CHOLECYSTITIS WITH CHOLELITHIASIS - CHOLECYSTITIS WITH...

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CHOLECYSTITIS WITH CHOLELITHIASIS Cholecystitis is an acute or chronic inflammation of the gallbladder, usually associated with gallstone(s) impacted in the cystic duct, causing distension of the gallbladder. Stones (calculi) are made up of cholesterol, calcium bilirubinate, or a mixture caused by changes in the bile composition. Gallstones can develop in the common bile duct, the cystic duct, hepatic duct, small bile duct, and pancreatic duct. Crystals can also form in the submucosa of the gallbladder causing widespread inflammation. Acute cholecystitis with cholelithiasis is usually treated by surgery, although several other treatment methods (fragmentation and dissolution of stones) are now being used. CARE SETTING Severe acute attacks may require brief hospitalization on a medical unit. This plan of care deals with the acutely ill, hospitalized patient. RELATED CONCERNS Cholecystectomy Fluid and electrolyte imbalances, see Nursing Plan CD-ROM Psychosocial aspects of care Total nutritional support: parenteral/enteral feeding Patient Assessment Database ACTIVITY/REST May report: Fatigue May exhibit: Restlessness CIRCULATION May exhibit: Tachycardia, diaphoresis, lightheadedness ELIMINATION May report: Change in color of urine and stools May exhibit: Abdominal distension Palpable mass in right upper quadrant (RUQ) Dark, concentrated urine Clay-colored stool, steatorrhea FOOD/FLUID May report: Anorexia, nausea/vomiting Intolerance of fatty and “gas-forming” foods; recurrent regurgitation, heartburn, indigestion, flatulence, bloating (dyspepsia) Belching (eructation) May exhibit: Obesity; recent weight loss Normal to hypoactive bowel sounds PAIN/DISCOMFORT May report: Severe epigastric and right upper abdominal pain, may radiate to mid-back, right shoulder/scapula, or to front of chest Midepigastric colicky pain associated with eating, especially after meals rich in fats Pain severe/ongoing, starting suddenly, sometimes at night, and usually peaking in 30 min, often increases with movement Recurring episodes of similar pain May exhibit: Rebound tenderness, muscle guarding, or abdominal rigidity when RUQ is palpated; positive Murphy’s sign RESPIRATION
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May exhibit: Increased respiratory rate Splinted respiration marked by short, shallow breathing SAFETY May exhibit: Low-grade fever; high-grade fever and chills (septic complications) Jaundice, with dry, itching skin (pruritus) Bleeding tendencies (vitamin K deficiency) TEACHING/LEARNING May report: Familial tendency for gallstones Recent pregnancy/delivery; history of diabetes mellitus (DM), IBD, blood dyscrasias Discharge plan DRG projected mean length of inpatient stay: 4.3 days considerations: May require support with dietary changes/weight reduction Refer to section at end of plan for postdischarge considerations.
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