CHOLECYSTITIS

Pathophysiology:
 [Causes]

--> Gallstones or obstruction --> ↓ Bile flow --> ↑ Pressure in gallbladder -->

Inflammation --> Cholecystitis

Signs and Symptoms:

 Severe abdominal pain (right upper quadrant)

 Nausea and vomiting

 Fever and chills

 Tenderness over gallbladder

 Jaundice (if bile duct obstructed)

Diagnostic Tests:

 Ultrasound: Identifies gallstones or thickened gallbladder wall

 Blood tests: Elevated white blood cell count, bilirubin, and liver enzymes

 HIDA scan: Evaluates gallbladder function

Non-pharmacological Management:

 Dietary changes: Low-fat diet to reduce gallbladder stimulation

 Symptom management: Rest, application of heat to the affected area

 Hydration: Adequate fluid intake

Pharmacological Management (Four Drugs):

1. Analgesics (e.g., NSAIDs): Mechanism - Pain relief; Side effects - GI irritation, renal

impairment; Nursing Interventions - Monitor for GI bleeding, assess renal function.

2. Antibiotics (e.g., Ciprofloxacin): Mechanism - Combat infection; Side effects - GI

upset, tendon rupture; Nursing Interventions - Monitor for allergic reactions, educate on

tendon safety.

3. Ursodeoxycholic Acid: Mechanism - Dissolves cholesterol stones; Side effects -

Diarrhea, liver problems; Nursing Interventions - Monitor liver function, educate on

medication compliance.
4. Antiemetics (e.g., Ondansetron): Mechanism - Control nausea/vomiting; Side effects -

Headache, constipation; Nursing Interventions - Assess for headache, monitor bowel

movements.

Surgical Treatment:

 Cholecystectomy: Surgical removal of the gallbladder; typically performed

laparoscopically.

Priority Nursing Diagnoses:

 Acute Pain

May be related to

 Biological injuring agents: obstruction/ductal spasm, inflammatory process, tissue

ischemia/necrosis

Possibly evidenced by

 Reports of pain, biliary colic (waves of pain)

 Facial mask of pain; guarding behavior

 Autonomic responses (changes in BP, pulse)

 Self-focusing; narrowed focus.

Nursing Interventions and Rationales

1. Promote bedrest, allowing the patient to assume a position of comfort.

Bedrest in low-Fowler’s position reduces intra-abdominal pressure; however, the patient

will naturally assume the least painful position.

2. Use soft or cotton linens; calamine lotion, oil bath; cool or moist compresses as

indicated.

Reduces irritation and dryness of the skin and itching sensation.

3. Control the environmental temperature.

Cool surroundings aid in minimizing dermal discomfort.

4. Encourage the use of relaxation techniques. Provide diversional activities.

Promotes rest, and redirecting attention may enhance coping.

5. Make time to listen to and maintain frequent contact with the patient.

Helpful in alleviating anxiety and refocusing attention, which can relieve pain.

6. Maintain NPO status, insert and/or maintain NG suction as indicated.

Removes gastric secretions that stimulate the release of cholecystokinin and gallbladder

contractions.
 Imbalanced Nutrition: Less Than Body Requirements

Risk factors may include

 Self-imposed or prescribed dietary restrictions, nausea/vomiting, dyspepsia, pain

 Loss of nutrients; impaired fat digestion due to obstruction of bile flow

 1. Provide a pleasant atmosphere at mealtime; remove noxious stimuli.

Useful in promoting appetite/reducing nausea.

 2.Provide oral hygiene before meals.

A clean mouth enhances appetite.

 3. Offer effervescent drinks with meals, if tolerated.

May lessen nausea and relieve gas. Note: May be contraindicated if the beverage causes

gas formation/gastric discomfort.

 4. Ambulate and increase activity as tolerated.

Helpful in the expulsion of flatus, and reduction of abdominal distension. Contributes to

overall recovery and a sense of well-being and decreases the possibility of secondary

problems.

 5. Consult with a dietitian or nutritional support team as indicated.

Useful in establishing individual nutritional needs and the most appropriate route.

 6. Begin a low-fat liquid diet after the NG tube is removed.

Limiting fat content reduces stimulation of the gallbladder and pain associated with

incomplete fat digestion and is helpful in preventing recurrence.

 7. Advance diet as tolerated, usually low-fat, high-fiber. Restrict gas-producing

foods (onions, cabbage, popcorn) and foods or fluids high in fats (butter, fried foods,

nuts).

Meets nutritional requirements while minimizing stimulation of the gallbladder.

Risk for Infection related to inflammation and impaired

bile flow.

 Evidence: Elevated white blood cell count and fever.

 Interventions:

 Administer prescribed antibiotics as ordered.

 Monitor temperature and WBC count.

 Educate patient on the importance of completing antibiotic course.