Nursing Care Plan (NCP) for Cholecystitis

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Outline

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, the 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

The 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 the anesthesia if surgery or diagnostic procedures are being performed. The 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 a source of pain
  • A pregnancy test should be done on all women of childbearing age to prevent the 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 the 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 the procedure
  • Withhold NSAIDs and anticoagulants prior to the 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

Writing a Nursing Care Plan (NCP) for Cholecystitis

A Nursing Care Plan (NCP) for Cholecystitis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey guys, in this care plan, we will explore Cholecystitis. 

 

So, in this Cholecystitis care plan, we’re going to talk about the desired outcome of our patient, the subjective and objective data, along with the nursing interventions and rationale for each SAR, medical diagnosis is Cholecystitis. 

 

So, Cholecystitis is inflammation of the gallbladder, which holds bile that is actually released into the small intestines. So, let’s imagine this is our small intestines here. So, when that bile duct between the gallbladder and the small intestines gets blocked, the bile becomes trapped causing that inflammation in the gallbladder. The obstruction of the bile duct causes inflammation and it could be caused by gallstones, biliary, sludge infections, tumors, or blood vessel compression. So, the desired outcome of our patient is that they’ll be free from pain and resume and maintain optimal diet and nutrition. 

 

Now, let’s look at our care plan. So, the patient may be experiencing some nausea and loss of appetite because of the blockage that isn’t allowing the bile to flow into the intestines. So, the patient may be experiencing severe abdominal pain in the right upper quadrant or in the center because of the blockage and inflammation. 

 

Now, let’s look at our objective data. So, the inflammation of the gallbladder might cause your patient to have a fever. Your patient may begin vomiting due to the blockage of the bile. The patient may have abnormal lab values like their liver enzymes because the liver is what creates the bile that then travels through the bile duct into the gallbladder. So, when Cholecystitis progresses and the tissue begins to die, the liver becomes more affected resulting in those elevated liver enzymes and even sometimes jaundice. So, Bilirubin may be elevated indicating bile duct obstruction as well. The patient might have clay colored stool because of the lack of bile to change the color of the stool to brown. 

 

Now, let’s look at our nursing interventions in the rationales. So, our first nursing intervention is to assess your patient’s vital signs. Look for tachycardia and fevers, because that could indicate infection in your patient. Next, you will assess the gastrointestinal status of your patient. Look for abdominal distension, listen for belching and feel for abdominal rigidity. 

 

Our next nursing intervention is to assess and manage your patient’s pain. The inflammation and obstruction causes pain that might radiate to the back. Next, you administer medications for the patient, such as antibiotics for infections, analgesics for pain, antiemetics for nausea and vomiting, and IV fluids to help hydrate your patient while they’re resting their bowels. Be sure to monitor the diagnostic testing of your patient. Look at those lab values in the imaging to view the gallbladder and how it’s doing. So, you will prepare for any procedures that they might have. The patient might be on a clear liquid diet prior, and you will have to withhold any anticoagulants and NSAIDS to avoid bleeding. 

 

Our last nursing intervention is to provide nutrition and lifestyle education, encourage a low fat diet because it’s easier to digest and avoid gastric irritants because they could worsen diarrhea. The diarrhea after gallbladder removal occurs because of the direct drainage of the bile into the intestine from the liver. It no longer will have the gallbladder to rest in. It’s going to go straight into the intestines causing diarrhea.

 

We love you guys. Now go out and be your best self today and as always, happy nursing!

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