHECKED 
OPERATIVE SITE – Prepared (area shaved, skin 
preparation attended)
– Checked 
PRESENT WITH PATIENT – Medical Record 
– Blood work 
CROSS MATCHED FOR BLOOD – Blood type (B+) 
DENTURES 
JEWELRY – Removed 
– Security taped 
REMOVAL – Make-up 
– Nail polish 
ALLERGIES – Seasonal Allergy 
THEATRE ATTIRE WORN BY PATIENT
RECORDED ON DAY OF SURGERY – Vital Signs 
– Weight (90 kg)

TIME DATE
PRE-MEDICATION GIVE 9:00 AM 04/21/22
Dormicun 7.5 mg PO @730 am
LAST VOID 12:00 AM 04/21/22
LEFT WARD 9:40 AM 04/22/22
ARRIVED IN THEATRE 10:00 AM 04/22/22
OTHER COMMENTS N/A
SIGNATURE WARD NURSE: Keithlyn Nicole
Sunga, RN DATE: 04/22/22
SIGNATURE THEATRE NURSE: Harriet Hozea C. DATE: 04/22/22
Estigoy, RN

4
 Immediately after clearance and Pre op checklist were accomplished, she was transported
to the Operating room for the procedure.

As per the OR nurse, the surgery was done almost 4 hrs. and blood loss was approximated
for 300 ml. The patient was transferred to the PACU for monitoring.

After a few hours, the patient was transferred to the Surgical Ward from post anesthesia
care unit, as endorsed by the RN, the patient is oriented about what happened to her, she
was given post op medications such as Tranexamic Acid 500mg IV every 8 hours,
Ondasetron 8mg IV every 8 hours x 2 doses, Ketorolac 30 mg IVP every 8 hours,
Omeprazole 40 mg IV every 8 hours, and Cefoxitin 1 gram IV every 8 hours. With IVF
of D5 Lactated Ringers Solution to run at 30 drops per min. She was also advised to
maintain on NPO maintained flat on bed for 6 hours (until 8 pm). She was closely
monitored for signs of bleeding and any untoward response from the surgery,

24 hours post-op, the patient developed a fever of 38.7 C, she also complained of pain in the surgical
site with PS of 8/10. Upon assessment of the surgical wound, it is noted to be reddish, with intact
sutures, well approximated minimal bloody discharges that covers about 25% of the surgical
dressing.

5
I. INTRODUCTION
A. Brief description of the disease condition

Cholecystitis is a redness and swelling (inflammation) of the gallbladder. It happens when

a digestive juice called bile gets trapped in your gallbladder. If the bile is blocked, it builds up in
your gallbladder. This causes inflammation and can cause infection. Cholecystitis can be sudden
(acute) or long-term (chronic). In most cases, this happens because lumps of solid material
(gallstones/cholelithiasis) are blocking a tube that drains bile from the gallbladder. When gallstones
block this tube, bile builds up in your gallbladder. This causes irritation and pressure in the
gallbladder. It can cause swelling and infection. Signs and symptoms of cholecystitis may include:
Intense, sudden pain in the upper right part of your belly, Pain (often worse with deep breaths) that
spreads to your back or below the right shoulder blade, Nausea, Vomiting, Fever, Yellowing of the
skin and eyes (jaundice), Loose, light-colored bowel movements, Belly bloating. Risk factors
include: Being female, Pregnancy, Hormone therapy, older age, Being Native American or
Hispanic, Obesity, Losing or gaining weight rapidly, Diabetes.

A cholecystectomy is surgery to remove your gallbladder. The gallbladder is a small organ

under your liver. It is on the upper right side of your belly or abdomen. The gallbladder stores a
digestive juice called bile which is made in the liver. There are 2 types of surgery to remove the
gallbladder: Open (traditional) method. In this method, 1 cut (incision) about 4 to 6 inches long
is made in the upper right-hand side of your belly. The surgeon finds the gallbladder and takes it
out through the incision. And Laparoscopic method. This method uses 3 to 4 very small incisions.
It uses a long, thin tube called a laparoscope. The tube has a tiny video camera and surgical tools.
The tube, camera and tools are put in through the incisions. The surgeon does the surgery while
looking at a TV monitor. The gallbladder is removed through 1 of the incisions.

A laparoscopic cholecystectomy is less invasive. That means it uses very small incisions in your
belly. There is less bleeding. The recovery time is usually shorter than an open surgery. In some
cases, the laparoscope may show that your gallbladder is very diseased. Or it may show other

6
problems. Then the surgeon may have to use an open surgery method to remove your gallbladder
safely.

B. Current trends and statistics about disease condition

(Foreign)

According to MHS, from 2014 through 2018, a total of 6,470 active component service
members underwent cholecystectomies. The overall incidence rate of cholecystectomy was 1.0 per
1,000 p-yrs. slightly more than three-fifths of all the procedures were performed in the outpatient
setting (n=4,220; 65.2%), and the vast majority were performed laparoscopically (n=6,300; 97.4%).
There was a small decrease in the annual rate of total cholecystectomy procedures during the
surveillance period from 1.1 per 1,000 p-yrs in 2014 to 0.87 per 1,000 p-yrs in 2018, with slight
decreases observed in the rates of inpatient and outpatient cholecystectomies as well as open and
laparoscopic cholecystectomies.

On average, there were 0.7 hospital bed days per laparoscopic cholecystectomy and 4.8
bed days per open cholecystectomy. The number of hospital bed days per laparoscopic
cholecystectomy remained under 1 bed day during each year of the surveillance period and was
stable throughout the surveillance period. Bed days per open cholecystectomy decreased each year
from a high of 6.6 bed days in 2014 to a low of 2.3 bed days in 2018.

7
(Local)

(Local)

Cholecystectomy is one of the most frequently performed surgical procedures worldwide.

In the Philippines, based on the Phil health claims for 2011, it is the most common general surgery
operation followed by appendectomy. Laparoscopic cholecystectomy (LC) has replaced open
cholecystectomy (OC) as the standard of treatment for uncomplicated cholecystitis globally. It
accounted for 83.3% of cholecystectomies performed in England from 2000 to 2009. In the
Philippine General Hospital (PGH), cholecystectomies done laparoscopically comprised 55% of
all elective cholecystectomies in 2014.

8
The mean age in the open group was 42 +/- 14 years, while mean age in the laparoscopic group
was 44 +/- 15 years. There is no significant difference found in the mean age between the two
groups. Females outnumbered males in both groups: 69% females vs 31% males in the open
cholecystectomy group and 60% female’s vs 40% males in the laparoscopic group.

C. Reasons for choosing the case for presentation

The reason our group has chosen the current case (Cholecystectomy) is for us to acquire

deeper knowledge about the condition and procedure, and how our role as future nurses could

contribute in providing quality care to our patients. This will also facilitate our critical thinking

skills specifically in prioritizing identified nursing problems, health and learning needs of our

patients.

9
 D. OBJECTIVES

General

The general objective of this study is to be able to identify what are the causes, signs and
symptoms, and appropriate interventions for our client. It helps us, student nurses, to expand our
knowledge regarding these issues.

Specific

• To provide a thorough analysis and interpretation of a patient's diagnostic result for

cholecystitis.
• Determine the important aspects affecting the client's current status and identify the
nursing problem based on the patient's clinical signs and symptoms.
• To develop a patient-centered care strategy and intervention.
• To Implement proper intervention that leads to a positive client prognosis.
• To evaluate patient’s condition and effectiveness of care.

10
II. NURSING PROCESS
A. ASSESSMENT
1. Personal Data
a. Demographic Data

Name: Patient TM
Age: 58-year-old
Date of Birth: November 15, 1963
Place of Birth: Tarlac City
Address: San Sebastian, Tarlac City
Sex: Female
Civil Status: Married
Occupation: Primary school teacher
Nationality: Filipino
Chief Complaint: Acute abdominal Pain
Admitting Diagnosis: To consider severe acute cholecystitis with cholelithiasis
Final Diagnosis: S/P CHOLECYSTECTOMY secondary to acute cholecystitis
with cholelithiasis

b. Environmental Status

Patient TM is currently living in San Sebastian, Tarlac City, together with her
husband and two daughters. Their house is made of cement with 3 rooms, which are well
ventilated. The water supply is prime water, and they drink purified water. The garbage
truck collects their garbage regularly every week. Their means of transport include
motorcycles and jeepneys.

c. Lifestyle

Patient TM does not drink alcohol, smoke, or use drugs. She is a primary school
teacher who has been taking her classes online since the pandemic began. She is fond of
eating fatty foods and has no time to exercise because of paper work.

11
2. Family history of health and illness

According to her, on the paternal side, her grandfather died at the age of 89. However, her
grandmother, from the paternal side, had hypertension and died at the age of 80. On her mother's
side, her grandfather and grandmother were both hypertensive and died at the ages of 75 and 73,
respectively. Her parents are still well and alive. Her father and mother sometimes had an episode
of arthritis at the ages of 85 and 84, respectively. She has two siblings; her sister, 50 years old, is
well and healthy, while her brother, 45 years old, recently had surgery for appendicitis and is taking
medication for hypertension. Her husband is 58 years old and her two daughters are both well and
healthy. The eldest, at the age of 28, is working at the bank, while her youngest daughter, at 22
years old, is still a first-year college student.

GENOGRAM

12
3. History of past illness

According to patient TM, she has hypertension and hypercholesterolemia, which she
manages with statins and amlodipine. She said that her stool was firmed and brown in color usually,
but she experienced clay colored stool, few days before she experiences other symptoms. She does
not drink alcohol, smoke, or use drugs. She also said that the pain is on and off. She began to feel
it once a week before and was treated by Buscopan, but the pain had worsened for a week, which
led them to seek consultation at the nearest hospital.

4. History of present illness

April 21, 2022: Day of admission, Patient TM was taken to the hospital by her husband at
about 8:00 AM with acute abdominal pain. Upon examination, patient T.M. stated that pain is in
the RUQ and radiates to the right shoulder. Her review of systems is positive for abdominal pain
(8/10), which started after having a heavy meal last night and was associated with nausea and one
episode of vomiting, and fever. During a physical examination, Murphy's sign was found to be
positive. Her lab results are as follows: for CBC results; Leukocytes 12,000 cells/mcL, Hemoglobin
15 mg/dL, Platelets 140,000-cells/mcL, ESR 35 mm/h, (CRP) Test 90 mg/L, for Blood Chemistry;
CR 0.8 mg/dL, BUN 16 mg/dL, Na 140 mEq/L, K 4.9 mEq/L, Bilirubin 2.4 mg/dL, ALP 160 IU/L,
AST 45 IU/L, ALT 60 IU/L and Cholesterol Test; LDL = 155 mg/dL, HDL = 32 md/dL. The result
of her ultrasound confirmed severe acute cholecystitis with cholelithiasis. At 9:00AM, patient TM
was admitted to the surgical ward, and at 10:30 AM, the patient consented to the surgical procedure
of cholecystectomy

13
5. Physical Assessment (IPPA)

13 Areas of Assessments

AREA OF NORMAL
FINDINGS ANALYSIS
ASSESSMENT FINDINGS
A. SOCIAL STATUS Patient TM is a 58 The ability to Based on the above
years old female, interact successfully statements, The patient
born on November with the people and has a good relationship
15, 1963 from San within the with his family and
Sebastian, Tarlac. environment of friends. as she
She lives with her which each person maintained intimacy
husband and 2 is a part, to develop within significant
daughters who are and maintain others. Hence, she has
all generally healthy. intimacy with an ability to interact
On admission, the significant others, successfully with people
patient verbalized and to develop and within the
that she was socially respect and environment.
close and actively tolerance for those
interacts with her with different
family. Patient TM opinions and
currently works as beliefs. This is a
teacher. Their house period of
is made of cement transformation, with
with electricity and a realization of
water supply. The mortality and a
motorcycle and concern for health.
jeepney are means of There is an increase
their transportation. in warmth and a
She stated that their decrease in
family is supportive negativism. The
as they share each spouse is seen as a
other’s challenges to valuable companion
ease everyone’s life. (Berman et.al.,
According to her, 2018).

14
 she has a good
relationship to her
family. She was fond
of eating fatty foods
and no time to
exercise.
B. MENTAL
STATUS

• General During the The patient should During the evaluation,

Appearance and evaluation, the appear relaxed with the client's general

Behavior client's general the appropriate appearance reveals that

appearance reveals amount of concern she was properly
that she was properly for the assessment. clothed in a hospital
clothed in a hospital The patient should gown and tidy. She
gown and tidy. She exhibit erect complained of
complained of posture, smooth gait dizziness, exhaustion,
dizziness, and symmetrical and restlessness as a
exhaustion, and body movement. result of post-operative
restlessness as a The patient should discomfort on the
result of post- be clean and well- incision site, which she
operative discomfort groomed and should described as a dull
on the incision site, wear appropriate abdominal pain on a
which she described clothing for age, pain rating of 8/10 that
as a dull abdominal weather, and becomes worse when
pain on a pain rating socioeconomic she moves. Due to her
of 8/10 that becomes status. Facial dietary constraints, she
worse when she expressions should stated that she is
moves. Due to her be appropriate to exceedingly hungry and
dietary constraints, the content of the thirsty
she stated that she is conversation and
exceedingly hungry should be
and thirsty. symmetrical. The
patient should be

15
 able to produce
• Level of On assessment the spontaneous,
Consciousness patient looks weak coherent speech.
due to the surgery Content of the
procedure and her message should
GCS score is 15/15. match the patient
Eye opening 4/4, educational level.
Verbal response of The patient should
5/5, and Motor be correctly
response 6/6. responding to
questions and to
identify all the
• Orientation While conducting objects as
the interview, she requested. Denial
was able to provide and poor eye
all pertinent data contact are normal
such as her full response on the first
name, age, where interaction that may
she was at that be due to
moment and the uneasiness on the
date/day, month and presence of a
year. Generally, she stranger or an
was able to answer attempt to screen or
and understand all ignore unacceptable
the questions given realities by refusing
to her during the to acknowledge
assessment. them. The patient
should demonstrate
a realistic
• Speech During the awareness and
interview, the patient understanding of
was able to self. The patient
formulate her should be able to
thoughts although evaluate and act

16
 she was speaking appropriately in
slowly most of the situations requiring
time. But she was judgment. Thought
able to verbalize her process should be
concerns. logical, coherent
and goal-oriented.
Thought content
• Intellectual During the initial should be based on
Function assessment, she was reality (Jensen,
able to respond to 2019).
the questions
properly and
correctly. She was
able to remember
past events and
recent happenings.
C. EMOTIONAL Patient TM is Normally, the Patient TM's capacity to
STATUS looking forward to patient should have articulate, accept, and
improving her health the ability to control her feelings and
following her manage stress and emotions correctly as
successful procedure to express emotion evidenced by her
three days after appropriately. It verbalization of her
admission. When also involves the positive attitude about
asked how she is ability to recognize, her illness. As a result,
feeling, she accept and express her emotional state is
expressed her feelings and to consistent. She could
optimism that her accept one’s verbally speak her
health will return to limitations (Berman condition and was able
normal, saying, et.al., 2018). to accept her condition.
"salamat, dahil sa
2nd life na binigay
sakin at marami
akong babaguhin sa

17
 buhay lalo sa
pagkain."
D. SENSORY
PERCEPTION
Sense of Sight
• Sense of Sight Client TM was not The client who has There is no erythema
wearing reading a visual acuity of and edema, and no
glasses at the time of 20/20 is considered ptosis noted. Lens is
the exam. To assess to have normal clear and sclera is white
distant vision, we visual acuity. The – means that Client TM
employed the eyes must be has no eye problem.
Snellen chart, in symmetrical during Eyes are symmetry and
which student nurses the six cardinal her visual acuity is
asked the patient to gazes’ tests. The 20/20 based on the
read the letters from sclera should be assessment.
a distance of 6 white with some
meters (20 feet), small blood vessels.
which she did Papillary
without difficulty constriction should
with a visual acuity occur when struck
of 20/20. The iris, by light. Ideal focus
eyebrows, lashes, as distances for
well as the form and reading and writing
symmetry of the average between 15
eyes, were all inches from the
examined and found eyes. (Health
to be in good Assessment and
working order. Physical
Pupils are Examination, Mary
completely round Ellen ZatorEstez)
and light receptive.
When an eye exam
evaluates the 6
ocular motions, the

18
 patient's eyes are
spherical and move
symmetrically.
There is no deviation
in the lens or sclera.

Sense of Taste
• Sense of Taste In the sense of taste, Patient TM sense of The patient’s mouth
we instruct the taste is normal as structures are normal
patient to close her she correctly and she can fully open
eyes and nose to identified what food her mouth. Patient TM
block off the scent of she tasted. Paleness sense of taste was
sugar, then we ask observed on the normal as she correctly
her what meal we mucous membranes identified what food she
gave her, and she is due to the tasted. Paleness
correctly answers vasoconstriction observed on the mucous
when she tastes it. A after an operation. membranes is due to the
tongue depressor vasoconstriction after an
was used to test her operation.
gag reflex, which
was found to be
normal. The patient's
mucous membranes,
on the other hand,
were pallid.
Sense of Hearing
• Sense of Hearing Rinne's test was used The auditory is Upon the assessment
by client TM to normal if the patient that was conducted,
examine her hearing. doesn't have any Client TM denies any
The nurse delicately tinnitus or any ear form of hearing
hit a tuning fork with problem. She abnormalities.
a U-shaped piece of should be able to Furthermore, ears are
metal on the heel of hear in the symmetrical and clean.
her hand. It was put minimum of two

19
 on the patient's feet away. (Health
mastoid process and assessment and
the point of the physical
tuning fork was examination, Mary
moved to the front of Ellen ZatorEstez).
the external auditory
meatus at 512Hz. It
will assist in
determining whether
both ears have
equivalent hearing.
We examine the ears
for appearance, and
they are
symmetrically
aligned, clean, and
free of obstructions
or abnormalities.

Sense of Smell
• Sense of Smell Using 70% isopropyl Nose must be Patient TMs nose is
alcohol, we sprayed symmetrical and symmetrical and does
it onto the cotton ball along the face. Each not have any blockage
and tried to smell it nostril must be or lesions. In addition,
to the patient to patented and she clearly smelled the
know if her sense of recognize the smell scent that was said to
smell is fine and of an object. state.
does not have (Health assessment
abnormalities. We and physical
inspect the nose for examination, mary
appearance, and it Ellen zatorestez).
shows that they are
symmetrically

20
 aligned and have no
blockage or lesions.
Tactile
• Tactile Sensory function is The skin contains Patient TM sensory
assessed using light receptors for pain, function is normal; she
touch, pain and touch, pressure and is able to correctly
temperature temperature. identify the sensations
sensations while Sensory signals are she felt during the
asking the patient to transmitted along assessment.
close her eyes during rapid sensory
the assessment. After pathways, and less
the assessment, distinct signals such
Client TM correctly as pressure of
determined what she localized touch are
felt when the pin, sent via slower
cotton, cold and hot sensory pathways.
water that we used (Health Assessment
touched her and Physical
extremities. Examination, Mary
Ellen ZatorEstez)
E. MOTOR To measure motor Patient should have Patient TM cannot stand
STABILITY
stability and gait, the a smooth and well- alone for too long and
patient was asked to coordinated needs assistance to walk
stand alone, walk at movement. Her due to her condition.
least 10 steps, and sit hands should swing
down without help. freely on the side. A
She consented, but patient should have
said she needed help a normal gait, able
since she was feeling to walk in smooth
dizzy and that her and steady manner.
fatigue and Abnormal findings
discomfort were might have hand
causing her walk to tremors,
become unsteady. As uncoordinated

21
 a result, she only had movement,
half of the steps we stiffness, shuffling,
required with a shoulders should
waddling gait. not be slumped
(Hinkle & Cheever,
2018).

F. BODY TEMPERATURE

DATE ASSESSED TIME TEMPERATURE

04/21/22 8:30 AM 38.2 ⁰C

7:00 AM 38.7⁰C

11:00 AM 38.5⁰C

3: 00 PM 37.2⁰C
04/22/22
7:00 PM 36.7⁰C

11:00 PM 36.9 ⁰C

3: 00 AM 37.4 ⁰C

7:00 AM 36.5 ⁰C

11:00 AM 37.0 ⁰C

3: 00 PM 37. 4 ⁰C
04/23/22
7:00 PM 36.7⁰C

11:00 PM 36.9 ⁰C

Upon admission, client’s temperature was checked using digital thermometer via
axilla and reveals elevated temperature.

On April 22, first day after operation, client’s temperature was assessed and shows
that it was still elevated.

22
 Norms:

The site of temperature measurement (oral, rectal, tympanic membrane, temporal

artery, esophageal, pulmonary artery, axillary, or even urinary bladder) is one factor that
determines a patient’s temperature. For healthy young adults, the average oral temperature
is 37°C (98.6°F). In the elderly population, the average core temperature ranges from 35°
to 36.1°C (95° to 97°F) because of changes in temperature regulation. The time of day
also affects the body temperature, with the lowest temperature (Hall et al., 2020).

Analysis:

Her temperature for the 3rd days was within the normal range but the first one
and 2nd day is above normal range it was result hyperthermia during the assessments based
on the findings and norms stated. Hyperthermia occurs due to release of cytokines that
happened because of inflammation and incision.

G. RESPIRATORY STATUS

DATE RESPIRATORY O2 SAT

TIME
ASSESSED RATE (ventilation)

04/21//22 8:30 AM 25 cpm 96%

7:00 AM 21 cpm 97%

11:00 AM 17 cpm 99%

04/22/22 3: 00 PM 15 cpm 99%

7:00 PM 19 cpm 96%

11:00 PM 19 cpm 97%

3: 00 AM 20 cp, 98%

7:00 AM 19 cpm 99%

11:00 AM 17 cpm 99%

04/23/22 3: 00 PM 15 cpm 98%

7:00 PM 20 cpm 97%

23
 11:00 PM 18 cpm 98%

During the admission, client’s respiratory rate was elevated but upon auscultation, clear
breath sounds was heard and there were no crackles nor wheezing noted.

On April 22, first day after the operation, the respiratory status remained within normal.

Norms:
A normal respiratory rate ranges from 12-20 cycles per minute. The average is 18
cycles per minute. Breathing patterns must be regular and even in rhythm. The normal
breath sound is bronchial which is high in pitch, loud in intensity, and blowing or hollow
in quantity, Broncho vesicular is moderate in pitch, moderate-intensity, and combination
of bronchial and vesicular, and vesicular is low in pitch, soft intensity, and gentle rustling
or breezy in quality. The normal oxygen saturation is 95%-100%, and below 70% is life-
threatening. (Berman et al., 2018)

Analysis:

Patient respiratory rate during admission was elevated but the following day after
surgery it is within normal range.

H. CIRCULATORY STATUS

DATE HEART BLOOD

ASSESSED TIME RATE PRESSURE

04/21/22 8:30 AM 83 bpm 150/90 mmHg

04/22/22 7:00 AM 110 bpm 110/80 mmHg

11:00 AM 89 bpm 120/80 mmHg

3: 00 PM 99 bpm 110/90 mmHg

7:00 PM 91 bpm 120/80 mmHg

24
 11:00 PM 91 bpm 120/90 mmHg

04/23/22 3: 00 AM 88 bpm 130/90 mmHg

7:00 AM 90 bpm 120/90 mmHg

11:00 AM 75 bpm 130/80 mmHg

3: 00 PM 79 bpm 120/80 mmHg

7:00 PM 80 bpm 110/80 mmHg

11:00 PM 73 bpm 120/80 mmHg

Upon admission, patient TM’s blood pressure was elevated and her heart rate
was fast and beyond normal range. The following monitoring her blood pressure and
heart rate has been managed within normal range.

During the assessment, client’s circulatory status was normal. There were no
murmurs heard during auscultation.

On April 22, second day after the operation, circulatory status remained
within normal range.

Norms:

A typical blood pressure for a healthy adult is 120/80 mmHg (pulse pressure of
40). The normal adult pulse rate is 80 (60–100) beats per minute. Blood pressure
depends on the volume of circulating blood. Most adults have a circulating blood
volume of 5000 mL (Hall et al., 2020).

Analysis:

Stones that lodged in gallbladder causes symptoms such as rapid heart rate and
drop in blood pressure.

I. NUTRITIONAL STATUS

She usually eats five (5) times a day and she mostly eat fatty and processed
foods such as crispy pata, liempo, hotdogs, chicharon bulaklak, pork belly, meatloaf,

25
 and tocino and she has no time to exercise because of lot of work to finish. She
consumes about 7 glasses of water per day.

On the day of her admission, she was placed on nothing per orem (NPO) diet starting
at 9 am until 3pm to have 6 hours of fasting prior to operation.

Parameter Computation Norms Analysis

Height: 5’5 Weight (kg) / Underweight Obesity
Weight: 90 kg [height(m)] ^2 = <18.5
Normal weight
BMI: 33.01 = 18. 5 – 24.9
Overweight
= 25 – 29.9
Obesity
= >30
(Berman et, al.,
2018)

Norms:

Lifestyle behaviors are also a great influence on people’s health. A person’s

physiologic age reflects his or her health status and may or may not reflect the person’s
chronological age. The following factors greatly affect a person’s health and his or her
physiologic age: sleeping regularly, eating well and balanced meals including breakfast,
engaging in physical activities regularly, not smoking nor using alcohol or drinking in
moderation, and maintaining a healthy body weight. Over the years, the effects of these
lifestyle choices accumulate and will manifest in a person’s life span. (Berman et al., 2016).

Analysis:

Patient TM has imbalance diet, and her weight is above normal within her age,
she also lacks of physical activities due to lot of school works. The patient nutritional
parameter showed that she was obese with a BMI of 33.01.

J. ELIMINATION STATUS

DATE ASSESSED INPUT OUTPUT

04/21/22 1200 cc 1180 cc

26
 04/22/22 1020 cc 1000 cc

04/23/22 1500 cc 1450 cc

Patient’s input and output in 24hrs were same and client’s urine color was dark
brown in color. During hospitalization, client defecates once a day. Her stool was firmed
and brown in color usually, but she experienced clay colored stool few days before
experiencing other symptoms. According to her, he vomited once.

Norms:

Normally defecation is painless, resulting in the passage of soft, formed stool.

Straining while having a bowel movement indicates that the patient may need changes in
diet or fluid intake or that there is an underlying disorder in GI function. (Hall et al., 2020)

Analysis:

If a gallstone blocks a bile duct leading to the bowel, trapped bile enters the
person's bloodstream instead of the digestive system. The bile pigments cause the urine to
become dark brown in color. Clay colored stool was due to decrease biliary drainage. Bile
salts are responsible for the color brown of the stool. Gallbladder sludge causes vomiting
to patient.

K. REPRODUCTIVE During assessment, Sexual health is a state Generally,

STATUS
there were no lesion, of well-being patient has a
irritations, and concerning sexuality good
unusual markings on across the lifespan that reproductive
patient’s reproductive involves physical, status.
organ. She has no emotional, mental, and
history of any spiritual dimensions. It
reproductive-related also includes the
diseases or sexually ability to understand
transmitted diseases. the benefits, risks, and
responsibilities of
sexual behavior. The

27
 Patient menstruation history of any
start at the age of 13. reproductive-related
diseases or sexually
transmitted diseases
should be assessed.
(Berman et al., 2018;
Jensen, 2018).

L. SLEEP-REST Patient TM usually Sleep is considered an Patient TM

PATTERN sleeps between 10- altered state of usually has
11pm and wakes up consciousness in enough sleep and
around 4-6 in the which the individual’s rest per night
morning to prepare perception of and which is 8-10
food for her family reaction to the hours. Also, she
and prepare for her environment are often has
online class but decreased. Sleep is disturbed
sometimes she often critical for normal sleeping pattern
wakes up in the development, health, due to the pain
middle of the night function, and healing. on her RUQ.
because of pain. The older adult (age 65
years and over) sleeps
between 7 and 9 hours
per night. Older adults
usually awaken 1.3
hours earlier and go to
bed approximately 1
hour earlier than
younger adults.
(Berman et al., 2018)
M. STATE OF SKIN Patient TM’s skin Skin should have The patient skin
APPENDAGES evenly colored skin
appears intact, warm of appendages is
tones, without unusual
to touch, without good. The
or prominent
edema, lesions, or discolorations. Skin slightly

28
unusual marks should be intact, and yellowish color
there are no reddened
present. However, her of her skin is due
areas. Skin should be
skin appears to be to high level of
smooth, without
slightly yellow. lesions. It should bilirubin which a
return to its original
condition called
contour when pinched.
Jaundice.
Normally, there should
be no elicited pain and
tenderness on either
light or deep palpation
of the abdomen. If
inguinal lymph nodes
are palpated, they
should be small and
freely
moveable. (Kelley &
Weber, 2018).

29
6. Laboratory and diagnostic procedures

Nursing
Diagnostic/ Analysis and
responsibilities prior
laboratory Date ordered Indication/ Purposes Result interpretation of results
to, during, and after
procedure (related to the disease)
the procedure
BLOOD TEST 04/21/22 • A complete blood CBC Hemoglobin, CR, BUN, Before:
count can help • Leukocytes Na. and K are all normal. • Inform the patient
detect a variety of R - 12,000 cells/mcL While there is an about the procedure
disorders N - 4,500 to 11, 000 increased number of and explain what
including cells/mcL WBC which indicates we are going to do
infections, anemia, presence of infection. why is necessary
diseases of the • Hemoglobin ESR and CRP is elevated and how can she
immune system, R - 15 mg/Dl which indicates that there cooperate.
and blood cancers. N - 12.0 to 15.5 mg/dL is inflammation. • Explain that slight
The Bilirubin, ALP, AST, discomfort may be
• Platelets and ALT is elevated and felt when skin is
it indicates there is liver punctured.
R -220,000 cells/mcL
damage.
N - 150,000 to 450,000 LDL is high while HDL is • Assist her in proper
below the average. This position.
may indicate that she has During:
• Sed rate, or • ESR hyperlipidemia. • Apply gloves and
erythrocyte R - 35 mm/h follow the standard
sedimentation N - 1–20 mm/hr precaution.
rate (ESR), is a • Advice the patient
blood test that can not to pull the hand
reveal during the
inflammatory procedure.

30
 activity in your • Clean the site to be
body punctured and ready
the bandage
• A c-reactive • CRP After:
protein test is R - 90 mg/L • Monitor the
used to check if N - Less than 10 mg/L puncture site for
there is any complications.
inflammation. • Apply dressing and
pressure to the
• Blood chemistry Blood Chemistry puncture site.
tests gives • CR • Put label on the
information if the R - 0.8 mg/Dl sample and deliver
kidneys, liver, and
N - 0.6 to 1.1 mg/dL it to the lab.
other organs are
working properly.
• BUN
R - 16 mg/dL
N - 7 – 21 mg/dL.

• Na
R -140 mEq/L
N - 135-145 mEq/L

• K
R - 4.9 mEq/L
N - 3.5-5.5 mEq/L

• Bilirubin
R - 2.4 mg/dL
N - 0.2 to 1.2 mg/dL

31
 • ALP
R - 160 IU/L
N - 44 to 147 IU/L

• AST
R - 45 IU/L
N - 10- 40 IU/L

• ALT
R - 60 IU/L
N - 7 to 56 IU/L

• Cholesterol test/ • LDL

screening test the
R - 155 mg/dL
Low-density
lipoproteins (LDL) N - Less than 100mg/dL
or “bad”
cholesterol and • HDL
High-density R - 32 mg/dL
lipoproteins N - 50mg/dL or higher
(HDL) or “bad”
cholesterol.
Cholesterol travels
through the blood
on proteins called
“lipoproteins.”

32
ABDOMINAL 04/21/22 Ultrasound is a Normal: Patient TM ultrasound Before:
ULTRASOUND noninvasive procedure confirmed severe acute
• Prepare the right
used to assess the cholecystitis with
instrument and
organs and structures cholelithiasis.
necessary devices.
within the abdomen by
creating an image or • Inform the patient
picture of it. This is about that
the best imaging test procedure or what
for finding gallstones. we are going to do
and why is it
necessary.
Result: • Instruct patient to
cooperate during
the procedure.
• Inform her that she
will feel cold when
the gel is applied
• Position the client
and provide privacy
• Provide appropriate
clothing.
During:

• Assist the trained

technician that is
performing the
procedure.
After:

• Help clean the gel

33
 Note the result and
inform the client that
the procedure is done
and that the physician
will discuss the findings
to the client

34
7. Anatomy and Physiology

The Gallbladder

- The gallbladder, a pear-shaped, hollow, sac like organ that is 7.5 to 10 cm (3 to 4

inches) long. It is located in the right upper quadrant and lies in a shallow depression

on the inferior surface of the liver, to which it is attached by loose connective tissue.

– The capacity of the gallbladder is 30 to 50 ml of bile. Its wall is composed largely of smooth
muscle.
– The gallbladder is connected to the common bile duct by the cystic duct.
– The gallbladder functions as a storage depot for bile. Between meals, when the sphincter of
Oddi is closed, bile produced by the hepatocytes enters the gallbladder.
– During storage, a large portion of the water in bile is absorbed through the walls of the
gallbladder; thus, bile in the gallbladder is 5 to 10 times more concentrated than that originally
secreted by the liver.
– When food enters the duodenum, the gallbladder contracts and the sphincter of Oddi (located
at the junction of the common bile duct with the duodenum) relaxes.
– Relaxation of this sphincter allows the bile to enter the intestine. This response is mediated by
secretion of the hormone cholecystokinin (CCK) from the intestinal wall.
– Bile is composed of water and electrolytes (sodium, potassium, calcium, chloride, and
bicarbonate) along with significant amounts of lecithin, fatty acids, cholesterol, bilirubin, and
bile salts. The bile salts, together with cholesterol, assist in emulsification of fats in the distal
ileum

35
– Approximately half of the bilirubin (a pigment derived from the breakdown of red blood cells)
is a component of bile.

36
8. Pathophysiology

Book-based

Modifiable Risk Factors: Non-Modifiable Risk Factors:

• Lifestyle • Forty
• Fat • Female
• Fertile (pregnancy especially multigravida) • Fair (Caucasian Race)
• Rapid weight loss • Diseases (DM, Metabolic syndrome,
• Use of Hormone replacement therapy (estrogen) cirrhosis)

Bile become supersaturated with cholesterol or calcium

The solute precipitates from solution to solid crystals

Crystals come together to form stones, either Cholesterol,

pigment or mixed in the gallbladder or CBD (Cholelithiasis)

A small stone may pass the gallbladder to the CBD

Obstruction of the cystic duct Legend:

Risk Factors -
Disease process -
Venous and lymphatic drainage is impaired
Diagnosis -

Proliferation of bacteria occurs

Localized cellular irritation or infiltration takes place

Areas of ischemia may develop

Inflammation of gallbladder wall is edematous

and thickened
Presence of empyema

Cholecystitis

37
 Patient-based

Modifiable Risk Factors:

• Diet (increased intake of fatty foods)
• Obese (BMI - 33.01) Non-Modifiable Risk Factors:
• Sedentary Lifestyle (Primary school
teacher online set-up) • Age (58-year-old)
• Stress related • Gender (Female)
• Hypercholesterolemia (HDL - 32
mg/dL, LDL - 155 mg/dL)

Diagnostic lab:
Increased cholesterol synthesis in the liver LDL - 155 mg/dL
HDL - 32 mg/dL

Decreased bile acid synthesis

Super saturation of bile with cholesterol

Legend:
Risk Factors -
Formation of Precipitates
Disease process -
Signs and Symptoms &
Diagnostic Lab -
Gallstones Surgical procedure -
Diagnosis -
(Cholelithiasis)

Diagnostic lab results:

Obstruction of the ALT - 60 IU/L
Nausea and Vomiting
common bile duct ALP - 160 IU/L
AST - 45 IU/L

Bile becomes trap to the gall bladder

Right Upper Quadrant pain that

radiates to the right shoulder
Increased muscle pressure of the (abdomnal pain: 8/10)
gallbladder

Conjugated bilirubin Jaundice

Back flow of conjugated enters the Diagnostic lab:
bilirubin to liver Bilirubin - 2.4 mg/dL
bloodstream

Fever Inflammation and distention

Diagnostic lab: + Murphy’s Sign
of the gallbladder
Leukocytes - 12,000
cells/mcL
ESR - 35 mm/h

Surgery:
Cholecystitis
Cholecystectomy
38
 B. PLANNING
Nursing Care Plan 1
(PRE-OPERATIVE)
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Acute pain Within 30 Independent: After 30 minutes of
“Sobrang sakit related to minutes of 1. Place the patient in a 1. To promote rest, nursing
ng kanang inflammation of nursing quiet and comfortable redirects attention, intervention, the
tagiliran ko” as gallbladder as intervention, the environment, on may enhancing patient will be able
verbalized by the evidenced by patient will be complete bed rest coping. Bedrest in to report relief of
patient. PQRST and a able to report with bathroom low-fowler’s pain and appear
positive relief of pain and privileges position reduces relaxed
PQRST: murphy’s sign appear relaxed intra-abdominal
P – Worse with pressure
deep breaths Scientific
Q – Sudden, Rationale: 2. Instruct deep and 2. Helpful in
sharp Acute pain is an slow breathing decreasing
R – upper right unpleasant perception and
side that radiate sensory and response to pain
to the shoulder emotional
S – pain scale of experience 3. Suggest any 3. Help to cope,
8/10 associated with diversional increase sense of
T – Less than 1 actual or adversities like control, and allay
to more than 6 potential tissue listening to a music anxiety
hours damage, or
described in Dependent:
Objective: terms of such 4. Administer 4. To alleviate the
• Nauseated damage. medication as symptoms of acute
• Facial prescribed: Toradol abdominal pain
grimace Source:
• Fatigue International
Association for

39
• Positive the Study of
murphy’s Pain
sign

Vital Signs:
• BP: 120/90
• PR: 83bpm
• RR: 33bpm
• TEMP:
38.2˚C

40
 Nursing Care Plan 2
(PRE-OPERATIVE)
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Mild Anxiety Within 1 hour of Independent: After 1 hour of
“Natatakot akong related to nursing 1. Provide a calm 1. Aids in meeting basic nursing intervention
maoperahan” as situational crisis intervention the environment, and soft human need, the patient appeared
verbalized by the as evidenced by patient will be music decreasing sense of relaxed and reported
patient facial tension able to appear isolation and assisting anxiety is reduced to
relaxed and report to feel less anxious a manageable level
Objective: Scientific anxiety is reduced
• Facial tension
Rationale: to a manageable 2. Instruct to do deep 2. Help the client to
• Shaky hands Anxiety is a level breathing exercise relax
• Voice vague feeling of
quivering discomfort or 3. Provide accurate 3. Help patient identify
• Restlessness dread information of the what is reality based
accompanied by surgery
an autonomic
Vital Signs: response; the 4. Encourage meditation 4. Effective nonchemical
• BP: 120/80 source is often way to reduce anxiety
• PR: 85bpm nonspecific or
• RR: 21bpm unknown to the 5. Assist in developing 5. To eliminate negative
• TEMP: 38.2˚C individual. skills like awareness of self-talk
negative thoughts, and
Source: substituting a positive
Nurse’s Pocket thought
Guide:
Diagnoses,
Prioritized
Interventions and
Rationales (15th
Edition)

41
 Nursing Care Plan 1
(POST OPERATIVE)
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Anxiety related Within 1 hour of Independent: After 1 hour of
“Natatakot to change in nursing 1. Provide a calm 1. Aids in meeting nursing
akong health status as intervention the environment, and soft basic human need, intervention the
maoperahan at evidenced by patient will be music decreasing sense of patient will be able
ayaw kong expressed able to appear isolation and to appear relaxed
matanggalan ng concern relaxed and assisting to feel less and report anxiety
apdo” as regarding report anxiety is anxious is reduced
verbalized by the changes reduced to a manageable
patient to a manageable 2. Instruct to do deep 2. Help the client to level
Scientific level breathing exercise relax
Objective: Rationale:
• Facial Anxiety is a 3. Provide accurate 3. Help patient identify
flushing vague feeling of information of the what is reality based
• Shaky hands discomfort or surgery
• Voice dread
quivering accompanied by 4. Encourage meditation 4. Effective
• Restlessness an autonomic
nonchemical way to
response; the
reduce anxiety
source is often
Vital Signs: nonspecific or
• BP: 120/80 unknown to the 5. Assist in developing 5. To eliminate
• PR: 85bpm individual. skills like awareness negative self-talk
• RR: 21bpm of negative thoughts,
• TEMP: Source: and substituting a
38.2˚C Nurse’s Pocket positive thought
Guide:
Diagnoses,
Prioritized

42
Interventions
and Rationales
(15th Edition)

43
 Nursing Care Plan 2
(POST OPERATIVE)
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Acute pain related Within 30 Independent: After 30 minutes of
“Ang sakit ng to surgical minutes of 1. Provide a quiet 1. To help alleviate or nursing
tahi ko” as incision site as nursing environment control the pain intervention, the
verbalized by the evidenced by intervention, the patient will be able
patient. Pain verbal reports of patient will be 2. Instruct and 2. Increases oxygen to report relief of
scale of 8/10 pain with a pain able to report demonstrate deep in the body and pain and appear
scale of 8 out of relief of pain breathing exercise provides comfort relaxed
Objective: 10 and appear
• Facial relaxed 3. Position the patient 3. To enhance
grimace Scientific and elevate head of comfort
• Excessive Rationale: the bed
sweating Acute pain is an
• Guarding unpleasant 4. Encourage 4. To enhance sense
behavior sensory and diversional activities of control and may
• Irritability emotional such as guided improve coping
experience imagery, and music abilities
Vital Signs: associated with
• BP: 120/90 actual or potential
• PR: 83bpm tissue damage, or Dependent:
described in terms 1. Administer 1. To alleviate the
• RR: 33bpm symptoms of acute
of such damage. medication as
• TEMP: abdominal pain
prescribed:
38.7˚C
Source: − Toradol
International
Association for
the Study of Pain

44
 Nursing Care Plan 3
POST OPERATIVE
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
OBJECTIVE: Risk for infection Short Term INDEPENDENT: Short Term
• Surgical related to invasive Objectives: 1. Regularly check 1. Involvement of Objectives:
procedure
incision site is After 4 hours of patient for sign and patient to early After 4 hours of
reddish, with nursing symptoms of identification of nursing
purulent Explanation of intervention, the infection. Educate infection can intervention, the
minimal the problem: patient’s patient on the signs improve the success patient’s surgical
drainage thatThe patient surgical incision of infection such as of treatment once it incision will be
covers about undergone will be clean, fever and chills was started. clean, dry, intact
25% of the surgery dry, intact and and the reddish
surgical (cholecystectomy) the reddish color 2. Monitor the surgical 2. It offers information color of the
dressing which means that of the incision incision to ensure it regarding the incision site will be
there will be an site will be is clean, dry, and possibility of lessened
Vital sign impaired skin lessened intact, and to infection. Local
• Temperature: integrity wherein determine whether inflammatory Long Term
36.5 °C the first line of Long Term incisions have reactions cause Objective:
defense was Objective: redness, edema and redness and edema. After 3 days of
obstructed. If the After 3 days of drainage As a result, purulent nursing
first line of nursing leaking and wound intervention, the
defense was intervention, the dehiscence may patient will remain
obstructed, there patient will develop. free from infection
will be an open remain free as evidenced by
wound that is a from infection 3. Maintain strict 3. Aseptic technique absence of fever,
good portal of as evidenced by aseptic technique for decreases the no drainage and
entry of absence of dressing changes and chances of normal skin color
microorganism. fever, no wound care transmitting or of surgical site
The open wound drainage and spreading
will be then normal skin pathogens to or
colonized by the between patients.

45
microorganism color of surgical Interrupting the
that is why the site chain of infection is
patient is high an effective way to
risk for infection. prevent the spread
of infection

4. Encourage rest and 4. Adequate sleep is

sleep. an essential
modulator of
immune responses.
A lack of sleep can
weaken immunity
and increased
susceptibility to
infection

DEPENDENT

5. Administer 5. Used to treat

medication as infections caused
prescribed: by bacteria
- Cefoxitin (1
gram IV
every 8
hours)

46
 C. IMPLEMENTATION

1. DRUGS

Route, dosage
Name of drugs
and frequency General action/ Indication/ Side effect/
(generic and Nursing Responsibilities
of Mechanism of action purpose adverse effect
brand name)
administration
Generic name: 5 mg, orally, Amlodipine inhibits Amlodipine is used to Dizziness,
Amlodipine once a day calcium ion influx treat chest pain lightheadedness, • Obtain patient history to
across cell (angina) and other headache, allergy of amlodipine.
Brand name: asthenia, fatigue, • Assess vital signs before
membranes, with a conditions caused by
Norvasc and lethargy therapy.
greater effect on coronary artery
Classification: vascular smooth disease. Amlodipine is peripheral edema • Monitor patient BP and
Calcium Channel muscle cells. This also used to treat high and arrhythmias cardiac rhythm.
Blockers causes vasodilation blood pressure • Monitor intake and output.
and a reduction in (hypertension). Flushing and rash
peripheral vascular Lowering blood • Monitor vital signs.
Nausea and • Be alert for adverse effects.
resistance, thus pressure may lower
abdominal
lowering blood your risk of a stroke or
discomfort
pressure. heart attack
Generic Name: 500mg IV every Tranexamic acid It can be used to • Nausea • Monitor blood pressure,
Tranexamic Acid 8 hours competitively and control severe • Vomiting pulse, and respiratory status
reversibly inhibits the bleeding due to • Diarrhea as indicated by severity of
Brand name: activation of surgery or trauma. • Hypotension bleeding.
Lysteda plasminogen via • Rash • Monitor for overt bleeding
binding at several • Thromboemboli every 15–30 min.
Classification: distinct sites. c: Arterial, • Assess for thromboembolic
Therapeutic: to prevent intra and venous, embolic complications.
Hemostatic agents post op bleeding

47
 • Monitor platelet count and
Pharmacologic: clotting factors prior to and
Fibrinolysis periodically throughout
inhibitors therapy in patients with
systemic fibrinolysis.
• Stabilize IV catheter to
minimize thrombophlebitis.
• Instruct patient to notify the
nurse immediately if
bleeding recurs.
• Caution patient to make
position changes slowly to
avoid orthostatic
hypotension.

Generic Name: 8mg IV every 8 Blocks the effects of Prevention and • Headache • Assess patient condition
Ondansetron hours x 2 doses serotonin at 5-HT3 treatment of • Dizziness before therapy.
receptor sites postoperative nausea • Drowsiness • Monitor improvements in
Brand name: (selective antagonist) and vomiting. • Fatigue GI symptoms.
Zofran located in vagal nerve • Weakness • Assess motor function, and
terminals and the • Fever report any extrapyramidal
Classification: chemoreceptor trigger reactions.
• Constipation
Therapeutic: zone in the CNS. • Assess dizziness and
• Diarrhea
Antiemetic drowsiness that might affect
• Abdominal
pain gait, balance, and other
Pharmacologic: functional activities
5-HT3 antagonist • Dry mouth
• Increased liver • Instruct the SO to report
enzymes balance problems and
functional limitations to the
• Malaise/
fatigue physician and nursing staff,
and caution the patient and

48
 • Poor family/caregivers to guard
oxygenation against falls and trauma.
• Monitor liver function tests
• Provide supportive
measures.
• Be alert for adverse
reactions of drugs

Generic Name: 30 mg IVP every Inhibits prostaglandin Toradol is indicated • Headache • Monitor signs of GI
Ketorolac 8 hours synthesis, producing for short term • Dizziness bleeding. Report these signs
peripherally mediated management of • Drowsiness to the physician
Brand name: analgesia. Also has moderately severe • Diarrhea immediately.
Toradol antipyretic and anti- acute pain that • Constipation • Monitor signs of allergic
inflammatory requires analgesia at • Gas reactions and anaphylaxis.
Classification: properties. the opioid level, • Sores in the • Notify the physician if
Therapeutic: usually in a mouth there’s untoward s/s occurs.
Nonsteroidal anti- postoperative setting. • Assess pain and other
• Sweating
inflammatory Therapeutic Effects: variables (range of motion,
agents, Nonopioid Decreased pain. muscle strength).
analgesics • Assess blood pressure (BP)
periodically and compare to
Pharmacologic: normal values.
Pyrrolizine • Assess symptoms of
carboxylic acid bronchospasm and asthma.
• Assess dizziness and
drowsiness that might affect
gait, balance, and other
functional activities
• Monitor and report
euphoria, abnormal
thinking, or other psychic
disturbances.

49
 • Verify any medication order
and make sure it’s
complete.
• Prepare medications for one
patient at a time.
Generic Name: 40 mg IV every 8 Omeprazole is a Suppresses gastric • Headaches • Monitor urinalysis for
Omeprazole hours proton pump inhibitor acid secretion • Feeling sick hematuria and proteinuria.
that inhibits secretion relieving (nausea) • Monitor improvements in
Brand name of gastric acid by gastrointestinal • Being sick GI symptoms (gastritis,
Prilosec irreversibly blocking distress and promoting (vomiting) or heartburn, and so forth) to
the enzyme system of ulcer healing. diarrhea help determine if drug
Classification: hydrogen/potassium Reduction of risk of • Stomach pain therapy is successful.
Proton-pump adenosine GI bleeding in • Constipation • Assess dizziness that might
inhibitors triphosphatase, the critically ill patients. • Farting affect gait, balance, and
proton pump (flatulence) other functional activities
• Educate the client and SO to
report any changes in
urinary elimination such as
pain or discomfort
associated with urination, or
blood in urine.
• Report severe diarrhea; drug
may need to be
discontinued.
• Monitor other CNS side
effects (drowsiness, fatigue,
weakness, headache), and
report severe or prolonged
effects.
Generic Name: 1 gram IV every Binds to bacterial cell Treatment of the • Injection site • Watch for seizures; notify
Cefoxitin 8 hours wall membrane, following infections reactions physician immediately if
causing cell death. caused by susceptible (swelling, patient develops or
Brand name: organisms: increases seizure activity.

50
Mefoxin Therapeutic Effects: Perioperative redness, pain, • Monitor signs of allergic
Bactericidal action prophylaxis or soreness) reactions and anaphylaxis,
Classification: against susceptible • Skin rash including pulmonary
Therapeutic: bacteria. Cefoxitin is an • Vaginal symptoms (tightness in the
Anti-infectives antibiotic used to treat itching or throat and chest, wheezing,
a wide variety of discharge cough dyspnea) or skin
Pharmacologic: bacterial infections. It • Loss of reactions (rash, pruritus,
Second-generation may also be used appetite urticaria). Notify physician
cephalosporin before and during • Nausea or nursing staff immediately
certain surgeries to • Vomiting if these reactions occur.
help prevent infection. • Stomach pain • Report prolonged or
This medication is • Diarrhea excessive injection-site
known as a reactions to the physician.
• Headache
cephalosporin • Instruct patient to notify
antibiotic. It works by physician immediately of
stopping the growth of signs of superinfection,
bacteria. including black, furry
overgrowth on tongue,
vaginal itching or discharge,
and loose or foul-smelling
stools.

Generic Name: 7.5 mg PO @ Benzodiazepines For premedication, Drowsiness, • Have oxygen and
Midazolam 7:30 am increase the activity of sedation, induction numbed emotions, resuscitation equipment
GABA, thereby and maintenance of reduced alertness, available in case of severe
Brand name: producing a sedating anesthesia confusion, fatigue, respiratory depression.
Dormicum effect, relaxing headache, • Monitor BP, HR and
skeletal muscles, and dizziness, muscle rhythm, respirations, airway
Therapeutic inducing sleep, weakness, ataxia integrity, and pulse
class: anesthesia, and or double vision. oximetry during procedure.
Anxiolytics amnesia. • Teach patient about drug's
use and potential adverse
reactions; advise patient to

51
Pharmacologic immediately report
class: difficulty breathing.
Benzodiazepines

52
2. MEDICAL MANAGEMENT

IVFs, BT, nebulization, oxygen therapy, etc.

Date
Medical
performed/ General Indication/
Management/ Client’s reaction
changed/ description Purpose
Treatment
discontinued
The typical reason
for NPO instruction
is the prevention of
aspiration
A Latin term
Date Started pneumonia, e.g., in
that means
04/21/22 those who will
“nothing by The client has no
undergo general
mouth” is used surgical
anesthesia, or those
in medicine to complications in
NPO Date stopped with weak
describe the pneumonia, bed
04/22/22 swallowing
instruction to sores and also no
musculature, or in
withhold fluids aspiration detected.
case of
and solid foods
gastrointestinal
from a person.
bleeding,
gastrointestinal
blockage or acute
pancreatitis.
5% Dextrose in
Lactated Ringer's
Ringer's is a
Injection provides
sterile solution
electrolytes and
for fluid and
Date Started calories, and is a
electrolyte
04/21/22 source of water for
replenishment. It
hydration. It is
Dextrose 5% restores fluid
capable of inducing
in Lactated and electrolyte The patient showed
Date stopped diuresis depending
Ringers balances, no signs of adverse
04/25/22 on the clinical
Solution produces reaction.
condition of the
diuresis, and
patient. This
acts as
solution also
alkalizing agent
contains lactate
(reduces
which produces a
acidity).
metabolic
alkalinizing effect.

53
3. SURGICAL MANAGEMENT

Nursing responsibilities,
Name of Indication/
Brief description prior to, during, and actual
procedure purposes
surgical procedure (actual)
Before:
• Complete the OR
Checklist.
• Administered an IV line.
• Witness signing of
Laparoscopic consent.
cholecystectomy After:
is minimally • Closely monitors vital
invasive surgery signs and inspects the
to remove the surgical incisions and any
gallbladder. It drains for bleeding.
It is removal of
helps people when
gallbladder through • Assesses the patient for
gallstones cause increased tenderness and
endoscope inserted
inflammation, rigidity of the abdomen. If
through abdominal
pain or infection. these signs and symptoms
Laparoscopic wall. It is indicated
The surgery occur, report to the
cholecystectomy for the treatment of
involves a few surgeon.
Cholecystitis (acute/
small incisions, • Instructs the patient and
chronic) and
and most people family to report any
symptomatic
go home the same change in the color of
cholelithiasis.
day and soon stools, because this may
return to normal indicate complications.
activities. • Assesses the patient for
It is also called anorexia, vomiting, pain,
endoscopic laser abdominal distension, and
cholecystectomy temperature elevation.
• The patient and family are
instructed verbally and in
writing about the
importance of reporting
these symptoms promptly
Open gallbladder Cholecystectomy is Before:
removal is surgery indicated in the • Identify the patient
to remove the presence of • Check doctors order
gallbladder gallbladder trauma, • Monitor vital sign
through a large cut gallbladder cancer, • Informed consent and
Open in your abdomen. acute cholecystitis, explain
Cholecystectomy The gallbladder is and other After:
an organ that sits complications of • Observe and document
below the liver. It gallstones. More location, severity, and
stores bile, which controversial are the characteristic of pain.
your body uses to indications for • Promote bedrest
digest fats in the elective • Encourage to use of
small intestine. cholecystectomy. relaxation technique.

54
 • Provide a quiet
environment.
• Encourage to eat high
fiber foods (fruits and
vegetables)

4. DIET

NUSRING
TYPE OF DIET DATE INDICATIONS
RESPONSIBILITY
Instruct the client and
To provide fluids to
relatives to provide
Admission ease thirst and energy
04/21/22 clear liquids such as
1st day post op from foods that
water, clear fruit
Clear liquids require very little
juice, and broth.
digestion and reduce
bowel residue.

To have a soft
Instruct the patient
consistency and it’s
and relatives to eat
easy to eat and also
like banana, egg, and
2nd day diet consist of foods that
04/22/22 potato.
Bland diet are low in fiber and
fat.

To consume food
Instruct the patient
that are low fat, low
and relatives to
cholesterol and low
provide a fruits and
3rd day in sodium and to help
04/23/22 vegetables, and also
DASH Diet to lower the
whole grains.
cholesterol level.

5. ACTIVITY/EXERCISE

TYPE OF GENERAL INDICATION/ CLIENT’S

EXERCISE DESCRIPTION PURPOSE RESPONSE
It is a medical treatment
that restricts most of a To prevent the side
patient’s activities. A effects of anesthesia The client was able to
Bed rest person must lie on a such as dizziness, rest, and no presence of
bed for most of the time headache, and bed sore was found.
to provide rest and vomiting.
recovery.

55
 Passive ROM exercises
To maintain and
require assistance from
increase range of The client was able to
the nurse or the
Active and motion and to present cooperate and perform
caregiver. The range of
passive range of stiffness in joints, to a range of motion
motion exercises
motion exercises stretch the muscles, and exercises. No muscle
includes flexion,
to prevent muscle atrophy was noted.
extension, abduction,
atrophy
adduction, and rotation.

56
6. NURSING MANAGEMENT

SOAPIE 1
(PRE-OP)

04/21/22 09:00am
Subjective
• “Sobrang sakit ng kanang tagiliran ko” as verbalized by the patient.

PQRST
• P-Worse with deep breath
• Q-Sudden sharp
• R-Upper right side that radiate to the shoulder
• S-Pain scale of 8/10
• T-Less than 1 to more than 6hours

Objective
• Nauseated
• Facial grimace
• Fatigue
• Positive murphy’s sign

Vital Signs:
• BP: 120/90
• PR: 83bpm
• RR: 33bpm
• TEMP: 38.2˚C

Assessment
• Acute pain related to inflammation of the gallbladder as evidenced by PQRST and
a positive murphy’s sign.

Planning
• Within 30 minutes of nursing intervention, the patient’s pain will be able to report
relief of pain and appear relaxed.

57
Intervention
• Placed the patient in a quiet and comfortable environment, on complete bed rest
with bathroom privileges
• Instructed deep and slow breathing for 10mins
• Suggested any diversional adversities like listening to a music
• Administered medication as prescribed: Toradol

04/21/22 09:30am
Evaluation
• After 30 minutes of nursing intervention, the patient reported relief of pain and
appear relaxed.

SOAPIE 2
(PRE-OP)

04/21/22 09:30am
Subjective
• “Natatakot akong maoperahan at ayaw kong matanggalan ng apdo” as verbalized
by the patient

Objective
• Facial tension
• Shaky hands
• Voice quivering
• Restlessness

Vital Signs:
• BP: 120/80
• PR: 85bpm
• RR: 21bpm
• TEMP: 38.2˚C

Assessment
• Anxiety related to change in health status as evidenced by expressed concern
regarding changes.

58
Planning
• Within 1 hour of nursing intervention the patient will be able to appear relaxed and
report anxiety is reduced to a manageable level

Intervention
• Provided a calm environment, and soft music
• Instructed to do deep breathing exercise for 10mins
• Provided accurate information of the surgery
• Encouraged meditation for 10mins
• Assisted in developing skills like awareness of negative thoughts, and substituting
a positive thought

04/21/22 10:00pm
Evaluation
• After 1 hour of nursing intervention the patient appeared relaxed and reported
anxiety is reduced to a manageable level

SOAPIE 3
(POST-OP)

04/22/22 3:15pm
Subjective
• “Ang sakit ng tahi ko” as verbalized by the patient.
• Pain scale of 8/10

Objective:
• Facial grimace
• Excessive sweating
• Guarding behavior
• Irritability

Vital Signs:
• BP: 120/90
• PR: 83bpm
• RR: 33bpm
• TEMP: 38.7˚C

59
Assessment
• Acute pain related to surgical incision site as evidenced by verbal reports of pain
with a pain scale of 8 out of 10

Planning
• Within 30 minutes of nursing intervention, the patient will be able to report relief
of pain and appear relaxed

Intervention
• Provided a quiet environment
• Instructed and demonstrate deep breathing exercise for 10mins
• Positioned the patient and elevate head of the bed
• Encouraged diversional activities such as guided imagery, and music
• Administered medication as prescribed:Toradol

04/22/22 3:45pm
Evaluation
• After 30 minutes of nursing intervention, the patient reported pain relieved and
appeared relaxed

SOAPIE 4
(POST-OP)

04/22/22 05:00am
Subjective
• “Hindi ako makagalaw ng maayos dahil sa tahi ko” as verbalized by the patient

Objective
• Facial grimaces
• Moaning or groaning when moving
• Guarding the incision site as she moves

Assessment
• Impaired physical mobility related to post-op pain

60
Planning
• After 4 hours of proper nursing intervention, the patient will be able perform
passive range of motion exercises without any discomfort or pain.

04/22/22 09:00am
Intervention
• Supported and encouraged the patient with muscular development and passive
stretching exercises every morning at 9am as required.
• Presented a safe environment: bed rails up, bed in a down position, important items
close by.
• Assisted patient for muscle exercises as able or when allowed out of bed; execute
abdominal-tightening exercises and knee bends; hop on foot; stand on toes.
• Promoted and facilitated early ambulation when possible. Aid with each initial
change: dangling legs, sitting in chair, ambulation.
• Executed passive or active assistive ROM exercises to all extremities for 1hr.
• Helped out with transfer methods by using a fitting assistance of persons or devices
when transferring patients to bed, chair, or stretcher.
• Let the patient accomplish tasks at his or her own pace. Do not hurry the patient.
Encouraged independent activity as able and safe.
• Instructed deep breathing exercise for 10mins.
• Provided the patient a 30mins-1hr of rest periods in between activities. Consider
energy-saving techniques.
• Administered medication as prescribed: Ketorolac 30mg IVP every 8hours

Evaluation
• After 4 hours of proper nursing interventions, the patient was able perform passive
ROM exercises and activities without any discomfort or pain.

SOAPIE 5
(POST-OP)
04/23/22 12:00pm
Objective
• Surgical incision site is reddish, with purulent minimal drainage that covers about
25% of the surgical dressing

Vital Signs
• TEMP: 36.5°C

61
Assessment
• Risk for infection related to invasive procedure

Planning
Short Term Objectives:
• After 4 hours of nursing intervention, the patient’s surgical incision will be clean,
dry, intact and the reddish color of the incision site will be lessened
Long Term Objective:
• After 3 days of nursing intervention, the patient will remain free from infection as
evidenced by absence of fever, no drainage and normal skin color of surgical site

Intervention
• Regularly checked patient for sign and symptoms of infection every 2hrs. Educated
patient for 10mins on the signs of infection such as fever and chills
• Monitored the surgical incision every 2hr to ensure it is clean, dry, and intact, and
to determine whether incisions have redness, edema and drainage
• Maintained strict aseptic technique for dressing changes and wound care.
• Encouraged rest and sleep for 8hrs if possible
• Administered medication as prescribed: Cefoxitin 1g IV every 8hours

04/23/22 12:00pm
Evaluation
Short Term Objectives:
• Goal met. The patient’s surgical incision was clean, dry, and intact and the reddish
color of the incision site was lessened
Long Term Objective:
• Goal met. The patient remained free from infection as evidenced by absence of
fever, no drainage and normal skin color of surgical site

62
 D. EVALUATION

Discharge planning

a. General condition upon discharge

Appearance of the patient after the surgery looks well, flushed, active, calm, and
not compliant. The Dressing of the incision site is noted to be reddish, with intact sutures,
well approximated with minimal drainage. The patient orientation base on the GCS is 15
because her eyes are opening spontaneously, she is oriented, obeys the commands, and is
fully awake.
The client might be able to keep and sustain a good health by maintaining strictly
compliance of the medication and exercises that has been given. However, as nurses, we
must not be complacent in the face of danger's silence. As a result, we must provide the
patient with critical details about her wellbeing and condition and how to avoid certain
things in order to ensure that his health is maintained even at home.

b. METHOD approach

MEDICATION
Use your pain medications as prescribed
• Co-amoxiclav (RiteMED) - 625 mg every 8 hours for pain.
• Ibuprophen (Advil) - 200mg orally every 2x a day, then only as needed to control pain/
discomfort.
• Dulcolax tablet 1tab q HS for constipation.
- Pain medications can cause nausea if taken on an empty stomach.
- You may resume your previous medication unless instructed otherwise.
• Unless you have been told otherwise by your physician, it is okay to resume aspirin, blood
thinners, and any other anticoagulants at discharge.
• Please consult with your surgeon prior to taking any herbal medications (some herbal
medications can increase the risk of bleeding).
• You may take antacids for indigestion and gas symptoms.
EXERCISE
• Rest when you feel tired. Getting enough sleep will help you recover.
• Walking will help the return of normal bowel function.
• It takes at least 1 week for you to get most of your strength and energy back.

63
 • Avoid strenuous activities, such as biking, jogging, and aerobic exercise, until your doctor
says it is okay.

TREATMENT
• Proper wound care is recommended. Wash your hand proper before touching your wound.
• Clean the site daily with betadine and cover with sterile gauze.

HEALTH TEACHING
Call your doctor or nurse call line now or seek immediate medical care if:
• You are sick to your stomach or cannot drink fluids.
• You have pain that does not get better when you take your pain medicine.
• You have signs of infection, such as:
• Increased pain, swelling, warmth, or redness.
• Red Bright blood or streaks/ purulent discharges from the incision.
• A spike in Temp
• You have loose stitches, or your incision comes open.
• You have signs of a blood clot in your leg (called a deep vein thrombosis), such as: Pain in
your calf, back of knee, thigh, or groin.
• Redness and swelling in your leg or groin.
• Watch closely for any changes in your health, and be sure to contact your doctor or nurse
call line if you have any problems.

OUTPATIENT FOLLOW-UP
• Go for a follow-up visit with your internist and surgeon 1 to 2 weeks after your surgery.

DIET
• Eat your regular diet. Eat high fiber foods and drink 8 glasses of water daily.
• Limit of eating, greasy, or spicy food for a few days.
• When you feel like eating, start with small amounts of food.
• Limit eating fatty foods for about 1 month. Fatty foods include hamburger, whole milk,
cheese, and many snack foods.
• You may notice that your bowel movements are not regular right after your surgery. This
is common.
• Try to avoid constipation and straining with bowel movements.

64
III. CONCLUSION
This case study has provided a significant body of knowledge relating to one of the
relatively common complications of gallstones, which is cholecystitis with cholelithiasis.
Cholecystectomy secondary to cholecystitis with cholelithiasis potentially serious because of the
risk of complications such as gangrene (tissue death) of the gallbladder, perforation (a hole that
forms in the wall of the gallbladder), pancreatitis (inflamed pancreas), persistent bile duct
blockage and inflammation of the common bile duct. If left untreated, cholecystitis can lead to
serious, sometimes life-threatening complications, such as a gallbladder rupture.
In the case presented, the client clinical impression was Cholecystectomy secondary to
cholecystitis with cholelithiasis. History taking and physical examination were done which
indicates the modifiable and non-modifiable risk factors which have contributed to the disease.
The nursing process was also utilized. Proper treatment and interventions were done to prevent
further complication and treat the infection and pain. Appropriate health teachings were given and
instructed to the patient. The client's symptoms significantly decreased and was being monitored
for status post cholecystectomy.
During the duration of our exposure to the surgical intensive care unit ward, we were able
to tackle a case regarding cholecystitis with cholelithiasis that underwent cholecystectomy. This
case helped us student nurses to develop a deeper understanding of one of the relatively common
complications of gallstones and it also gave us knowledge on how to properly handle this disease.
All the learnings that we students were able to gather in this study would be of great use in our
journey to becoming a future nurse.

IV. RECOMMENDATION

To the Student Nurse:

This case study will give the nursing student a broader knowledge about cholecystectomy
secondary to cholelithiasis with cholecystitis in able for them to understand the disease process and
assist them on how to properly assess a client that has this kind of disease. It will also make it easier
for the student to formulate appropriate nursing care plans, interventions, and other management
for the disease.

To the Client and Family members:

It is recommended for the Client’s that have the same condition and for the other members
of the family to provide an effective health teaching on the different medications, exercises,

65
activities, and diet that client need to have and to perform to improve the client’s condition and
prevent complications.

To the Institution and Health Care Provider:

This will be beneficial to the institution to provide an additional information on the new
trends about cholecystectomy secondary to cholelithiasis with cholecystitis and this will also aid
the institution to develop an effective program, and counseling for the family and client, on how to
properly manage a family member with cholecystectomy secondary to cholelithiasis with
cholecystitis at home and to prevent different complications and recurrences of the said disease.

V. REVIEW OF RELATED LITERATURE/STUDIES

Foreign

According to Yvette C. Terri(2020), In the United States, an estimated 20 million people

have gallstones, termed cholelithiasis, with women being two to three times more likely to have
them compared with men. Cholelithiasis is a costly digestive disease for the healthcare system;
the pain associated with it is a common reason for emergency department visits. Patients with
chronic cholelithiasis may develop cholecystitis, which can be acute or chronic. Gallstones are
most commonly diagnosed using ultrasound. Treatment depends on patient symptoms, other
comorbidities, and overall health. Treatment for cholelithiasis may involve surgery or medical
management with oral bile acids. Treatment of cholecystitis depends on the patient’s presentation
and the severity of the condition.

According to Portincasa P, et al. (2020) An estimated 500,000 individuals present with

symptoms or complications of cholelithiasis that warrant a cholecystectomy, the removal of the
gallbladder. Pain from gallstones is one of the most common causes for emergency department
(ED) visits; determining which patients need surgery can sometimes be challenging for clinicians.
One study found that one in five patients who went to the ED with gallbladder pain and were sent
home to schedule surgery returned to the ED within 30 days requiring a cholecystectomy; the rate
of surgical complications increased with the time before the surgery.

66
VI. BIBLIOGRAPHY

Dungca, L., & Perez, A. (2020). Comparative analysis of the direct hospitalization cost of
laparoscopic and open cholecystectomy at the Philippine General Hospital. From
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ct_hospitalization_cost_of_laparoscopic_and_open_cholecystectomy_at_the_Philippine_
General_Hospital

Discharge Instructions for Laparoscopic Cholecystectomy. Saint Luke’s Health System. From
https://www.saintlukeskc.org/health-library/discharge-instructions-laparoscopic-
cholecystectomy

Hassler, K., Collins, J., et al. (2022). Laparoscopic Cholecystectomy. From

https://www.ncbi.nlm.nih.gov/books/NBK448145/#:~:text=Cases%20of%20gallbladder
%20cancers%20are,the%20population%20has%20asymptomatic%20gallstones.

Lormand, D., Williams, V., et al. (2019). Update: Gallbladder Disease and Cholecystectomies,
Active Component, U.S. Armed Forces 2014–2018. From
https://health.mil/News/Articles/2019/12/01/Gallbladder-Disease-and-
Cholecystectomies?page=2#pagingAnchor

Comerford, K. C., & Durkin, M. T. (2021). Nursing 2021 drug handbook. 41st edition.
Philadelphia: Wolters Kluwer.

Heuman, D. M., MD. (2021, October 17). Gallstones (Cholelithiasis): Practice Essentials,
Background, Pathophysiology. From https://emedicine.medscape.com/article/175667-
overview#:%7E:text=Cholelithiasis%20involves%20the%20presence%20of,on%20the%
20stage%20of%20disease

U.S. National Library of Medicine. (n.d.). Acute cholecystitis: Medlineplus medical encyclopedia.
MedlinePlus. Retrieved May 17, 2022, from
https://medlineplus.gov/ency/article/000264.htm?fbclid=IwAR14FUjSbbmQvsFaDSbuAW
1lfbi-Pfifn7mGbZlFW9nMln5dpj2izVF-xKQ

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