CHOLECYSTITIS

A Case Presentation of Group 1&2

 Our Team
Carl David Adriano Princess Khryzz de Borja

Eden Joy Aganan Georgia De Ocampo

Saimon Rafael Amat Juliann Nicole Del Mar

Jeff Erol Amin Maria Stephany Dela Cruz

Thomas Adrian Ampuan Jaimelyn Duran

Rachele Ann Arganda Diane Hershey Evangelista

Sarah Borja Alec Elmer Guilas

Marie Janie Mae Bularon Shady Ann Jumaoas

Quesiah Kate Junio
Anne Gelen Buyoc
Rose Ann Lacuarin
Fatima Suzerain Dahalan
Presentation Outline
Etiology
Diagnostic and Laboratory
Concept Map (Theoretical)
Medical Surgical Management
Concept Map (Client-based)
Drug Study
Anatomy and Physiology
Nursing Care Plan

Pathophysiology (Theoretical)
Discharge Planning

Pathophysiology (Client-based)
CASE SCENARIO
PATIENT’S PROFILE
Name of Patient: Patient L
Sex: Female
Date of Birth: Malabon
Age: 45 years old
Nationality: Filipino

Religion: Roman Catholic

Date Admission: August 02, 2020
Time: 11:30 pm
Chief complaint: abdominal pain
Admitting Diagnosis: Cholecystitis
 CASE SCENARIO
History of Present Illness:
A 45-year-old female presents with a complaint of abdominal pain for

the past 3 days. She localizes the pain to her epigastric area and

states that it radiates to her right upper quadrant. She notes that it

became markedly worse after eating dinner last night. She recalls a

past history of similar pain, but has never had any diagnostic workup.

 CASE SCENARIO

Past Medical History:

Her past medical history is significant for hypertension and

hypercholesterolemia. She is status post a total abdominal

hysterectomy 1 year ago.

She does not smoke, drink alcohol, or use drugs.
Her ROS is positive for abdominal pain, nausea, one episode of

vomiting, and subjective fever.

 CASE SCENARIO

Physical Examination
Family History
Her VS are BP 155/90, HR 110, RR 14,
(-) HPN
T 100.6, SpO2 98% on RA.
(-) Diabetes
Her physical exam reveals an overweight
(-) Asthma
woman in no acute distress.
(-) Cancer
Her ROS is positive for abdominal pain,

nausea, one episode of vomiting, and a

subjective fever.
HEENT:
 Head: Normocephalic and atraumatic
 Mouth: Moist mucous membranes
 Macroglossia
 Eyes: Conjunctiva and EOM are normal. Pupils are equal,
round, and reactive to light. No scleral icterus. Bilateral
periorbital edema present.
 Neck: Neck supple. No JVD present. No masses or surgical
scarring.
 Throat: Patent and moist
Cardiovascular:
Her chest and cardiovascular exams are normal except for mild tachycardia.

Pulmonary/Chest:
No respiratory status distress at this time,

Abdominal:
Her abdominal exam is significant for tenderness to palpation to her
epigastric and right upper quadrants without rebound tenderness. Bowel
sounds are normal

Skin:
Skin is very dry
Neurologic:
Alert, awake, able to protect her airway. Moving all extremities. No sensation
losses
Admission Order:
Basic blood work, fluids, and an anti-pyretic. CT and decide to attempt to
visualize her right upper quadrant via ultrasound at the bedside.
ETIOLOGY
Presentor: Juliann Del Mar
✦ cholecystitis ✦
is an acute inflammation of the gallbladder. This inflammation
may cause pain, tenderness, and rigidity of the upper right
abdomen that may spread to the midsternal area or right
shoulder; and is often accompanied by nausea, vomiting, and
other usual signs of an acute inflammation. An empyema or a
collection of pus in the pleural cavity between the lungs and the
membrane that surrounds the pleural space will develop if the
gallbladder becomes filled with pus or purulent fluid.
✦ signs & symptoms ✦
Cholecystitis' signs and symptoms vary on each person's case. It
may include: sudden but intense pain in the upper right part of
your belly, pain that radiates to your back or below the right
shoulder blade, nausea, vomiting, fever, jaundice, loose and
light-colored bowel movements, and belly bloating. These
symptoms often show up after a heavy fatty meal.
✦ causes ✦
→ Cystic duct blockage
→ Calculous cholecystitis
→ Bacteria
↪ Escherichia coli
↪ Klebsiella species
↪ Streptococcus
→ Gallbladder stones
→ Blood vessel damage
→
✦ risk factors
Age and Sex
✦
↪ Cholecystitis is more common to females over 40 years old.
→ Obesity
↪ According to different studies, overweight women with BMI greater than
30kg/m² have higher chances on forming gallstones in the gallbladder.
→ Fertility
↪ Fertile women were thought to be at higher risk due to higher estrogen
levels.
→ Race
↪ It was said that this gallbladder disease is more common to Caucasian
women.
 Incidence
Although not all occurrences of cholecystitis are related
cholelithiasis, more than 90% of patients with acute
cholecystitis have gallstones.
The acute form is most common during middle age.
The chronic form usually occurs among elderly patients.
✦ possible complications ✦
→ Torn gallbladder
→ Intraabdominal abscess
→ Bile duct injury
→ Hepatic injury
→ Small bowel injury
→ Refined stones in the bile duct
→ Bleeding
→ Infection within the bladder
→ Death of gallbladder tissue
CONCEPT
MAP
(Theoretical)
Presentors: Sarah Borja & Fatima Dahalan
THEORETICAL
ETIOLOGY

- Gallstone

NON-MODIFIABLE MODIFIABLE
RISK FACTORS RISK FACTORS

- Family history - Obesity

- Age - Rapid weight
- Female gender loss
 PATHOPHYSIOLOGY
Cholecystitis is primarily due to obstruction of biliary outflow by a stone. Other rare causes may
be stricture, kinking of the cystic duct, intussusception of a polyp, torsion of the gallbladder,
pressure of an overlying lymph node on the cystic duct, or inspissated and concentrated bile.
As the gallbladder distends following the obstruction, the blood vessels in the gallbladder wall
become compressed, giving rise to a patch of gangrene on the fundus which can rupture and
produce bile peritonitis. In addition to these mechanical and vascular factors various
investigators have favored infection or chemical irritation as the cause of this disease.

MEDICAL DIAGNOSIS
Cholecystitis

 Clinical
Management and
Diagnostic tests
manifestations treatment
Biliary Colic (RUQ pain,
Ultrasound
Medical
radiating to back or right
Cholescintigraphy
Analgesics
shoulder) Cholecystography
Antibiotics
Fever Endoscopic Retrograde

IVFs
Palpable abdominal mass Cholangiopancreatograp

NGT suctioning
Nausea and vomiting
hy (ERCP)
(usually after a heavy
Surgical
Magnetic Resonance

meal) Cholecystectomy
Cholangiopancreatograp

Stool/urine color change Lithotripsy

hy (MRCP)
Vitamin Deficiency
 Significant findings

Increased ALP
Sonographic Murphy Sign
Gallbladder Wall Thickening
Sludge
Distention of Gallbladder or Bile duct

Nursing Diagnosis
Acute pain related to stones obstruction as

evidenced by localized pain in the

epigastric area that radiates to the right

upper quadrant
 Nursing Interventions
Independent:
Perform pain assessment each time pain occurs. Document and investigate changes from

previous reports.
Monitor and assess vital signs as follows: Blood Pressure. Temperature, and Pulse rate.
Promote bed rest, allowing the patient to assume position of comfort
Encourage use of relaxation techniques. Provide diversional activities.
Dependent:
Administer anticholinergics such as atropine or propantheline as prescribed by the physician
Administer opioids such as morphine as indicated
Administer sedatives such as phenobarbital as indicated
Use soft or cotton linens; calamine lotion, oil bath; cool or moist compresses as

indicated.Collaborate with the dietician for proper diet

High in fiber such as fruits, vegetables, beans, and peas. Whole grains, including brown rice,

oats, and whole wheat bread

Eat healthy fats, like fish oil and olive oil
 Expected outcome
After 1 hour of rendering proper nurrsing intervention,the Short Term Goal was completely met.
As evidenced by, the patient was able to:
Demonstrate use of relaxation skills and diversional activities as indicated for individual
situations.
Patient describes satisfactory pain control level of 3 in the scale of 0-10
CONCEPT
MAP
(Client-based)
Presentors: Georgia De Ocampo & Quesiah Junio
client-based
ETIOLOGY
Cholecystitis happens when a
digestive juice called bile gets
trapped in your gallbladder.

NON-MODIFIABLE MODIFIABLE
RISK FACTORS RISK FACTORS

- Female - BP - 155/90
- 45 yrs old - HR - 110
- Total abdominal - Overweight
hysterectomy 1 yr ago
 PATHOPHYSIOLOGY
See next page...

MEDICAL DIAGNOSIS
Cholecystitis

 Clinical
Management and
Diagnostic tests
manifestations treatment
Mild tachycardia Abdominal Ultrasound
Antipyretic fluid
Abdominal Tenderness CT Scan
Diet
Skin is very dry CBC

Surgical Treatment
Cholecystectomy
 Significant findings
Alkaline Phosphate - 194
WBC - 16.2 cells/mcL
Aspartate Aminotransferase - 39
RBC - 4.8 cells/mcL Alanine Aminotransferase - 52
Hemoglobin - 15.7 gm/dl Glucose - 152 mg/dL
Platelets - 304,000 uL Creatinine - 0.9 mg/dL
Hematocrit - 5.88*10^6 ul Cholesterol - 240 mg/dL
Albumin - 4.2 g/dL HDL-Cholesterol - 50 mg/dL
Bilirubin - 2.4 mg/dl LDL-Cholesterol - 172 mg/dL

Nursing Diagnoses
Acute pain related to obstruction as
Hyperthermia related to
evidenced by localized pain in the
inflammatory process secondary
epigastric area that radiates to the right
to disease process as evidenced
upper quadrant by increased temperature
 Nursing Interventions
Independent:
Perform pain assessment each time pain occurs. Document and investigate changes from previous reports.
Monitor and assess vital signs as follows: Blood Pressure. Temperature, and Pulse rate.

Promote bed rest, allowing the patient to assume position of comfort

Encourage use of relaxation techniques. Provide diversional activities.

Dependent:
Administer anticholinergics such as atropine or propantheline as prescribed by the physician

Administer opioids such as morphine as indicated

Administer sedatives such as phenobarbital as indicated

Use soft or cotton linens; calamine lotion, oil bath; cool or moist compresses as indicated.
Collaborate with the dietician for proper diet

High in fiber such as fruits, vegetables, beans, and peas. Whole grains, including brown rice, oats, and whole wheat bread
Eat healthy fats, like fish oil and olive oil

Expected outcome
After 1 hour of rendering proper nurrsing intervention,the Short Term Goal was completely met. As evidenced by, the patient was able to:

Patient describes satisfactory pain control at a level, less than 3 to 4 on a rating scale of 0 to 10

After 12hrs of rendering proper nursing intervention,the Long Term Goal was completely met. As evidenced by, the patient was able to:

Demonstrate use of relaxation skills and diversional activities as indicated for individual situations.
Patient display improved well-being such as baseline levels for pulse, BP, Temperature, and relaxed muscle tone or body posture.
Patient use pharmacological and non-pharmacological pain-relief strategies.
ANATOMY &
PHYSIOLOGY

Presentor: Eden Joy Aganan

DIGESTIVE

SYSTEM
 The human body uses the process

of digestion to break down food into

a form that can be absorbed and

used for fuel.

The organs of the digestive system

are the mouth, esophagus, stomach,

pancreas, liver, gallbladder, small

intestine, large intestine and anus

 GALLBLADDER
the small sac-shaped organ beneath

the liver, in which bile is stored after

secretion by the liver and before

release into the intestine.

Its main function is to store bile.
 BILIRUBIN, a brownish-yellow pigment of

bile
It is produced in bone marrow cells and in

the liver as the end product of red-blood-

cell (hemoglobin) breakdown.

Cholesterol is essential for making

the cell membrane and cell

structures and is vital for the

synthesis of hormones, vitamin D,

and other substances

 Bile salts are composed of
the salts of four different kinds of free

bile acids
they act as detergents to emulsify fat

and reduce the surface tension on fat

droplets

Bile, also called gall,

is a greenish-yellow secretion that is produced in the

liver and passed to the gallbladder for

concentration, storage, or transport into the first

region of the small intestine, the duodenum.

PATHOPHYSIOLOGY
(Theoretical)
Presentors: Jaimelyn Duran & Marie Bularon
 ETIOLOGY:

Gallstone

NON-MODIFIABLE RISK
MODIFIABLE RISK FACTOR:
FACTOR:
- Age: 40 years old and above
- Multiparity
- Female
- Rapid weight loss and gain
- Obesity
- Physical inactivity - Fertile
- Use of oral contraceptives - Family history
PATHOPHYSIOLOGY
(Client-based)
Presentor: Saimon Rafael Amat
DIAGNOSTIC &
LABORATORY
Presentors: Adrian Ampuan & Alec Guilas
 Laboratory Tests
NORMAL
Test RESULT RANGE
INTERPRETATION
Analysis
16.2 Above The Gallbladder wall is
4.5 to 11.0 ×
WBC cells/mcL 10^9 cells/mcL
thickening and its increasing
Normal WBC

Above There is an obstruction in

Alkaline
194 53 to 128 common bile duct causing ALP to
Phosphate Normal rise

Aspartate Slightly
Aminotransferase 39 2 to 37
Elevated indication that there is a
hepatocellular injury in patient
Above
52
Alanine
3 to 41
Aminotransferase
Normal
 Laboratory Tests
NORMAL
Test RESULT
INTERPRETATION
Analysis
RANGE
Indication of excess secretion of
Less than 140 Above
Glucose 152 mg/dL insulin in the body that can risk
mg/dL Normal of having gallstone

Above there is a sign of build-up of

140 to 220
Cholesterol 240 mg/dL cholesterol crystals that can form
mg/dL Normal into gallstone

LDL- 100 to 160 Above indication of build up on the

172 mg/dL
Cholesterol mg/dL Normal walls of the arteries

less than 0.3 Above Gallstones blocks or slow down the

Bilirubin 2.4 mg/dl passage of a liquid bile
mg/dL Normal that causes bilirubin to compensate
 Diagnostic Tests
Findings:
Diagnostic Tests (Hypothetical) Nursing Consideration

The gallbladder obstructed

1. NPO/Nothing to eat or drink from
by a stone, inflammation of
Abdominal midnight until after the examination
the gallbladder wall, and
Ultrasound pericholecystic exudate
2. Patient may take medications with a
SMALL amount/sip of water.
separating the liver bed.
 Diagnostic Tests
Findings:
Diagnostic Tests (Hypothetical) Nursing Consideration

Gallbladder distention, wall 1. Check for NPO status.

thickening, mucosal 2. Instruct the patient to wear comfortable,
loose-fitting clothing during the exam.
hyperenhancement,
3. Instruct the patient to remain still and to
pericholecystic fat stranding
CT Scan or fluid, and gallstones with a
immediately report symptoms of itching,
difficulty breathing or swallowing, nausea,
sufficient attenuation vomiting, dizziness, and headache.
difference from bile to be 4. Encourage the patient to increase fluid
visualized intake to promote excretion of the dye.
 MEDICAL SURGICAL &
NURSING MANAGEMENT
Presentor: Shady Ann Jumao-as
 Medical Management
Diet- The patient should avoid eggs, cream, pork, fried foods, cheese and rich dressings, gas-forming vegetables,
and alcohol. It is important to remind the patient that fatty foods may bring on an episode of pain.
IV fluid hydration to prevent dehydration for electrolyte correction

Pharmacologic Therapy
Antibiotic therapy- Levofloxacin and Metronidazole for prophylactic antibiotic coverage against the most
common organisms.
Promethazine may control nausea and prevent fluid and electrolyte disorders.
Ursodeoxycholic acid (UDCA JUrso, Actigall) and chenodeoxycholic acid (chenodiol or CDCA [Chenix])
are effective in dissolving primarily cholesterol stones.

Nonsurgical Treatments usually performed by the Doctors in Clinic/ outpatient settings

Small Gallstones Can Be Broken Apart With Shock Waves
Another nonsurgical treatment for which gallstones must meet certain criteria is extracorporeal shock-wave
lithotripsy (ECSWL). Although it is most commonly used to treat kidney stones, it can also be used on gallstones.
The goal of the treatment is to break up, or fragment, gallstones by sending shock waves through the soft tissue
of the body.
Gallstones Can Be Dissolved With an MTBE Injection
This nonsurgical treatment option involves injecting a solvent known as methyl tertiary-butyl ether (MTBE)
into the gallbladder to dissolve the gallstones.

Percutaneous Cholecystostomy Is Best for Seriously Ill Patients

This is a nonsurgical treatment option, but it’s most effective when followed by gallbladder removal.
Percutaneous cholecystostomy (PC) is typically saved for seriously ill patients who cannot tolerate surgery
right away. The procedure involves using a needle to withdraw fluid from the gallbladder and then
inserting a catheter through the skin to drain the fluid. The catheter is left in place for a number of weeks,
after which gallbladder removal surgery is performed to prevent recurrence.
 Surgical Management
Cholecystectomy is most commonly
performed by using a laparoscope and
removing the gallbladder.
To prepare for a cholecystectomy, your nurse may instruct you
to:
Eat nothing the night before your surgery. You may drink a
sip of water with your medications, but avoid eating and
drinking at least four hours before your surgery.
Stop taking certain medications and supplements. Tell your
doctor about all the medications and supplements you take.
Continue taking most medications as prescribed. Your
doctor may ask you to stop taking certain medications and
supplements because they may increase your risk of
bleeding.
Surgical Management
Post operative care
Pneumonia and atelectasis are possible postoperative complications that can
be avoided by deep-breathing exercises and frequent turning. The
patient should be informed that drainage tubes and a nasogastric tube and
suction may be required during the immediate postoperative period if an
open cholecystectomy is performed
Considered the type of anesthesia used- Spinal anesthesia instruct the patient
lay flat on the bed.
Suction machine for saliva to prevent choking

DRUG STUDY
Presentors: Diane Hershey Evangelista & Jeff Erol Amin
 ADVERSE NURSING
MEDICATION DOSAGE ACTION USAGE
EFFECTS CONSIDERATIONS

CNS: confusion,
Monitor blood pressure,
DOSAGE
Antagonism of INDICATION disorientation, pulse, RR, frequently for
DRUG CLASSIFICATION histamine H1, sedation, dizziness, patients receiving IV
muscarinic, and Treatment of various fatigue, insomnia, and doses
Antiemetics NAUSEA AND
nervousness.
VOMITING: dopamine receptors allergic conditions and Monitor patient for the
in the medullary motion sickness. onset of extrapyramidal
Preoperative sedation. GI: constipation, dry side effects, notify health
12.5 to 25mg P.O,
vomiting center mouth care provider if
make promethazine Treatment and
GENERIC NAME IM, IV or PR q 4-6
prevention of nausea
symptoms occur
hrs prn useful in the CV: Hypertension,
and vomiting. Assess the patient for
Promethazine treatment of nausea bradycardia, nausea and vomiting
and vomiting. hypotension, before and after
tachycardia administration.

BRAND NAME CONTRAINDICATION LAB TEST

CONSIDERATION:

Some products contain

SIDE EFFECTS CBC should be
Promethazine DM, slowed breathing evaluated
alcohol and bisulfites and periodically
Promethegan should be avoided in
breathing stops
for a short time PO: Administer with food,
patients with known
fever water, or milk to minimize
intolerance. GI irritation.
sweating
stiff muscles
yellowing of the
skin or eyes
rash
hives
 ADVERSE NURSING
MEDICATION DOSAGE ACTION USAGE
EFFECTS CONSIDERATIONS

CNS: dizziness, Assess cognitive

DRUG CLASSIFICATION DOSAGE INDICATION fatigue, headache function (memory,

Binds with opioid attention,

Opioid MODERATE TO CV: hypertension

receptors in the Moderate to severe
SEVERE PAIN THAT
DERM: rash reasoning,

Analgesics REQUIRES OPIOID CNS, altering the pain (alone or with

GU: urinary language, ability to

ANALGESICS AND perception of and non-opioids agents)

FOR WHICH frequency perform simple

GENERIC NAME emotional response tasks) periodically

ALTERNATIVE
to pain
Meperidine TREATMENTS ARE SIDE EFFECTS during therapy
CONTRAINDICATION
INADEQUATE:
50 to 150 mg P.O, IM, or lightheadedne
BRAND NAME subcut. q 3-4 hrs p.r.n Hypersensitivity, ss Lab Test

OR 10 mg IV slowly by
extreme calm. Consideration:
hypersensitivity to mood changes.
Demerol patient-controlled May cause anemia
bisulfites nausea.
analgesia device, with a
vomiting
range of 1-5 mg per stomach pain PO: may be

dose; lockout interval is Use cautiously in: or cramps

6-10 mins. OR continuous dry mouth administered

Alcoholism
IV infusion of 15 to 35 without regard to

mg/hour prn.
food
NURSING CARE
PLAN
Presentors: John Virgilio Cabildo, Rose Ann Lacuarin,
Princess Khryzz De Borja & Carl David Adriano
NCP 1 NCP 2
Acute Pain Hyperthermia
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Acute pain related to

Short Term Goal: Independent: After 1 hour of
“Sumasakit ang stones obstruction rendering proper
After 1 hour of Perform pain To demonstrate nurrsing
tiyan ko nitong as evidenced by
assessment each time improvement in status or intervention,the Short
rendering proper to identify worsening of
nakaraang tatlong localized pain in the
pain occurs. Term Goal was
nursing intervention, Document and underlying condition/
araw, Kagabi, epigastric area that
the patient will be completely met. As
investigate changes developing complications. evidenced by, the
pagkatapos kumain radiates to the right
able to: from previous reports. Nurse’s Pocket Guide 15th patient was able to:
mas lalo itong upper quadrant ed. By Doenges et al. pp.
635 Demonstrate use
sumakit.”, as
Demonstrate use of relaxation skills
verbalized by the Monitor and assess Changes in vitals signs
of relaxation skills and diversional
patient. vital signs as follows: especially heart rate, activities as
and diversional
Blood Pressure. blood pressure and indicated for
activities as respirations usually
Temperature, and
Objective: indicated for Pulse rate. altered in acute pain.
individual
individual situations. such as
1. Guarding Nurse’s Pocket Guide 15th deep breathing
Behavior situations. ed. By Doenges et al. pp. exercises, and
636 Listening to music
2. Epigastric Pain
3. Facial grimace Promote bed rest, Bed rest in a low fowler's
4. CT-Scan result allowing the patient to position reduces intra-
reveals Gallstone assume position of abdominal pressure.
comfort VERA, 2019

Vital Signs: Encourage use of Promotes rest, redirects

BP: 155/90, relaxation techniques attention, and may
HR: 110 such as breathing enhance coping. VERA,
exercises Provide 2019
T: 100.6 diversional activities.
Pain scale: 7/10
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Dependent: After 12hrs of
C - Acute pain Long Term Goal: rendering proper
Administer
Anticholinergic drugs
nursing intervention,
O - Past 3 days After 12hrs of block nerve signals to
the Long Term Goal
rendering proper anticholinergics such as

atropine or propantheline
involuntary smooth
was completely met.
nursing intervention, muscles such as those
As evidenced by, the
L - Epigastric the patient will be as prescribed by the

area, radiating on physician found in the gallbladder,

patient was able to:
able to: causing those muscles

Right Upper
to relax. SISON 2020 The patient
Quadrant Patient describes
describes
satisfactory pain
satisfactory pain
D - few hours control level of
control level of
after eating 2/10. Opioid drugs are

Administer opioids such

2/10
administered in patients

as morphine as

S - 7/10 with acute cholecystitis

indicated
to relieve pain during an

acute attack. JOEHL

P - after taking et.al, 1984

meals
Administer sedatives
Promotes rest and

A - Nausea and relaxes smooth muscle,

such as phenobarbital as

vomiting, indicated relieving pain.

diarrhea, VERA,2019
subjective fever

Use soft or cotton linens;

Reduces irritation and

calamine lotion, oil bath;

dryness of the skin and

cool or moist
itching sensation.

compresses as indicated. VERA,2019

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Collaborate with the

This helps the patient to
dietician for proper diet feel secure and have
someone to rely on
during the course of
treatment.
High in fiber such as

fruits, vegetables,
For making the best
beans, and peas.
improvements to
Whole grains,
patients’ diet and
including brown rice,
lifestyle
oats, and whole wheat

bread High fiber and whole

grain helps keep
gallstones away. Fiber
Eat healthy fats, like
gets the digestive
fish oil and olive oil system moving and
flushes bile from the
body. (RATINI,2020)

Helps the gallbladder

contract and empty on a
regular basis.
(NIDDK,2017)
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
SHORT TERM

Hyperthermia Independent: SHORT TERM

Subjective: GOALS:
GOALS:
related to
Accurately measure Using a consistent
“Nurse, para
After 30 minutes to 1
and document the temperature
pong mainit ang
inflammatory
hour of nursing
client's temperature measurement After 30 minutes to 1

pakiramdam ko
process
intervention, the client’s
every 1 to 4 hours or method, site, and hour of nursing

sa loob at
temperature will return
when there is a change device will help make intervention, the

giniginaw din
secondary to
to normal range as

in the patient’s accurate treatment

condition. client’s temperature

ako” as
decisions and assess
verbalized by the

disease
manifested by: returned to normal

trends in temperature.
patient process as
range and was fully

met as manifested by:

evidenced by
Use a hypothermia
Normal body
blanket if the patient's Shivering increases
Objective: increased
temperature
temperature rises metabolic rate, Normal body

temperature
above 39.4ºC. Monitor increasing temperature

Increased
(36.5 to
vital signs every 15 temperature
body
and flushed,
37.1ºC) minutes for 1 hour and (36.5 to 37.1ºC)
temperature
then as indicated. Turn
than normal
warm skin. off the blanket if
range
shivering occurs.
(38.1ºC) LONG TERM
LONG TERM GOALS:
GOALS: Monitor heart rate and After 2-3 days of

rhythm, blood pressure, To evaluate

Flushed,
After 2-3 days of
nursing intervention,

respiratory rate, LOC, effectiveness of

warm skin the client was able to

nursing intervention,
level of interventions and
Tachycardia
the client will be able
responsiveness, and monitor for fully met as manifested
capillary refill every 1 to complications by:
(110 bpm) to:
4 hours
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Determine patient’s
Fluid resuscitation

Increased
preferences for oral
may be required to

blood
Be freed from
correct dehydration. Be freed from
fluids, and encourage

pressure rate
hyperthermia patient to drink as
hyperthermia
than normal
much as possible,

range (155/90
unless

mmHg) Experience no
Experience no
contraindicated.

exacerbation of
Monitor and record I
exacerbation of
Poor skin
symptoms & O. symptoms
turgor
Use
To lower body

Muscle
nonpharmacologic
temperature and
Experience no
rigidity; chills Experience no
measures to reduce
promote comfort. associated
associated
excessive fever such
complications .
complications . as:
-sponging reduces
- removing body temperature by
sheets, blankets increasing
and most evaporation from
clothing skin.
- Placing ice bags - Tepid water because
on axillae and cold water increases
groin shivering, thereby
- Sponging with increasing metabolic
tepid water. rate and causing
temperature to rise.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Dependent:

Administer Antipyretics act on

antipyretic the hypothalamus
medication as to regulate
temperature.
prescribed.

Administer IV Because insensible

fluid if fluid loss increases
indicated. by 10% for every
1.8 F (1ºC)
increase in
temperature,
patient must
increase fluid
intake to prevent
dehydration.
DISCHARGE
PLANNING
Presentors: Anne Gelen Buyoc & Stephany Dela Cruz
Medication
Instruct the patient and inform the family to comply with the treatment provided by

the doctor.
Instruct the patient to take only the medicine prescribed by the doctor and explain the

dose, frequency of administration, and possible side effects of the medicine.

ANTIEMETICS: Promethazine
NAUSEA AND VOMITING: 12.5 to 25mg by mouth q 4-6 hrs prn.
PATIENT TEACHING: Tell patient to take oral form with food or milk, to reduce GI irritation.
Always take your promethazine tablets or capsules with a drink of water. Swallow them whole. Do not chew
them.
To help you sleep, take promethazine 20 minutes before you go to bed. It normally takes about 30 minutes to

work.
Warn patient to avoid alcohol and hazardous activities that requires alertness until CNS effects of drug are

known.
Plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and

sunscreen. Promethazine may make your skin sensitive to sunlight.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the

missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed

one.
Medication
Instruct the patient and inform the family to comply with the treatment provided by

the doctor.
Instruct the patient to take only the medicine prescribed by the doctor and explain the

dose, frequency of administration, and possible side effects of the medicine.

OPIOID ANALGESICS: Meperidine

DOSAGE: 50 to 150 mg by mouth q 3-4 hrs as needed for pain.
PATIENT TEACHING: If you are taking the meperidine tablets, swallow them whole; do not chew, break, or

crush them. Swallow each tablet right after you put it in your mouth.
Advise the patient that meperidine may make you drowsy. Do not drive a car or operate machinery until you

know how this medication affects you.

Advise the patient that meperidine may cause dizziness, lightheadedness, and fainting when you get up too

quickly from a lying position. This is more common when you first start taking meperidine. To avoid this

problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
Inform the patient that this medication is usually taken as needed. If your doctor has told you to take

meperidine regularly, take the missed dose as soon as you remember it. However, if it is almost time for the

next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to

make up for a missed one.

Environment/Exercise
Maintain a quiet environment to promote relaxation.
Provide a clean and comfortable environment.
Instructed the patient to do exercise regularly as tolerated such
as walking (ideally 30 minutes a day)
Treatment
Instructed the patient to continue the medications.
Advise patient to take multivitamins for increased immunity.
Teach the patient about wound care.
If your incision was closed with staples or stitches that need to be removed, it may be

covered with a bandage, change the dressing over your surgical wound once a day, or

sooner if it becomes dirty.

Keep the wound area clean by washing it with mild soap and water. You may remove

the wound dressings and take showers the day after surgery.
If tape strips (Steri-strips) were used to close your incision, cover the incision with plastic

wrap before showering for the first week. Do not try to wash off the Steri-strips. Let them

fall off on their own.

Do not soak in a bathtub, hot tub, or go swimming until physician tells you it is OK.
To reduce swelling and pain, put ice or a cold pack on your belly for 10 to 20 minutes at a

time.
 Health Teaching
Provide oral and written instructions of health teaching about:
-Activities needed and restrictions.
-diet recommendations,
-medications,
- follow-ups
Educate regarding causes of the disease, complications if left untreated,
and medical and surgical options.
Encourage the patient to have enough rest at least 7-8 hours of sleep
 Out-Patient
Instruct to come back for a follow-up check-up 1 week after the surgery. Remind

the patient that regular check-ups are important to ensure that the patient's

condition is constantly monitored by the doctor.

Instruct the patient and family to contact health care provider if the patient

experience:
Any of the wounds start to bleed
Painful, red, inflamed, or swollen
Pain is not relieved by the prescribed painkillers.
Diet
Advised the patient to a diet as tolerated but preferably avoiding salty and fatty foods.
low fat, high protein, high carbs
Read food labels to be sure the foods that the patient are choosing are low in fat.
Limit the use of high-fat meats, dairy products, animal fats, and vegetable oils.
Eating a diet high in fiber (found in vegetables, fruits, and whole grains)
Encouraged to increase fluid intake.
 Sex
Abstain from any sexual intercourse until full course of medication is

Spiritual
complete.

.- encourage the patient and family members to pray.

“We also glory in our sufferings, because we know that suffering produces
perseverance, perseverance produces character, and character produces hope.
And hope does not put us to shame, because God’s love has been poured into
our hearts through the Holy Spirit, who has been given to us.” - Romans 5:3-5
REFERENCES