Cholecystitis NCLEX Nursing Review into the duodenum.

into the duodenum. Bile will then fulfill its role with helping digest fats and help the bilirubin
leave the body via stool.

Unfortunately, this process will become messed up when the gallbladder becomes inflamed
and the gallbladder won’t be able to drain bile properly. Instead the bile will become thick and
this will increase wall pressure within the gallbladder and lead to inflammation.

The inflammation can become so severe it can cause inflammation of the liver (hepatitis),
pancreas (pancreatitis), sepsis, or perforate.

Causes of Cholecystitis

Chole: bile
Cyst: membranous sac
itis: inflammation
When you put all of this together you get: A membranous sac that contains bile is inflamed.
Therefore, cholecystitis is the inflammation of the gallbladder.

What’s the gallbladder?

It’s a dark green organ that is rotund in shaped. Some may say that it sort of looks like a little
green pear.

The gallbladder is found under the liver on the right side of the body, which is very
convenient since the liver and gallbladder are connected to each other and work together. They
share their love for BILE!

Bile is greenish brownish substance and is created by the liver and travels to the gallbladder to
be stored and concentrated via the hepatic ducts, which is why the organ is greenish in color.

Bile helps us digest and absorb fats that we consume like fat soluble vitamins such as A, D, E, Obstruction of some type:
and K. So, if our gallbladder isn’t working (like from a blockage or inflammation) our body
can’t have access to these fats and they will exit the body as greasy/fatty stools called
“steatorrhea”. • Cholelithiasis “gallstones”: main cause

In addition, bile is also a vehicle for helping the body rid itself of bilirubin, which is created
from the breakdown of old/worn out red blood cells. Bilirubin is a brownish/orange/yellowish
substance and helps give our stool its brown color. So, if the gallbladder isn’t releasing bile
properly (which contains bilirubin) the stool will become a light color (like clay), the sclera of
the eyes could turn orange/yellow along with the skin (jaundice), and the urine will turn dark
in color. This is because the bilirubin has leaked into the skin and urine rather than exiting the
body in the stool.
How the gallbladder deals with bile?
• Risk factors: woman, obese, older, family history,
pregnant, Native American or Mexican American
• Or any other type of obstruction in the gallbladder where
bile can’t flow out via the cystic duct
—What happens? Bile stays in the gallbladder and becomes thick. This increases pressure in
the gallbladder and damages the wall of the gallbladder, which causes inflammation and
swelling of the gallbladder. Furthermore, due to the swelling and inflammation, blood flow to
the gallbladder can be compromised and lead to death of the organ.

The gallbladder squirts bile into the duodenum (a part of the small intestines). This happens Acalculous “without a gallstone issue”: This is where the gallbladder is NOT working
when chyme (a thick semi-pulpy liquid that contains gastric juices and half-way digested food properly and it doesn’t contract
created by the stomach) enters into the duodenum which stimulates the gallbladder to contract.
When this occurs, bile travels down the cystic duct and into the common bile duct and then
 • This tends to occur to high acuity patient (very sick patients who are • Provide mouth care
hospitalized), after surgery or during a severe illness like sepsis, burns, or
major trauma, and even when a patient has been on TPN for a long period of
time (the gallbladder isn’t being stimulated).
—What happens? Bile becomes thick and the gallbladder is not contracting like it should (not
being stimulated) and this leads to inflammation.

Signs and Symptoms of Cholecystitis

• Nausea/Vomiting

• Pain in abdomen (epigastric) that tends to radiate to the right shoulder pain,
especially after consuming a greasy meal

• Positive Murphy’s Sign: lay patient in supine position and palpate under the
ribs on the right side at the midclavicular line. Then have the patient breathe
out and then take a deep breath in. While the patient is breathing in, palpate
on this area under the ribs…if the patient stops breathing in during palpation
it is considered a positive Murphy’s Sign.
Analgesics for pain, antiemetics for nausea
• Fever
Low-fat, gas-free foods diet when recovered
• Bloating

• Steatorrhea, jaundice, dark brown urine, light colored stools (chronic Large bore IV for fluids to hydrate and maintain electrolytes (many patients become
cholecystitis) dehydrated and have electrolyte imbalances from nausea and vomiting)

Diagnosed? abdominal ultrasound, HIDA scan, or CT scan Breathing in stopped by patient during palpation of gallbladder because it hurts “Murphy’s
Sign”
Nursing Interventions for Cholecystitis
Labs: electrolytes, bilirubin (jaundice?), WBC, liver enzymes, pancreatic enzymes, renal
“Gallbladder” function

GI rest Antibiotics for infection (IV)

• NPO until recovered then clear liquids and advanced as tolerated per MD
order
• When diet is ordered to be advanced assess how patient is
tolerating the advancement…are they having
nausea/vomiting, pain?
• Nausea/vomiting may be very severe and a nasogastric tube with GI
decompression may be inserted. The NG tube, per MD order, may be set to
low intermittent suction to help remove stomach contents so the gallbladder
isn’t stimulated.
Drain care
• Cholecystostomy tube “C-tube”: this is different than a t-tube which is
sometimes placed after the removal of the gallbladder and is placed in the
bile duct.
• C-tubes are place through the abdominal wall and into the gallbladder. They are for
patients who can’t have surgery immediately to remove the gallbladder but the infected
bile needs to be removed.
• It will drain infected fluid from the gallbladder.

• Things to remember:

• keep the collection bag at waist level to drain

 • empty and record drainage Removal of gallbladder “cholecystectomy”

• Note color

• Monitor insertion site for infection

• Flush per MD order so it won’t get blocked and teach patient how to
care for drain.
Deterioration signs and symptoms? How to tell if treatment is not helping and the patient is
getting worst?

• Mental status changes, increased heart rate, decreased blood pressure, high
temperature, high WBC, change in stool consistency and color (steatorrhea,
light colored, jaundice, dark urine…no bilirubin), increasing or worsening
abdominal pain (RUQ)
ERCP to remove the gallstones from the bile duct and assess areas of the gallbladder…an
endoscope is inserted through the mouth and into the stomach to the small intestine and to the
bile duct.

• Since the gallbladder is removed bile will now drain from the liver via the
bile duct into the duodenum.

• This procedure can be performed laparoscopically (most common) or open.

• Monitor for infection.

• Be aware that many patient who have the gallbladder removed

laparoscopically will have shoulder pain from carbon dioxide (that was used
during the procedure) not being reabsorbed by the body.

• Side lying with knees bent can help the pain along with
heat application to the shoulders, or analgesics.

• Make sure the patient is ambulating soon after the procedure to prevent
post-opt complications and coughing and deep breathing (splinting
incision)…remind the patient how to use the incentive spirometer.
T-Tube care: 1. The gallbladder is found on the __________ side of the body and is located under the
____________. It stores __________.
• A t-tube works as a drain and it can be used for testing where dye is injected into the
tube and an x-ray is taken to see if there are any more stones. It will light up the A. right; pancreas; bilirubin

B. left; liver; bile

C. right; thymus’ bilirubin

D. right; liver; bile

The answer is D. The gallbladder is found in the RIGHT side of the body and is located
under the LIVER. It stores BILE.
biliary tree.
2. Which statements below are CORRECT regarding the role of bile? Select all that
• The T part of the t-tube is placed in the bile duct to drain bile while the duct is healing apply:
after surgery because there will be swelling in the duct. It helps drain the excessive bile
so it doesn’t all go into the small intestine because it will have to get use to having this A. Bile is created and stored in the gallbladder.
amount of bile draining down (remember normally the gallbladder contracted and
delivered it at intervals). B. Bile aids in digestion of fat soluble vitamins, such as A, D, E, and K.
• Things to Remember:
C. Bile is released from the gallbladder into the duodenum.
• Patient will have a drainage bag that will need to be kept at the
abdomen so it can drain properly and the patient should be upright in D. Bile contains bilirubin.
the Semi-Fowlers position to help with draining.

• Monitor drainage and that is it actually draining because it can become The answer are B, C, and D. Option A is INCORRECT because bile is created in the
blocked. LIVER (not gallbladder), but bile is stored in the gallbladder.

• Drainage should NOT be more than 500
mL/day….first day post-op the drainage may be
bloody and then will turn greenish/brown.
• Maintain skin care because bile is harsh on the skin.
3. You’re providing a community in-service about gastrointestinal disorders. During your
teaching about cholecystitis, you discuss how cholelithiasis can lead to this condition.
What are the risk factors for cholelithiasis that you will include in your teaching to the
participants? Select all that apply:

• You must have a physician’s order to flush the t- A. Being male

tube.
B. Underweight
• You may be ordered to clamped the tube 1 hour
before and 1 hour after meals (MUST HAVE MD C. Being female
ORDER FOR THIS) so bile can enter the small
intestine to help digest fats.
D. Older age
• When the tube is clamped monitor
how the patient tolerates E. Native American
it….notify MD if the patient has
nausea/vomiting, pain etc. F. Caucasian
Cholecystits NCLEX Questions
G. Pregnant
H. Family History
I. Obesity
The answers are C, D, E, G, H and I. Cholelithiasis is the formation of gallstones. Risk
factors include: being female, older age (over 40), Native American or Mexican
American descent, pregnant, obesity, and family history.
4. A patient is being transferred to your unit with acute cholecystitis. In report the
transferring nurse tells you that the patient has a positive Murphy’s Sign. You know that
this means:
A. The patient stops breathing in when the examiner palpates under the ribs on the right
upper side of the abdomen at the midclavicular line.
B. The patient stops breathing out when the examiner palpates under the ribs on the right
upper side of the abdomen at the midclavicular line.
C. The patient verbalizes pain when the lower right quadrant is palpated.
D. The patient reports pain when pressure is applied to the right lower quadrant but then
reports an increase in pain intensity when the pressure is released.
The answer is A. Murphy’s Sign can occur with cholecystitis. This occurs when the
patient is placed in the supine position and the examiner palpates under the ribs on the
right upper side of the abdomen. The examiner will have the patient breathe out and then
take a deep breath in. The examiner will simultaneously (while the patient is breathing in)
palpate on this area under the ribs at the midclavicular line (hence the location of the
gallbladder). It is a POSITIVE Murphy’s Sign when the patient stops breathing in during
palpation due to pain.
5. Your patient is post-op day 3 from a cholecystectomy due to cholecystitis and has a T-
Tube. Which finding during your assessment of the T-Tube requires immediate nursing
intervention?
A. The drainage from the T-Tube is yellowish/green in color.
B. There is approximately 750 cc of drainage within the past 24 hours.
C. The drainage bag and tubing is at the patient’s waist.
D. The patient is in the Semi-Fowler’s position.
The answer is B. A T-Tube should not drain more than about 500 cc of drainage per day
(within 24 hours). A T-Tube’s drainage will go from bloody tinged (fresh post-op) to
yellowish/green within 2-3 days. The drainage bag and tubing should be below the site of
insertion (at or below the patient’s waist so gravity can help drainage the bile), and the
patient should be in Semi-Fowler’s to Fowler’s position to help with draining the bile.
6. The physician orders a patient’s T-Tube to be clamped 1 hour before and 1 hour after
meals. You clamp the T-Tube as prescribed. While the tube is clamped which finding
requires you to notify the physician?
A. The T-Tube is not draining.
B. The T-Tube tubing is below the patient’s waist.
C. The patient reports nausea and abdominal pain.
D. The patient’s stool is brown and formed.
The answer is C. A nurse should ONLY clamp a T-Tube with a physician’s order. Most
physicians will prescribe to clamp the T-tube 1 hour before and 1 hour after meals.
WHY? So, bile will flow down into the small intestine (instead out of the body) during
times when food is in the small intestine to help with the digestion of fats. This is to help
the small intestine adjust to flow of bile (remember normally it received bile when the
gallbladder contracted but now it will flow from the liver to the small intestine
continuously). Option C is an abnormal finding. The patient should not report nausea or
abdominal pain when the tube is blocked. This could indicate a serious problem. Option
A is correct because the T-tube should not be draining because it’s clamped. Option B is
correct because the T-tube tubing should be below or at the patient’s waist level. Option
D is correct because this shows the body is digesting fats and bilirubin is exiting the body
through the stool (remember bilirubin is found in the bile and gives stool its brown
color…it would be light colored if the bilirubin was not present). You would NOT want
to see steatorrhea (fat/greasy liquid stools) because this shows the bile isn’t being
delivered to help digest the fats.
7. Your recent admission has acute cholecystitis. The patient is awaiting a
cholecystostomy. What signs and symptoms are associated with this condition? Select all
that apply:
A. Right lower quadrant pain with rebound tenderness
B. Negative Murphy’s Sign
C. Epigastric pain that radiates to the right scapula
D. Pain and fullness that increases after a greasy or spicy meal
E. Fever
F. Tachycardia
G. Nausea C. The C-Tube is placed through the abdominal wall and directly into the gallbladder
where it will drain infected bile from the gallbladder.
The answers are C, D, E, F, and G. Option A and B are not associated with cholecystitis,
but a POSITIVE Murphy’s Sign is. D. The tubing and drainage bag of the C-Tube should always be level with the insertion
site to ensure the tube is draining properly.
8. A patient in the emergency room has signs and symptoms associated with
cholecystitis. What testing do you anticipate the physician will order to help diagnose The answer is C. This is the only correct statement about a cholecystostomy. A
cholecystitis? Select all that apply: cholecystostomy, also sometimes called a C-Tube, is placed when a patient can’t
immediately have the gallbladder removed (cholecystectomy) due to cholecystitis. It is
A. Lower GI series placed through the abdominal wall and into the gallbladder. It will drain infected bile
(NOT gallstones). The tubing and drainage bag should be at or below waist level so it
drains properly.
B. Abdominal ultrasound
11. A patient, who has recovered from cholecystitis, is being discharged home. What
C. HIDA Scan (Hepatobiliary Iminodiacetic AciD scan) meal options below are best for this patient?

D. Colonoscopy A. Baked chicken with steamed carrots and rice

The answers are B and C. These two tests can assess for cholecystitis. A lower GI series B. Broccoli and cheese casserole with gravy and mashed potatoes
would not assess the gallbladder but the lower portions of the GI system like the rectum
and large intestine. Option D is wrong because it would also assess the lower portions of
the GI system. C. Cheeseburger with fries

9. You’re precepting a nursing student who is helping you provide T-Tube drain care.
You explain to the nursing student that the t-shaped part of the drain is located in what
part of the biliary tract?
A. Cystic duct
D. Fried chicken with a baked potato
The answer is A. The patient should eat a low-fat diet and avoid greasy/fatty/gassy foods.
Option B is wrong because this contains dairy/animal fat like the cheese and gravy, and
broccoli is known to cause gas. Option C and D are greasy food options.

B. Common hepatic duct 12. Your patient is diagnosed with acute cholecystitis. The patient is extremely nauseous.
A nasogastric tube is inserted with GI decompression. The patient reports a pain rating of
9 on 1-10 scale and states the pain radiates to the shoulder blade. Select all the
C. Common bile duct appropriate nursing interventions for the patient:

D. Pancreatic duct A. Encourage the patient to consume clear liquids.

The answer is C. The “T-shaped” part of the drain is located in the common bile duct and B. Administered IV fluids per MD order.
helps deliver bile to the duodenum (small intestine).
C. Provide mouth care routinely.
10. Your patient is unable to have a cholecystectomy for the treatment of cholecystitis.
Therefore, a cholecystostomy tube is placed to help treat the condition. Which statement
about a cholecystostomy (C-Tube) is TRUE? D. Keep the patient NPO.

A. The C-Tube is placed in the cystic duct of the gallbladder and helps drain infected bile
from the gallbladder.
B. Gallstones regularly drain out of the C-Tube, therefore, the nurse should flush the tube
regularly to ensure patency.
E. Administer analgesic as ordered.
F. Maintain low intermittent suction to NG tube.
The answers are B, C, D, E, and F. The treatment for cholecystitis includes managing
pain, managing nausea/vomiting (a NG tube with GI decompression (removal of stomach
 contents) to low intermittent suction may be ordered to help severe cases), keep patient
NPO until signs and symptoms subside, mouth care from vomiting and nasogastric tube,
and administer IV fluids to keep the patient hydrated.
Cholecystitis is the inflammation of the gallbladder, usually associated
with gallstones impacted in the cystic duct. 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, 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.
Cholelithiasis, stones or calculi in the gallbladder, results from changes in bile components.
Gallstones are made of cholesterol, calcium bilirubinate, or a mix of cholesterol and bilirubin.
They arise during periods of sluggishness in the gallbladder due to pregnancy, hormonal
contraceptives, diabetes mellitus, celiac disease, cirrhosis of the liver, and pancreatitis.
Nursing Care Plans
Nursing care planning and management for patients with cholecystitis include relieving pain
and promoting rest, maintaining fluid and electrolyte balance, preventing complications, and
provision of information about the disease process, prognosis, and treatment.
Here are four (4) nursing care plans and nursing diagnoses for cholecystitis
(cholelithiasis):
1. Risk for Deficient Fluid Volume
2. Acute Pain
3. Risk for Imbalanced Nutrition: Less Than Body Requirements
4. Deficient Knowledge
Risk for Deficient Fluid Volume
Patients with cholecystitis and cholelithiasis are at risk for deficient fluid volume due to
excessive losses resulting from vomiting or diarrhea, limited intake due
to nausea and anorexia, and altered clotting processes due to liver dysfunction. This can lead
to dehydration and impaired perfusion, which can worsen the inflammatory response
associated with these conditions and potentially lead to systemic complications.
Nursing Diagnosis
• Risk for Deficient Fluid Volume
Risk factors may include
• Excessive losses through gastric suction; vomiting, distension, and gastric
hypermotility
• Medically restricted intake
• Altered clotting process
Possibly evidenced by
• Not applicable. A risk diagnosis is not evidenced by signs and symptoms,
as the problem has not occurred and nursing interventions are directed at
prevention.
Desired Outcomes
• The client will demonstrate adequate fluid balance evidenced by stable
vital signs, moist mucous membranes, good skin turgor, capillary refill,
individually appropriate urinary output, and absence of vomiting.
Nursing Assessment and Rationales
1. Maintain accurate record of I&O, noting output less than intake, and
increased urine specific gravity. Assess skin and mucous membranes, peripheral pulses,
and capillary refill.
To provide information about the fluid status and circulating volume needing replacement.
2. Monitor for signs and symptoms of increased or continued nausea or vomiting,
abdominal cramps, weakness, twitching, seizures, irregular heart rate, paresthesia,
hypoactive or absent bowel sounds, and depressed respirations.
Prolonged vomiting, gastric aspiration, and restricted oral intake can lead to deficits
in sodium, potassium, and chloride.
3. Assess for unusual bleeding: oozing from injection sites, epistaxis, bleeding gums,
ecchymosis, petechiae, hematemesis, or melena.
Prothrombin is reduced and coagulation time is prolonged when bile flow is obstructed,
increasing the risk of bleeding or hemorrhage.
Nursing Interventions and Rationales
1. Eliminate noxious sights or smells from the environment.
Reduces stimulation of vomiting center.
2. Perform frequent oral hygiene with alcohol-free mouthwash; apply lubricants.
Decreases dryness of oral mucous membranes; reduces the risk of oral bleeding.
3. Use small-gauge needles for injections and apply firm pressure for longer than usual
after venipuncture.
Reduces trauma, and risk of bleeding or hematoma formation.
4. Keep patient NPO as necessary. Nursing Interventions and Rationales
Decreases GI secretions and motility.
1. Promote bedrest, allowing the patient to assume a position of comfort.
5. Insert NG tube, connect to suction, and maintain patency as indicated. Bedrest in low-Fowler’s position reduces intra-abdominal pressure; however, the patient will
To rest the GI Tract naturally assume the least painful position.

Acute Pain
Patients with cholecystitis and cholelithiasis may experience acute pain due to obstruction of
the gallbladder or bile ducts by gallstones, inflammation and irritation of the gallbladder wall,
and tissue ischemia resulting from impaired blood flow to the affected area. The pain is often
located in the right upper quadrant of the abdomen and may be accompanied by other
symptoms such as fever, nausea, and vomiting.
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.

Nursing Diagnosis Promotes rest, and redirecting attention may enhance coping.

• Acute Pain 5. Make time to listen to and maintain frequent contact with the patient.
May be related to Helpful in alleviating anxiety and refocusing attention, which can relieve pain.

• Biological injuring agents: obstruction/ductal spasm, inflammatory 6. Maintain NPO status, insert and/or maintain NG suction as indicated.
process, tissue ischemia/necrosis Removes gastric secretions that stimulate the release of cholecystokinin and gallbladder
Possibly evidenced by contractions.

• Reports of pain, biliary colic (waves of pain) 7. Administer medications as indicated:

• Facial mask of pain; guarding behavior
• Autonomic responses (changes in BP, pulse)
• 7.1. Anticholinergics: atropine, propantheline (Pro-Banthı-ne)
• Self-focusing; narrowed focus Relieves reflex spasms and smooth muscle contraction and assists with
Desired Outcomes pain management.
• 7.2. Sedatives: phenobarbital
• The client will report relief or control of pain. Promotes rest and relaxes smooth muscle, relieving pain.
• The client will demonstrate the use of relaxation skills and diversional • 7.3. Narcotics: meperidine hydrochloride (Demerol), morphine sulfate
activities as indicated for the individual situations. Given to reduce severe pain. Morphine is used with caution because it
may increase spasms of the sphincter of Oddi, although nitroglycerin may
Nursing Assessment and Rationales
be given to reduce morphine-induced spasms if they occur.
• 7.4. Monoctanoin (Moctanin)
1. Observe and document location, severity (0–10 scale), and character of pain (steady, This medication may be used after cholecystectomy for retained stones or
intermittent, colicky). for newly formed large stones in the bile duct. It is a lengthy treatment (1–
Assists in differentiating causes of pain, and provides information about disease progression 3 wk) and is administered via a nasal-biliary tube. A cholangiogram is
and resolution, development of complications, and effectiveness of interventions. done periodically to monitor stone dissolution.
• 7.5. Smooth muscle relaxants: papaverine (Pavabid), nitroglycerin,
2. Note the response to medication, and report to the physician if the pain is not being amyl nitrite
relieved. Relieves ductal spasm.
Severe pain not relieved by routine measures may indicate developing complications or a need • 7.6. Chenodeoxycholic acid (Chenix), ursodeoxycholic acid (Urso,
for further intervention. Actigall)
These natural bile acids decrease cholesterol synthesis, dissolving
 gallstones. The success of this treatment depends on the number and size
of gallstones (preferably three or fewer stones smaller than 20 min in
diameter) floating in a functioning gallbladder.
• 7.7. Antibiotics
To treat infectious processes, reducing inflammation.
Risk for Imbalanced Nutrition: Less Than Body Requirements
Patients with cholecystitis and cholelithiasis are at risk for imbalanced nutrition, with less than
the body’s requirements, due to dietary restrictions to avoid exacerbating symptoms, loss of
nutrients from impaired digestion and absorption, impaired fat digestion and malabsorption,
and pain and dyspepsia leading to decreased intake. These factors can lead to malnutrition and
nutrient deficiencies, potentially worsening the inflammatory response and impairing overall
healing.
Nursing Diagnosis
• Risk for 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
Possibly evidenced by
• Not applicable. A risk diagnosis is not evidenced by signs and symptoms,
as the problem has not occurred and nursing interventions are directed at
prevention.
Desired Outcomes
• The client will report relief from nausea/vomiting.
• The client will demonstrate progression toward desired weight gain or
maintain weight as individually appropriate.
Nursing Assessment and Rationales
1. Calculate caloric intake. Keep comments about appetite to a minimum.
Identifies nutritional deficiencies and/or needs. Focusing on a problem creates a negative
atmosphere and may interfere with intake.
2. Weigh as indicated.
Monitors the effectiveness of the dietary plan.
3. Assess for abdominal distension, frequent belching, guarding, and reluctance to move.
Nonverbal signs of discomfort associated with impaired digestion, and gas pain.
4. Monitor laboratory studies: BUN, prealbumin, albumin, total protein, and transferrin
levels.
Provides information about nutritional deficits or the effectiveness of therapy.
Nursing Interventions and Rationales
1. Consult with the patient about likes and dislikes, foods that cause distress, and
preferred meal schedules.
Involving the patient in planning enables the patient to have a sense of control and encourages
eating.
2. Provide a pleasant atmosphere at mealtime; remove noxious stimuli.
Useful in promoting appetite/reducing nausea.
3. Provide oral hygiene before meals.
A clean mouth enhances appetite.
4. 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.
5. 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
related to immobility (pneumonia, thrombophlebitis).
6. Consult with a dietitian or nutritional support team as indicated.
Useful in establishing individual nutritional needs and the most appropriate route.
7. 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.
8. 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.
9. Administer bile salts: Bilron, Zanchol, and dehydrocholic acid (Decholin), as
indicated.
Promotes digestion and absorption of fats, fat-soluble vitamins, and cholesterol. Useful in
chronic cholecystitis.
10. Provide parenteral and/or enteral feedings as needed.
Alternative feeding may be required depending on the degree of disability and gallbladder
involvement and the need for prolonged gastric rest.
Deficient Knowledge
Patients with cholecystitis and cholelithiasis may have deficient knowledge about the
condition due to a lack of information or misinformation about the disease, misinterpretation
of available information, and unfamiliarity with the medical terminology and concepts
associated with the condition. This can lead to confusion, anxiety, and uncertainty about how
to manage the condition and prevent future complications.
Nursing Diagnosis
• Deficient Knowledge
May be related to
• Lack of knowledge/recall
• Information misinterpretation
• Unfamiliarity with information resources
Possibly evidenced by
• Questions; request for information
• Statement of misconception
• Inaccurate follow-through of instruction
• Development of preventable complications
Desired Outcomes
• The client will verbalize understanding of the disease process, prognosis,
and potential complications.
• The client will verbalize understanding of therapeutic needs.
• The client will initiate necessary lifestyle changes and participate in the
treatment regimen.
Nursing Assessment and Rationales
1. Review disease process and prognosis. Discuss hospitalization and prospective
treatment as indicated. Encourage questions and expressions of concern.
Provides a knowledge base from which patients can make informed choices. Effective
communication and support at this time can diminish anxiety and promote healing.
2. Review drug regimen, and possible side effects.
Gallstones often recur, necessitating long-term therapy. Development of diarrhea or cramps
during chenodiol therapy may be dose-related or correctable. Note: Women of childbearing
age should be counseled regarding birth control to prevent pregnancy and the risk of fetal
hepatic damage.
3. Review signs and symptoms requiring medical intervention: recurrent fever;
persistent nausea and vomiting, or pain; jaundice of skin or eyes, itching; dark urine;
clay-colored stools; blood in urine, stools, vomitus; or bleeding from mucous membranes.
Indicative of the progression of the disease process and development of complications
requiring further intervention.
Nursing Interventions and Rationales
1. Explain reasons for test procedures and preparations as needed.
Information can decrease anxiety, thereby reducing sympathetic stimulation.
2. Discuss weight reduction programs if indicated
Obesity is a risk factor associated with cholecystitis, and weight loss is beneficial in the
medical management of chronic conditions.
3. Instruct patient to avoid food/fluids high in fats (pork, gravies, nuts, fried foods,
butter, whole milk, ice cream), gas producers (cabbage, beans, onions, carbonated
beverages), or gastric irritants ( spicy foods, caffeine, citrus).
Limits or prevents recurrence of gallbladder attacks.
4. Recommend resting in a semi-Fowler’s position after meals.
Promotes flow of bile and general relaxation during the initial digestive process.
5. Suggest the patient limit gum chewing, sucking on straws and hard candy, or smoking.
Promotes gas formation, which can increase gastric distension and discomfort.
6. Discuss avoidance of aspirin-containing products, forceful blowing of the nose,
straining for bowel movement, and contact sports.
Reduces the risk of bleeding related to changes in coagulation time, mucosal irritation, and
trauma.
7. Recommend the use of a soft toothbrush or electric razor.
Reduces the risk of bleeding related to changes in coagulation time, mucosal irritation, and
trauma.