Case Study of Cholecystolithiasis

i. Objectives

ii. Disease Overview

iii. Demographic Data

iv. Patient's History

v. Physical Assessment

vi. Gordon's 11 Functional Health Pattern

vii. Laboratory Results

viii. Anatomy and physiology

ix. Pathophysiology

x. Course in the Ward

xi. Drug Study

xii. Nursing Care Plan

xiii. Discharge Planning

 I. Objectives

GENERAL OBJECTIVES

The purpose of a case presentation is to demonstrate the student's knowledge

of a patient's general health and disease condition, as well as to stimulate theoretical

knowledge research on pathology, signs and symptoms, physical examination

techniques related to nursing and its possible complications, treatment plan, medical

and nursing interventions.

SPECIFIC OBJECTIVES

 To Provide an accurate general assessment of the client, including physical

examination and family history taking.

 To understand the pathophysiology and etiology of the presented case.

 To understand the role of drug therapy in client management in relation to the

patient's diagnosis.

 To recognize the factors that contributed to the development of the diagnosis.

 To present the data relevant to the case in a systematic manner.

 Provide appropriate and proper nursing diagnoses in accordance with the client's

medical condition, as well as skillfully formulate nursing care plans for the

problems identified.

II. Patient & Disease Overview

Overview

This study presents the important considerations of diagnosis and treatment in

view of the ongoing study of the admitted patient. Patient MB is a 33 years of age

from Ramon Isabela. She was rush to the hospital because she was experiencing

severe abdominal pain and vomiting and also she said she got her disease because of

fatty food and salty foods and patient MB has an allergy to fish such as Tilapia and

Bangus.

Disease Overview

Cholecystolithiasis is the condition of having gallstones. Gallstones are

hardened deposits of digestive fluid that can form in your gallbladder. Your

gallbladder is a small, pear-shaped organ on the right side of your abdomen, just

beneath your liver. The gallbladder holds a digestive fluid called bile that's released

into your small intestine.

Gallstones range in size from as small as a grain of sand to as large as a golf ball.

Some people develop just one gallstone, while others develop many gallstones at the

same time.

People who experience symptoms from their gallstones usually require gallbladder

removal surgery. Gallstones that don't cause any signs and symptoms typically don't

need treatment.

Different types of Cholecystolithiasis

Types of gallstones that can form in the gallbladder include:

 Cholesterol gallstones

The most common type of gallstone, called a cholesterol gallstone, often

appears yellow in color. These gallstones are composed mainly of undissolved

cholesterol, but may contain other components.

 Pigment gallstones

These dark brown or black stones form when your bile contains too much

bilirubin.

Risk Factors

 Age: As people age, their risk of developing gallstones increases, particularly

after the age of 40.

 Gender: Women are more likely to develop gallstones than men, especially

during pregnancy, due to hormonal changes.

  Obesity: Being overweight or obese increases the risk of gallstones, as it can

lead to increased cholesterol levels in the bile.

 Rapid weight loss: Losing weight quickly, such as through crash dieting or

bariatric surgery, can increase the risk of developing gallstones.

 Family history: A family history of gallstones can increase the likelihood of

developing them.

 Sedentary lifestyle: Lack of physical activity or being sedentary for long

periods can increase the risk of gallstones.

 Certain medical conditions: Certain medical conditions, such as Crohn’s

disease, irritable bowel syndrome, and metabolic syndrome, increase the risk

of gallstones.

 Certain medications: Some medications, such as cholesterol-lowering drugs,

can increase the risk of gallstones.

 Fasting: Fasting or not eating for extended periods can lead to gallstone

formation.

 Ethnicity: Some ethnic groups, such as Native Americans and Mexican

Americans, have a higher risk of developing gallstones.

Sign and Symptoms

Gallstones may cause no sign and symptoms. If gallstone lodges in a duct and causes

a blockage, the resulting signs and symptoms may include:

 Sudden and rapidly intestifying pain in the upper right portion of your

abdomen
  Sudden and rapidly intestifying pain in the center of your abdomen, just below

your breastbone

 Back pain between your shoulder blades

 Pain in your right shoulder

 Nausea and Vomiting

Complications

 Acute cholecystitis: Inflammation of the gallbladder due to blockage by a

gallstone.

 Choledocholithiasis: When a gallstone becomes lodged in the common bile

duct, which can lead to jaundice, pancreatitis, and cholangitis.

 Pancreatitis: Inflammation of the pancreas, which can cause severe abdominal

pain, nausea, and vomiting.

 Cholangitis: Inflammation of the bile ducts, which can cause fever, chills, and

jaundice.

 Gallbladder cancer: Although rare, long-standing inflammation of the

gallbladder caused by cholecystolithiasis can increase the risk of developing

gallbladder cancer.

 Biliary peritonitis: Infection of the peritoneum (the lining of the abdomen) due

to a ruptured gallbladder.
  Gallstone ileus: When a gallstone becomes lodged in the small intestine,

which can cause bowel obstruction.

 Empyema: The formation of pus within the gallbladder, which can lead to

sepsis.

 Chronic cholecystitis: Long-term inflammation of the gallbladder, which can

lead to scarring and decreased function.

Diagnostic test

Ultrasound: This is the most common test used to diagnose cholecystolithiasis. It uses

sound waves to create images of the gallbladder and can detect the presence of

gallstones.

CT scan: This imaging test uses X-rays to create detailed images of the gallbladder

and surrounding organs. It can be helpful in detecting complications of gallstones,

such as inflammation or infection.

HIDA scan: This test uses a special radioactive dye to evaluate the function of the

gallbladder and bile ducts. It can help determine if the gallbladder is functioning

properly and if there is any obstruction in the bile ducts.

Endoscopic retrograde cholangiopancreatography (ERCP): This is a procedure that

uses a small camera and X-rays to examine the bile ducts and pancreas. It can be used

to remove gallstones that are lodged in the bile ducts.

Blood tests: Certain blood tests can be used to evaluate liver function and look for

signs of inflammation or infection that may be associated with cholecystolithiasis.

Medical Management:

Pain management: Medications such as nonsteroidal anti-inflammatory drugs

(NSAIDs), opioids, or other pain medications may be prescribed to manage pain

associated with gallstones.

Antibiotics: If there is an infection associated with gallstones, antibiotics may be

prescribed to treat the infection.

Bile acid therapy: Medications that dissolve gallstones may be prescribed in some

cases, particularly for patients who are not good candidates for surgery.

Ursodiol: A medication that can be used to dissolve small gallstones in some cases.

Surgical Management:

Cholecystectomy: This is the most common surgical procedure for treating

cholecystolithiasis. It involves the removal of the gallbladder and any gallstones that

are present.

Laparoscopic surgery: This minimally invasive surgical procedure involves making

small incisions in the abdomen and using a laparoscope to remove the gallbladder and

gallstones.

Open surgery: In some cases, open surgery may be necessary if the gallbladder is

severely inflamed or if there are complications associated with the gallstones.

Nursing Management:
Pain management: Nurses can administer prescribed pain medication, monitor for side

effects, and evaluate the effectiveness of pain management interventions.

Monitoring for complications: Nurses can monitor patients for signs of infection,

bleeding, or other complications associated with gallstones.

Education: Nurses can provide education to patients about the signs and symptoms of

gallstones, the importance of follow-up care, and lifestyle modifications that may be

necessary after treatment.

Nutritional support: Nurses can provide guidance on diet modifications and nutritional

support to help manage symptoms associated with gallstones.

Wound care: Nurses can monitor and provide care for the surgical incision site to

prevent infection and promote healing.

Causes

 Excess cholesterol in the bile: When the liver produces too much cholesterol,

it can combine with bile and form stones.

 Too much bilirubin in the bile: Bilirubin is a waste product that is formed

when red blood cells break down. When there is too much bilirubin in the bile,

it can combine with other substances to form stones.

 Bile that is not emptying properly: When the gallbladder does not empty

completely or frequently enough, bile can become concentrated and form

stones.

Prevention
  Prevention of complications: If complications such as cholecystitis,

pancreatitis, or choledocholithiasis occur, hospitalization and more invasive

treatments may be necessary.

 Prevention of recurrence: Once gallstones have been treated or removed, steps

can be taken to prevent recurrence. Maintaining a healthy weight and diet,

staying active, and taking medication as prescribed can reduce the risk of

gallstones returning.

III. Demographic Data

Name: MB

Age: 33 years of age

Sex: Female

Address: Ramon, Isabela

Birthdate: January 30, 1990

Religion: Roman Catholic

Civil Status: Married

Nationality: Filipino

Weight:

Height:

BMI:

Chief Complaint: Abdominal Pain and Vomiting

Admitting Diagnosis: Cholecystolithiasis

Date of Admission: April 15, 2023

Time of Admission: 9:00 AM

Date of Discharge: Not for Discharge

Time of Discharge: Not for Discharge

IV. Patient's History

Past History

In 2005, she had an operation on his appendix and that was his first operation.
Moreover, when she was sick with cough, cold and fever, she only took paracetamol
without checking up at the hospital or at the barangay health clinic. Patient MB has a
4 month history of intermittent abdominal pain before she decided to go for check
ups.

Present History

Prior to admission patient MB experienced sever abdominal pain radiating to

back and vomit 5 times. She was assessed and have an admitting diagnosis of
Cholecystolithiasis.
Family History
 V. Physical Assessment

GENERAL APPEARANCE:

Upon our physical assessment last April 20, 2023, at exactly 1 in the afternoon
our patient is awake, conscious and coherent. Her body type is ectomorphic. Her hair
is in a ponytail, her clothes is clean and there is no foul odor upon our assessment.
She feels a little bit discomfort and pain in her abdomen with pain scale of 4 out of 10
because of her surgery incision in her right upper quadrant. Her vital signs are Blood
Pressure of 110/70 mmHg, Pulse Rate of 88 BPM, Respiratory Rate of 16 cpm,
Temperature of 36 °C and Oxygen Saturation of 99%. She is active in range of
motion, she is cooperative in Nursing Patient Interaction, and lastly, She can speak
and understand Ilocano and Tagalog.

CEPHALOCAUDAL (HEAD TO TOE) ASSESSMENT

AREA METHOD ACTUAL NORMAL INTER

FINDINGS FINDINGS T

SKIN The color of skin is The color of the skin ABNO

brownish. It has may vary from the Due to
surgical (subcostal) ethnicity or race of inci
incision in her the patient. There is cholecy
right upper no scars, lesions,
quadrant of bruises, edema and
abdomen with a pus.
INSPECTION
length of 12.7 cm.
It has a little bit red
color in the side of
the incision site.
There is no pus and
foul odor
manifested.
PALPATION There is no masses There is no masses or
or lumps with lumps and the
normally warm
 temperature and the temperature NOR
skin turgor is intact is normally warm.
and it is less than 2 The skin turgor is
seconds to return to intact and it can
its original state return to its original
state in span of 2
seconds
HEAD HAIR INSPECTION The patient hair is The color of the hair NOR
in a ponytail. The vary from ethnicity
hair strand is color or race of the patient.
black, little curly The hair strand is
and moisture. The moist and not freezy
hair length is below or dry. There is no
the shoulder. It is large amount of hair
equally distributed fall upon combing.
without dandruff, The hair is equally
nit and lice distributed without
manifested. dandruff, lice and nit.
SCALP INPECTION The scalp is round, The scalp is round, NOR
moisture in texture moisture in texture
without lesions or without lesions or
lumps. lumps.
PALPATION There is no There is no NOR
tenderness, masses tenderness, masses
and lumps and lumps
The The occipitofrontalis
occipitofrontalis is is intact and hard.
intact and hard.
FACE INSPECTION The face is The color and shape NOR
symmetrical, oval of the face may vary
in shape, brown from race and
skin tone without ethnicity. The face is
bruises, scar, symmetric without
masses and lesions bruises, scars, masses
 and lesions
CN V The patient’s There is no loss of NOR
(TRIGEMIN sensory are good, it sensation. it can
AL) can feel and there’s chew food without
corneal reflex. muscle paralysis.
The motor function
is good, it can
chew food without
muscle paralysis.
CN VII The patient’s It can identify NOR
( FACIAL) sensory are good, it different kinds of
can taste different flavors. There is no
kinds of flavors. facial grimace that is
The motor function involve and it can do
of patient is good smile, frown, raise
also, the patient can eyebrow. There is no
smile, frown, raise evident of drooping
eyebrow. There is or bells palsy.
no evident of
drooping.
EYES INSPECTION The eyes is The eyes is NOR
symmetrical. The symmetrical. The
sclera is white and sclera is white and
moist. The moist. The
conjunctiva is conjunctiva is
pinkish in color and pinkish in color and
the Pupils is round. the Pupils is round.
There is no dark There is no dark eye
eye shadow around shadow around the
the eyes eyes
PALPATION There is no masses There is no masses NOR
around the eyes. around the eyes.
CN II The visual acuity of The visual acuity of NOR
(OPTIC) the patient is 20/20 the patient is good
 in vision. It can see and can see object
object from near from near or far
and far distance. distance.
CN III, IV, VI The eye movement The eye movement is NOR
(OCCUMOT is normal without normal without
OR, droopy eyelid. droopy eyelid and the
TROCHLEA The pupillary Pupillary
R, constriction size is Constriction size: 2-
ABDUCENT) 3mm and the size 4mm
of dilation is 7mm. Pupillary Dilation
The patient does size:
not sensitive to 4-8mm
light The patient does not
sensitive to light
EARS INSPECTION Appearance has no Appearance has no NOR
Pull pinna up lesions and bruises. lesions and bruises.
then back The auditory The auditory meatus
meatus has no has no discharge and
discharge and it is it is odorless without
odorless without foreign bodies,
foreign bodies, cerumen and redness.
cerumen and
redness.
PALPATION The ears has no The ears has no NOR
masses or lumps. masses or lumps.
CN VIII The patient can The patient can NOR
(VESTIBULO hear whisper both distinguish words
COCHLEAR) left and right ear coming from the
from 2 feet behind. whisper of student
nurse behind.
NOSE INPECTION There has no The nose has no NOR
lesions, bruises, lesions bruises, nasal
nasal flaring, flaring, redness and
redness and discharge.
 discharge
PALPATION Bone and cartilage Bone and cartilage is NOR
is in the midline. in the midline. There
There is no lumps is no lumps or
or masses. masses.
CN I Both nostrils are Both nostrils are NOR
(OLFACTOR normal and can normal and can
Y) distinguish odors. distinguish odors.
MOUTH INSPECTION The mouth is The mouth is pinkish NOR
pinkish in color in color without
without lesions and lesions and edema.
edema. The gums is pinkish
The gums is in color with
pinkish in color retraction and no
with retraction and bleeding.
no bleeding Complete set teeth
The patient’s teeth without abnormal
are color white and eruption, excessive
it has complete set spacing, crowding,
of teeth. open bite, overbite
The tongue is and tooth decay.
pinkish in color, The tongue is pinkish
has no lesions and in color, has no
lumps, it is lesions and lumps, it
moisture. is moisture.
The size of tonsil is The size of tonsil is
behind the pillar behind the pillar
without without
inflammation. inflammation.
Without foul odor. Without foul odor.

CN IX, CN X, The patient did not Can distinguish the NOR

CN XII taste a bitterness, flavor of the food.
 (GLOSSOPH and metallic taste
ARYNGEAL, in her food and can The uvula is at the
VAGUS and distinguish the mid in pinkish color
HYPOGLOSS flavor of the food and it moves up and
SAL) (lugaw) that she eat forward as the patient
. says “ah”.

The uvula is at the The tongue can

mid in pinkish move freely without
color and it moves pain and difficulty.
up and forward as
the patient says
“ah”.

The tongue can

move freely side by
side, in and out
without pain and
difficulty and it has
gag reflex.

NECK INSPECTION The neck is The neck is NOR

symmetric has no symmetric has no
lesions, bruises or lesions, bruises or
pus. There is also pus. There is also no
no jugular venous jugular venous
distension. distension.
PALPATION The carotid pulse The carotid pulse and NOR
and trachea is trachea is palpable.
palpable. Without Without masses or
masses or lumps. lumps.
LYMPH PALPATION The lymph nodes is The lymph nodes is NOR
NODES not swollen and not swollen and
 palpable. palpable.
CHEST THORAX INSPECTION There are no There are no lesions, NOR
lesions, redness and redness and bruises.
bruises.
PALPATION Apical pulse is Apical pulse is NOR
palpable without palpable without
tenderness, lumps tenderness, lumps or
or masses. masses.
AUSCULTA HEART HEART NOR
TION The aortic sound is The aortic sound is
strong and regular strong and regular in
in rhythm rhythm

LUNGS LUNGS
The lungs has The lungs has
vesicular sound or vesicular sound or
soft, blowing sound soft, blowing sound
and not crackling or
whistling sound
UPPER ARMS INSPECTION There is no lesion There is no lesion NOR
EXTREMITIE and redness but and redness. There is
S there is scars and no scars and
scratches. Both scratches. Both arms
arms are in equal are in equal size
size. There is no without dislocation
dislocation of of bones
bones.
PALPATION There is no masses There is no masses NOR
and tenderness and tenderness
CN XI The shoulder can The shoulder can NOR
(ACCESSOR shrug freely shrug freely without
Y) without pain and pain and difficulty
difficulty
 HANDS INSPECTION The capillary refill The capillary refill in
AND in nails is 2 nails appear in span
NAILS seconds. The nails of 2 seconds. The
are pinkish in color. nails are pinkish in
The lunula is color. The lunula is
visible. The nails visible. The nails has
has no ridges, no ridges, brittles and
brittles and onychogryphosis.
onychogryphosis. The hand has no
The hand has no lesions, visible
lesions, visible masses, edema and
masses, edema and bruises.
bruises
ABDOMEN INSPECTION The abdomen has The abdominal has ABNO
surgical (subcostal) no scars without Due to
incision in her bruises and it has inci
right upper respiratory cholecy
quadrant of movement
abdomen with a The umbilicus is
length of 12.7 cm. found in lower
It has a little bit red quadrant and the
color in the side of contour is flat
the incision site.
There is no pus and
foul odor
manifested
The umbilicus is
found in lower
quadrant and the
contour is flat
 AUSCULTA It has a bowel The bowel sounds NOR
TION sounds of 5. consist of clicks and
gurgles is 5-30 per
minutes

PALPATION There is no There is no ABNO

tenderness, masses tenderness, masses Due to
and muscle and muscle guarding. inci
guarding. It has also aortic cholecy
It has also aortic pulses without
pulses. abdominal pain
It has abdominal
pain with pain scale
of 4 out of 10
LOWER INSPECTION There are no scars, There are no scars, NOR
EXTREMITIE lesions, bruises, lesions, bruises,
S edema and redness. edema and redness.
There is also no There is also no
dislocation. The dislocation. The
lower extremities lower extremities are
are in equal size. It in equal size. It has
has balance and the balance and the
patient can stand patient can stand
alone. alone.
PALPATION There is no tender There is no tender or NOR
or masses masses

PALPATION The inguinal lymph The inguinal lymph NOR

nodes is not nodes is not palpable
INGUINA palpable and there and there is not
L LYMPH is not swollen. swollen.
NODES
FOOT INSPECTION The capillary refill The capillary refill in NORM
AND in nails is 2 nails is 2 seconds.
NAILS seconds. The nails The nails are pinkish
are pinkish in color. in color. The nails
The nails has no has no ridges, brittles
ridges, brittles and and
onychogryphosis. onychogryphosis.
The nail has no The nail has no
fungal infections fungal infections it’s
it’s odorless. odorless.
The foot has no The foot has no
lesions, visible lesions, visible
masses, edema and masses, edema and
bruises. It is also bruises. It is also
odorless odorless
 VI.. 11 Gordon’s Functional Health Pattern

Date: 04/20/23

FUNCTIONAL BEFORE DURING INTERPRETATION

HEALTH HOSPITALIZATION HOSPITALIZATION

PATTERN

Health The patient verbalized that The patient still believed The patient’s

Perception/Health health is very important to that health is important, perception about

Management Pattern her. and she still believes in health remains the

“hilot”. According to same.

According to the patient, her, she will prioritize

she is allergic to sea foods her health more and will

and she said that she gets live a healthy lifestyle.

cough easily. According to

the patient, she had

undergone surgery on her

appendix way back 2005.

The patient stated that she

takes Vitamin B Complex.

She said that she uses

herbal medicines like

dangla and oregano, and

she also believes in hilot.

Nutrition and According to the patient she Since the patient recently The patient’s nutrition

Metabolic Pattern eats 3x a day, and her diet undergone surgical and metabolic pattern
 is usually meat like adobo operation, the patient is changed, because of

and vegetables like in a soft diet. According the patient's condition.

“pakbet”. She also eats to her, her appetite

bakery bread for snack. decreased. She drinks at

According to her, she has least 1 liter of water a

good appetite and she has day.

no problem in swallowing. Upon admission, the

She is also allergic to sea patient weighs 52kg.

foods.

The patient drinks 7-8

glasses of water a day, and

she also drinks 2 cups of

coffee a day. She also said

that she consumes 2 bottles

of soft drinks a week. She

is not a smoker and a

alcohol drinker.

The patient weighs 54kg.

Elimination Pattern Patient defecates every According to the patient, The patient’s bowel

other day, with smooth before the operation her movement or pattern

consistency and brown with bowel movement is changed because the

white in color. normal, she defecates patient has recently

everyday since she was undergone operation.

She urinates 4-5x a day admitted in the hospital,

 with yellow color. She also the consistency is

said that she does not smooth and yellow-

experience any difficulty in brown in color. She

defecating and urinating. urinates 7x a day, and

yellow in color.

After operation, she has

no bowel movement yet.

She urinates via catheter

connected to a urine bag

and the output is

1,500ml since the

catheter was inserted.

The color of the output is

yellow.

Activity and Exercise The patient is a housewife, Since she was The patient was not

Pattern so her main exercises were hospitalized, she was not able to do her routines

household chores like doing able to move freely, so due to her current

the laundry, washing the she stays in hospital bed condition.

dishes, and cleaning the all day.

house, she also looks after

her kids. The patient said that her

only exercise is when

She said that she does not she goes to the CR, she

get tired easily, and when uses her phone to watch

 she has free time, she YouTube when she is

watches TV. feeling bored.

Sleep – Rest Pattern According to the patient, During hospitalization, The patient’s sleep

she sleeps usually at the patient sleeps at and rest pattern

11:30pm and wakes up at 8pm-5am. She also takes changed because she

6am. She said that she afternoon naps, usually does not have to do

sleeps about 5hrs a day, and 2hrs long. her responsibilities for

she also take short naps in the mean time, and she

the afternoon. She said that her sleep is have more time to rest

interrupted due to the and recover, but her

The patient’s sleep is not healthcare providers sleep is still slightly

continuous because she visiting their room to disturbed.

looks after her baby, take vital signs, she also

whenever her baby wakes said that the environment

up, she needs to get up too is noisy.

to make some milk for her

baby.

Cognitive-Perceptual The patient's 5 senses; The patient is a happy The patient’s

Pattern eyesight, hearing, taste, person. She is all smiles personality is always

touch and smell are and responds correctly to positive and alert.

perfectly fine. She has a the questions that have

good memory and speaks been asked. She is aware

Ilocano and Tagalog. The of the people, time, place

patient can read and write. and her surroundings.

Self-Perceptual and The patient feels good The patient still feels The patient stayed
Self Concept Pattern about herself and also on good about herself and positive about herself

her physical appearance but her physical appearance. regardless of losing

since the day she knew that She does not mind her weight and her

she was sick, she tried to incision and the incision.

lose weight and eat more possibility that it will

vegetables and fruits to leave a big scar on her

maintain a healthy body. body because she feels

She stated that she got more relieved that she is

angry and stressed because okay now than what

sometimes her children are happened to her body.

naughty.

Role-Relationship The patient’s family As being hospitalized, Due to her condition,

Pattern structure is extended. They the patient is away from she was not able to

live together with their 3 her children so her perform her roles and

kids, her mother-in-law and mother in law took her responsibilities but

sister-in-law. The patient place and responsibilities still communicates

and her husband both have in their home. She is with her children

authority in their able to communicate through video calls.

household. They both with her children

discuss first before through video call and

deciding, and then the they are happy that their

patient also said that they mother's condition have

share their problems with gotten better.

each other. The patient

have a good relationship

 with her children and they

feel sad about their

mother's condition.

Sexuality- The patient is married and Due to being Since the patient was

Reproduction has 3 children, she is G3P3. hospitalized, the patient hospitalized, she was

Pattern She and her husband are is not involved in any not able to do sexual

sexually active and they are sexual activities with her activities.

doing sexual activities 2-3 husband for the mean

times a week. She is using time.

contraceptive like depo.

She had her menarche when

she was 12 years old. She

has a regular menstrual

cycle, heavy menstrual flow

for the first 2 days and

light flow in the third day.

Coping-Stress- The patient stated that she Patient talks with her The patient’s coping-

Tolerance Pattern shares her problems with husband about her stress-tolerance

her husband. They'll talk it problems and pains. She pattern did not change

out and fix it together. She sleeps when she feel as she continues to

walks in their backyard and pain and discomforts. share what she feels

sometimes go quite place She said that she gets her and vent out her stress

where she can relax. She strength and courage to to her husband.

wants to be alone when she get better by seeing and

feels stressed and come thinking about her

 back when she’s fine. children and their future.

Value-Belief Pattern The patient's religion is The patient said that she The patient’s values
Roman Catholic. She prays every night asking and beliefs remains
attends mass 3 times a God for fast recovery the same.
month and prays to God and to give her a long
about all her burdens and life. Her faith have
problems. strengthened and
believes that God will
help her overcome her
condition.
 VII. Laboratory and Diagnostic Procedures
Date: 4/15/2023 10:10 AM

COMPLETE BLOOD COUNT

Parameters Result Unit Ref. Ranges Interpretation

WBC 10.69 10^9/L 4.00-10.00 ABNORMAL

High WBC indicates that there is an in

disease and inflammatory disea

Neu% 72.5 % 50.0-70.0 ABNORMAL

Inflammation, and an infections mostl

by bacteria will increase the Neutrophi
the blood.

Lym% 20.1 % 20.0-40.0 NORMAL

Mon% 5.2 % 3.0-12.0 NORMAL

Eos% 1.9 % 0.5-5.0 NORMAL

Bas% 0.3 % 0.0-1.0 NORMAL

RBC 4.61 10^12/L 3.50-5.00 NORMAL

HGB 13.8 g/dL 11.0-15.0 NORMAL

HCT 41.0 % 37.0-47.0 NORMAL

MCV 88.9 fL 80.0-100.0 NORMAL

MCH 29.8 pg 27.0-34.0 NORMAL

MCHC 33.6 g/dL 32.0-36.0 NORMAL

PLT 309 10^9/L 150-450 NORMAL

RDW-CV 13.5 % 11.0-16.0 NORMAL

RDW-SD 44.1 fL 35.0-56.0 NORMAL

 MPV 10.3 fL 6.5-12.0 NORMAL

PDW 15.9 15.0-17.0 NORMAL

PCT 0.319 % 0.108-0.282 ABNORMAL

A high level of procalcitonin in you

may be a sign of a serious infec

NRBC % 0. 00 % 0.00-9999.99 NORMAL

Date: 04-15-2023

PROTHROMBIN TIME PERCENT ACTIVITY (PTPA)

RESULT INTERPRETATION

PATIENT 11.4 10 - 15 seconds NORMAL

CONTROL 13.0 10.4 - 15.5 seconds NORMAL

PERCENT ACTIVITY 124.2% 83.4% - 125% NORMAL

INR 0.96 0.781 - 1.17 NORMAL

ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)

RESULT NORMAL INTERPRETATION

VALUE

PATIENT 32.7 26 - 38 seconds NORMAL

CONTROL 29.4 23.5 - 35.2 seconds NORMAL

Date: 04-16-2023
 ELECTROLYTES

RESULT NORMAL INTERPRETATION

VALUE

Potassium 3.4 NORMAL

Sodium 140.7 NORMAL

Chloride

Calcium-Total

Calcium-Ionized

Date: 04-16-23

FLUID: Serum

HEMOLYSIS (H) : 15 ICTERUS (I) : 2 TURBIDITY (T) : 22

ASSAY RESULT H I T RANGES

Creatinine 53.8 umol/L 46.0-92.0

Date: 04-20-23

FLUID: Wh Blood

ASSAY RESULT RANGES

Hemoglobin Alc 5.7 4.3-6.4

 XRAY RESULT

CHEST PA/L

RESULT

CHEST

DATE AND TIME DONE: 04-15-23/ 9:57 AM

There are no frank parenchymal infiltrates or areas of consolidation noted.

The pulmonary vascular pattern is within normal limits.

The cardiac shadow is not enlarged.

The aorta is unremarkable.

The diaphragm and lateral costophrenic sulci are intact.

The osseus structures are unremarkable.

Impression: No significant chest findings.

 RBS / HEMOGLUCOTEST MONITORING FORM

DATE TIME RESULT

04-17-23 10 am 95

2 pm 93

6 pm 151

DAT DIC

Q4° Once NPO

04-19-23 12 am 90

4 am 85

8 am 78

11:40 am 109

4 pm 87

8 pm 99

04-20-23 12 am 87

4 am 99

8 am 98
ECG
 VIII. Anatomy and Physiology

The biliary tract is a series of organs and ducts that are involved in the

production, storage, and transport of bile from the liver to the small intestine. It

includes the following structures:

Liver – The liver is the largest organ in the body and produces bile.

Gallbladder – The gallbladder is a small sac-like organ that is located beneath the

liver. It stores bile and releases it into the small intestine when fat is present.

Bile ducts – The bile ducts are a network of tubes that transport bile from the liver

and gallbladder to the small intestine. The bile ducts consist of two main parts: the

intrahepatic ducts (located inside the liver) and the extrahepatic ducts (located outside

the liver).

Common bile duct – The common bile duct is formed by the junction of the cystic

duct (which connects the gallbladder to the common bile duct) and the common

hepatic duct (which carries bile from the liver). The common bile duct then transports

bile to the small intestine.

Sphincter of Oddi – The sphincter of Oddi is a muscular valve located at the end of

the common bile duct that controls the flow of bile into the small intestine.

The biliary tract plays an important role in the digestion and absorption of fats.

Bile produced by the liver is stored in the gallbladder and released into the small

intestine when fat is present. The bile ducts transport bile from the liver and

gallbladder to the small intestine, where it helps to emulsify fats and aid in their

digestion and absorption. The sphincter of Oddi controls the flow of bile into the

small intestine, ensuring that it is released in the appropriate amounts.

 The gallbladder is a small pear-shaped organ, measuring around 7-10 cm in

length and 4 cm in width, and is composed of three distinct parts: the fundus, the

body, and the neck. The gallbladder’s fundus is the rounded portion that protrudes

past the liver’s border. The gallbladder’s primary component is called the “body,”

while the narrow “neck” is the structure’s connection to the cystic duct.

The cystic duct is a tiny tube that links the gallbladder to the common bile

duct, which ultimately empties into the small intestine after transporting bile from the

liver. Before entering the small intestine, the common bile duct communicates with

the pancreatic duct.

The duodenum is the part of the small intestine where food is digested, and the

small intestine signals the gallbladder to release bile. When the gallbladder is full, the

cystic duct contracts, forcing the bile out into the common bile duct, where it

combines with pancreatic enzymes and travels to the small intestine. When fats are

present, the small intestine secretes the hormone cholecystokinin (CCK), which

triggers the release of bile into the small intestine.

 Bile is a digestive fluid that is produced by the liver and stored in the

gallbladder. It is composed of various substances that play an essential role in the

digestion and absorption of fats. Here is a breakdown of the composition of bile:

1. Water – Bile is primarily composed of water, which makes up approximately

95% of its volume.

2. Bile salts/acid – These are the most important components of bile as they aid

in the digestion of fats. Bile salts emulsify fats, breaking them down into

smaller droplets that can be more efficiently digested by enzymes. They also

help in the absorption of fatty acids and fat-soluble vitamins.

3. Bilirubin – This is a pigment that is produced when red blood cells break

down. Bilirubin is excreted by the liver into bile, giving it a yellowish-green

color. Excessive bilirubin in the body can lead to jaundice, a condition

characterized by yellowing of the skin and eyes.

4. Cholesterol – Bile contains cholesterol, which is a type of fat that is essential

for the formation of cell membranes and the production of certain hormones.

However, when there is an excess of cholesterol in bile, it can crystallize and

form gallstones.

5. Phospholipids – These are fats that contain phosphorus and are essential for

the formation of cell membranes. In bile, phospholipids help to emulsify fats

and prevent them from clumping together.

6. Electrolytes – Bile also contains various electrolytes, including sodium,

potassium, and bicarbonate. These help to maintain the body’s pH balance and

regulate fluid balance.

IX. Pathophysiology
 X. Course in the Ward

DATE AND PROGRESS DOCTOR’S ORDER INTERPRETATION

TIME NOTES

04/15/23  Please admit to surgery  For further monitoring and

ward management
9am
 Secure consent for  To have ethical consideration
admission and management and to protect patients freedom
to make healthcare decision

 For nourishment
 DAT

 IVF to follow
 To ensure the v/s of the patient
 Monitor VS Q4 and
are in normal range
recorded
 To ensure the patient has
 Monitor I & O q shift and
proper intake of fluid and
record
determine patients output if
adequate and has normal
defecation

 To help figure out what

Diagnostic: CBC with BT,
disease or condition of person
PT,PTT INR,Chest x ray PA
has based on their signs and
symptoms

Therapeutics: Omeprazole  To decrease the amount of acid

40mg/IV OD once on NPO in the stomach

 Endorsed to Dr.D  To know the patients condition

 For elective open  To remove gallstone in the

cholecystectomy gallbladder

04/15/23 +Abdominal pain  Start IVF: PNSS 1L x8hrs  For IV access specially for
RUQ
7:36pm Pain scale 9/10 emergency purposes

 Give ketorolac 30mg IV q8  For pain

PRN

04/16/23  Request for Na,k,  To check electrolytes

Creatinine stat imbalance and check kidney
9:16am
function

 To remove gallstone in the

 For open cholecystectomy
gallbladder
on Monday ,Am case
 For legal basis and purposes
 Secure consent
 For the preparation of the OR
 Notify Or team and
Theater/Or team and pre op of
anesthesia
the patient prior to OR
 NPO post midnight
 To prevent aspiration and
gastric emptying

 Start cefoxitin 2g IV  To treat bacterial infection

2hrs.prior to OR ANST
then 1g IV q8hrs thereafter
 To ensure receive the care they
 Refer accordingly
need

04/16/23 Pre anesthetic Pre anesthesia record

evaluation form
2pm  Patient seen and  To ensure the patient is safe to
attached waiting
examined,history and PE undergo on operation
for
done
Na,K,Creatinine
result  Anesthetic plan and risk
 To assure that the patient is
explained to patient or
fully understand the risk and
relative and fully
benefits of anesthesia prior
understood and accepted
giving consent
 Please secure consent for  For legal basis and purposes
anesthesia

IVF : D5LRS 1L x 8hrs.once on

 To keep the patient hydrated
NPO

Medication:
 To prevent vomiting
 Omeprazole 40mg IV OD

 Ondansetron 4mg IV
30mins.prior to OR

Laboratory

 For ECG now  To check the electrical activity

of the heart

 To check and measure the

 CBG Q4 once NPO
blood glucose level of the
patient

 Ensure patency of IV to  To ensure the line are patent

transfer to OR for IV medication access

 Please secure 1unit PRBC  For possible OR use

 Monitor V/S and I and O  To ensure the vital signs of the

record pt.are in normal range and the
patient has proper intake and
adequate output
 Refer accordingly
 To ensure receive the care they
need

 Please inform AROD once  To know the baseline of the

laboratory result without laboratory result of the patient
fail
 prior to OR

04/17/23  Maintain NPO  For the patient safety since the

patient scheduled for OR
10:04am  For OR today
 To ensure receive the care they
 Refer accordingly
need

04/17/23  Give D5050 1 vial now  To replace glucose in the

blood
2:34pm

4/18/23 Awake  Dat then NPO post 

midnight
9am Afebrile
 For OR tomorrow : open
(-) Abdominal
cholecystectomy
pain
 For legal basis and purposes
 Consent secure for the
procedure

 Shift D5LRS 1L x 8hrs  To keep the patient hydrated

once NPO

 Omeprazole 40mg/IV once

 To decrease the amount of acid
NPO
in the stomach
 Refer

4/18/23  Omeprazole 40mg IV OD  To prevent vomiting

on NPO
10:40am
 Ondansetron 4mg IV prior
transfer to OR
 Ensure the line is patent for IV
 Ensure IV patency
medications
 Refer

4/19/23  Give D5050 1 vial now  To replace glucose in the

5:38am blood

4/19/23  Give D5050 1 vial now  To replace glucose in the

blood
8:00am

4/19/23 S/p open  To PACU  For closely monitor patient for

cholecystectomy possible post operative
1:40pm
under combined complications
GA: LMA +  Hook to 02 on simple O2
 To maintain a safe level of
CLEA mask at 5-6LPM
oxygen saturation
Awake , extubated  Monitor V/S
 Closely monitoring the
q15mins.x2hrs, record and
Stable V/S patients vital signs and
q1hour until stable
complications due to effect of
BP:120/80
anesthetic drug
PR:89

RR:19
 NPO  To ensure that patient will not
O2 Sat.:98% have an aspiration due to
anesthesia effect
 D5LRS 1L x 8hrs
 To keep the patient hydrated

Medication
 It will work as an analgesic
 Single dose morphine 2mg post operative
in 10cc PNSS via epidural
catheter care at AROD
1:30pm

 Paracetamol 1g IV q6 hours
for 3 doses loading dose
given at 1:15pm

 Ketorolac 30mg IV
q8hrs.for 3 doses ANST to
 start at 3pm

 Keep normothermic please

 Keep the body temperature is

regulated within normal
limits(36.5-37.5 °C)
 I and o monitoring q1 and
 For strict monitoring of urine
record
output due to concurrent
 Insert IFC condition

 To prevent bladder distention

or incontinence in the
anesthetized patient, as well as
to facilitate the measurement
of urine output during and
 Refer
after surgery

4/19/23  Give 1 vial D5050 now  To replace glucose in the

blood
5:20pm

4/20/23  Give 1 vial D5050 now  To replace glucose in the

blood
12:05am
 To check the blood sugar level
 For HBA1C
of the patient
 Refer

4/20/23 Afebrile  Soft diet Serve as a transition that easy to

digest
8:40am Awake
 To support body function until
 Continue medication
other treatments or body
response can take over

 Maintain dressing  To protect the wound from

soiling with body fluids and
 promote wound healing

 To prevent adhesion

 Encourage ambulation

 Refer

4/20/23  Wound care done  To prevent infection

9:40am  For bladder training then  To return to normal bladder

remove IFC function and reduce the
incidence of urinary retention

 To determined if there's a
 For repeat CBC
changes in blood component
Refer status
 Drug
Drug Actual
Actual Classificati
Classificati Mechanism
Mechanism of
of Indication
Indication Contraindicati
Contraindicati Adverse
Adverse Nursing
Nursing
Drug
Name
Name Actual
Dose,
Dose, Classificati
on
on Mechanism
action of
action Indication Contraindicati
ons
ons Adverse
Reaction
Reaction Nursing
Responsibility
Responsibility
Name Dose,
Frequen
Frequen on action ons Reaction Responsibility
Frequen
cy
cy and
and
cy and
Route:
Route:
Generic
Generic 40
30Route:
24mggmg
mgIV
mg IVq8 Opioids
Proton
Anti-
Antiemetic
Nonsteroid Binds
Suppresses
The
selective
Inhibitswith Relief
Used
used
usedto
Used as
for
of the
to Contraindicated
Hypersensitivity
Contraindicated Most
most
Most common
common:
common:
common
common: Before:
Before: XI. Drug
Generic 1local
IVvial
2hrs
30 Carbohydra used to acidof treatment of Documented Most common: Before: Study
Name:
Name: prnOD
for pump
infective
drug
al Anti- gastric
bactericidal
antagonist
opioid
prostaglandin short-term
Perioperative
prevent
moderate
relieve nausea
to with
to ondansetron
morphine,
with
now
once
prior
minutes
pain te describe of the insulin hypersensitivity; nausea/vomiting
Nausea/vomiting
Nausea/vomiting  Observe
Observe 14 14
Name:
Omeprazol
Cefoxitin
Ondansetr
Morphine pain in
on
to inhibitor
drug
inflammato secretion
action
the
receptors
serotonin
synthesis by
by treatment
prophylaxis
and
severe,
vomiting
moderatelyacute,
and hypersensitivity
cephalosporin’s;
or
acute
anyor severe
hypersensitivity, diarrhea
Nausea/vomiting  rights
Observe 14
Ketorolac NPO to
OR
prior
epidural hypertonic six carbon
specific
cefoxitin
receptor
within CNS hypoglycemia
symptomatic
that
or chronic
may be severe
to
components
asthma,
omeprazole
GI of in drug
rights in drug
Dextrose ry drug decreasing an severe pain, asthma, hepatic Headache
Seizures
Constipation
Dizziness rights in drug
e
on
sulfate ANST
OR
catheter solution sugar d- 5-HT3
inhibition
results
subtype
inhibiting to restore Serious
dehydration administration
administration
(NSAID) enzymefrom of relief
caused
pain
usuallyofby
pain or
the
obstruction,
its
formulation
disease, peptic constipation
Diarrhea
monohydra AROD glucose,
the
inhibition
ascending and
hydrogen- blood glucose hypersensitivity dizziness,
Pseudomembran
Diarrhea  administration
Ask foronset,
Assess patient
drug
Brand
Brand needed forof heartburn
surgery
that occursthat components
severe
ulcer disease, Drowsiness
 Assess
Monitor health
for
the principal
potassium
cell
pathways
wall levels
occurs to penicillin’s Edema
ous colitis epigastric
allergies
for
type, location,
te
Name:
Brand biosynthesis: after antwo or hepatic/renal
CV bleeding headache
somnolence
Dizziness
Name: form
ATPase of
synthesis. more daysorper impairment Tremors  history
pain
or abdominal
nausea/vomiti
duration
Administer of
analgesic, anti operation Fever
Diarrhea  Watch for
Mefoxin
Name:
Toradol carbohydrate
enzyme system week (frequent drowsiness pain
ng,
prescribed
inflammatory, other painful diarrhea
Drowsiness
Seizures During:signs of
Brand used
at the by the
secretory heartburn) Phlebitis  Obtain
Check
dosagethe vital
Prilosec
Zofran
Duramorp antipyretic procedure it Cramps During:hypervolemia
Name: body
surface constipation  signs
status
Assessbefore
offorfluid
h effects of the works by malaise
Hypertension
gastric parietal decreasing the Rashes  giving
and
infection
patient’s
Assess client eyes:
D50W abdominal pain During:
cells; blocks amount of acid Constipation electrolytes
medication
redness,
Urticaria history for any
During:levels
the final step produced in  Monitor
swelling,and
During:contraindicatio
of acid the stomach  observe
During:
tearing,
ns
Monitor itching
the
site
production.  patient
Provide
Assess for
Check
frequently during
safety
for for
any
administration
measure
 adequate
hypersensitivit
Monitor
thrombophlebithe
 Monitor
Instruct
y to anyfor
patient
voiding
tis blood
patient
any
glucose
to report
 Monitor
component
adverse
Frequently levels
of
daily
 Prevent
change
the drug
reactions
pattern
assess fluid
in
of sites
I.V
urine
overload
 bowel
Evaluate
Monitor
for pattern
signs fluid
activity
of
 Monitor
intake for
patient’s
infiltration ECGand
After:
 adverse
Monitor for
phlebitiseffects
After:
signs
 Provide
Instruct
Monitor andpatient
for
symptoms
to
sidenotify
 comforteffects
Explain the
After:
health
 Provide
measures care
After: side effects
 professional
Monitor
comfort
that may occur
Report
measures
patient
 ineffective
and also the
Educate
After:
 compliance
Instruct
danger
patient
pain signs
control,
about to
patient
 drug
to
the therapy.
forverbalize
adverse
constipation,
action,
Advise patient
 urinary
Evaluate
feelings
reportand
reaction
indication,
to to
signs
concerns.
patient
common
retention
of infection sideor
 Drug Actual Classificati Mechanism of Indication Contraindicati Adverse Nursing
Name Dose, on action ons Reaction Responsibility
Frequen
cy and
Route:
Generic 1 gm IV Antipyretic Inhibits Treat mild to Hypersensitivity Most common: Before:
Name: q6 x3 prostaglandin moderate pain , Severe hepatic
doses Non- synthesis in and reduction impairment or Headache  Observe 14
Paracetam narcotic rights in drug
the CNS which of fever active liver Nausea/vomiting
ol analgesic results in pain disease (IV) administration
relief and fever Abdominal pain
 Perform
reduction
Brand Diarrhea handwashing
technique
Name: Constipation before and
Tylenol after giving
medication
 Assess
patient’s fever
or pain

During:

 Assess allergic
reactions
 Check and
monitor vital
signs every 4
hours XII.
 Report Nursing
unusual
swelling, Care
dizziness and
trouble Plan
breathing

After:

 Monitor CBC
 Acute Pain

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Acute pain related The patient will 1) Encourage 1) To provide After 4 hours of

to surgical incision. verbalize non- comfort and to nursing

Pain Scale of 4/10
understanding of pharmacologic decrease pain interventions the
Objective:
pain management al pain relief without the use patient verbalized its

 Guarding techniques and the measures such of medication. understanding of

behavior when importance of as guided pain management

being assessed adhering to imagery, techniques. And

prescribed relaxation Patient verbalized a

 Facial Grimace
medications within techniques, pain scale from 4/10

2 hours of nursing and heat or to 1/10 with the use

interventions. cold therapy. of techniques and

2) Encourage the medication given.

patient to

move and
 reposition 2) To prevent

frequently to stiffness and

prevent reduce pain.

stiffness and

reduce pain.

3) Educate the

patient on the

importance of

adherence to

pain 3) To know where

management to go back to

plan, potential the clinic and to

side effects of have

pain background

medication, knowledge

and the about the

current
 importance of situation.

reporting any

changes in

pain level or

medication

response.

4) Provide

education and

support to the

patient and

family

regarding pain 4) For the patient

management, to be self-aware

self-care, and on her current

follow-up condition and to

care. provide enough

 5) Administer knowledge and

Pain understanding.

medication as

ordered.

5) To medically

decrease the

pain.

Risk for Infection

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Risk for infection Short Term: 1) Assess the 1) To monitor After 3 hours of

related to surgical surgical the wound nursing

Objective: The patient will
incision and incision site and it’s interventions the
demonstrate
Open wound
potential for and document potential risk patient
understanding of
surgical incision site
contamination any changes for infection. demonstrated its
proper wound care
5cm
in appearance understanding in
and hygiene within
or drainage. proper wound care
3 hours of nursing
2) To prevent
2) Provide and hygiene for
interventions.
bacterial
appropriate preventive measures
Long term: growth and
wound care and understand the
provide
The patient will and dressing sign and symptoms
preventive
have no signs or changes per for the patient
maintenance
symptoms of institutional awareness when to
in risk of
infection within 5 protocol. go back to the clinic.

days of surgery. 3) Encourage the

 patient to infection.

practice good 3) For

hand hygiene preventive

etiquette. measures.

4) Educate the

patient and 4) To

significant understand

others on the possible

signs and signs for

symptoms of infection and

infection and to manage it

when to immediately.

report them to

healthcare

providers.
 Risk for Impaired Skin Integrity

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Risk for impaired The patient will 1) Encourage to 1) to promote Evaluate the

skin integrity related verbalize take adequate wound effectiveness of

Objective:
to surgical incision understanding of nutrition and healing. preventive measures
Surgical Incision
risk factors and hydration and adjust
Site around 5cm
preventive measures 2) Encourage to 2) to prevent interventions as
long.
for skin breakdown use skin needed.

within 2 hours of incontinence breakdown.

Review the patient’s
nursing intervention. products and
understanding of
skin
risk factors and
protectants
preventive measures
3) Educate the 3) To provide
and provide
patient and understandin
additional education
Significant g in the

others on the possible risk

 importance of and provide as needed.

skin care and preventive

prevention. measures.

4) Encourage the 4) To promote

patient to good blood

perform range circulation.

of motion

exercises

and/or

provide

passive range

of motion

exercises as

needed
 XIII. Discharge Planning

MEDICATION • Advise and instruct patient to take her medication at the

right time, dose and frequency as prescribed by the doctor.

• Advise the patient not to miss the medication given.

• Explain to the patient the side effects of each

medication.

• Antibiotics: If prescribed, encourage to take the full

course of antibiotics to prevent infection.

ENVIRONMENT • She can do light exercises like gradually walking.

• Hygiene: Take showers instead of baths and avoid

soaking in a tub until advised by your healthcare provider.

• Rest: Avoid strenuous activities and get plenty of rest

during the recovery period.

TREATMENT • Wound care: Keep the incision area clean and dry.
Change the dressing as directed by your healthcare provider

• Advise patient to comply medication as prescribed by

the physician.

HEALTH TEACHINGS • Advise to check the wound daily for the signs of
infection.

• Teach the patient how to care for their incision site,

including how to change dressings and recognize signs of
infection. Provide written instructions and a contact number for
the healthcare provider in case of any concerns.

OPD • Encourage patient to visit the Doctor at given time and

date for follow up check- up.

• Follow-up appointments: Schedule and attend follow-up

 appointments with your healthcare provider to monitor your
recovery.

• Physical therapy: If recommended by your healthcare

provider, attend physical therapy sessions to help with the
recovery process.

DIET • Avoid foods that may cause constipation.

• Avoid processed foods and dairy products.

• Drink plenty of water.

• Gradual reintroduction of foods: Start with a light,

bland diet and gradually introduce solid foods as advised by
your healthcare provider.

• Avoid fatty foods: Avoid fatty and greasy foods for a

few weeks after surgery to prevent digestive problems.

SPIRITUAL • Encourage patient to have faith in God and keep praying.