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HOWARD COMMUNITY COLLEGE

NURSING EDUCATION PROGRAM

NURSING CARE PLAN

Student Name: Date Submitted:

_____________________

Patient Initials: Age/Sex 74 years Medical Diagnosis: Acute cholecystitis

Complete using your nursing textbooks (cite references used). Underline the etiologies and

clinical manifestations that relate to your client.

I. Pathophysiology:

The infection of the gallbladder is referred to as acute cholecystitis. The occlusion of the cystic

duct is the underlying the pathogenesis process of acute cholecystitis. Acute cholecystitis is

mostly treated surgically; however, it may also be managed conservatively if required. This

condition may be categorized as acute or chronic, and it may occur with or without gallstones. It

can be found in both males and females; however, it may be more prevalent in particular groups.

Certain traditional signs and symptoms may also be present. Peptic ulcer disease, inflammatory

bowel disease (IBD) and heart disease are all conditions that might be misdiagnosed with acute

cholecystitis. Pancreatitis, both chronic and acute, may look like gallbladder disease (Thangavelu

et al., 2018).

The pathophysiology of this condition is dysfunction of the biomechanics of gallbladder

emptying or blockage of the cystic duct. Acute cholecystitis that goes untreated may lead to

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gallbladder perforation, infection, and death. Gallstones are made up of a variety of substances,

including bilirubinate and cholesterol. In diseases like sickle cell disease, where erythrocytes are

broken down, surplus bilirubin is formed, and pigmented stones develop, these materials raise

the risk of cholecystitis and cholelithiasis. Calcium rocks may occur in those who have a lot of

calcium, for example, those diagnosed with hyperparathyroidism. Cholesterol stones may occur

in patients with increased cholesterol levels. Gallstone production may also be caused by

blockage of the biliary tract, which can arise due to neoplasms or strictures.

II. Etiology:

Acute cholecystitis is often caused by an occlusion of the cystic duct, which leads to

inflammation. Bile is normally produced in the liver, moved via the bile duct, and kept in the

gallbladder. The gallbladder is prompted to empty its bile via the cystic duct and into the biliary

tract into the duodenum after consuming specific meals, especially spicy or oily foods. This

procedure assists in the digestion of food.

The gallbladder is capable of both storing and concentrating bile. When homeostasis is

compromised, which may happen owing to bile stasis, supersaturation of cholesterol and lipids

from the liver, disturbance in the concentration process, and cholesterol crystal nucleation,

concentrated bile is vulnerable to precipitation creating stones (Ferreres, 2021).

Acute calculous cholecystitis is a condition in which a stone blocks the cystic duct. It's crucial to

understand that biliary colic is discomfort caused by a brief blockage caused by gallstones. If the

pain does not go away after six hours, the diagnosis of biliary colic is changed to acute calculous

cholecystitis. Acute acalculous cholecystitis occurs when no stone is found.

The gall wall edema will ultimately produce wall ischemia by becoming gangrenous, regardless

of the reason of the obstruction. Gas-forming organisms may infect the gangrenous gallbladder,

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producing acute emphysematous cholecystitis; all of these disorders can rapidly become life-

threatening, and rupture has a high fatality risk.

III. Clinical Manifestations (Signs & Symptoms):

Chronic cholecystitis symptoms include food intolerances (especially fatty and spicy meals),

nausea, and vomiting, bloating, more flatulence, and pain in the right upper quadrant of the

abdomen. It is also possible that one may feel pain in their midback or shoulder. This discomfort

might last for years before being diagnosed (Thangavelu et al., 2018). The clinical manifestations

of acute cholecystitis are similar to those of chronic cholecystitis, but they are more severe. Signs

are often misdiagnosed as cardiac problems. Murphy sign, or right upper abdomen discomfort

with deep palpation, is a unique symptom of this disease. The acute phase is often preceded by a

particular food incident.

IV. Treatment and Nursing Management:

Laparoscopic cholecystectomy is the most effective treatment for cholecystitis. There are

minimal rates of morbidity and death, as well as rapid recovery. In circumstances when the

patient is not a suitable laparoscopic candidate, this may also be done using an open approach.

When a patient is very unwell and seen as a poor surgical match, temporizing percutaneous

gallbladder drainage may be used to treat him or her. Low fat and spice diets can be used to

manage mild instances of chronic cholecystitis in people who are not surgical candidates. This

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therapy has a wide variety of outcomes. Ursodiol has also been found to be efficient in the

medical management of gallstones.

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V. Diagnostic Studies/Lab Analysis

Diagnosis of cholecystitis is done thorough physical examination and collection of medical

history. It is also necessary to conduct a full metabolic profile and a complete blood count

(CBC). These findings may be normal in situations of persistent cholecystitis. The leucocyte

count (WBC) could be raised in acute cholecystitis or chronic condition. Raised liver enzymes

can also occur. A common sign of bile duct stone is having a bilirubin level is higher than 2. It's

worth noting that lab readings may be normal even if you have significant gallbladder illness. A

CT scan is often requested as the initial test in the workup at the emergency room. This imaging

often reveals the presence of cholecystitis and gallstones.

Test Date Client’s Normal Reason

Result Result

Complete 15.11.2021 WBC- 11.70 WBC count is

Blood Count (H) elevated due to

infection

Urea, 15.11.2021 Sodium - 144

electrolytes Potassium –

and Creatinine 3.3 (L)

test

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Calcium 9.3

VI. Discharge Planning and Client Teaching

Before being discharged, the patient should be informed of the occurrence of a fatty food

intolerance, which might result in bloating or diarrhea. This is due to the reduction of

accumulated bile in the gallbladder. This causes the speed of fat emulsification to slow down.

This may be momentary or, to some extent, permanent. The liver will increase bile production in

the majority of patients, and symptoms will improve with time.

VIII. Growth & Development

According to Erikson: Stage: Ego Integrity vs Despair

Crisis: Retrospection is the last developmental task: individuals reflect on their life and

achievements. If people think they have lived a pleasant and useful life, they acquire emotions of

happiness and integrity. If they reflect on a life filled with failures and unmet objectives, they

may become depressed.

Tasks:

A. Describe your patient’s ability to achieve their growth and developmental

tasks. How is this ability affected by the underlying disease process and/or the

current admission?

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There could be a renewed interest in many subjects at this phase. This is thought to happen

because people at this age seek to be self-sufficient. They try to establish a feeling of equilibrium

while their bodies and brains decline. They may cling to their independence so that they are not

completely dependent on others. According to Erikson, it's also critical for adults at this time to

maintain interactions with people of all ages in order to build integrity. The underlying disease

may incapacitate the patient hence prevent him from maintaining his autonomy.

B. List nursing actions to assist your client in meeting their growth and

developmental needs.

The nurse should provide psychological support to the patient to reduce anxiety and discomfort

IX. List in priority order all relevant nursing diagnoses for your patient. Include

NANDA diagnosis, etiology and supporting data.

1. Pain: Inflammation and occlusion of the bile duct and its accompanying ducts may cause

acute pain and discomfort.

2. Deficiency in nutrition: Nutritional shortage may occur as a result of nausea and

vomiting, as well as anorexia.

3. Mental challenges: Anxiety and dissatisfaction may arise as a result of discomfort,

repeated hospital changes, and the impending cholecystectomy surgery.

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Assessment Data Nursing Diagnosis Nursing Actions Rationale Evaluation

Identify all data that According to NANDA List in order of priority. State the rationale for each Evaluate the patient

support the priority nursing action. Cite response to each nursing

nursing diagnosis. reference and page action providing objective

number. & subjective data. Revise

nursing actions as

necessary.

The patient reports of sharp Pain due to acute  Pain management 1. To relieve the Subjective: the patient

pain in the right upper inflammation using analgesics patient from pain reports of pain reduction

quadrant. such as morphine. and make them Objective: the patient’s

 Develop a meal more comfortable. pain level drops on the pain

plan which involves 2. Avoiding fatty diets level scale

Expected Outcome: less fatty foods. will prevent acute

Short Term Goal (STG):  Patient education inflammatory

Pain Management on food restrictions episodes which

and recommended cause pain.

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Long Term Goal (LTG): dietary intake. 3. Patient education

Educate the patient on on the

dietary restrictions recommended diet

will make them

aware of the dietary

Evaluate each expected restrictions.

outcome:

Short Term Goal (STG):

Patient reports of reduction

of pain within the RUQ on

the pain level scale

Long Term Goal (LTG):

The patient maintains a

balanced diet with reduced

fatty intake to prevent

occurrence of acute

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episodes.

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Assessment Data Nursing Diagnosis Nursing Actions Rationale Evaluation

Identify all data that According to NANDA List in order of priority. State the rationale for each Evaluate the patient

support the priority Label aspect of care. nursing action. Cite response to each nursing

nursing diagnosis. reference and page action providing objective

number. & subjective data. Revise

nursing actions as

necessary.

The patient appears restless Anxiety and dissatisfaction  Alternative 1. Alternative

and anxious due to pain and repeated therapies for pain therapies may be

admissions management such recommended when

as music therapy in elderly patients

and soft talking. due to

polypharmacy to

avoid prescribing

too many drugs.

Expected Outcome:

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Short Term Goal (STG):

The patient appears more

relaxed and at ease

Long Term Goal (LTG):

The patient scores well

psychologically

Evaluate each expected

outcome:

Short Term Goal (STG):

Soft talking to the patient

and breathing exercises

Long Term Goal (LTG):

Providing psychological

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support to the patient

though a social worker or

therapist

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MEDICATION PREPARATION SHEET

Allergies: Paracetamol, Sudafed

Med as per MAR: Pantoprazole

MD Order: 40mg, P.O,

Time(s) Due: BID

Generic/Trade Name: Pantoloc

Normal Dosage:

Classification/Action: Proton pump inhibitor

Indication for Patient: Pathological presecretory conditions

Major Side Effects: Headache, Hyperglycemia

Parameters Checked: Vital signs, Blood sugar

Med as per MAR: Scopolamine

MD Order: 1mg transdermal

Time(s) Due: QID 3 days 11/15/21

Generic/Trade Name: Transderm-scop

Normal Dosage:

Classification/Action: Anticholinergics

Indication for Patient: prevent motion sickness, prevent post-operative nausea and

vomiting

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Major Side Effects: drowsiness, confusion, tachycardia, blurred vision

Parameters Checked: Vital signs

Med as per MAR: Dextrose

MD Order: Dextrose 5% with 0.45% NaCl 1000ml inj IV @ 75ml per hr

Time(s) Due: continuous infusion

Generic/Trade Name:

Normal Dosage:

Classification/Action: IV fluid

Indication for Patient:

Major Side Effects:

Parameters Checked:

Med as per MAR: Acetaminophen-hydrocodone (10 tabs) 5mg

MD Order: Hab, PO, QID,

Time(s) Due: PRN, pain moderate (4-6)

Generic/Trade Name: paracetamol

Normal Dosage:

Classification/Action: analgesic (Bobyrov et al., 2020)

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Indication for Patient: Pain management

Major Side Effects: Drowsiness, confusion

Parameters Checked: Vital Signs

References

Bobyrov, V. M., Vazhnicha, O. M., Devyatkina, T. O., & Devyatkina, N. M. (2020).

Pharmacology.

Ferreres, A. R. (2021). Pathophysiology and Diagnosis of Acute Calculous Cholecystitis.

In Difficult Acute Cholecystitis (pp. 9-19). Springer, Cham.

Thangavelu, A., Rosenbaum, S., & Thangavelu, D. (2018). Timing of cholecystectomy in acute

cholecystitis. The Journal of emergency medicine, 54(6), 892-897.

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