CASE

STUDY:
CHOLELITHIASIS/CHOLESYSTEC
TOMY

Submitted by:
Ma. Theresa B. Guillen
 INTRODUCTION
Gallstones disease is well known over the world!

Over the past few months, you’ve had several bouts of pain in your upper abdomen. Lately, the
pain had been more constant, lasting much longer and accompanied by nausea. Tests show
you’ve been having gallbladder attacks due to gallstones.

Gallstones are common, affecting one in 12 persons in countries such as the United States.
They’re also more common as you age. In the Philippines, thousands of new cases are
diagnosed each year and cholecystectomy (the surgical removal of the gallbladder), is one of
the most common abdominal operations done locally. Luckily, most gallstones don’t require
surgical treatments. But sometimes, they cause painful attacks and lead to more serious
complications.

Calculous disease of the biliary tract is the general term applied to diseases of the gallbladder
and biliary tree that are a direct result of gallstones. Gallstone disease is the most common
disorder affecting the biliary system. The true prevalence rate is difficult to determine because
calculous disease may often be asymptomatic.

There is great variability regarding the worldwide prevalence of gallstone disease. High rates of
incidence occur in the United States, Chile, Sweden, Germany, and Austria. The prevalence
among the Masai peoples of East Africa is 0% whereas it approaches 70% in Pima Indian
women. Asian populations appear to have the lowest incidence of gallstone disease. In the
United States, approximately 10–15% of the adult population has gallstones, with
approximately one million cases presenting each year. Gallstones are the most common
gastrointestinal disorder requiring hospitalization. The annual cost of gallstones in the United
States is estimated at 5 billion dollars.

Why did I choose this topic? Simply because It is interesting and I already encountered this kind
of case before. This is also one of the major health problem in the Philippines and not only in
this country but also in the whole world and so that I can also be aware. So I already learn how
to prevent this kind of disease not all preventions but somehow it helps. I also learn that in
order to prevent this kind of health problem we must have self-discipline for our health and be
careful of what we eat everyday because we didn’t know the worst thing that follows and what
will happen next. And in this way people will have a healthy and happy living.

II-DEOGRAPHIC DATA

Name: A.D.P

Age: 44 years old

Sex: Male

Address: Brgy. San Francisco Victoria Laguna

Occupation: Family Driver

Marital Status: Married

Religion: Roman Catholic

Date of Birth: December 29, 1974

Educational Attainment: High school grad.

Source of health care: Hospital

III- NURSING HISTORY

 He was with his wife while Im doing the interview

14 months prior to admission, patient experienced his first episode of epigastric

pain, non-radiating, associated with commiting of previously ingested food. He
consulted at company clinic and was prescribed with unrecalled pain medications
which afforded temporary relief of abdominal pain. In the interim, patient had
intermittent epigastric pain, patient will just consult at ER and will be treated with
pain medication and patient will be subsequently discharged.

8 months prior to admission, another episode of epigastric pain associated with

vomiting of previously ingested food was noted. Patient consulted at emergency
department, Ultrasound of abdomen was dine which reveals gallstones. Patient
was advised to undergo operation but he refuse it .

I month prior to admission, epigastric pain now radiated to the back associated
with vomiting. No jaundice noted. Patient was admitted at local hospital at
Laguna where pain medications was given and was advised to undergo operation
as well but he refuse it again and he transfer here at MJH . He admitted on March
28 at 1:55 PM and he was undergo operation on April 1, 2019 at 12 pm ; For
Cholesystectomy under Dr.Venturina and anesthesiologist Dr. Ngo.

IV-PAST HEALTH HISTORY

IMMUNIZATION

 Complete immunization when he was a child

 Did not receive any immunization being an adult

CHILDHOOD ILLNESSES
●measles, chicken pox and mumps
SURGICAL HISTORY
● No surgical history. It is her first time to be hospitalized in this institution and undergo
operation.
OBSTETRIC HISTORY
He was born on Dec. 29, 1974. Via NSD. 5kg and he has a twin
SOCIAL HISTORY
ALCOHOL: Non-alcoholic
SOFTDRINK: Occassionally
COFFEE: Once a day every morning
TOBACCO: Non-smoker
PETS: No pet at home
TRAVEL HISTORY: Last travel in Palawan on December, 2018

V- GORDON'S FUNCTIONAL PATTERN

● HEALTH MANAGEMENT PATTERN
Before admission
 Take unrecalled medication for pain
 Take vitamins Enervon 500 mg OD
 Doesn’t have a regular check-up
Admitted in the hospital
 Take and receive pain medications and antibiotic
 assessment were done by the doctors
●NUTRITIONAL METABOLIC PATTERN
Before admission
 Patient stated that He likes to eat salty and fatty foods
 He always had appetite
 drinks at least one liter of water everyday for his water therapy
Admitted in the hospital
 On NPO diet for 3 days
*Post operation- The Doctor’s ordered GL diet (water and jelly ace)
●ELIMINATION PATTERN:
Before admission
 defecates once to twice a day without constipation and brownish to yellowish in color
 urinates 5 to 6 times a day and it is light yellow color
Admitted in the hospital
 defecates once a day without constipation and brownish to yellowish in color
*Post operation- with Foley catheter to CDU. On April 2 FC removed, and after 4 hours
the patient urinate of 240 cc urine.
●REST AND SLEEP PATTERN
Before admission
 sleeps 7-8 hours every night without difficulty and does not sleep in the morning
because of his work
Admitted in the hospital
  he had a good sleep during the night but sometimes he disturbs due to pain at his
operative site

●ACTIVITY AND EXERCISE PATTERN

Before admission
 In the morning he do exercise like walking for 30 mins.
Admitted in the hospital
 doing simple exercise like stretching and twisting
●ROLE AND RELATIONSHIP PATTERN
Before admission and admitted in the hospital
 4th among 5 sibling
 Breadwinner
 Husband to his wife
 He don’t have a child
●SEXUAL AND REPRODUCTIVE PATTERN
Before admission and admitted in the hospital
 With good terms with his loving wife
●COGNITIVE PATTERN
Before admission and admitted in the hospital
 No impaired vision
 with good hearing ears
 Alert and Responsive
 answers appropriately to the questions being asked
●COPING STRESS PATTERN
Before admission
 Watching TV and sleep
Admitted in the hospital
 Sleep and Pray

●SELF-PERCEPTION PATTERN
Before admission
“Gusto ko ng maoperahan para matanggal na itong sumasakit sakin” as claimed
Admitted in the hospital
"Kinakabahan parin ako sa operasyon ko at sa posibleng maging resulta nga opera ko" claimed
●VALUES AND BELIEFS PATTERN
Before admission and admitted in the hospital
 Roman Catholic
 Does not go to church regularly
 Believes in both scientific explanations and superstitious beliefs

VI-PHYSICAL EXAMINATION
General Survey:
GCS: 15, Concious, coherent, not in cardio-respiratory distress, oriented.
Vital Signs
 Temperature: 36.9°C
 Cardiac rate: 70 bpm
 Respiratory rate: 20 cpm
 BP: 120/80 mmHg
 O2sat: 98%
A. Skin
 No jaundice, no pallor, TAN in color
 Afebrile, Good skin turgor (of less than one second)
B. Hair
C. With black short hair
D. Nails
  Convex shaped ,capillary of 1-2 secs
E. Eyes
 Pink palpebral conjunctivae, Outer cantus is symmetrical to the ears
F. Nose
 No nasal discharge , no nasal flaring

G. Ears
 Good hearing ears and no discharges
H. Lips
 Pinkish and moist lips
I. Mouth
 Pinkish and moist buccal mucosa
J. Neck
 No palpable lymph nodes
K. Chest
 Symmetrical Chest expansion
L. Lungs
 Clear and equal breath sound
M. Heart
 normal heart rate, regular rhythm, no murmur
N. Abdomen
Soft and (+) direct tenderness @ epigastric area. Normoactive bowel sounds
O. Extremities
 Symmetrical Size and shape of limbs and can ambulate
 Color is uniform to the rest of the body

VII-RISK FACTOR

DIET AND DIETING

Diet high in fat and cholesterol and low in fiber may increase your risk. In addition,
low-calorie intake crash diets can upset the chemical balance of bile and cause your
gall bladder to contract less often.
-In the case of my patient , He likes to eat foods that high in cholesterol and fats.
(Fried foods, Fast food, Processed meat)
 VIII-ANATOMY AND PHYSIOLOGY

Gallbladder
The gallbladder is a pear-shaped, hollow structure located under the liver and on the
right side of the abdomen. Its primary function is to store and concentrate bile, a yellow-
brown digestive enzyme produced by the liver. The gallbladder is part of the biliary tract.
The gallbladder serves as a reservoir for bile while it’s not being used for digestion. The
gallbladder's absorbent lining concentrates the stored bile. When food enters the small
intestine, a hormone called cholecystokinin is released, signaling the gallbladder to
contract and secrete bile into the small intestine through the common bile duct.

The bile helps the digestive process by breaking up fats. It also drains waste products
from the liver into the duodenum, a part of the small intestine.

An excess of cholesterol, bilirubin, or bile salts can cause gallstones to form. Gallstones
are generally small, hard deposits inside the gallbladder that are formed when stored
bile crystallizes. A person with gallstones will rarely feel any symptoms until the
gallstones reach a certain size, or if the gallstone obstructs the bile ducts..

The gallbladder is divided into three sections:

1. The fundus.
 2. The body.
3. The neck.

The neck tapers and connects to the biliary tree via the cystic duct, which then joins the
common hepatic duct to become the common bile duct. At the neck of the gallbladder is a
mucosal fold where gallstones commonly get stuck.

IX- PATHOPHYSIOLOGY

DECREASED BILE ACID SECRETION

INCREASE CHOLESTEROL IN THE LIVER

SUPER SATURATION OF BILE WITH

CHOLESTEROL

FORMATION OF PRECIPITATES

GALLSTONES (CHOLELITHIASIS) PRESSURE OBSTRUCTION BILE STASIS

INFLAMMATORY CHANGES
(CHOLECYSTITIS) DECREASE FAT EMULSIFICATION

 FAT INTOLERANCE
 ANOREXIA
 GASEOUS ERUCTATION
 WEIGHT LOSS
 FLATULENCE

INFLAMMATION

 PAIN (RUQ) AND EPIGASTRIC

AREA
 FEVER
 LEUKOCYTOSIS 10.4

INFECTION

 PANCREATITIS
 X-LABORATORY AND DIAGNOSTICE TESTS

HEMATOLOGY REPORT

APRIL 02, 2019

COMPLETE RESULT UNIT REFERENCE

BLOOD COUNT VALUE

HEMOGLOBIN 128 g/dl 130-180

HEMATOCRIT 0.38 % 0.42-.048

RBC COUNT 4.55 10^6/UL 4.7-6.1

LEUKOCYTE 10.4 10^5/UL 5.0-10.0
COUNT

DIFFERENTIAL
COUNT
 SEGMENTERS 0.74 % 0.36-0.66

LYMPHOCYTES 0.11 % 0.22-0.40

NURSING INTERPRETATION:

There is Low hemoglobin, hematocrit and RBC count. It shows that the patient has anemia. That’s Why the patient
had Blood Transfusion of 1 unit PRBC . The Leukocyte, Segmenters and lymphocytes is High it indicates that there
is presence of Infection. The lymphocytes is also low.

NURSING IMPLICATION:

Monitored Vital Signs as baseline data. Monitored for other signs and symptoms of infection.

APRIL 2, 2019

TEST RESULT REFERENCE RESULT SI REFERENCE

RANGE RANGE SI

Na+ 145.20 135-145 145.20 mmol/IL 135-145 mmol/IL

NURSING INTERPRETATION:

The result shows that the patient has hypernatremia or High level sodium in the blood.

NURSING IMPLICATION:

Monitor for signs of Dehydration and Assess level of consciousness.

 XI-DRUGS STUDY

Date/Time ordered: March 29, 2019 7:00 PM Ordered by: Dr.Gazmin

Doctor’s order Drug Name Drug’s Drug’s Drug’s side Nursing Why is it given?

Classification action effects consideration

Omeprazole 40 Omeprazole Proton pump It Headache, Hypersensitivity It is give to

mg/IV for am inhibitor suppresses nausea and relieve
stomach vomiting indigestion
acid symptoms
secretion
 Tramadol Tramadol Analgesic It inhibits Headache, Hypersensitivity It is give to
50mg/IV now the nausea, relieve the pain
reuptake of vomiting,
serotonin sedation
and
norepinephr
ine

Date/Time Ordered: March 31, 2019 10:15PM Ordered by: Dr. Talosig

Doctor’s order Drug Name Drug’s Drug’s Drug’s side Nursing Why is it given?

Classification action effects consideration

 (+) Direct Tramadol Analgesic It inhibits Headache, Hypersensitivity The Doctors
tenderness at the nausea, ordered this
RUQ and reuptake of vomiting, because the
epigastric serotonin sedation patient still in
and pain and Its help
Tramadol norepinephr to relieve the
50mg/IV q6 ine pain

Date/Time Ordered: April 1, 2019 9:00 PM Ordered by: Dr. Gazmin

POST-OP MEDS.

Doctor’s order Drug Name Drug’s Drug’s Drug’s side Nursing Why is it given?

Classification action effects consideration

(+) incision site Tramadol Analgesic It inhibits Headache, Hypersensitivity It is give to
pain the nausea, relieve the pain.
reuptake of vomiting, And the reason
Give Tramadol serotonin sedation why dosage of
100 mg/IV now and tramadol
norepinephr increase
ine because the
patient was in
pain during his
first day after he
was being
operated
 Date/Time Ordered: April 01, 2019 10 PM Ordered by: Dr Talosig

Doctor’s order Drug Name Drug’s Drug’s Drug’s side Nursing Why is it given?

Classification action effects consideration

Cefuroxime Cefuroxime Cephalospori It inhibits Headache, Hypersensitivity/ch It is given to

750mg q8hrs x n protein nausea, eck for hepatic and prevent the
2 doses synthesis vomiting renal function patient from
getting an
infection

Ketorolac 30mg Ketorolac Analgesic, It inhibits Head ache, Hypersensitivity, It is given as an

q6hr x 4 doses NSAIDS,antip prostaglandi dizziness, Monitor V/S, check additive effect to
yretic n synthesis nausea, for hepatic and relieve pain
vomiting, renal function
diarrhea
 Date/Time Ordered: April 02, 2019 11 AM Ordered by: Dr. Gazmin

Doctor’s order Drug Name Drug’s Drug’s Drug’s side Nursing Why is it given?

Classification action effects consideration

Shift all Cefuroxime Cephalospori It inhibits Headache, Hypersensitivity/ch It is given to

medications to n protein nausea, eck for hepatic and prevent the
synthesis vomiting renal function patient from
Cefuroxime getting an
500m/tab BID infection

Celecoxib Celecoxib NSAIDS It inhibits Head ache, Hypersensitivity, It is given as an

200mg/cap BID prostaglandi dizziness, Monitor V/S, check additive effect to
n synthesis nausea, for hepatic and relieve pain
vomiting, renal function
diarrhea

Cetradol 1 tab Cetradol Analgesic It works by Headache,Na Hypersensitivity to It is given to

q8 x 4 doses blocking the usea, High paracetampl relieve pain of
reuptake of Blood
natural pressure
chemicals
(Norepinep
 hrine and
serotoninwh
ich produce
pain in the
body

XII-COURSE IN THE WARD

APRIL 01, 2019

FOCUS= Pain R/T surgical incision

DATA= “Sobrang sakit, lalo na kapag umuubo or lumulunok ako” as stated, with facial
grimacing, guarding behaviour with pain scale of 10/10, with scanty amount of blood on post-
op dressing.
ACTION= Placed on moderate high back rest, instructed to do deep breathing
exercises,Tramadol 50 mg given TIV as now ordered
RESOLUTION= Pain decreases from 8/10

APRIL 02, 2019

FOCUS= Acute Pain R/T surgical incision

DATA= “Medyo masakit pa din yung sugat ko” as stated, with facial grimacing, guarding
behaviour with pain scale of 7/10. with scanty amount of blood on post-op dressing.
ACTION= Placed on moderate high back rest, instructed to do deep breathing exercises,Proper
advised to turning side to side Tramadol 100 mg given TIV
RESOLUTION= Pain decreases from 5/10

FOCUS=Risk for infection R/T open wound

DATA= Post lap. Chole. Post-op dressing is intact, with minimal blood stained noted. No swelling
noted at operative site.
 ACTION= Monitored Temperature. Change of dressing done by Dr. Santos. Instructed the
patient to prevent touching the wound and Instructed to do handwashing to prevent spread of
infection.
RESOLUTION= No signs and symptoms of infection noted.

XIII-NURSING THEORY

PEPLAU’S THEORY OF INTERPERSONAL RELATIONSHIPS

Peplau published her Theory of Interpersonal Relations in 1952, and in 1968, interpersonal techniques became the
crux of psychiatric nursing. The Theory of Interpersonal Relations is a middle-range descriptive classification
theory. It was influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elger Miller.

The four components of the theory are: person, which is a developing organism that tries to reduce anxiety caused
by needs; environment, which consists of existing forces outside of the person, and put in the context of culture;
health, which is a word symbol that implies forward movement of personality and other other human processes
toward creative, constructive, productive, personal, and community living. The nursing model identifies four
sequential phases in the interpersonal relationship: orientation, identification, exploitation, and resolution.

The orientation phase defines the problem. It starts when the nurse meets the patient, and the two are strangers.
After defining the problem, the orientation phase identifies the type of service needed by the patient. The patient
seeks assistance, tells the nurse what he or she needs, asks questions, and shares preconceptions and
expectations based on past experiences. Essentially, the orientation phase is the nurse's assessment of the
patient's health and situation.

The identification phase includes the selection of the appropriate assistance by a professional. In this phase, the
patient begins to feel as if he or she belongs, and feels capable of dealing with the problem which decreases the
feeling of helplessness and hopelessness. The identification phase is the development of a nursing care plan based
on the patient's situation and goals.

The exploitation phase uses professional assistance for problem-solving alternatives. The advantages of the
professional services used are based on the needs and interests of the patients. In the exploitation phase, the
patient feels like an integral part of the helping environment, and may make minor requests or use attention-
getting techniques. When communicating with the patient, the nurse should use interview techniques to explore,
understand, and adequately deal with the underlying problem. The nurse must also be aware of the various phases
of communication since the patient's independence is likely to fluctuate. The nurse should help the patient exploit
all avenues of help as progress is made toward the final phase. This phase is the implementation of the nursing
plan, taking actions toward meeting the goals set in the identification phase.

The final phase is the resolution phase. It is the termination of the professional relationship since the patient's
needs have been met through the collaboration of patient and nurse. They must sever their relationship and
dissolve any ties between them. This can be difficult for both if psychological dependence still exists. The patient
drifts away from the nurse and breaks the bond between them. A healthier emotional balance is achieved and
both become mature individuals. This is the evaluation of the nursing process. The nurse and patient evaluate the
situation based on the goals set and whether or not they were met.

The goal of psychodynamic nursing is to help understand one's own behavior, help others identify felt difficulties,
and apply principles of human relations to the problems that come up at all experience levels. Peplau explains that
nursing is therapeutic because it is a healing art, assisting a patient who is sick or in need of health care. It is also
an interpersonal process because of the interaction between two or more individuals who have a common goal.
The nurse and patient work together so both become mature and knowledgeable in the care process.

The nurse has a variety of roles in Hildegard Peplau's nursing theory. The six main roles are: stranger, teacher,
resource person, counselor, surrogate, and leader.

As a stranger, the nurse receives the patient in the same way the patient meets a stranger in other life situations.
The nurse should create an environment that builds trust. As a teacher, the nurse imparts knowledge in reference
to the needs or interests of the patient. In this way, the nurse is also a resource person, providing specific
information needed by the patient that helps the patient understand a problem or situation. The nurse's role as a
counselor helps the patient understand and integrate the meaning of current life situations, as well as provide
guidance and encouragement in order to make changes. As a surrogate, the nurse helps the patient clarify the
domains of dependence, interdependence, and independence, and acts as an advocate for the patient. As a leader,
the nurse helps the patient take on maximum responsibility for meeting his or her treatment goals. Additional
roles of a nurse include technical expert, consultant, tutor, socializing and safety agent, environment manager,
mediator, administrator, record observer, and researcher.

I chose this nursing theory because my patient was admitted in the Mary hospital for the first time and also he was
his first time to undergone surgery. He was anxious about outcome of disease as well as adjusting in new
environment. He was fully conscious, alert and he can do care himself by minimal assistance, So I applied Peplau's
theory and: Interpersonal Relationship with the mutual understanding of patient and family members while caring
him. And also according to peplau’s theory nurse-client relationship was the foundation of nursing practice

XIV-NURSING CARE PLAN

Subjective: Ito kinakabahan ako sa operasyon ko first time ko kasi ma-ooperahan" as stated
Objective: anxious- always looking at his cellphone
asking a lot of questions about his condition
asking about what will happen during and after the operation
Nursing Diagnosis: Anxiety R/T Present Health Condition and the Scheduled Surgery Operation
Planning: After the 8 hours of duty, the patient's anxiety will be reduce by doing nursing
interventions as evidence by expressing his emotions.
Interventions:
 pray for the patient
R: To have strong faith in Jesus Christ and lessen his anxiety
 Encourage to express himself about his anxieties and concerns
R: To help him by answering the questions he will ask that I am allowed to answer
 Encourage the family to provide moral support to the patient
R: For him to know that he is not alone in his condition.
Evaluation: Goal meet, patient, anxiety were reduce as his surgeon talk to him about the
operation on what to be done and also diverting his attention to the movie he watched.

APRIL 02,2019
Subjective: Sumasakit pa rin yung sugat ko lalo na pag- gumagalaw galaw ako"as stated
Objective: diaphoretic on his forehead and back
guarding behavior noted
facial grimacing noted when speaking and moaning noted
 with pain scale of 7/10 Nursing Diagnosis: Acute pain R/T disruption of skin and
tissues
Planning: After the 8 hours of duty, the pain scale of the patient will reduced from 7/10-5/10
through nursing interventions.
Interventions:
 Encourage client to verbalize concerns. Active-listen these concernand
provides support by acceptance remaining with client and giving
information.
R: Reduction of anxiety and fear can promote relaxation and comfort
 Encourage to do deep breathing exercises
R: To reduce muscle tensions
 Provide comfort measures and repositioning
R: Reduces muscle tension, promotes relaxation and may enhance coping capabilities.
 Encourage use of relaxation techniques
R: Helps client rest more effective and refocuses attention thereby reducing pain and
discomfort.
 Investigate and report abdominal muscle rigidity, involuntary guarding and
rebound tenderness
R: Suggestive of peritoneal inflammation , which requires prompt medical interventions
 Monitor vital signs accordingly
R: To provide proper interventions/ managements for emergency
Evaluation: Goal partially meet, At the end of the of 8 hours of duty the patient claims that he
has pain scale of 5/10 and the patient was able to sleep well as stated.

XV- HEALTH TEACHINGS

 Activity: Light activity is advised for 1‐2 weeks after surgery.

 Medicines: Pain medications are typically prescribed. These are to be taken as directed.
 Bathing: Generally, showering is fine 24 hours after the surgery. Wash the skin around your
incision daily with mild soap and water.
 Proper Nutrition: Limit the use of high fat meats, dairy products and vegetable oils
 Proper Handwashing: Do handwashing everyday especially before and after cleaning the wound
and after change the dressing
 Post‐operative follow‐up: Sutures may be dissolvable or may have to be removed a week after
surgery. A post‐ operative follow‐up is typically scheduled for about a week after surgery.
 Have a clinic visit to your healthcare provider if the following symptoms don’t go away within a
week after surgery(Fatigue, Pain around the incision, Diarrhea or constipation and Loss of
appetite)

XVI-CONCEPTUAL PARADIGM
NURSE PATIENT

ORIENTATION PHASE

 The patient is 44 years old male diagnosed with

Cholelithiasis and he was undergo operation on April
01,2019
 The patient is non-alcoholic, non-smoker
 The patient likes to eat salty, oily and Fatty Foods
 The patient have no appetite due to episode of nausea,
vomiting and dyspepsia
 The patient was on NPO for 3 days
 The patient has epigastric pain and (+) at RUQ abdomen
 The patient has increased sodium in the blood
 The patient complains with pain at operative site with
pain scale of 8/10.

IDENTIFICATION PHASE

DIAGNOSIS/PLANNING

 Acute pain and discomfort R/T surgical

incision/Relief of Pain
 Risk for Impaired skin integrity R/T
disruption of skin/Maintain Good skin
integrity and Intact
 EXPLOITATION

Post operative

Promoting skin care  Place the patient in the

low fowler’s position
RESOLUTION  Note and pain
Relieving report RUQ
 Provide intravenous
 abdominal
Administer pain, nausea
Analgesic and
agents Fluids
 Reports decrease in pain vomiting
as prescribed to relieve pain  Provide water and other
 Exhibits normal skin integrity  Observed for redness
Help the patient and
to turn, fluids and GL dies- Soft
 Obtains relief of dietary swelling at incision
cough, breathe site and
deeply, diet is started when
intolerance  Changes
ambulatefrequently the outer
as indicated. bowel sounds return.
 Absence of complications dressing and protection of
the skin from irritation.

Improving nutritional status

 Encourage the patient to eat
a diet low in fats and high in
carbohydrates and proteins
immediately after surgery.

MONITORING AND MANAGING

POTENTIAL COMPLICATIONS

 After open cholesystectomy,

assessed the patient for loss
of appetite, vomiting, pain,
distention of abdomen and
elevation of temp.