Cholecystitis Nursing Care Plans Diagnosis and Interventions
Cholecystitis NCLEX Review and Nursing Care Plans
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
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.
|Cholecystitis Nursing Interventions||Rationale|
|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.|
Cholecystitis Nursing Care Plan 2
Nursing Diagnosis: Risk for Deficient Fluid Volume
Desired Outcome: Within 48 hours of nursing interventions, the patient will be able to maintain fluid balance.
|Cholecystitis Nursing Interventions||Rationales|
|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.|
Cholecystitis 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.
|Cholecystitis Nursing Interventions||Rationale|
|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.|
Cholecystitis Nursing Care Plan 4
Nursing Diagnosis: Deficient Knowledge related to lack of recall/knowledge, misinterpretation of data, and unawareness of available information sources secondary to cholecystitis as evidenced by inquiries; information requests, misconception statements, instructions are not followed correctly, complications that could have been avoided.
- The patient will explain the disease process, prognosis, and probable complications.
- The patient will demonstrate that you understand the therapeutic needs.
- The patient will make the essential lifestyle modifications and follow the treatment plan.
|Cholecystitis Nursing Interventions||Rationale|
|Explain the reasons for test procedures and preparations.||Information can help to reduce anxiety and, as a result, sympathetic activation.|
|Examine the disease’s progression and prognosis. As needed, discuss hospitalization and potential treatment options. Encourage people to ask inquiries and share their concerns.||Provides a knowledge base for patients to make well-informed decisions. At this time, effective communication and support can help to reduce anxiety and encourage healing.|
|Examine your drug schedule and any potential side effects.||Gallstones return often, demanding long-term treatment. The occurrence of diarrhea or cramps when taking certain drugs may be dose-related or treatable. To avoid pregnancy and the risk of fetal hepatic impairment, women of reproductive age should be counseled about birth control.|
|Review drug regimen if chemical stone dissolving is chosen or medicine is used for prophylaxis.||Some clients with cholesterol gallstones may be treated with ursodeoxycholic acid, which causes the gallstones to dissolve gradually (e.g., over 6 to 18 months). Until the gallstones are dissolved, the client is at danger of problems. This medicine may also be used to prevent gallstones in people who are losing weight quickly (e.g., through bariatric surgery or a very low-calorie diet).|
|If necessary, talk about weight-loss programs.||Obesity is a risk factor for cholecystitis, and losing weight can help with medical management of the chronic condition.|
|Instruct the patient to avoid meals/fluids that are high in fats (pork, gravies, nuts, fried foods, butter, whole milk, ice cream), gas generators (cabbage, beans, onions, carbonated beverages), or stomach irritants (pork, gravies, nuts, fried foods, butter, whole milk, ice cream) (spicy foods, caffeine, citrus).||Prevents or reduces the frequency of gallbladder attacks. Reduced gallbladder sensitivity to cholecystokinin causes dietary trans fatty acids to raise plasma triglyceride levels and impede gallbladder motility. These data revealed that trans fatty acid-induced hypertriglyceridemia enhanced the likelihood of cholesterol gallstones.|
|Recurrent fever; persistent nausea and vomiting, or discomfort; jaundice of the skin or eyes, itching; dark urine; clay-colored feces; blood in urine, stools, or vomitus; or bleeding from mucous membranes are all indications and symptoms that require medical attention.||Indicative of disease progression and the emergence of problems that necessitate further care.|
|After meals, consider relaxing in a semi-Fowler’s position.||During the first stages of digestion, it encourages the flow of bile and general relaxation.|
|Limit the patient’s gum-chewing, straw, and hard candy sucking, and smoking.||Increases stomach distension and discomfort by promoting gas production.|
|Discuss the dangers of aspirin-containing drugs, nasal blowing with force, bowel straining, and contact sports.||Reduces the risk of bleeding due to coagulation time alterations, mucosal irritation, and trauma.|
|Soft toothbrushes and electric razors are recommended.||Reduces the risk of bleeding due to coagulation time alterations, mucosal irritation, and trauma.|
|Recurrent fever, persistent nausea and vomiting, pain, skin or eye jaundice, itching, dark urine, clay-colored feces, blood in urine, stools, or vomitus, or bleeding from mucous membranes are all indications and symptoms that require medical attention.||Indicative of disease progression and the emergence of problems that necessitate further care.|
|Examine the cause of the condition, the surgical method, and the prognosis.||Provides a knowledge base for clients to make well-informed decisions.|
|Show how to care for incisions, dressings, and drains.||Reduces the risk of problems such as infection and biliary blockage by promoting independence in care.|
|Instruct in the drainage of the T-tube collection bag on a regular basis. If indicated, output should be recorded.||Reduces the likelihood of reflux, tube strain, and appliance seal. It also provides details on how to get rid of ductal edema. and the resumption of ductal function for the proper timing of T-tubes must be removed.|
|Emphasize the necessity of sticking to a low-fat diet, eating small meals often, and gradually reintroducing fat-containing foods and fluids over a 4- to 6-month period.||During the first six months after surgery, a low-fat diet minimizes the demand for bile and relieves the discomfort associated with poor fat digestion.|
|Discuss the importance of avoiding or limiting alcoholic beverages.||Reduces the chance of pancreatic involvement.|
|Inform the client that loose stools can last for months.||It takes time for the intestines to acclimatize to the constant stimuli of bile production|
|Advise the client to keep track of and avoid meals that seem to aggravate their symptoms of indigestion.||Although drastic dietary modifications are rarely required, minor limits, such as the consumption of tiny amounts of fats, may be beneficial. After a time of adjustment, the client should be able to eat most foods without difficulty.|
|Dark urine, jaundiced sclera and skin, clay-colored feces, voluminous stools, or recurring heartburn and bloating are all signs and symptoms that should be reported to a healthcare provider.||Indicators of bile flow obstruction or impaired digestion necessitate additional investigation and treatment.|
|Examine your activity constraints, depending on your specific scenario.||In most cases, normal activities can be resumed within 4 to 6 weeks.|
Cholecystitis Nursing Care Plan 5
Impaired Skin Integrity
Nursing Diagnosis: Impaired Skin Integrity related to surgical procedure (cholecystectomy), chemical substance (e.g., bile, stasis of secretions), unbalanced dietary state, as well as a malfunctioning metabolic state secondary to acute cholecystitis as evidenced by disturbance of skin/subcutaneous tissues and T-tube punctures or incisions invading bodily structure.
- The patient will ensure that wounds heal quickly and without problems.
- The patient will demonstrate habits that will aid in skin healing and avoid skin deterioration.
|Cholecystitis Nursing Interventions||Rationale|
|Examine the biliary drainage (NG and T-tube) for color and character.||Initially, drainage may contain blood and blood-stained fluid, but after a few hours, it usually becomes greenish brown (bile hue).|
|Maintain T-tube in a closed collection system.||Skin irritation is avoided, and the possibility of contamination is reduced.|
|Ensure that the T-tube and incisional drains are free-flowing.||T-tube may be left in the common bile duct for 7 to 10 days to remove any microscopic stones or grit that have remained. Drains are placed at the incision site to eliminate any collected fluid or bile. Bile does not back up in the operational area due to proper placement.|
|Dressings should be changed as needed.||Clean the patient’s skin using soap and water. Around the incision, use sterile petroleum jelly gauze, zinc oxide, or karaya powder. Keeps the skin around the incision clean and acts as a barrier against excoriation.|
|Allow enough tubing to allow free rotation and avoid kinks and twists while anchoring drainage tube.||Avoids tube dislodging and lumen blockage.|
|Initially, change dressings frequently, then as needed. Clean the patient’s skin using soap and water. Around the incision, use sterile petroleum jelly gauze, zinc oxide, or another skin protectant.||Maintains the skin around the incision clean and offers a barrier to prevent the skin from bile spilling outside the T-tube, which can cause excoriation.|
|Adjust the Montgomery straps if necessary.||Montgomery straps are nonallergenic tape strips with ties placed through holes on one end. To attach the dressings, one set of straps is inserted on either side of the wound and tied like shoelaces. The straps are unfastened, the wound is cared for, and then the straps are retied to hold the new dressing. To protect the skin, a skin barrier is frequently put before the straps. Only replace the straps or ties if they become loose or dirty. Allows for more frequent dressing changes while reducing skin stress. Dressings that require frequent dressing changes, such as wounds with excessive drainage, should be secured with Montgomery straps. With these straps, the nurse can do wound care without having to remove adhesive strips like tape with each dressing change. As a result, the risk of skin irritation and harm is reduced.|
|Over a stab wound drain, use a disposable ostomy bag.||Heavy drainage can be collected with ostomy equipment for more accurate output measurement and skin protection.|
|Position the patient in a low- or semi-Fowler’s low position and promote early ambulation.||Bile drainage is made easier.|
|If an endoscopic operation is performed, keep an eye on the puncture sites (3–5).||Staples and Steri-Strips may loosen at puncture wound sites, causing bleeding.|
|Allow enough tubing to allow free rotation and avoid kinks and twists while anchoring the drainage tube.||Avoids tube dislodging and/or lumen occlusion.|
|Hiccups, abdominal distension, or indications of peritonitis or pancreatitis should all be looked out for.||If bile leaks into the belly or the pancreatic duct is clogged, dislodging the T-tube might cause diaphragmatic discomfort or more serious consequences.|
|Evaluate skin for itching. Check for color changes in the skin and sclerae for jaundice, and urine (i.e., dark brown).||The appearance of jaundice could suggest a blockage in bile flow secondary to bile stone retention.|
|Take note of the color and consistency of the stools.||When bile isn’t present in the intestines, it causes clay-colored feces.|
|Examine complaints of severe or unrelenting right upper quadrant (RUQ) discomfort, fever, tachycardia, and bile drainage leaking around the tube or from a wound.||Abscess or fistula formation symptoms that necessitate medical attention.|
|Antibiotics should be given as directed.||Treatment for an abscess and/or infection is required.|
|Clamp the T-tube as directed.||Before the tube is withdrawn, it is tested for patency of the common bile duct. Clamping can also be done 1 hour before and after meals if the tube is left in place for a long time. To help digestion, the bile is diverted back to the duodenum.|
|As needed, prepare for surgical operations.||To treat an abscess or repair a fistula, a blocked duct should be drained or a fistulectomy performed. A bile duct injury will necessitate stenting or, if stenting is unsuccessful, surgical repair.|
|Laboratory exam results such as WBC should be monitored.||Leukocytosis is a symptom of an inflammatory condition, such as the formation of an abscess or the onset of peritonitis or pancreatitis.|
Cholecystitis Nursing Care Plan 6
Ineffective Breathing Pattern
Nursing Diagnosis: Ineffective Breathing Pattern related to the surgical procedure (cholecystectomy) secondary to acute cholecystitis as evidenced tachypnea, changes in respiratory depth, and a reduction in vital capacity, alterations in chest excursion (e.g., reluctance to cough; holding of air).
- The patient will create an efficient breathing pattern.
- The patient will demonstrate the absence of signs or symptoms of respiratory impairment or consequences.
|Cholecystitis Nursing Interventions||Rationale|
|Keep track of your breathing rate and depth.||Hypoventilation or atelectasis can be caused by shallow breathing, splinting with respirations, or holding air. As a response to pain or as a first compensatory mechanism, respiration may be increased. Greater labor of breathing, on the other hand, may imply increased oxygen use and energy expenditures, as well as a reduction in respiratory reserve.|
|Perform auscultation of breath sounds.||Atelectasis is indicated by areas of reduced or nonexistent breath sounds, whereas congestion is indicated by adventitious noises (wheezes, rhonchi).|
|Assist the patient with turning, coughing, and taking deep breaths on a regular basis.||Promotes lung segment ventilation as well as secretion mobilization and expectoration.|
|Demonstrate how to splint an incision to the patient. Instruct students on how to breathe well.||Lung expansion is made easier. Splinting gives incisional support and reduces muscular strain, allowing the therapeutic regimen to be followed more easily.|
|Maintain a low-position Fowler’s by elevating the head of the bed.||Increases lung expansion to prevent or treat atelectasis.|
|When coughing or ambulating, keep the patient’s abdomen supported.||Coughing, deep breathing, and movement are all made easier.|
|Encourage the patient and staff to practice good handwashing.||This decreases the risk of cross-contamination.|
|Assist with respiratory treatments, such as a spirometer with an incentive.||Increases lung expansion to prevent or treat atelectasis. Changes in pulmonary function test volumes are associated with open cholecystectomy, and these changes may be linked to respiratory problems such as hypoxemia and atelectasis.|
|As needed, administer analgesics on a regular or continuous basis.||Movement, coughing, deep breathing, and activities are all made easier.|
More Nursing Diagnosis for Cholecystitis
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. (2022). 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
Please follow your facilities guidelines and policies and procedures.
The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.
This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.