Chinese General Hospital Colleges College of Nursing Discharge Plan

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Chinese General Hospital Colleges College of Nursing Discharge Plan

I. Methods 1. Inform the client to take medications on time or as directed for the full course of therapy even if feeling better. 2. Inform the client about the adverse effects and possible side effects of the medications. 3. Inform the importance of taking prescribed medications and the consequences of not following the treatment regimen. Exercise 1. Promote regular light exercise as tolerated. 2. Inform the client about proper exercise regimen to avoid injury. 3. Alternate rest periods with activity. 4. Encourage walking exercise. Treatment 1. Instruct the client to continue drug therapy as ordered. 2. Inform the client as well as the family the dangers of non compliance to treatment regimen. 3. Discuss to the client the complications and other problems that might arise from the condition. 4. Encourage client to strictly comply with the doctors orders, especially in taking the prescribed medications. 5. Encourage the client to have followed up visitations to the physician after discharge. Health Teaching 1. Encourage client to avoid strenuous activities. 2. Encourage to have adequate hydration. 3. Encourage to have a restful and quiet atmosphere at home. 4. Encourage the client of use relaxation skills when in pain. 5. Encourage client to seek emotional and social support especially to family and friends to promote strength and comfort. OPD Check Up Remind client to attend follow up check up under Dr. Jeffrey Chua Lee one week after discharge at Chinese General Hospital for evaluation progress of the condition. Diet 1. Increase oral fluid intake. 2. Advice to try to have a meal that is high fiber, moderate calorie, low fat and low salt. 3. Encourage patient to increase nutritious food intake by eating fresh vegetables, whole grain products and lean meat. Meal Plan: A. Breakfast Pandesal and Coffee B. Lunch Chopsuey, Rice, Banana, Water C. Dinner Sinigang na Bangus, Rice, Water Signs and Symptoms Watch out for: Excessive bleeding in the surgical site Infection of the surgical wound: redness, inflammation, fever, drainage, pain

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Post - Cholecystectomy Syndrome: pain, bloating, gas or diarrhea

Chinese General Hospital Colleges College of Nursing Pathophysiology

Predisposing factors: Female Increasing age Ethnicity Diabetes Mellitus

Precipitating factors: Obesity Fasting Drugs (hormonal therapy for women) Pregnancy

Bile stagnates in the gallbladder Pigment solute precipitate as solid crystals Crystals clump together and form stones Gallstones Gallbladder contracts after intake of fat to release bile Upon contraction, a stone is moved and becomes impacted on the cystic duct

CHOLELITHIASIS

Lumen is obstructed by stones Bile stasis Chemical reaction inside gallbladder triggers the release of inflammatory enzymes (Prostaglandins) Fluids leak into gallbladder Edema Increased intraluminal pressure and distention of the gallbladder Constriction of blood vessels ACUTE CHOLECYSTITIS Inflammation of the gallbladder Biliary Colic (RUQ PAIN) Murphys Sign

Chinese General Hospital Colleges College of Nursing Theoretical Framework


Theory of Nursing Systems Based on the manner in which all individuals act and that this process is used by a nurse to meet a patients need for help; meeting this need improves the patients behavior. The components of Orlandos Nursing Process Theory are (1.) patient behavior, and (2.) nurse reaction, and (3.) nurse action.

Patient Behavior The nursing process is set in motion by the patients behavior and all patient behavior, no matter how significant, may represent a cry for help because the patient who cannot resolve a need feels helpless, and the persons behavior reflects this feeling. Nurse Reaction Nurse reaction to a patients behavior is through the senses; this perception leads to thought, which evokes a feeling, and because these three parts occur automatically and almost simultaneously a nurse must identify each part of the reaction to help the patient. Nurse Action Is whatever the nurse says or does to benefit the patient and when performing an action, the nurse influences by stimuli related to the patients needs. States that the function of the nurse is to find out and meet the patients immediate need for help and to use the nursing process (nurse-patient interaction) to relieve a patients feelings of helplessness or suffering. Orlandos theory keeps the student nurses focus on the needs and concerns of the patient whether the client or her significant others stated it or not. Learning How to interpret and validate both verbal cues and non verbal cues is essential in any hospital situation for not all cues is presented as it is. Therefore, the student nurses applied Orlandos theory to aid them in interpreting the actions and behaviors of the patient. They also made sure to verify first what theyve observed before planning anything. The student nurses paid close attention to any signs that may lead to distress that might threaten the patients life. Application of the theory also helps the student nurse prepare and plan the course of action towards the situation. This preparation leads to an appropriate intervention by the nurse that might relieve the patient of her distress or might even save the patients life.

Chinese General Hospital Colleges College of Nursing Journal


Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. OBJECTIVE: A prospective randomized study was undertaken to compare early with delayed laparoscopic cholecystectomy for acute cholecystitis. METHOD: During a 26-month period, 99 patients with a clinical diagnosis of acute cholecystitis were randomly assigned to early laparoscopic cholecystectomy within 72 hours of admission (early group, n = 49) or delayed interval surgery after initial medical treatment (delayed group, n = 50). Thirteen patients (four in the early group and nine in the delayed group) were excluded because of refusal of operation (n = 6), misdiagnosis (n = 5), contraindication for surgery (n = 1), or loss to follow-up (n = 1). RESULTS: Eight of 41 patients in the delayed group underwent urgent operation at a median of 63 hours (range, 32 to 140 hours) after admission because of spreading peritonitis (n = 3) and persistent fever (n = 5). Although the delayed group required less frequent modifications in operative technique and a shorter operative time, there was a tendency toward a higher conversion rate (23% vs. 11%; p = 0.174) and complication rate (29% vs. 13%; p = 0.07). For 38 patients with symptoms exceeding 72 hours before admission, the conversion rate remained high after delayed surgery (30% vs. 17%; p = 0.454). In addition, delayed laparoscopic cholecystectomy prolonged the total hospital stay (11 days vs. 6 days; p < 0.001) and recuperation period (19 days vs. 12 days; p < 0.001). CONCLUSIONS: Initial conservative treatment followed by delayed interval surgery cannot reduce the morbidity and conversion rate of laparoscopic cholecystectomy for acute cholecystitis. Early operation within 72 hours of admission has both medical and socioeconomic benefits and is the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.

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