Colegio San Agustin-Bacolod
College Of Nursing
Topic: Cholecystectomy
Level Of Learner:
Date: October 14, 2010
Time Allotment:
Reference/Sources/Visual Aids: Brunner and Suddarth’s Medical-Surgical Nursing, www.mayoclinic .com, Manila Paper, Pictures, cartolina
Venue:
General Objectives: To Provide students with the knowledge, skills and attitude about the surgical procedure Cholecystectomy.
SPECIFIC OBJECTIVES
Within of ward class,
the students will be able to:
1.Define cholecystectectomy
as a surgical procedure
2. Identify the different
indications of Cholecystectomy
3. Enumerate the risk factors
of cholecystectomy
5. Ascertain the complications
as a result of cholecystectomy
6. Differentiate open method
and laparoscopic method of
cholecystectomy.
7. Explain clearly the
procedures done in
Cholecystectomy.
8. Discuss nursing
responsibilities in the Pre, Intra
LESSON PLAN
CONTENT
I. Definition Of Cholecystectomy
 Cholecystectomy is the surgical
removal of the gallbladder, an organ
located at under the liver on the
upper right quadrant of the
abdomen. The gallbladder stores and
concentrates bile, a substance
produced by the liver, use to break
down fats for digestion
II. Indication
Perform to treat:
 Cholelithiasis – gallbladder contains
gallstones
 Cholecystitis-inflammation of the
gallbladder
 Tumors or cancerous masses
III. Risks Factors
 Respiratory problems related to
location of the incision
 Wound Infection
 Abscess formation
IV. Operation Performed
 Open Method- 2-3 inches of incision
are made in the upper right side of
the abdomen. The Surgeon locates
the gallbladder and removes it
through the incision.
TEACHER’S ACTIVITY
1.Define clearly 1.Define terms with
Cholecystectomy. appropriateness.
2. Identify the different
indications of
Cholecystectomy.
3. Enumerate the different
risk factors of
Cholecystectomy.
4. Differentiate the two
types of Cholecystectomy.
5.Illustrate the location of
the organ involved and the
site of incision
6. Explain the clearly the
procedures done in
Cholecystectomy.
7.Emphasize the principles
of aseptic technique.
STUDENT’S ACTIVITY
2. Identification of
indications of
Cholecystectomy.
3.Enumeration of risk
factors, and complications of
Cholecystectomy.
4. Differentiation of open
and laparoscopic method of
Cholecystectomy.
5. Determine the procedures
done in cholecystecttomy.
6. Participation in the
discussion.
7. Determine the different
nursing responsibilities in
pre, intra and post operative
procedure.
EVALUATION
At the end of of ward
discussion. The students were
able to:
.Define cholecystectectomy as
a surgical procedure
2. Identify the different
indications of
Cholecystectomy
3. Enumerate the risk factors
of cholecystectomy
5. Ascertain the complications
as a result of cholecystectomy
6. Differentiate open method
and laparoscopic method of
cholecystectomy.
7. Explain the clearly the
procedures done in
Cholecystectomy.
and Post Operative Periods.
9. Enumerate the different
instruments used in
Cholecystectomy.
10. Understands clearly the
surgical procedure
Cholecystectomy.
11. Emphasize the principles of
aseptic technique.
12. Participate actively and
attentively in the ward
discussion.
 Laparoscopic Method-cannulation of 8. Discuss comprehensively
the gallbladder under the direct 8. Familiarization of different nursing responsibilities in the
laparoscopic visualization and instruments used in Pre, Intra and Post Operative
removal of the gallbladder. Several 8. Discuss the nursing Cholecystectomy. Periods.
incisions are made and 3 or more responsibilities in the Pre,
laparoscope is used. The surgeon
Intra, Post Operative 9. Application of the 9. Familiarize the different
performs surgery while looking at the
TV monitor. Gallbladder is removed
Periods. principles of aseptic instruments used in
through one of the incisions. teachnique. Cholecystectomy.
V. Nursing Responsibilities and 9. Enumerate the different
Procedures Done (Open Method) instruments use in 10. Ask questions and/or 10. Understands clearly the
a. Preparation Cholecystectomy. clarify things related to the surgical procedure
 Confirm a sign consent topic being discussed. Cholecystectomy.
 Food and fluid will be prohibited after 10. Evaluate the student’s
midnight before the procedure knowledge, skills and values 11. Emphasize the principles of
 Enemas may be ordered to clean out the learned throughout the aseptic technique.
bowel discussion by asking
 If nausea and vomiting are present, a questions. 12. Participate actively and
suction tube to empty stomach maybe
attentively in the ward
used
discussion.
 Notify physician if patient is pregnant or
allergic to some medications and has
history of bleeding disorders As evidenced by:
b. During  Actively and attentively
 Performed under spinal anesthesia participating in the
 Remove any objects in the body that may discussion
interfere with the procedure  Answering questions
 Wear gown being relayed to them
 IV line will be inserted  Asking questions if
 Positioned in operating table topic is unclear or need
 Anesthesiologist continue to monitor HR, some further
BP, breathing, blood oxygen level
examples/explanation
 Skin over the surgical site will be
 Sharing one’s idea
cleansed with antiseptic solution
 An incision is slant under the ribs on the related to the topic
right side of the abdomen, or it may be  Giving one’s reaction
an up and down incision in the upper to the topic being
part of the abdomen talked about.
 Gallbladder is removed
 In some cases, one or more drains may
be inserted through the incision to allow
 drainage of fluids or pus.
 Gallbladder will be sent to laboratory for
examination.
 Skin incisions will be closed with stitches
or surgical staples.
 Instruments, sharps, sponges will be
counted, checked and should be
complete.
 Sterile bandage/dressing or adhesive
strips will be applied.
c. Post-Operative Care
 Monitor blood pressure, pulse,
respiration and temperature
 Demonstrate patient how to support
operative site when breathing deeply
and coughing. May given pain medication
as necessary.
 Measure fluid intake and output.
 Operative site is observed for color and
amount of wound drainage.
 Fluid is given intravenously 24-48 hours
until the patient’s diet is gradually
advanced as bowel activity resumes
 Encourage patient to walk 8 hours after
surgery and discharged 3-5 days, with
return to work approx. 4-6 wks after the
procedure.
VI. Instrument Used
 Kelly Curve
 Kelly Straight
 Allis long and short
 Bobcock long and short
 Kocher’s long and short
 Long tissue forceps with & without teeth
 Short tissue forceps with &without teeth
 Mixters long & short
 Adson’s with & without teeth
 Army navy short & long
 Metzenbaum short & long
 Mayo
 Richardson
 Cautery
 Suction
 Ovums
 Towel clips
 Deaver
 Mallable
 Needle Holder
 Blade Holder

Prepared By: Marisol Jessa J. Macayana

BSN IV-C/Group 11