Cholecystitis NCLEX Review Care Plans
Nursing Study Guide on Cholecystitis
Cholecystitis is a condition characterized by the inflammation of the gallbladder.
The gallbladder is a pear-shaped organ located on the right upper quadrant of the abdomen just beneath the liver. It acts as storage for bile, a liquid made by the liver that helps in fat digestion.
Cholecystitis may occur due to tumors, bile duct problems, infections, or other illnesses but the presence of gallstones often causes the inflammation in most cases.
It can be classified as acute cholecystitis for sudden onset, and chronic cholecystitis, if the condition persists for a long time.
Cholecystitis may lead to complications that are life-threatening if not treated urgently. Surgery is often the best treatment for this condition.
Signs and Symptoms of Cholecystitis
The signs and symptoms of cholecystitis are usually triggered by the intake of a large volume and high-fat meal.
In the case of acute cholecystitis, the pain is constant and sudden in onset.
- Pain in the right upper quadrant of the abdomen
- Epigastric pain that may radiate to the right shoulder or scapula
- Pain upon inspiration during palpation (Murphy’s Sign)
- Abdominal tenderness and rigidity
- Mass in the right upper quadrant (may be present upon palpation)
- Sign of dehydration
When biliary obstruction is present, the following symptoms may appear:
- Dark orange and foamy urine
- Fatty stool (steatorrhea) and clay-colored feces
Causes of Cholecystitis
The presence of gallstones in the gallbladder can obstruct the cystic duct, the tube through which the bile flows after it is release.
This causes distention and disruption in blood flow and lymphatic drainage. This will eventually cause the bile to build up, resulting to inflammation and infection, which may lead to gallbladder perforation if not treated.
The inflammation can also be due to a variety of conditions such as the presence of a tumor which prevents bile from draining properly, clogging of bile duct due to a kink or scar, and problems in the blood vessels brought about by certain illnesses.
Risk Factors of Cholecystitis
- The existence of gallstones is the main cause and risk factor for developing the disease. The gallstones can form from different materials like bilirubin and cholesterol.
- Certain illnesses that can cause excess bilirubin, calcium and cholesterol increase the likelihood of developing gallstones.
- Gender, age, and obesity. Although cholecystitis can affect both men and women, the risk for acquiring gallbladder disease is more prevalent in women, obese patients and those who are above 40 years of age.
- Genetics. Gallstone formation can also be hereditary, so having a familial history also increases the chance of having the disease.
- Pregnancy and labor. Prolonged labor during childbirth and pregnancy can further increase the risk for cholecystitis.
Complications of Cholecystitis
If left without treatment, cholecystitis can develop to serious complications such as:
- Gallbladder infection. The bile may be infected if there is buildup of bile, causing. cholecystitis.
- Tissue death and gangrene. Tissue death is a complication often seen in the elderly, people with diabetes, and those that were not able to receive prompt treatment. When cholecystitis is left untreated, the tissue in the gallbladder dies causing the development of gangrene.
- Perforation. The inflammation and infection of the gallbladder may cause a tear in the gallbladder. It is a rare but a serious complication of the disease.
- Cholestasis and pancreatitis. In rare cases, the gallstone can lodge and obstruct the common bile duct (cholestasis) and the pancreatic duct (pancreatitis).
Diagnosis of Cholecystitis
- Blood tests – may include white blood cell count to check for presence of infection and bilirubin, alkaline phosphatase and serum aminotransferase levels
- Ultrasound of the abdomen
- Computerized tomography (CT) scan
- Hepatobiliary iminodiacetic acid or (HIDA) scan – determines the flow of bile and its production, through the use of a radioactive dye.
Treatment of Cholecystitis
- Hospitalization. The treatment for cholecystitis would require hospitalization to prevent worsening of symptoms. Management would include the following measures:
- Fasting – the patient will be placed on nothing per orem (nothing by mouth) status to prevent stress from the gallbladder. This also helps during episodes of nausea and vomiting to prevent aspiration.
- Intravenous therapy -fluids will be administered using an intravenous access to prevent further dehydration
- Antibiotics – may be given to control fight off the infection
- Natural bile acids – to reduce the synthesis of cholesterol and dissolve a maximum of 3 gallstones that are less than 20 mm in diameter each
- Analgesics – to relieve pain and decrease inflammation; pain relievers may include:
- Anticholinergics – to relieve pain by reducing reflex spasm and smooth muscle contraction
- Narcotics – to relieve severe pain; morphine must be used in caution as it can increase abdominal spasms
- Sedatives and smooth muscle relaxants – to promote relaxation of smooth muscles in the abdomen
- Surgery. Symptoms usually improve two or three days after medical intervention but if there is still presence of gallbladder inflammation, surgical intervention may be required. It will depend on the severity of symptoms and the risk for complications. The surgery may be performed within 48 hours as outpatient or during hospitalization if there is low surgical risk. However, if complications such as perforation and tissue death of gallbladder are already present, surgery should be performed immediately.
- Cholecystectomy. This is a surgical procedure that involves the removal of the gallbladder. The surgeon often uses a minimally invasive approach, usually via laparoscopy, during the procedure. An open surgery can also be required but is rarely done nowadays.
- Choledocholithotomy. This is a surgical procedure that can be done using the laparoscopic approach. The surgeon will incise the common bile duct to remove the gallstone.
- Endoscopic retrograde cholangiopancreatography (ERCP). It is a diagnostic procedure that can be used to remove the gallstones from the bile duct.
- Lifestyle changes. It is vital that we live a healthy lifestyle to reduce the risk of developing cholecystitis. This includes eating nutritious foods and weight monitoring.
Nursing Care Plans for Cholecystitis
Nursing Care Plan 1
Nursing Diagnosis: Acute Pain related to inflammation of the gallbladder as evidenced by pain score of 10 out of 10, verbalization of right upper quadrant abdominal pain, Murphy’s sign, guarding sign on the abdomen, abdominal rigidity, and restlessness
Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.
|Administer prescribed pain medications.||To alleviate the symptoms of acute abdominal pain. Pain on the right upper quadrant of the abdomen suggests the involvement of the gallbladder.|
Pain medications may include narcotics, anticholinergics, or smooth muscle relaxants.
|Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.||To monitor effectiveness of medical treatment for the relief of abdominal pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.|
|Elevate the head of the bed and position the patient in semi Fowler’s.||To increase the oxygen level by allowing optimal lung expansion.|
|Place the patient in complete bed rest during severe episodes of pain||To reduce gastrointestinal stimulations thereby decreasing GI activity.|
|Perform non-pharmacological pain relief methods: relaxation techniques such as deep breathing exercises, guided imagery, and provision of distractions such as TV or radio.||To provide optimal comfort to the patient.|
|Prepare the patient for surgery as ordered.||Severe acute pain due to cholecystitis may indicate perforation or tissue death of the gallbladder. This requires immediate surgical intervention.|
Nursing Care Plan 2
Nursing Diagnosis: Risk for Deficient Fluid Volume Deficit
Desired Outcome: Within 48 hours of nursing interventions, the patient will be able to maintain fluid balance.
|Commence a fluid balance chart, monitoring the input and output of the patient.||To monitor patient’s fluid volume accurately and effectiveness of actions to prevent dehydration.|
|Start intravenous therapy as prescribed.||To replenish the fluids lost from vomiting, and to promote better blood circulation around the body.|
|Educate the patient (or guardian) on how to fill out a fluid balance chart at bedside.||To help the patient or the guardian take ownership of the patient’s care, encouraging them to drink more fluids as needed, or report any changes to the nursing team.|
|Monitor patient’s serum electrolytes and recommend electrolyte replacement therapy (oral or IV) to the physician as needed.||Sodium, potassium, and chloride are some of the important electrolytes that are lost when a person is vomiting.|
|Place the patient in “nothing by mouth” or NPO status. Insert a nasogastric tube as ordered.||To rest the gastrointestinal tract, if indicated by the physician.|
Nursing Care Plan 3
Nursing Diagnosis: Risk for Imbalanced Nutrition: Less than Body Requirements
Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
|Ask the patient’s preferences regarding food and drinks. Discuss with the patient the short term and long-term nutritional goals.||To help the patient gain a sense of control in his/her nutritional intake and meal planning.|
|Create a daily weight chart and a food and fluid chart. Calculate caloric intake.||To effectively monitor the patient’s daily nutritional intake and progress in nutritional goals.|
|Help the patient to select appropriate dietary choices to follow a low-fat liquid diet following NG tube removal.||Low-fat liquid diet ideal for patients after NG tube is removed.|
|Refer the patient to the dietitian.||To provide a more specialized care for the patient in terms of nutrition and diet in relation to post-cholecystectomy status.|
Other Nursing Diagnoses for Diabetes:
- Deficient Knowledge
- Risk for Infection (Post-operative)
- Alteration in Comfort
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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