Nursing Care Plan for Cholecystitis

Monitor for signs of cardiopulmonary stress and signs of infection

• Tachycardia
• Fever

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

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.

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

• 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

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

• 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

• 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