Nursing Care Plan for Cholecystitis

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Pathophysiology

Cholecystitis is the inflammation of the gallbladder, which holds bile, a digestive juice, that is released into the small intestine. When the path (bile duct) between the gallbladder and small intestine is blocked, bile becomes trapped, builds up and causes inflammation. Surgical removal of the gallbladder is commonly required.

Etiology

The cause of obstruction of the bile duct may vary. The majority of cases are caused by gallstones (calculi) that get trapped in the bile duct. Biliary sludge is the mixture of bile, cholesterol and salt that can build up and form a blockage. Other obstructions may develop from infection, tumors, or edema from compression of the blood vessels.

Desired Outcome

Patient will be free of pain and resume and maintain optimal diet and nutrition.

Cholecystitis Nursing Care Plan

Subjective Data:

  • Nausea
  • Loss of appetite
  • Severe abdominal pain, RUQ or center

Objective Data:

  • Fever
  • Vomiting
  • Jaundice (severe cases)
  • Abnormal labs
  • Clay-colored stools

Nursing Interventions and Rationales

  • Assess vital signs

 

Monitor for signs of cardiopulmonary stress and signs of infection

  • Tachycardia
  • Fever

 

  • Assess Gastrointestinal status

 

  • Look– for distention
  • Listen– for frequent belching
  • Feel– for abdominal rigidity and palpable gallbladder, note tenderness

 

  • Initiate IV access and administer fluids

 

IV access will be required for medication administration and for anesthesia if surgery or diagnostic procedures are being performed. Patient will need to be on bowel rest program and IV hydration is essential.

 

  • Assess and manage pain

 

Severe pain is the most common and worrisome symptom. Patients may report pain that radiates from the RUQ to the back

  • Administer medications
  • Assist with positioning, place in semi-Fowler’s following meals to aid in digestion
  • Promote bedrest for comfort

 

  • Administer medications
    • Monitor for effectiveness
    • Monitor for side effects / adverse reactions

 

  • Antibiotics (levofloxacin, cephalosporins, metronidazole) – in cases of infection and for prophylaxis during surgery or procedures
  • Antiemetics (ondansetron, promethazine) – to control nausea and prevent electrolyte imbalances
  • Analgesics (oxycodone, acetaminophen)- to manage pain
  • Cholecystokinin may be given to prevent gallbladder sludge in patients receiving TPN

 

  • Monitor diagnostic testing
    • Labs
    • Imaging (Ultrasound, CT, MRI, x-rays)

 

Labs: labs may not always be reliable, but the following are often noted:

  • AST/ALT – may be elevated due to liver dysfunction in cases of obstruction
  • Elevated bilirubin may indicate common bile duct obstruction/liver dysfunction
  • Urinalysis- can be used to rule out pyelonephritis and renal calculi as source of pain
  • Pregnancy test should be done on all women of childbearing age to prevent fetal demise

Imaging:  Ultrasound is the diagnostic choice as it allows visualization of acute disease without excessive radiation exposure

  • Ultrasound
  • CT, MRI- may be done for more detailed evaluation or when ultrasound is inconclusive

 

  • Prepare patient for diagnostic procedures:
    • ERCP (Endoscopic Retrograde Cholangiopancreatography) – allows visualization of the biliary system to help diagnose and treat problems with the bile and pancreatic ducts.
    • HIDA scan (Hepatobiliary Iminodiacetic Acid)- performed by injecting a radioactive dye into the bloodstream and visualizing the flow through a special camera placed on the abdomen

 

  • Place patient on clear liquids only for 6-12 hours prior to procedure
  • Withhold NSAIDS and anticoagulants prior to procedure to avoid excess bleeding and interference with the test
  • Assist patient with ambulation after the tests as medication (often morphine) given during the procedure may cause drowsiness

 

  • Nutrition and Lifestyle education

 

  • Obesity is often related to gallbladder disease- encourage diet and exercise to control weight
  • Avoid foods high in fat such as pork, gravies, fried foods, butter
  • Avoid gas producing foods such as cabbage, beans, carbonated drinks
  • Limit or avoid gastric irritants such as alcohol, coffee, tea, caffeine

 


References

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