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Choledocholithiasis G2 3A Finalll
Choledocholithiasis G2 3A Finalll
Choledocholithiasis G2 3A Finalll
Submitted by:
Alcantara, John Emmanuel
Cruz, Machelle
Dimaiwat, Marvin C.
Dionisio, Alessandra Dennise
Feliciano, Anabelle
Franco, Mary Joy
Garcia, Carl Marvin
Gasgonia, Regine
Meneses, Joy
Torres, Dorina
Submitted to:
CHS Faculty
2023
1
Table of Contents
I. Introduction ............................................................................................. 3
II. Objectives ................................................................................................ 4
III. Anatomy and Physiology .................................................................... 5
IV. Pathophysiology .................................................................................... 9
V. Nursing History ..................................................................................... 11
VI. Physical Assessment............................................................................. 15
VII. Course in the Ward ............................................................................. 17
VIII. Diagnostic and Laboratories .............................................................. 18
IX. Drug Study............................................................................................ 22
X. Nursing Care Plan .................................................................................. 32
XI. Health Teaching.................................................................................... 38
XII. Evaluation ........................................................................................... 40
XIII. REFERENCES .................................................................................. 41
2
I. Introduction
Choledocholithiasis is the presence of gallstones in the common bile duct. This duct
carries bile from the gallbladder. The stone formed may be made up of bile pigments or
calcium and cholesterol salts. They can develop in any place bile flows through.
The most common sign and symptom of Choledocholithiasis is a sharp pain in the right
upper quadrant of the abdomen. Some individuals with this condition manifest fever, loss
of appetite, yellowish skin color and sclera, nausea, and vomiting.
As reported by Cleveland Clinic (2022), about 15% of the total population is diagnosed
with Choledocholithiasis.
3
REFERENCE:
4
II. Objectives
General Objectives
The mere purpose of this study is to provide and expand understanding of
choledocholithiasis disease for both patients and students. Its goal is to apply what has been
learned in real-life scenarios and in clinical settings, as well as to create characters that will
help nurses become more effective in the future.
Specific Objectives
5
III. Anatomy and Physiology
A 64-year-old gentleman presented with four days of right upper quadrant abdominal pain.
The patient manifests fever, loss of appetite, nausea, and vomiting. Upon assessment and
diagnostic procedures, he is diagnosed with Choledocholithiasis.
6
When food entered in your mouth, the digestive process begins (Mechanical digestion).
When you swallow, the food is pushed into your throat by your tongue. To prevent choking, a
small flap of tissue called the epiglottis folds over your windpipe, allowing food to pass into your
esophagus. Your esophagus, once you begin swallowing, the process becomes automatic. Your
brain signals the muscles of the esophagus and peristalsis begins. In addition, the lower esophageal
sphincter it will relax and allow the food to pass within the stomach and LES keep closed to keep
it inside the stomach and prevent from backflow in to esophagus. After the food enters your
stomach, the stomach muscles mix the food and liquid with digestive juice and stomach slowly
empties its contents, called chyme, into your small intestine. The small intestine, its muscle is to
mix food with digestive juices from the pancreas, liver, and intestine and push the mixture for
further digestion. The walls of small intestine absorb water and the digested nutrients into your
blood stream. As peristalsis continues, the waste products of the digestive proves move into the
large intestine which waste products from the digestive process include undigested parts of food
and fluid. However, the large intestine absorbs water and changes the waste from liquid into stool.
Peristalsis helps the stool to move into your rectum. Lastly, the rectum stores the stool until it
pushes out your anus during a bowel movement.
MOUTH
The first section of the digestive system is the mouth, or oral
cavity. It is designed to absorb food, break it into small particles,
and then combine it with saliva (Mechanical digestion). The
boundaries are formed by the palate, cheeks, and lips
SALIVARY GLANDS
The salivary glands are organs on each side of the face. It plays
a role for lubrication of the mouth and throat, aid in swallowing and
digestion, and help shield your teeth from cavity-causing bacteria and
contains an enzyme called amylase, which helps your stomach break
down starches in food.
PHARYNX
From the mouth, food
passes posteriorly into the oropharynx and laryngopharynx.
In addition, it permits the passage of swallowed solids and
liquids into the esophagus, or gullet, and conducts air to and
from the trachea, or windpipe, during respiration.
7
ESOPHAGUS
Carries the food from mouth to stomach. It essentially a passageway
that conducts food (by peristalsis) series of wave-like muscle
contractions that move food through the stomach. The upper
esophageal sphincter (UES) is a high-pressure zone at the transition of the
pharynx and the cervical esophagus. The lower esophageal sphincter
(LES) is a high-pressure zone located where the esophagus meets the
stomach and protects the esophagus from the reflux of gastric
contents.
STOMACH
It produces enzymes (substances that create
chemical reactions) and acids (digestive juices). This mix
of enzymes and digestive juices breaks down food so it can
pass to your small intestine.
LIVER
The liver
makes a digestive
juice called bile that helps digest fats and some vitamins. In
addition, the liver processes this blood and breaks down,
balances, and creates the nutrients and also metabolizes drugs
into forms that are easier to use for the rest of the body or that
are nontoxic.
GALLBLADDER
Gallbladder is small pear-shaped organ is connected to your
liver and intestines. It stores digestive fluid made by the liver called
bile. When you eat fatty foods, your gallbladder releases it through
tubes, or ducts, to help break down your food. Bile helps with
digestion by breaking fats into fatty acids. It travels through the duct
system and enters your digestive system at the duodenum. During
mealtime, your gallbladder contracts, and the valve opens, pushing
the stored bile out of your gallbladder, through the cystic duct and
down the common bile duct into your intestine. Bile mixes with the
partially digested food, further helping the breakdown of the fat in
your diet.
8
PANCREAS
The pancreas is an organ and gland. In addition, it performs 2 main
functions. The Exocrine function: Produces substances (enzymes)
that help with digestion and the Endocrine functions: Produces
substances (enzymes) that help with digestion. Furthermore, enzymes
are produced in the pancreas. These enzymes breakdown
carbohydrates, lipids, and sugars. By producing hormones, the
pancreas also supports your digestive system. These chemical
messengers move throughout your bloodstream.
SMALL INTESTINE
Absorption is the major function of small intestine.
After foods mix with stomach acid, they move into the
duodenum where they mix with bile from the gallbladder
and digestive juices from the pancreas. In addition, after
chemical digestion in the duodenum, food moves into the
jejunum (accomplished by active transport and diffusion
across the intestinal wall into circulation), where the muscle
work of digestion picks up and the ileum, it absorbs any
final nutrients, with major absorptive products being
vitamin B12 and bile acids.
LARGE INTESTINE
The process of absorbing water and electrolytes from digestive
wastes, which typically takes 24 to 30 hours, as well as holding on to
feces until they can be passed. In addition, by the time partially
digested foodstuffs reach the end of the small intestine (ileum), about
80% of the water content has been absorbed. The colon absorbs most
of the remaining water.
ANUS
The anus is where food waste exits your body after passing
through your digestive system. The anus is the opening at the lower
end of the digestive tract that controls the expulsion of feces
(Defecation).
9
IV. Pathophysiology
10
A.D is a patient diagnosed with the presence of stones that obstructs the common bile
duct, Choledocholithiasis, in which modifiable and non-modifiable risk factors of
choledocholithiasis contribute to the occurrence of the disease. The non- modifiable risk
factor in our study only includes the age above 40. This becomes a risk factor because of
asymptomatic gallstone due to gallbladder dysfunction and increase lithogenicity of bile
that predispose the gallbladder of elderly patient. On the other hand, the modifiable risk
factor which is only included in our study is the diet of the patient. This becomes a risk
factor because too much cholesterol intake of the patient can lead to bile cannot be
breakdown. However, other risk factor of the disease can be identified as 4F’s which are
female, fertile, fat and forty.
In the case wherein patient A.D is at high risk of the occurrence of the disease,
abnormal metabolism of cholesterol and bile salt will occur. As this happens, it affects the
patient’s gallbladder motility in which there will be an inability to move bile out into the
bile ducts. When this happen, bilirubin becomes crystallize which it is a condition with
high heme turnover and bilirubin will be present in bile at higher than normal
concentrations. Then, crystals will be build up to form stones. As this happen, gallstone
will be formed. A gallstone is a hard pebble-like piece of material usually made of
cholesterol bilirubin. Subsequently, small and some stones will pass from gallbladder to
common bile duct in which it will get lodges and impacted to the common bile duct. As
the stones becomes impacted, it obstructs the common bile duct which a patient may have
fever as first manifestation. Fever, occurs because as the common bile duct becomes
obstructed there is an inflammation and infection due to the obstruction.
When, the obstruction in the common bile duct occurs, the body will try to dislodge
the stones which will result to the spasm of the biliary tracts. When this happen, patient
will have a manifestation of abdominal pain. Furthermore, with the occurrence of the
obstruction there will be no bile that will reach the GIT. In this case there will be two
results that will occur. First, there will be a decrease bile in small intestine for fat digestion
that could to decrease emulsification of fats. And with that, patient may experience loss of
appetite, nausea and vomiting. Second, a decrease bile in duodenum will happen and leads
to decrease sterobilin. In this case patient may have a manifestation of a clay colored stool
and dark brown urine.
Lastly, with the occurrence of the obstruction in the common bile duct, there will be
a backflow of conjugated bilirubin to the liver. As this happen, the conjugated or formed
together bilirubin will enter the blood stream. When this occur, patient may have a
manifestation of a yellowish discoloration to the skin and sclera.
11
Nursing History
1. Personal Data
Patient A.D. is a 64-year-old male patient born on September 13, 1958. He is married and
living with her spouse residing in Meycauayan City, Province of Bulacan. A.D was a Filipino
Citizen and speaks the Filipino language. He is baptized as a Roman Catholic. He has been
working as a construction worker before he retired.
Patient arrived at the emergency department accompanied by his wife at exactly 9:00 am
on March 15, 2023, with a chief complaint of “Napakasakit na ng tiyan tapos mas sumasakit
siya kapag humihinga ako ko kaya naisip ko magpunta na sa ospital” as verbalized by the
patient.
The next day, 3 days prior to admission, he still experiencing abdominal pain that
fades for some times. In the afternoon, he noticed that the pain he’s experiencing
spreads to his right shoulder.
Two days prior to admission, the patient is experiencing the same manifestations.
On that morning, he manifested nausea and vomiting and developed fever. He still did
not consult to a doctor but do self-medications such as taking Paracetamol for fever
and pain relief.
One day prior to admission, the abdominal pain becomes more severe and other
symptoms are still present. Along with this, medications don’t relieve these symptoms. He
and his wife decided to go to the doctor the next day for check-up.
An hour prior to admission, the patient was still experiencing the same with an
elevated body temperature of 38.9°C.
At around 9 in the morning, upon arrival in the emergency department and upon
the evaluation by the ER nurse, the patient appears weak and slightly yellowish in the
color of the skin and eyes. His vital signs are temperature: 38.9°C, BP: 100/60, RR: 21,
HR: 128.
3. Past Health History
Patient A.D. stated that his past laboratory results, he was assessed with high
cholesterol level. He had been given medications and health teaching regarding this,
but due to financial constraints and noncompliance to it, he didn’t maintain this
treatment.
12
4. Family Health History
13
6. Nutrition and Metabolic Pattern
A.D eats three heavy meals every day with snack times in between. The patient usually
eats affordable and easy to prepare breakfasts like eggs, processed meats, and canned
products. For lunch, the patient usually eats in carinderia near his work. He usually eats
sinigang na baboy and chicken, nilagang baboy and adobo with usually one and half cup of
rice. Furthermore, in snack time he usually eats monay bread with peanut butter, chips and
soft drinks. For dinner, he usually eats fried chicken brought in carinderia, egg and
processed meats with one and half cup of rice.
14
7. Elimination Pattern
A.D. reported that does not experience pain in urinating and urinates for about 5-6
times a day. He described his urine as dark brown and slightly cloudy. He added that
his stools appeared to be small, hard, dry and clay colored.
15
V. Physical Assessment
A. General Survey
A.D. arrives at the emergency room with abdominal pain. He described that the
pain started on his right upper quadrant and much worse during breathing. The
following are vital signs obtained upon admission:
Blood pressure (BP): 100 / 60 mmHg
Heart rate (HR): 128
RR: 21
Temperature: 38.9 C
Oxygen saturation: 95%
Height 5'6" (170 cm)
Weight 170 lbs. (77kg)
B. Review of System
16
Skin warm, dry,
Skin Inspection The patient's The patient's Yellow skin
with good turgor,
skin is skin is discoloration is
No abnormal
yellowish, yellowish, the common
pigmentation,
warm, and warm, and causeof skin
bleeding, rash, or dry. The skin dry. The skin problems in
other lesions. turgor is turgor is poor patients with
poor and the and the Choledocholithia
patient patient sis due to
appears appears abnormally high
dehydrated. dehydrated. levels of bilirubin
(bile pigment) in
the bloodstream.
17
Upper and Inspection/ Both extremities Reported Reported Indicates swollen
Lower Palpation are equal in size sudden sudden and inflamed
Extremities and also have sharp pain sharp pain gallbladder.
the same in the upper in the upper
contour with right right
prominences of quadrant of quadrant of
joints. No the the
voluntary abdomen. abdomen.
movements, no
edema, and the
color is even
and has an equal
contraction.
Genito- Inspection, Clear, pale-yellow The patient The patient Dark urine and
urinary palpation, urine, absence of presents presents clay-colored
and pain, urgency, dark dark urine stools are
observation frequency, or brown and clay- indicative of
retention urine and colored common bile duct
no foul odor clay- stools. obstruction in
colored patients with.
stools.
18
VI. Course in the Ward
Day 1
Patient A.D. with a chief complaint of abdominal pain was admitted to the Emergency
Room on March 14, 2023, at 9:00 AM with the following vital signs: BP: 100/60 mmHg,
HR: 128 bpm, RR: 21 cpm, Temp: 38.9 degrees and O2 Sat of 95%.
The patient was placed on NPO while vital signs were monitored every 4 hours
including fluid intake and output. The patient was given IVF D5LR 1L to run for 8 hours.
Diagnostics for CBC, Urinalysis, CBG, 12-lead ECG, Chest X-Ray (PA), Abdominal X-
Ray (UR and Supine), BUN/Creatinine, Na, K, SGPT, SGOT and Troponin I was requested.
Medications ordered were Omeprazole 40 mg TIV once a day, Tramadol 50 mg every 8
hours PRN, Ketorolac 30 mg TIV every 8 hours, Cefuroxime 750 mg TIV every 8 hours,
Metronidazole 500 mg TIV every 8 hours and Paracetamol 300mg TIV every 4 hours. The
patient was requested for FC insertion with strict output monitoring as well as NGT
insertion for open bottle feeding. The patient was also scheduled for an abdominal pelvic
CT-Scan, CBG and ECG whereas results were seen and cleared by the doctor.
At 2 PM
Patient was scheduled for Exploratory Laparotomy at 2 o'clock in the afternoon so a
fast drip of 200 CC of PNSS was given to the patient as ordered. The patient was seen and
examined by the doctor in charge before the operation, meanwhile, pre-operative checklist
and consent were secured. The patient was endorsed to the OR and underwent surgery.
At 9 PM
The patient was successfully received from the Post Anesthesia Care Unit (PACU)
conscious and coherent with NGT, O2 support 2L/min, IVF #2 D5LR 1L x 8 hours, SP
drain and FC attached. Patient was transferred to bed safely and comfortably by the nurses
in-charge. Diet was NPO and scheduled for CBC, Na, K, Creatinine, and histopathology of
the gallbladder later on.
Day 2
The patient has received continuous care from the healthcare providers and has not
shown further complaints or further complications. There are negative signs of subjective
pain on the operative site as well as on the abdominal area. The patient was still NPO.
Day 3
The patient was reported positive for flatus and negative for subjective pain. The patient
was still on NPO diet up until seen by the doctor. Patient was introduced to a soft diet such
as jelly ace, clear liquids and crackers. Care for the incision site and the patient himself was
successfully rendered by the healthcare providers.
Day 4
Patient was up for discharge with health teachings successfully understood.
19
VII. Diagnostic and Laboratories
A. Diagnostic Tests
On the other hand, there are the following diagnostic test that can be done to diagnose
Choledocholithiasis:
Abdominal ultrasounds
Endoscopic ultrasound
20
B. Laboratory Test
HEMATOLOGY
URINALYSIS
21
CHEMISTRY
Total 3.7 mg/dL 0.3 – 1.2 mg/dL INCREASE Higher than usual levels of bilirubin
Bilirubin may indicate different types of liver or
bile duct problems. It may also lead to
yellow cast to the skin and the
yellowish discoloration of the sclera of
the eyes.
Direct 1.3 mg/dL 0.0 – 0.2 mg/dL INCREASE Higher than usual levels of bilirubin
Bilirubin may indicate different types of liver or
bile duct problems. It may also lead to
yellow cast to the skin and the
yellowish discoloration of the sclera of
the eyes.
Lipase 185.7 U/l 0-60 U/l INCREASE Increase in level of lipase indicates that
heterotopic pancreas tissue plays a role
in exocrine functioning. As such, it is
possible that the exocrine activity of
heterotopic pancreas could cause pain
and lead to the onset of acalculous
cholecystitis.
22
VIII. Drug Study
23
General Actu Mechanis Indicatio Contraindic Adverse Nursing Responsibilities
Name al m of n ation effects
Dosa Action
ge
24
General Actu Mechani Indicatio Contraindica Adverse Nursing Responsibilities
Name al sm of n tion effects
Dosa Action
ge
Ophthalmic
25
- Transient stinging, burning
may occur upon
installation.
- Do not administer while
wearing soft contact lenses.
26
General Act Mecha Indication Contraindicatio Adverse Nursing
Name ual nism n effects Responsibilities
Dos of
age Action
27
anaphylaxi - May cause GI upset
). (may take with food,
milk).
28
General Actu Mechanism Indication Contraindi Advers Nursing
Name al of Action cation e Responsibilities
Dosa effects
ge
PATIENT/FAMILY
TEACHING
- Urine may be red-
brown or dark.
- Avoid alcohol, alcohol-
containing preparations
(cough syrups, elixirs)
29
for at least 48 hrs after
last dose.
- Avoid tasks that require
alertness, motor skills
until response to drug is
established.
- If taking metronidazole
for trichomoniasis,
refrain from sexual
intercourse until full
treatment is completed.
- For amebiasis, frequent
stool specimen checks
will be necessary.
Topical:
- Avoid contact with
eyes.
- May apply cosmetics
after application.
- Metronidazole acts on
erythema, papules,
pustules but has no effect
on rhinophyma
(hypertrophy of nose),
telangiectasia, ocular
problems (conjunctivitis,
keratitis, blepharitis).
- Other recommendations
for rosacea include
avoidance of hot/spicy
foods, alcohol, extremes
of hot/ cold temperatures,
and excessive sunlight.
30
General Name Act Mechan Indicati Contraindi Adverse Nursing
ual ism of on cation effects Responsibilities
Dos Action
age
31
analgesi - Many nonprescription
c effect. combination products
contain acetaminophen.
- Avoid alcohol use.
32
IX. Nursing Care Plan
Dependent:
- Note the response - Pain not relieved by routine
to medication, and measures may indicate
report to the developing complications or
physician if the pain a need for further
is not being intervention.
relieved.
33
- Administer - To reduce pain that the
narcotics agents as client is experiencing.
prescribed by the
physician.
- Administer - Promotes rest and relaxes
sedatives smooth muscle, relieving
medication as pain.
indicated.
Collaborative:
34
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Wholly Independent: Patient’s condition
> “Ilang araw na ako Compensatory - Assess vital signs, - This may suggest improved as
hindi natatae at noting presence of hypoperfusion or developing manifested by
nagaalala na ako at Short-term low blood pressure, sepsis. reestablished and
baka kung ano na ang Goal: elevated heart rate, maintained normal
nangyayari saakin” as After 1 hour of and fever. pattern of bowel
verbalized by the nursing - Discuss fluid - Water is necessary to functioning.
client. interventions, the intake appropriate general health and GI
patient will to individual function; client may need
verbalize situation. encouragement to increase
Objective: understanding of intake or to make appropriate
- 2 bowel movement causative factors fluid choices if intake is
for a week and rationale for restricted for certain medical
- Hard, dry, and small treatment conditions.
stool regimen - Encourage eating - High fiber diet and
- Difficulty defecating foods rich in fiber increased fluid intake can
- Hypoactive bowel Long-term and increase fluid promote bowel movement.
sounds Goal: intake.
After 3 days of
Nursing Diagnosis: nursing
Dysfunctional interventions, the
gastrointestinal patient will - To manage fluid losses and
- Measure GI output
motility related to reestablish and replacement needs and
periodically and
decreased and lack of maintain normal electrolyte balance.
note characteristics
peristaltic activity pattern of bowel
of drainage
within the functioning.
- Emphasize the - To stimulate peristalsis and
gastrointestinal importance of and help reduce GI complications
system. assist with early associated with immobility.
ambulation,
especially following
surgery
- Studies have shown various
- Recommend deleterious short and long-
smoking cessation term effects of smoking on
the GI circulation and
organs. Smoking is a risk
factor for acquiring or
exacerbation certain GI
disorders.
35
- Maintain GI rest - To reduce intestinal
when indicated – bloating and risk for
nothing by mouth vomiting.
(NPO), fluids only,
or gastric or
intestinal
decompression.
36
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Partially Independent: The risk was
Compensatory - Weigh as - To monitor the effectiveness prevented as evidence
indicated. of the dietary plan by patient
Objective: Short-term - Provide oral - A clean mouth enhances demonstrated
- Blood pressure of Goal: hygiene before appetite. progression toward
100/60 After 3 hours of meals. desired weight gain.
-Dry skin and mucous nursing - Provide a - Useful in promoting
membrane interventions, the pleasant appetite/reducing nausea.
- Weight loss patient will atmosphere at
- Decrease in urine demonstrate mealtime; remove
output behaviors to noxious stimuli.
monitor current - Offer - May lessen nausea and
deficit, as effervescent drinks
Nursing Diagnosis: relieve gas.
indicated. with meals, if
Risk for Imbalance
tolerated.
Nutrition
Long-term Goal:
After 3 days of - Ambulate and
- It’s helpful in the expulsion
nursing increase activity as
of flatus, and reduction of
interventions, the tolerated.
abdominal distention.
patient will
Contributes to overall
demonstrate
recovery and a sense of well-
progression
being and decreases the
toward desired
possibility of secondary
weight gain.
problems related to
immobility.
- Begin a low-fat - Limiting fat content reduces
liquid diet after the stimulation of the gallbladder
NG tube is and pain associated with
removed. incomplete fat digestion and
is helpful in preventing
recurrence.
- Provide - Alterative feeding may be
parenteral and/or required depending on the
enteral feedings as degree of disability and
needed. gallbladder involvement and
the need for prolonged gastric
rest.
37
Dependent:
- Administer bile - To promote digestion and
salts: Bilron, absorption of fats, fat-soluble
Zanchol, and vitamins, and cholesterol.
dehydrocholoic Useful in chronic
acid (Decholin), as cholecystitis.
indicated.
Collaborative:
- Consult with a - Useful in establishing
dietitian or individual needs and the most
nutritional support appropriate route.
team as indicated.
38
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Independent: Patient's condition
Partially improved as manifested
"Medyo nagsusugat yung Compensatory - Perform wound - Wound care differs depending by patient or significant
lugar kung saan ako care per guidelines on the type of skin breakdown, other demonstrate proper
inoperahan" as verbalized Short-term and orders
by the patient. location on the body, and size of wound cleaning and
Goal: the wound. Wound care helps hygiene.
prevent infection.
Objective: After 3 hours of
nursing
- Pruritus interventions, the - Skin at risk for breakdown
- Continued
- Disruption of skin patient will verbalize assessment of skin should be closely monitored at
surface understanding of least once a shift. Observed
and wounds
- T: 38.5 preventing skin wounds should be monitored to
irritation. ensure dressings are intact or
Nursing Diagnosis: that skin breakdown is not
worsening, such as increased
Risk for Impaired Skin Long-term Goal: redness.
integrity related to
surgical procedure. After 3 days of
nursing - Body secretion thru the suture
- Keep the skin
interventions, the site is considered abnormal.
clean and dry
patient or Maintaining a dry skin can avoid
significant other attracting of microorganisms.
demonstrate
proper wound - Proper intake of fluids increases
- Encourage
cleaning and oxygen and nutrient delivery.
nutrition and
hygiene. Intake of high protein foods and
hydration
understanding of supplements is essential for
daily skin repairing body tissues.
inspection.
- Encourage - Ambulation reduces pressure on
ambulation as the skin from immobility thus
indicated lessening the factors that may
result in impaired skin integrity.
39
Dependent:
40
X. Health Teaching
Educate the patient about home medications that should be taken and
administered with strict monitoring.
Inform the client that if constipation occurs talk with the physician and
ask for bowel regimen. Pain medicines can be constipating.
For post-op care, instruct the client to gently wash the skin around the
incision with soap and water.
Educate and instruct the patient that if there is a gauze dressing on the
incision, change it daily or as often as needed to keep it dry and clean.
41
O- Instruct a patient about the continuity of prescribed medications and
Outpatient schedule follow-up checkups.
D-Diet Instruct the patient about the appropriate and right diet including low-
fat diet and avoid foods/ fluids that contain high-fat such as fried
foods, canned fish, processed meats, full fat dairy products, fast foods,
whole milk, carbonated beverages, coffee, gas producers like cabbage,
beans, and etc.
42
XI. Evaluation
The case of patient A.D. with a diagnosis of Choledocholithiasis was able to get treated
successfully inside the hospital with no further complications. The student nurses were able to
broaden their knowledge and understanding about the disease and its process. They also executed
with care and precision each intervention prepared for the patient with Choledocholithiasis.
Lastly, the student nurses build a strong therapeutic relationship with the patient up until fully
healed. Meanwhile, the patient and relatives understood the disease management and health
teachings imparted by the healthcare providers and were able to apply health teachings provided
to prevent further complications as well as appropriate behavior during the entire course of
treatment, and lastly, willingness for healing and recovery from the disease was successfully
achieved.
Nursing Theory
Virginia Avenel Henderson also known as “The Nightingale of Modern Nursing” was a nurse,
theorist, and author known for her Need Theory. She defined nursing as, “The nurse’s unique
function is to be in service to individuals, well or sick, in the activity performances contributing to the
health or recovery (or to peaceful death) that he/she would perform unaided if possesses the will,
strength, and knowledge (Gonzalo, 2023). The theory shows great relevance to the case study since it
deeply emphasizes the importance of patients’ independence by allowing them to perform and
function on their own inside the hospital with the guidance of healthcare providers like nurses. This
would permit the patient to have fewer setbacks during recovery and have a smoother transition
when finally, out for discharge.
43
XII. REFERENCES
Pisano, M., Allievi, N., Gurusamy, K. et al. 2020 World Society of Emergency Surgery updated guidelines for
the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg 15, 61 (2020).
https://doi.org/10.1186/s13017-020-00336-x
Christopher, F., Pastorino, A., Farooq, U., et al. (2023). Choledocholithiasis. National Library of Medicine.
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