Cholecystits/Cholelithiasis

PATHOPHYSIOLOGY Medical Diagnosis Cholecystitis/Cholelithiasis Nursing Diagnosis Activity superstition r/t laparoscopic abdominal incisions AEB SOB during ambulation, increased respirations at 38, O2 sit down 80% room air after walking 50 ft. dominion Physiology The gallbladder is situated inferior to the liver. The gallbladder is a structure that functions as a storage space for saddle sore that is produced in the liver. The liver produces and secretes bile into the gallbladder from the cover and left hepatic television channel join unneurotic to become the common hepatic duct then into the gallbladder via the cystic duct.During the digestion of fatty food, the gallbladder releases bile that passes through the common bile duct and into the duodenum through the Sphincter of Oddi to break down fat into fatty acids to be absorbed by the small intestine to be used as energy and storage of energy for metabolic fills of the body. Pathophysiology Cholecystitis, and fire of the g allbladder, is a chassis which can be caused by cholelithiasis, the formation of gallstones. Most stones be formed of cholesterol. Excess cholesterol in bile is associated with obesity, high cholesterol viands and drugs that are prescribed to lower cholesterol levels.The excess colour of cholesterol can lead to the formation of stones. This customer had an elevated low-density lipoprotein and low HDL levels that do state the node had excess cholesterol. liverish stasis, which is slow emptying of the gallbladder, can also cause the formation of stones. An inflammation of the gallbladder allows for excess water and bile salt reabsorption which beef also lead to the formation of stones. This lymph gland did take oer wall lymph gland and distention of the gallbladder that indicates a inflammation of the gallbladder over a period of time.This is the second time the client came to the ER with distressingness in a 6 week period. Potential Complications If a gallstone migrates appear of the gallbladder into the ducts, it can lead to cholangitis which is an inflammation of the duct. Obstruction of the common bile duct whitethorn cause bile reflux into the liver causation pain, jaundice, and liver damage. The clients ALT, liver function test was elevated indicating liver unsoundness process and in this clients case it is due to the back-up of bile into the liver from block in the common bile duct.The client can also have pancreatitis due to the inability of the pancreas to secrete digestive enzymes through the pancreatic duct. The client had mild pancreatitis confirmed by CT scan. Complications of the cholecystitis/cholelithiasis can lead to a collection of infected fluid within the gallbladder, gangrene, and perforation resulting in peritonitis or abscess formation. A fistula into adjacent organs can for such as in the duodenum the colon or stomach. During the laparoscopic cholecystectomy, the clients gallbladder was famed with gangrene but no perfora tion, peritonitis, fistula or abscess formation was note.If this condition goes untreated, death can result from hemorrhage, peritonitis, hypovolemic shock, septicemia and septic shock. The client did not die because discourse and surgery was performed. Nursing Interventions &038 Rationales Independent 1. ambulate with client 11 assist. The client should not ambulate alone. The client is at risk for chances for injury to do her military action intolerance for SOB and decreased O2 sats. This go away ensure the client does not fall and if she does become weak or unstable it volitioning sign the injury. . spotlight the client in semi-fowler during resting time in bed. This will decrease orthopnea and jockstrap the client breath better by decreasing pressure on the diaphragm allowing for better expansion of the lungs. 3. Monitor respiratory status and examine lung sound every 4 hours. This will process treasure interventions and any changes needed for their respiratory sta tus. Dependent 4. Monitor and respect clients clients O2 sat level and administer O2 at 2L NC per physicians orders. The clients O2 sit had been at 80% room air nd after activity with O2. This will help monitor client ask and evaluate the need for any changes this client may need for a decrease or increase in O2 delivery. 5. Administer morphine sulfate 1-5 mg IV push prn q2h over 2 minutes. Administering pain meds can help decrease pain associated with the client needing to cough and lately breath and will help the client ambulate. Although the client has not indicated much pain, giving former to activity will help the client tolerate ambulation, cough and wooden-headed breath and spirometer. 6.Administer Cefoxitin 1 gm in 100mg/NaCl 0. 9% over 1 hr q8h per physicians orders. The administration of antibiotics will reduce the client risk for peritonitis from gangrene of the gallbladder and risk of contagion form the surgery. This will also help with healing of the clients mild p ancreatitis noted on CT scan Interdependent 7. Collaborate with dietician to come across with the client regarding diet. In a client with the removal of the gallbladder, the client needs to be educated on the types of food to avoid after surgery.This will help identify what types of foods the client can continue to enjoy and those that will facilitate abdominal problems post cholecystectomy. Ensuring the family is also involved when the dietician is endue will help increase the likelihood of adhering to a new diet holding the client accountable for food choices. 8. Collaborate with respiratory therapy to assess the need for respiratory assistance such as the need for nebulizer treatment or the need for portable O2 for ambulatory purposes. The clients O2 quick drops after taking D/C of O2. 9.Collaborate with occupational therapy to assess the ability for the client to go root word. The client is an elderly lady and may need to be evaluated preliminary to discharge to assess ADLs since she lives on her own. This will ensure the client can safely return berth or may need to be transferred to rehab former to going home and educate the client on throw rugs, shower use and other in home dangers that elderly clients are at risk for. thickening Teaching Instruct the client on the need to cough and deep breath and spirometry. The client has had SOB post op and decreased O2 saturation.The client has atelectasis in her right upper lobe with diminished lung sounds throughout with decreased expiratory effort. I educated the client on coughing and deep breathing every hour x10 and how to use the pillow for splinting her abdomen due to abdominal pain post operatively. Client understood and demonstrated this very well and prior to end of shift I assessed the client and had her demonstrate what I had taught her prior to leaving and she performed properly and also stated she had been doing it every hour as instructed. Textbook Signs &038 Symptoms . Pain, abrupt onset, severe and steady 2. Pain radiate to the back, right scapula and shoulder lasting from 12-18 hours 3. Nausea, vomiting and anorexia 4. Chills and fever 5. Abdominal guarding pretend Factors 1. Female over age of 65 2. Family history 3. Native American northern European heritage 4. Obesity 5. Hyperlipidemia 6. Use of viva contraceptives 7. Biliary stasis pregnancy, fasting or prolonged parenteral nutrition 8. Diseases or condition DM cirrhosis ileal disease or resection sickle prison cell anemiaReferences Domino, F. n. d. ). 5-minute clinical consult Powered by Skyscape (Ipod). Lippincott, WIlliams &038 Wilkins. LeMone, P. , Burke, K. , &038 Bauldoff, G. (2011). Medical-surgical nursing care sarcastic thinking in patient care (5th ed. ed. ). Upper Sadle River, NJ Pearson Education. Martini, F. H. , &038 Neth, J. L. (2009). basics of anatomy and physiology (Eight ed. ). San Fransisco Pearson Benjamin Cummings. Pagana, K. , &038 Pagana, T. (2009). Mosbys diagnostic and laboratory t est reference (Ninth ed. ). St. Louis, Missouri, unite States Mosby Elsevier.