Cholecystitis with Cholelithiasis
Cholecystitis is an acute or chronic inflammation of the gallbladder, usually associated with gallstone(s) impacted in the cystic duct, causing distension of the gallbladder.
Stones (calculi) are made up of cholesterol, calcium bilirubinate, or a mixture caused by changes in the bile composition. Gallstones can develop in the common bile duct, the cystic duct, hepatic duct, small bile duct, and pancreatic duct. Crystals can also form in the submucosa of the gallbladder causing widespread inflammation.
Acute cholecystitis with cholelithiasis is usually treated by surgery, although several other treatment methods (fragmentation and dissolution of stones) are now being used.
Here is a sample of Nursing care plan for cholecystitis.
Nursing Care Plan for Cholecystitis with Cholelithiasis | Nursing Priorities; Discharge Goals
Nursing Priorities | Nursing Care Plan for Cholecystitis with Cholelithiasis
- Relieve pain and promote rest.
- Maintain fluid and electrolyte balance.
- Prevent complications.
- Provide information about disease process, prognosis, and treatment needs.
Discharge Goals| Nursing Care Plan for Cholecystitis with Cholelithiasis
- Pain relieved.
- Homeostasis achieved.
- Complications prevented/minimized.
- Disease process, prognosis, and therapeutic regimen understood.
- Plan in place to meet needs after discharge
Nursing Care Plan for Cholecystitis with Cholelithiasis | Nursing Diagnosis for Cholecystitis with Cholelithiasis
Nursing Care Plan for Cholecystitis with Cholelithiasis | Nursing Diagnosis for Cholecystitis with Cholelithiasis; Desired Outcomes
Nursing Diagnosis for Cholecystitis with Cholelithiasis: Acute Pain
May be related to
- Biological injuring agents: obstruction/ductal spasm, inflammatory process, tissue ischemia/necrosis
Possibly evidenced by
- Reports of pain, biliary colic (waves of pain)
- Facial mask of pain; guarding behavior
- Autonomic responses (changes in BP, pulse)
- Self-focusing; narrowed focus
Desired Outcomes/Evaluation Criteria | Nursing Care Plan for Cholecystitis with Cholelithiasis
Patient Will:
Pain Control (NOC)
- Report pain is relieved/controlled.
- Demonstrate use of relaxation skills and diversional activities as indicated for individual situation.
Nursing Care Plan for Cholecystitis with Cholelithiasis | Nursing Interventions for Cholecystitis with Cholelithiasis
Nursing Care Plan for Cholecystitis with Cholelithiasis | Nursing Interventions for Cholecystitis with Cholelithiasis and Rationale;
Nursing Interventions for Cholecystitis with Cholelithiasiss and Rationale
Pain Management (NIC)
Nursing Interventions for Cholecystitis with Cholelithiasiss (Independent) | Nursing Care Plan for Cholecystitis with Cholelithiasis
- Observe and document location, severity (0–10 scale), and character of pain (e.g., steady, intermittent, colicky). Rationale: Assists in differentiating cause of pain, and provides information about disease progression/resolution, development of complications, and effectiveness of interventions.
- Note response to medication, and report to physician if pain is not being relieved. Rationale: Severe pain not relieved by routine measures may indicate developing complications/need for further intervention.
- Promote bedrest, allowing patient to assume position of comfort. Rationale: Bedrest in low-Fowler’s position reduces intra-abdominal pressure; however, patient will naturally assume least painful position.
- Use soft/cotton linens; calamine lotion, oil (Alpha Keri) bath; cool/moist compresses as indicated. Rationale: Reduces irritation/dryness of the skin and itching sensation.
- Control environmental temperature. Rationale: Cool surroundings aid in minimizing dermal discomfort.
- Encourage use of relaxation techniques, e.g., guided imagery, visualization, deep-breathing exercises. Provide diversional activities. Rationale: Promotes rest, redirects attention, may enhance coping.
- Make time to listen to and maintain frequent contact with patient. Helpful in alleviating anxiety and refocusing attention, which can relieve pain.
Nursing Care Plan for Cholecystitis with Cholelithiasis
Pain Management (NIC)
Nursing Interventions for Cholecystitis with Cholelithiasiss (Collaborative) | Nursing Care Plan for Cholecystitis with Cholelithiasis
- Maintain NPO status, insert/maintain NG suction as indicated. Rationale: Removes gastric secretions that stimulate release of cholecystokinin and gallbladder contractions.
- Administer medications as indicated:
- Anticholinergics, e.g., atropine, propantheline (Pro-Banthı-ne); Rationale: Relieves reflex spasm/smooth muscle contraction and assists with pain management.
- Sedatives, e.g., phenobarbital; Rationale: Promotes rest and relaxes smooth muscle, relieving pain.
- Narcotics, e.g., meperidine hydrochloride (Demerol), morphine sulfate; Rationale: Given to reduce severe pain. Morphine is used with caution because it may increase spasms of the sphincter of Oddi, although nitroglycerin may be given to reduce morphine-induced spasms if they occur.
- Monoctanoin (Moctanin); Rationale: This medication may be used after a cholecystectomy for retained stones or for newly formed large stones in the bile duct. It is a lengthy treatment (1–3 wk) and is administered via a nasal-biliary tube. A cholangiogram is done periodically to monitor stone dissolution.
- Smooth muscle relaxants, e.g., papaverine (Pavabid), nitroglycerin, amyl nitrite; Rationale: Relieves ductal spasm.
- Chenodeoxycholic acid (Chenix), ursodeoxycholic acid (Urso, Actigall); Rationale: These natural bile acids decrease cholesterol synthesis, dissolving gallstones. Success of this treatment depends on the number and size of gallstones (preferably three or fewer stones smaller than 20 min in diameter) floating in a functioning gallbladder.
- Antibiotics. Rationale: To treat infectious process, reducing inflammation.
Nursing Care Plan for Cholecystitis with Cholelithiasis
Pain Management (NIC)
Nursing Interventions for Cholecystitis with Cholelithiasiss (Collaborative) - continuation| Nursing Care Plan for Cholecystitis with Cholelithiasis
- Prepare for procedures, e.g.:
- Endoscopic papillotomy (removal of ductal stone); Rationale: Choice of procedure is dictated by individual situation.
- Extracorporeal shock wave lithotripsy (ESWL); Rationale: Shock wave treatment is indicated when patient has mild or moderate symptoms, cholesterol stones in gallbladder are 0.5 mm or larger, and there is no biliary tract obstruction. Depending on the machine being used, the patient may sit in a tank of water or lie prone on a water-filled cushion. Treatment takes about 1–2 hr and is 75%–95% successful. Note: This procedure is contraindicated in patients with pacemakers or implantable defibrillators.
- Endoscopic sphincterotomy; Rationale: Procedure done to widen the mouth of the common bile duct where it empties into the duodenum. This procedure may also include the manual retrieval of stones from the duct by means of a tiny basket or balloon on the end of the endoscope. Stones must be smaller than 15 mm.
- Surgical intervention. Rationale: Cholecystectomy may be indicated because of the size of stones and degree of tissue involvement/presence of necrosis. Refer to Care Plan: Cholecystectomy.
This is a sample of Nursing Care Plan for Cholecystitis with Cholelithiasis.
