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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/high-starch 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
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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.
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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 around
7am 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 District
Hospital). On his first admission into this hospital he had undergone throidectomy
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 ashtma when he was 7 years old that lasts when he is 21 years old, his
ashtma just stopped when he start drinking alcohol beverages as he said.
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As for his present illness, he was admitted into this hospital because of cholecystitis,
he was admitted last February 13, 2006. He was been diagnosed with cholecystitis with
multiple cholelithiasis a month prior to admission due to severe epigastric pain and
weight loss and was advised to remove his gallbladder. He just did not have his
cholecystectomy done immediately due to financial problem. When the money needed
for his operation was enough he then goes to Porac District Hospital last February 13,
2005 for his operation. He was diagnosed and surgically operated by Dr.
Serrano.According to Mr. Castro. Upon admission he had undergone some laboratory
examination such as UTZ, Chest X-ray, U/A, CBC, FBS, BUN,Creatinine and ECG. His
initial medication were H2bloc and Cefuroxime.
D. Physical Examination
Physical Assessment done by the attending physician reveals that patient is;
afebrile
with pink palpebral conjunctiva
(-) cyanosis
(+) NABS
non tender abdomen
Vital Signs upon admission (February 13, 2006)
BP- 130/90RR-19PR-84Temp-36.5 oCPhysical Assessment done by the student reveals that patient is;
afebrile
with pink palpebral conjunctiva
(+) dry lips
(+) paleness
(+) dryskin
decreased skin turgor
(-) bowel movement
(-) weakness
Vital Signs taken and recorded as of February 15, 2006 are as follows;BP- 140/90PR- 85RR- 21
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Temp- 36.4 oC
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III. ANATOMY AND PHYSIOLOGY
Gallbladder, muscular organ that serves as a reservoir for bile, present in most
vertebrates. In humans, it is a pear-shaped membranous sac on the undersurface of the
right lobe of the liver just below the lower ribs. It is generally about 7.5 cm (about 3 in)
long and 2.5 cm (1 in) in diameter at its thickest part; it has a capacity varying from 1 to
1.5 fluid ounces. The body (corpus) and neck (collum) of the gallbladder extend
backward, upward, and to the left. The wide end (fundus) points downward and forward,
sometimes extending slightly beyond the edge of the liver. Structurally, the gallbladder
consists of an outer peritoneal coat (tunica serosa); a middle coat of fibrous tissue and
unstriped muscle (tunica muscularis); and an inner mucous membrane coat (tunica
mucosa).
The function of the gallbladder is to store bile, secreted by the liver and transmitted
from that organ via the cystic and hepatic ducts, until it is needed in the digestive process.
The gallbladder, when functioning normally, empties through the biliary ducts into the
duodenum to aid digestion by promoting peristalsis and absorption, preventing
putrefaction, and emulsifying fat. Digestion offat occurs mainly in the small intestine, bypancreatic enzymes called lipases. The purpose of bile is to; help the Lipases to Work, by
emulsifying fat into smaller droplets to increase access for the enzymes, Enable intake of
fat, including fat-soluble vitamins: Vitamin A, D, E, and K, rid the body of surpluses and
metabolic wastes Cholesterol and Bilirubin.
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IV. PATHOPHYSIOLOGY
Risk factor
Heredity
Obesity
Rapid Weight Loss, through diet or surgery
Age Over 60
Bile must becomesupersaturated with
cholesterol and calcium
The solute precipitatefrom solution as solid
crystals
Crystals must cometogether and fuse to form
stones
Gallstones
Obstruction of the cystic duct and common bile duct
Sharp pain in the rightpart of abdomen Jaundice
Distention of the gall bladder
Venous and
lymphatic drainageis impaired
Proliferation of
bacteria
Localized cellularirritation or
infiltration or bothtake place
Areas of
ischemia mayoccur
Inflammation of gall bladder
CHOLECYSTITIS
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V. DIAGNOSTIC AND LABORATORY PROCEDURE
1. Complete Blood Count (CBC)
This is to determine blood components and the response to
inflammatory process and streptococcal infection.
Date Ordered: February 13, 2006
Date Result In: February 13, 2006
Results:
WBC - 10.9 g/l
RBC - 5.5 g/l
Lymphocyte - 27
Conclusion:
WBC is slightly elevated based on the normal value of 4.3-10 g/l which
confirms the presence of infection.
2. Fasting Blood Sugar
This is to measure the blood glucose levels.
Date Ordered: February 13, 2006
Date Result In: February 13, 2006
Results:
94.8 mg/dl
Conclusion:
The result is within normal range based on the normal value of < 126
mg/dl.
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3. Creatinine
This is the indicator of the renal function
Date Ordered: February 13, 2006
Date Result In: February 13, 2006
Results:
1.0 mg/dl
Conclusions:
The result is within normal range based on the normal value of 0.60-1.7
mg/dl.
4. BUN
This is an indicator of renal function and perfusion, dietary intake of
CHON and the level of protein metabolism
Date Ordered: February 13, 2006
Date Result In: February 13, 2006
Results:
10.7 Mg/dl
Conclusions:
The result is within normal range based on the normal value of mg/dl.
5. Urinalysis
Urinalysis yields a large amount of information about possible disorders of
the kidney and lower urinary tract, and systematic disorders that alter urine composition.
Urinalysis data include color, specific gravity, pH, and the presence of protein, RBCs,
WBCs, bacteria, Leukocyte, esterase, bilirubin,glucose, ketones, casts and crystals.
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Date Ordered: February 10, 2006
Date Result In: February 10, 2006
Results:
Color- yellow
Specific Gravity- 0.010
Sugar/ Albumin- negative
Pus cells- 0.1 hpf
Conclusions:
The results are normal but there is a presence of pus cells in the urine
which means that there is also the presence of infection.
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VI. Patients Care
a. Nursing Care Plan
Preoperative NCP
1. Acute Pain
Cues Nursing
Diagnosis
Scientific
Explanations
Objectives Nursing
Interventions
Rationale Evaluation
S
O- pain scale
of 7/10- difficulty in
moving asmanifestedby facial
grimaces- (+) pallor - (+) muscle
guarding- RR- 30- BP- 140/90
Acute painrelated toinflammationand distortionof thegallbladder asevidenced byverbal reportsof pain.
Due to thepresence ofstones in thegallbladder itcauses someobstruction inthe cystic ductwhich in turncauses a sharpacute pain onthe right part of
the abdomen.
After 4 hoursof nursingintervention thepatient willreport relieveof pain.
1. Observe anddocumentlocation,severity (010scale),and character ofpain (e.g.,steady,intermittent,colicky).
2. Promotebedrest,allowing patientto assumeposition ofcomfort.
3. Control
- Assists indifferentiating causeof pain, and providesinformation aboutdiseaseprogression/resolution,development ofcomplications, andeffectiveness ofinterventions.
- Bedrest in low-Fowlers positionreduces intra-abdominalpressure; however,patient will naturallyassume leastpainful position.
- Cool surroundings
Is there a changeon the patients;
a. Painscale
b. RR c. BPd. Reports
of paine. Facial
expressions.
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environmentaltemperature.
4. Encourageuse ofrelaxationtechniques, e.g.,
guidedimagery,visualization,deep-breathingexercises.Providediversionalactivities.
5. Make time tolisten to andmaintainfrequent contactwithpatient.
6. Administeranalgesics asindicated
aid in minimizingdermal discomfort.
- Promotes rest,redirects attention,may enhance coping.
- Helpful in alleviatinganxiety and refocusingattention,which can relievepain.
- Relief of painfacilitates cooperationwith othertherapeuticinterventions,
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2. Fluid Volume deficient
Cues Nursing
Diagnosis
Scientific
Explanations
Objectives Nursing
Interventions
Rationale Evaluation
S
O- (+) pallor - (+) body
weakness- (+)
vomiting- with poor
skinturgor
- (+) dryskin
- (+) drymouth
Fluid VolumeDeficient relatedto vomiting
Because ofvomitingexcessive losses
through normalroutes occur thuscauses FluidVolumeDeficient
After series ofNI the pt. willmaintain
adequate fluidvolume asevidenced bymoist mucousmembranes andgood skin turgor,
1. Maintainaccurate recordof I&O, noting
output less thanIntake, increasedurine specificgravity. Assessskin/mucousmembranes,peripheralpulses, andcapillaryrefill.
2. Performfrequent oralhygiene
3. Provide skinand mouth care
- Providesinformationabout fluid
status/circulatingvolume andreplacementneeds.
- Decreasesdryness of oralmucous
membranes;reducesrisk of oralbleeding.
- Skin andmucousmembranes aredry, withdecreased
Is there still thepresence of;
a. vomiting
b. dry skinc. dry
mouthd. poor skin
turgore. body
weakness
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4. Increase fluid
intake
5. Ascertainpatientsbeveragepreferences, andset up a 24-hr schedule forfluid intake.Encourage foodswith highfluid content.
6. Administerantiemetics, e.g.,prochlorperazine(Compazine) asordered by thephysician.
elasticity,because ofvasoconstrictionand reducedintracellularwater.- promotes
hydration.
- Relieves thirstand discomfortof dry mucousmembranesand augmentsparenteralreplacement.
- Reduces nauseaand preventsvomiting.
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Post-operative NCP3. Knowledge Deficit
Cues Nursing
Diagnosis
Scientific
Explanations
Objectives Nursing
Interventions
Rationale Evaluation
Spwede bang
maulit angsakit ko asverbalized bythe patient
O- Frequently
askingquestionabout hiscondition,treatmentand diet
- Withworriedgaze
Deficientknowledge
related tocondition,prognosis,treatment,self-care, anddischargeneeds
There is thispresence of
knowledgedeficit due tosomeunfamiliarinformationthat causessome confusionto the clientthat needs to bediscussed.
After an hourof nurse-patient
interaction thepatient willVerbalizeunderstandingof diseaseprocess,prognosis, andpotentialcomplications.
1. Provideexplanations
of/reasons for testprocedures andpreparationneeded.
2. Reviewdiseaseprocess/prognosis.Discusshospitalizationand prospectivetreatment asindicated.Encourage
questions,expression ofconcern.
3. Review drugregimen, possibleside effects.
- Information candecrease anxiety,
thereby reducingsympatheticstimulation.
- Provides knowledgebase from whichpatient can makeinformed choices.Effectivecommunication andsupportat this time candiminish anxiety and
promote healing.
- Gallstones oftenrecur, necessitatinglong-term therapy.
- Prevents/limits
- Does thepatient
understandsand couldrecall alltheteachingsgiven?
- Is there asignificantchangesthat occuron thepatientsknowledgeregarding;
a. diseaseconditionb. dietc. treatmentd. medicatione. self-care
needs
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4. Instruct patientto avoidfood/fluids highin fats (e.g.,whole milk, icecream, butter,fried foods, nuts,
gravies,pork), gasproducers (e.g.,cabbage, beans,onions,carbonatedbeverages), orgastric irritants(e.g., spicyfoods, caffeine,citrus).
5. Suggest patientlimit gumchewing, suckingon straw/hardcandy, orsmoking.
recurrence ofgallbladder attacks.
- Promotes gasformation, which canincrease gastricdistension/discomfort.
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b. Drug Study
Name of Drug Date
Ordered
Route/
Dosage and
Frequency
Action Indication Adverse
Reaction
Nursing Consideration
GN: H2Bloc(Pepcidine)
BN:Famotidine
02-13-06 PO20 mg tab at
bedtime
- Anti-ulcer- competitively
inhibits actionof histamine onthe H2 atreceptor sites ofparietal cells,decreasinggastric acidsecretion
-for short termtreatment of
duodenal ulcer
- headache,dizziness,
malaise, drymouth
1. Check for doctors order2. not to be given in patients
hypersensitive to drugs3. Inform the patient about thepossible side effect of the drug4. Instruct patient to take drugwith food5. Advised patient to take drugonce daily usually at bed time6. Advise patient to reportabdominal pain or blood instools or is vomiting.
GN:CefuroximeBN: Zinacef
02-13-06 IV750 mgevery 8o
prior to OR(30 to 60minutesbefore)
- anti-infective- a 2nd
generationcephalosporinthat inhibitscell-wallsynthesis,promotingosmoticinstability
- perioperativeprophylaxis
- Nausea andVomiting
1. Check for doctors order2. Perform ANST prior toadmission3. Should not be given ifpositive skin test4. Slow IV push5. Inform the patient about thepossible side effect of the drug6. Advise patient to report anydiscomfort on the IV insertionsite
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Name of Drug Date
Ordered
Route/
Dosage and
Frequency
Action Indication Adverse
Reaction
Nursing Consideration
GN:ClomipramineHClBN: Placil
02-13-06 PO10 mg tab,at 6 am
- Anti-depressants
- for depressionand chronic pain
- headache,dizziness,malaise, drymouth
1. Check for doctors order2. not to be given in patientshypersensitive to drugs3. Inform the patient about the
possible side effect of the drug
GN:GentamicinDulfateBN: Genticin
02-14-06 IV80 mg amp,every 80
- Anti-infective- inhibitsproteinsynthesis
- endocarditisprophylaxis forGI or GUprocedure orsurgery
- Nausea andVomiting,headache,dizziness
1. Check for doctors order2. Perform ANST prior toadmission3. Should not be given ifpositive skin test4. Slow IV push5. Inform the patient about thepossible side effect of the drug6. Advise patient to report anydiscomfort on the IV insertionsite7. Monitor urine output, specificgravity, U/A, BUN andcreatinine levels
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Name of Drug Date
Ordered
Route/
Dosage and
Frequency
Action Indication Adverse
Reaction
Nursing Consideration
GN: AmpicillinBN: Omnipen
02-14-06 IV1 g amp,every 80
- Anti-infective- inhibitsproteinsynthesis
- endocarditisprophylaxis forGI or GUprocedure or
surgery
- Nausea andVomiting,headache,dizziness
1. Check for doctors order2. Perform ANST prior toadmission3. Should not be given if
positive skin test4. Slow IV push5. Inform the patient about thepossible side effect of the drug6. Advise patient to report anydiscomfort on the IV insertionsite
GN: MgSO4 02-14-06 IV0.03% 7mlevery 120
-anti-convulsant-replacesmagnesium andmaintainsmagnesiumlevel
- magnesiumsupplementation
- drowsiness,hypotension
1. Use parenteral magnesiumwith extreme caution in patientswith impaired renal function2. Test knee jerk and patellarreflexes before each additionaldose3. check magnesium level afterrepeated doses4. Monitor fluid intake andoutput5. Monitor renal function
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Name of Drug Date
Ordered
Route/
Dosage and
Frequency
Action Indication Adverse
Reaction
Nursing Consideration
GN: KetorolacTromethamineBN: Toradol
02-14-06 IV30 mg amp,every 60
- Anti-inflammatory- inhibits
prostaglandinsynthesis
- short termmanagement ofmoderately
severe, acute pain
- dizziness,sedation,headache,
flatulence,nausea andvomiting
1. Check for doctors order2. Perform ANST prior toadmission
3. Should not be given ifpositive skin test4. Slow IV push5. Inform the patient about thepossible side effect of the drug6. Advise patient to report anydiscomfort on the IV insertionsite
Anesthetic drug
Name of Drug DateOrdered
Route Action Adverse Reaction Nursing Consideration
GN: Lidocaine HCl 02-14-06 IV Anestheticdrugs
-lethargy,hypotension
1. Monitor BP, PR, and RR before andafter giving the medication
2. Monitor patient for toxicity
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c. Medical/ Surgical Management
1. Chest X-ray- this is used to rule out respiratory causes of referred pain.
2. Intake and Output- I&O measurement provide an other means of
assessing fluid balance. This data provide insight into the cause of
imbalance such as decrease fluid intake or increase fluid loss. These
measurement are not that accurate as body weight, however, because of
relative risk of errors in recording.
3. Electrocardiogram- The ECG is an essential tool in evaluating cardiac
rhythm. Electrocardiography detects and amplifies the very small
electrical potential changes between different points on the surface of the
body as a myocardial cell depolarize and repolarize, causing the heart tocontract.
4. O2 Inhalation- Oxygen therapies are used to provide more oxygen to the
body into order to promote healing and health.
5. Intravenous Rehydration- when the fluid loss is severe or life
threatening, intravenous (IV) fluids are used for replacement.
6. ultrasound (Also called sonography.) - a diagnostic imaging technique
which uses high-frequency sound waves to create an image of the
internal organs. Ultrasounds are used to view internal organs of the
abdomen such as the liver spleen, and kidneys and to assess blood flow
through various vessels.
7. hepatobiliary scintigraphy - an imaging technique of the liver, bile ducts,
gallbladder, and upper part of the small intestine.
8. cholangiography - x-ray examination of the bile ducts using an
intravenous (IV) dye (contrast).
9. percutaneous transhepatic cholangiography (PTC) - a needle is
introduced through the skin and into the liver where the dye (contrast) is
deposited and the bile duct structures can be viewed by x-ray.
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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 x-rays 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 x-rays.
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.
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VII. Clients Daily Progress
DAYS ADMISSION
2/13/06
DAY 2
2/14/16
DAY 3
2/15/16
DISCHARGE
2/16/06
Nursing Problem
Acute pain * *
Fluid Volume Deficient * *Knowledge Deficit * *
Vital Signs BP- 130/90PR- 84RR- 19Temp- 36.5 oC
BP- 140/90PR- 82RR- 21Temp- 36.2 oC
BP- 140/90PR- 85RR- 21Temp- 36.4 oC
BP- 130/90PR- 83RR- 20Temp- 36.1 oC
Dx & Lab Procedures
CBC *
U/A *
FBS *
BUN *
Creatinine *
Medical & Surgical
Management
Chest X-ray *12-L ECG *
O2 inhalation *
D5LRS, 1Lx 30-31gtts/min
* *
D5NM, 1Lx 30-31gtts/min
* *
Drugs
H2 Bloc *
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Cefuroxime * * *
Ketorolac * *
Ampicillin * *
Gentamicin * *
MgSO4 * *
Lidocaine * *
Placil * * *
DietNPO *
Clear liquid *
Soft Diet *
DAT *
Activity & Exercise
FOB *
Sit on Bed *
Ambulation as Tolerated * *
* First started and indicates the duration it was done and taken.
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VIII. DISCHARGE PLANNING
M - Instructed the patient to continue medication as ordered
1. Cephalexin 500 mg cap 3 x day (8am-1pm-8pm) for 1 week
2. Mefenamic Acid 500 mg cap 3 x day (am-1pm-8pm) for 1 week
E - Instructed the patient to do exercise as tolerated such as walking
T - Instructed the patient to continue the medication
H - 1. Encouraged patient to increase fluid intake
2. Encouraged patient to eat foods rich in Vitamin and Nutritious
foods
3. Encourage patient to avoid salty and fatty foods
4. Encourage patient to have enough rest
O - Instructed to come back for follow-up check-up on February 23, 2006,
Thursday.
D - Advised the patient to a diet as tolerated but preferably avoiding salty
and
fatty foods.
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IX. Conclusion
Our patient, Mr. Aproniano Castro has a chief complaint of epigastric pain.
He was admitted in Porac District Hospital and he was diagnosed of having a
cholecystitis with multiple cholelithiasis based on the diagnostic procedure conducted
in him like the CBC, U/A, 12-L ECG, FBS, BUN, Crea, X-ray and UTZ. Due to the
result the surgeon decided for a surgery to remove the gallbladder which is known as
the cholecystectomy. We are happy to say that most of our group mates witness the
operation. The following day we were given the chance to visit and assess our
patients condition. Fortunately, the patient had recovered at once he is no longer
complaining of epigastric pain. What he was complaining is if he could already eat
his food for he is on a liquid diet! And of course the pain of his operative site which is
just normal for several days after undergoing the operation.
Since cholecystitis is the inflammation of the gall bladder which is usually
accompanied by gallstones or cholelithiasis these gallstones may block the way of
toxic substances that really needs to go out, but due to this blockage this toxic
substances are not then being expelled and are just being stored in the bladder for a
period of time. This then causes inflammation of the gallbladder. The treatment
usually done is the cholecystectomy.
In order to lower the risk of having this kind of condition each and every one
of us must be conscious in our diet. We should try to avoid foods which are rich in
salt and fats, especially those foods which contains many seasonings. Though there is
a saying that Mas masarap pag bawal which always pertains to the food were
eating we should still be conscious on our health especially if we want to live longer
and also to avoid those life-threatening diseases which not only shorten our life but
causes us some financial problem. Remember also the saying Mahal ang
magkasakit. Just like on what our patient had experience he still has to collect
money for the operation he had underwent causing them to have debt with different
persons. Let us not enjoy ourselves with the delicious food were eating that is rich in
salts and fats but we should enjoy living because we have a healthy condition.
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X. BIBLIOGRAPHY
Books
Joyce M. Black,PhD, RN, CPSN, CWCN & Jane Hokanson Hawks, DNSc, RN, BC,Medical- Surgical Nursing 7th edition, pg.1302-1314.
Nursing 2004 Drug Handbook, 24th edition
Doenges, Moorhouse, & Murr, Nurses pocket guide 9th edition.
Online Resources
www.facs.org
http://tjsamson.client.web-health.com/web-health/topics/GeneralHealth/generalhealthsub/generalhealth/liver&gallbladder/what_gallbladder.html
http://www.emedicine.com/emerg/topic97.htm
http://www.emedicine.com/radio/topic163.htm
http://www.healthsystem.virginia.edu/uvahealth/adult_liver/chole.cfm
http://www.emedicine.com/EMERG/topic98.htm
Microsoft Encarta 2004
Nursing Care Plan Content CD-ROM
http://www.facs.org/http://tjsamson.client.web-health.com/web-health/topics/GeneralHealth/generalhealthsub/generalhealth/liver&gallbladder/what_gallbladder.htmlhttp://tjsamson.client.web-health.com/web-health/topics/GeneralHealth/generalhealthsub/generalhealth/liver&gallbladder/what_gallbladder.htmlhttp://tjsamson.client.web-health.com/web-health/topics/GeneralHealth/generalhealthsub/generalhealth/liver&gallbladder/what_gallbladder.htmlhttp://www.emedicine.com/emerg/topic97.htmhttp://www.emedicine.com/radio/topic163.htmhttp://www.healthsystem.virginia.edu/uvahealth/adult_liver/chole.cfmhttp://www.emedicine.com/EMERG/topic98.htmhttp://www.facs.org/http://tjsamson.client.web-health.com/web-health/topics/GeneralHealth/generalhealthsub/generalhealth/liver&gallbladder/what_gallbladder.htmlhttp://tjsamson.client.web-health.com/web-health/topics/GeneralHealth/generalhealthsub/generalhealth/liver&gallbladder/what_gallbladder.htmlhttp://tjsamson.client.web-health.com/web-health/topics/GeneralHealth/generalhealthsub/generalhealth/liver&gallbladder/what_gallbladder.htmlhttp://www.emedicine.com/emerg/topic97.htmhttp://www.emedicine.com/radio/topic163.htmhttp://www.healthsystem.virginia.edu/uvahealth/adult_liver/chole.cfmhttp://www.emedicine.com/EMERG/topic98.htm