TARLAC STATE UNIVERSITY COLLEGE OF NURSING Lucinda Campus Brgy.

Ungot, Tarlac City

A Case Study on Cholecystitis

In Partial Fulfillment of the Requirements of the Subject Nursing Care Management 101 RLE

Presented to the Faculty Of the Tarlac State University College of Nursing

Presented by: BSN III - D Group D4 Sotelo, Jeffrey R. Suarez, Christine Karen A. Suba, Mary Joy L. Sumang, Jerico B. Sy, Ruby Ann U. Tabago, Nicole Angelo M. Tan, Jaizelien D. Timbang, Michael Rico M. Tipay, Renceeh S. Tolentino, Troy T. Tomas, Judith

Date Submitted: September 04, 2009

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/highcholesterol/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 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. Importance of the Study Conducting a case study is one of the requirements in NCM 101 RLE. It is important here we exercise our skills and apply it either in hospital and community setting. Though out the subject in NCM 101 it serve as a guide for us to know more about the complications of Cholecystectomy, while we are doing this case study we build trust and team work to each other. Through this study, we learned to apply the nursing process in the care of patient with cholecystectomy, intra-operatively. In addition, this case study allows us to develop critical thinking and use our nursing judgment among different problems and situations to fully develop our nursing skills and to hasten our clinical eye.

OBJECTIVES

General: The objective of our case study is to develop and acquire understanding, skills, and knowledge about the disease, and health promotion to prevent further complication on the condition of the patient. Specific: Nurse Centered To establish rapport with the patient.
To gain more knowledge about this complication of Cholecystitis.

To understand the Etiology, Pathophysiology and Treatment of the disease. To acquire knowledge about the procedure, Cholecystectomy. To work as a group and develop our thinking skills and capabilities in fulfilling and finishing this case study.

PERSONAL DATA A. Demographic Data Name: Age: Sex: Civil Status: Occupation: Religious Affiliation: Role position in the family: Address: Date and Place of birth: Nationality: Health Care Financing: Chief Complaint: Admitting Diagnosis: Date admitted: Case No.: Mr. M 45 Male Married OFW Roman Catholic Father Victoria, Tarlac March 13, 1964 / Victoria, Tarlac Filipino Family RUQ pain, epigastric pain Acute Calculous Cholecystitis September 2, 2009 132023

CASE #: 132023 Patients name: Mr. M Sex: Male DIAGNOSTIC AND LABORATORY PROCEDURES Diagnostic/ procedures Laboratory Date Ordered and Date Indication/s or purposes Resulted
For examining many of the bodys internal organs, including but not limited to the heart and blood vessels, including the abdominal aorta and its major branches, liver, gallbladder, spleen, pancreas, kidneys, bladder, uterus, ovaries, eyes, thyroid and parathyroid glands, scrotum (testicles), and is also used to guide procedures such as needle biopsies. For examination of the urine for cells, tiny structures, bacteria, and chemicals that suggest various illnesses.

Ultrasound (abdominal)

August 18, 2009

Urinalysis

August 18, 2009

Hematology Report

August 27, 2009

Complete blood count (CBC) is a determination of the number of red and white blood cells per cubic millimeter of blood. A CBC is one of the most routinely performed test in a clinical laboratory and one of the most valuable screening and diagnostic techniques. It also helps the health professional to check the patients condition, such as anemia, infection and some symptoms like fatigue.

ANATOMY AND PHYSIOLOGY

Gall bladder, 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 of fat occurs mainly in the small intestine, by pancreatic 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 fatsoluble vitamins: Vitamin A, D, E, and K, rid the body of surpluses and metabolic wastes Cholesterol and Bilirubin.

PATHOPHYSIOLOGY A. Book - based MODIFIABLE Lifestyle Diet Vices NON MODIFIABLE Genetic Age over 60

Bile must become supersaturated with cholesterol and calcium.

The solute precipitate from solution as solid crystals.

Crystals must come together and fuse to form stones.

Gall stones

Sharp pain in the right part of abdomen

Obstruction of the cystic duct and common bile duct.

Jaundice

Distention of the gall bladder

Venous and lymphatic drainage is impared

Proliferation of bacteria

Localized cellular irritation or both take place

Areas of ischemia may occur

Inflammation of gall bladder

CHOLECYSTITIS

b. Patient - based

MODIFIABLE Lifestyle Diet (high fat intake)

NON MODIFIABLE Genetic

Gall stones

Obstruction of the cystic duct and common bile duct.

Nausea

Sharp pain in the right part of the abdomen.

Fever

Limited body movements

CHOLECYSTITIS

MEDICAL MANAGEMENT

Medical Management / Treatment

Date ordered / Date performed / Date changed / Date discontinued

General Description

Indication/s or Purpose/s

Clients reaction to treatment

1. PLRS 30gtts

1L Date ordered: Sept. 02, 2009 (12:00 AM) Date Consumed: Sept. 02, 2009 (04:30 PM) Date ordered: Sept. 02, 2009 (04:30 PM) Date Consumed: Sept. 02, 2009 (12:00 AM)

Isotonic Solution

Used for large Fluid volume fluid replaced. replacement.

loss

2. D5NM 1L 30gtts

A hypertonic solution with greater concentration of solutes than plasma and can draw fluids out of the cells and interstitial spaces into the vascular system.

To increase the volume of blood following severe loss of blood or plasma and is used for fluid and electrolyte replenishment and caloric supply.

There were no signs of inflammation or infiltration during the infusion.

3. D5NM 1L 30gtts

Date ordered: Sept. 03, 2009 (12:00 AM)

A hypertonic solution with greater concentration of solutes than plasma and can draw fluids out of the cells and interstitial spaces into the vascular system.

To increase the volume of blood following severe loss of blood or plasma and is used for fluid and electrolyte replenishment and caloric supply.

There were no signs of inflammation or infiltration during the infusion.

NURSING RESPONSIBILITIES: Before, during and after the treatment: 1. Explain the procedure to the patient. 2. Secure consent from patient before IV infusion. 3. Verify physicians order indicating the type of solution, amount to be administered, and rate of flow of the infusion. 4. Inspect IV site for signs of infiltration or inflammation. 5. Check IV flow rate and monitor fluid volume overload. 6. Monitor intake and output.

SURGICAL MANAGEMENT

Name of procedure

Date performed

Brief Description

Indication/s or Purpose/s

Clients response to the operation

A cholecystectomy is a surgical procedure in which the doctor Cholecystectomy September 02, removes your 2009 gallbladder and its contents. It is the most common method for treating symptomatic gallstones,

It is a method for treating symptomatic gallstones, although there are other indications for the procedure, including carcinoma.

The patient is unconscious due to the effect of anesthesia.

although there are other indications for the procedure, including carcinoma. NURSING RESPONSIBILITY: Before, during and after the surgical procedure: 1. Explain procedure to the patient. 2. Advise the patient to not eat or drink for several hours before the examination. 3. Provide patient privacy 4. Observe for patients response to the procedure 5. Assist patient to move from supine to sitting position 6. Follow up for the result of the procedure.

Anesthesia: Name of Drug Tetracaine + morphine sulfate Date Ordered September 2, 2009 Route IV Anesthetic drugs Action Adverse Reaction -lethargy, hypotension, drowsiness Nursing Consideration - Monitor BP, PR, and RR before and after giving the medication. - Monitor patient for toxicity.

BIBLIOGRAPHY Books Joyce M. Black,PhD, RN, CPSN, CWCN & Jane Hokanson Hawks, DNSc, RN, BC, Medical- Surgical Nursing 7th edition. Nursing Diagnosis Handbook, 5th Edition 2006 by Ackley and Ludwig Doenges, Moorhouse, & Murr, Nurses pocket guide 9th edition. Online Resources www.yahoo.com www.google.com www.scribd.com www.nursingcrib.com