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CHOLECYSTECTOMY Cholecystectomy is performed most frequently through laparoscopic incisions using laser. However, traditional open cholecystectomy is the treatment of choice for many patients with multiple/large gallstones either because of acute symptomatology or to prevent recurrence of stones. CARE SETTING This procedure is usually done on a short-stay basis; however, in the presence of suspected complications, e.g., empyema, gangrene, or perforation, an inpatient stay on a surgical unit is indicated. RELATED CONCERNS Cholecystitis with cholelithiasis Pancreatitis Peritonitis Psychosocial aspects of care Surgical intervention Patient Assessment Database/Diagnostic Studies Refer to CP: Cholecystitis with Cholelithiasis. TEACHING/LEARNING Discharge plan considerations: DRG projected mean length of inpatient stay: 1 (laparoscopic)–4.3 days May require assistance with wound care/supplies, homemaker tasks Refer to section at end of plan for postdischarge considerations. NURSING PRIORITIES 1. Promote respiratory function. 2. Prevent complications. 3. Provide information about disease, procedure(s), prognosis, and treatment needs. DISCHARGE GOALS 1. Ventilation/oxygenation adequate for individual needs. 2. Complications prevented/minimized. 3. Disease process, surgical procedure, prognosis, and therapeutic regimen understood. 4. Plan in place to meet needs after discharge. NURSING DIAGNOSIS: Breathing Pattern, ineffective May be related to Pain Muscular impairment Decreased energy/fatigue Possibly evidenced by Tachypnea; respiratory depth changes, reduced vital capacity Holding breath; reluctance to cough DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Respiratory Status: Ventilation (NOC) Establish effective breathing pattern. Experience no signs of respiratory compromise/complications.
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ACTIONS/INTERVENTIONS Respiratory Monitoring (NIC) Independent Observe respiratory rate/depth. Auscultate breath sounds. Assist patient to turn, cough, and deep breathe periodically. Show patient how to splint incision. Instruct in effective breathing techniques. Elevate head of bed, maintain low-Fowler’s position. Support abdomen when coughing, ambulating. Collaborative Assist with respiratory treatments, e.g., incentive spirometer. Administer analgesics before breathing treatments/ therapeutic activities. RATIONALE Shallow breathing, splinting with respirations, holding breath may result in hypoventilation/atelectasis. Areas of decreased/absent breath sounds suggest atelectasis, whereas adventitious sounds (wheezes, rhonchi) reflect congestion. Promotes ventilation of all lung segments and mobilization and expectoration of secretions.
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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