Cholelithiasis Case Study

Cholelithiasis Interventions
I.INTRODUCTION Cholecystitis is an inflammation of the

gallbladder wall and nearby abdominal lining.
Cholecystitis is usually caused by a gallstone in the cystic
duct, the duct that connects the gallbladder to the
hepatic duct. The presence of gallstones in the
gallbladder is called cholelithiasis. Cholelithiasis is the
pathologic state of stones or calculi within the gallbladder
lumen. A common digestive disorder worldwide, the
annual overall cost of cholelithiasis is approximately $5
billion in the United States, where 75-80% of gallstones
are of the cholesterol type, and approximately 10-25% of
gallstones are bilirubinate of either black or brown
pigment. In Asia, pigmented stones predominate,
although recent studies have shown an increase in
cholesterol stones in the Far East. Gallstones are
crystalline structures formed by concretion (hardening) or
accretion(adherence of particles, accumulation) of normal
or abnormal bile constituents. According to various
theories, there are four possible explanations for stone
formation. First, bile may undergo a change in
composition. Second, gallbladder stasis may lead to bile
stasis. Third, infection may predispose a person to stone
formation. Fourth, genetics and demography can affect
stone formation. Risk factors associated with
development of gallstones include heredity, Obesity,
rapid weight loss, through diet or surgery, age over 60,
Native American or Mexican American racial makeup,
female gender-gallbladder disease is more common in
women than in men. Women with high estrogen levels, as
a result of pregnancy, hormone replacement therapy, or

the use of birth control pills, are at particularly high risk
for gallstone formation, Diet-Very low calorie diets,
prolonged fasting, and low-fiber /high-cholesterol/highstarch diets all may contribute to gallstone formation.
Sometimes, persons with gallbladder disease have few or
no symptoms. Others, however, will eventually develop
one or more of the following symptoms; (1) Frequent
bouts of indigestion, especially after eating fatty or
greasy foods, or certain vegetables such as cabbage,
radishes, or pickles, (2) Nausea and bloating (3) Attacks
of sharp pains in the upper right part of the abdomen.
This pain occurs when a gallstone causes a sometimes,
persons with gallbladder disease have few or no
symptoms.
Others ,however, will eventually develop one or more of
the following symptoms; (1) Frequent bouts of
indigestion, especially after eating fatty or greasy foods,
or certain vegetables such as cabbage, radishes, or
pickles, (2) Nausea and bloating (3) Attacks of sharp pain
blockage that prevents the gallbladder from emptying
(usually by obstructing the cystic duct). (4) Jaundice
(yellowing of the skin) may occur if a gallstone becomes
stuck in the common bile duct, which leads into the
intestine blocking the flow of bile from both the
gallbladder and the liver. This is a serious complication
and usually requires immediate treatment. The only
treatment that cures gallbladder disease is surgical
removal of the gallbladder, called cholecystectomy.
Generally, when stones are present and causing
symptoms, or when the gallbladder is infected and
inflamed, removal of the organ is usually necessary.

When the gallbladder is removed, the surgeon may
examine the bile ducts, sometimes with X rays, and
remove any stones that may be lodged there. The ducts
are not removed so that the liver can continue to secrete
bile into the intestine. Most patients experience no
further symptoms after cholecystectomy. However, mild
residual symptoms can occur, which can usually be
controlled with a special diet and medication
II.NURSING ASSESSMENT
A.Personal History
Mr. Aproniano Castro is a 56 year old male, a Filipino
citizen who resides at PulongSantol, Porac Pampanga. He
was born on January 22, 1950 at Pulong Santol, his
religious affiliation is Roman Catholic and he is married to
Mrs. Brigida M. Castro. He is a jeepney driver bound in
Porac-Angeles route. He is also the president of their
jeepneys association. Mr. Castro usually works for 10 to
12 hours a day usually around7am to 7 pm. He always
sleeps around 9 in the evening and wakes up at 6 in the
morning. His wife was the one who prepares him the
breakfast and the snack. He has day-offs but uses this
day in working as the president of the jeepney
association. He usually eats instant food and love eating
foods which has condiment like patis, vinegar and soy
sauce. He also love eating vegetable salads and fatty
salty food. He is not also choosy on the food he eats
because he really eat a lots. He seldom drinks alcohol and
smoke. Regarding the finances about health he is using

his wifes PHILHEALTH card to compensate the finances
needed. Family Health and Illness History
B.Family Health and Illness History

According to Mr. Castro that the familial disease he knows
that they have in their family was the hypertension that is
on his fathers side. His father died because of heart
attack and her mother died of natural cause. He also
added that cholecystitis is prone to their family, because
of one of his siblings also had acquired this disease.
C. History of Past and Present Illness This is the second
time Mr. Castro been admitted into this hospital (Porac
DistrictHospital). On his first admission into this hospital
he had undergone thyroidectomy operation, which is
almost 3 years ago. He had not experience any accident
and injuries, even though his job is prone to accident
particularly vehicular accident. He also added that he had
an asthma when he was 7 years old that lasts when he is
21 years old, his
Postop Interventions
The client is four (4) hour postoperative open
cholecystectomy. Which data warrant immediate
intervention by the nurse?
1. Absent bowel sounds in all four (4) quadrants
2. The T-tube has 60 Ml of green drainage
3. Urine output of 100 Ml in the past three (3) hours
4. Refusal to turn, deep, breathe, and cough

Answer: 4 Refusing to turn, deep breathe, and cough
places the client at risk for pneumonia. This client needs
immediate intervention to prevent complications
Medication Interventions
Fever
A patient is prescribed Primaxin 500 mg IV for a
temperature of 101.5 C. Before you give the antibiotic,
what will you assess?
Assess allergies, including allergies to cephalosporins
and penicillins, as cross-sensitivity might occur.
Assess for a history of seizure disorders because this
drug might cause seizures.
Check IV site and ensure patency.
Check the physician orders. Given the degree of
temperature elevation, the surgeon likely ordered pancultures for blood, urine cultures, and sputum cultures.
These need to be collected before the
antibiotic is begun.
Primaxin- contains cilastin and imipenem
Medical Interventions
10.endoscopic retrograde cholangiopancreatography
(ERCP) - a procedure that allows the physician to
diagnose and treat problems in the liver, gallbladder, bile
ducts, and pancreas. The procedure combines x-ray and
the use of an endoscope. A long, flexible, lighted tube.
The scope is guided through the patient's mouth and
throat, then through the esophagus, stomach, and
duodenum. The physician can examine the inside of
these organs and detect any abnormalities. A tube is then
passed through the scope, and a dye is injected which will

allow the internal organs to appear on an x-ray.
11.computed tomography scan (CT or CAT scan) - a
diagnostic imaging procedure using a combination of xrays and computer technology to produce cross-sectional
images (often called slices), both horizontally and
vertically, of the body. A CT scan shows detailed images
of any part of the body, including the bones, muscles, fat,
and organs. CT scans are more detailed than general xrays.
12.Cholecystectomy- removal of the gallbladder. This
procedure may be performed to treat chronic or acute
cholecystitis, with or without cholelithiasis, to remove a
malignancy or to remove polyps.
13.Cholecystotomy- the establishment of an opening into
the gallbladder to allow drainage of the organ and
removal of stones. A tube is then placed in the
gallbladder to established external drainage. This is
performed when the patient cannot tolerate
cholecystectomy.
14.Choledochoscopy- the insertion of a choledoscope into
the common bile duct in order to directly visualize stones
and facilitate their extraction

Cholelithiasis Case Study

Uploaded by

Copyright:

Available Formats

Cholelithiasis Case Study

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Cholelithiasis Case Study

Uploaded by

Copyright:

Available Formats

Cholelithiasis Interventions

I.INTRODUCTION Cholecystitis is an inflammation of the

a result of pregnancy, hormone replacement therapy, or

inflamed, removal of the organ is usually necessary.

smoke. Regarding the finances about health he is using

B.Family Health and Illness History

4. Refusal to turn, deep, breathe, and cough

passed through the scope, and a dye is injected which will

You might also like