Holy Angel University

Angeles City

College of Nursing

A case study on

CHOLELITHIASIS

Submitted by

Demando, Rovina Ana

Dizon, Noeliza
Dizon, Shara Joyce
Dizon, Stephen Zyrus
Gambaloza, Jerisa
Gatpolintan, John Arzen

Submitted to

Mr. Ryan P. Manabat, RN

I. I N T R O D U C T I O N
 Description of the Disease

Cholelithiasis is the presence of one or more calculi (gallstones) in

the gallbladder. In developed countries, about 10% of adults and 20% of
people > 65 yr have gallstones. Gallstones tend to be asymptomatic. The
most common symptom is biliary colic; gallstones do not cause dyspepsia
or fatty food intolerance. More serious complications include cholecystitis;
biliary tract obstruction (from stones in the bile ducts or
choledocholithiasis), sometimes with infection (cholangitis); and gallstone
pancreatitis. Diagnosis is usually by ultrasonography.

Gallstones are made

of cholesterol, calcium
bilirubinate, or a mixture
of cholesterol and bilirubin
pigment. They arise
during periods of
sluggishness in the
gallbladder due to
pregnancy, hormonal
contraceptives, diabetes
mellitus, Chron's disease,
cirrhosis of the liver, and pancreatitis, obesity and rapid weight loss. Their
development is insidious, and they may remain asymptomatic for
decades. Migration of gallstones may lead to occlusion of the biliary and
pancreatic ducts, causing pain (biliary colic) and producing acute
complications, such as acute cholecystitis, ascending cholangitis, or acute
pancreatitis.
 Cholelithiasis is a common health problem, affecting about 1 out of
every 1,000 people and is the fifth leading cause of hospitalization among
adults and accounts for 90% of all gallbladder and duct diseases. The
prognosis is usually good with treatment unless infection occurs, in which
case the prognosis depends on its severity and response to antibiotics.

Prevalence of cholelithiasis is affected by many factors including ethnicity,

gender, comorbidities, and genetics. In the United States, about 20 million
people (10-20% of adults) have gallstones. Every year 1-3% of people
develop gallstones and about 1-3% of people become symptomatic.

In an Italian study, 20% of women had stones, and 14% of men had
stones. In a Danish study, gallstone prevalence in persons aged 30 years
was 1.8% for men and 4.8% for women; gallstone prevalence in persons
aged 60 years was 12.9% for men and 22.4% for women.

Excision of the gallbladder (cholecystectomy) to cure gallstone

disease is among the most frequently performed abdominal surgical
procedures.
 Objectives

The student’s chose this case study primarily because of interest to

gain further understanding regarding the disease condition. This will also
help in providing current and accurate information concerning the latest
approaches for the treatment of cholelithiasis and its complications.
Moreover, it will initiate participation of client and family members in the
therapy for the disease. This will also help in ensuring that the client
understand treatment options and provide clarification when necessary.

The student nurses have the following objectives in this case study:
• Recognize the disease condition; understand risk
factors, pathophysiology, signs and symptoms, and its
underlying complications.
• Gather complete data upon assessment of the patient
that will help on the accomplishment of the case study.
• Formulate nursing diagnosis related to the stress of the
illness.
• Identify the nursing responsibilities for the patient with
cholelithiasis.
• Understand the pharmacology of treating cholelithiasis.
 II. N U R S I N G HISTORY

1. Personal History
Demographic Data
This is the case of Mrs. Tweety, 30 years old, female,
Filipino. She was born on January 11, 1978 in Quezon City.
She is presently residing at 1608 Tamarind St., Clarkview,
Brgy. Malabanias, Angeles City. She is the fourth child of Mr.
and Mrs Pooh. . She is now married to Mr. Bugs Bunny and is a
mother to two children. She was admitted at Angeles Medical
Center on August 4, 2008 at 11:48 pm.

Socio-Economic and Cultural Factors

Ms. Tweety is currently a program supervisor at
Sutherland Global Services. Her hospitalization expenses are
covered by her insurance company and her needs are
adequately compensated as she and her husband are both
working. She graduated a four year course in Marketing
Management from Angeles University Foundation. She is born
a Roman Catholic. She is considered a modern woman; she
works and at the same time she is a mother to two children.
Mostly for light pains or discomforts she takes pain relievers
and consults a clinic if she and/or her other family members
experience some health problems. As a working mother and
depending on her schedule at work she is barely the one
cooking food and if ever she has the time she cooks foods
which are easily done for example fried foods. And when at
work she eats any food that is available at the place or
sometimes passes by fast foods to order.
2. Family-Health Illness History
Grand
Grand Grand Father Mother
Grand Father
Mother

Father Mother

A1 A4
A2 A3 tweety

Legend:
Blue = male = Decease
Pink = female

= AMI
= DM
=HPN
 This Diagram shows the family health –illness history of the
patient. Both grand mother and grand father in her father's side
died of old age. On her mother's side her grand father died of old
age and her grandmother died due to myocardial Infarction. His
father exhibited good health while her mother is hypertensive.
Her other siblings also did not manifest any hereditary or existing
disease. In the family she was the only person who manifested
cholecystolithiasis. The diseases which are present on her
mother's side of the family has no relation to her condition, but
the Diabetis Mellitus of her grand father may or may not be
related to her having Cholecystolithiasis.

2. History of Past Illness

She acquired chicken pox and measles when she was

young. Mrs. Tweety was hospitalized before for two times
already. Those include both her delivery to her two children. But
aside from that she was never brought to hospital for conditions
which are related to her condition now.

3. History of Present Illness

During the past 7 months (starting January) the patients
has been experiencing pain on her right upper side part of the
abdomen which she ignored. And she verbalized that it was a
tolerable pain and when she sleeps the pain is alleviated and due
to her work she did not had a check up or medical examinations
done. Two months(June 2008) before the hospitalization, she had
experienced an intense pain but instead of going to the hospital
for check up she just took pain relievers. She had experienced
nausea and vomiting. Two days prior to admission the patient
again experienced intense pain while at work accompanied by
 fever (august 4, 2008) and by 11 pm of August 4(Monday) the
patient was admitted at Angeles Medical Center.

III. P H Y S I C A L A S S E S S M E N T
(I P P A – C E P H A L O C A U D A L )

August 4, 2008 (upon admission, based on the patient's chart)

 Patient Is conscious, coherent but in distress

 Vital signs:
BP- 90/60
T- 38
P-80
R-18
 Pale palpebral conjunctiva
 Normal abdominal Bowel sound, soft (+) epigastric and right upper quadrant
tenderness
 No cyanosis, no edema, (+) jaundice

August 5, 2008(patient's chart)

 Patient is conscious and coherent with IVF of 1L D5LRS regulated at 30

gtts/min
 Vital signs:
BP-100/70
T-37.1
P-87
R-21

August 6, 2008 (Nurse- Patient Interaction)

 Patient is awake, conscious and coherent but appears weak

  with ongoing IVF of 1 L D5LRS regulated at 30 gtts/min
 Vital signs:
BP-110/80
T-36.7
P-78
R-19

REVIEW OF SYSTEMS

HEAD

Hair and Scalp: Client has evenly distributed short, thick, coarse, no
infestation.

Skin and Face: Client has a rounded, smoothly contoured skull. Skull has
uniform consistency. No nodules, masses or depression palpated. Facial
features are symmetric.

Eye and Vision: Client’s eyebrow has evenly distributed hair. Eyebrows are
symmetrically aligned and with equal movement. Eyelashes are evenly
distributed and curled slightly outward. Skin of the eyelids is intact and
without discharge. Lids close symmetrically, bilaterally. Sclera appears
yellowish. Corneas are transparent, shiny and smooth with details of iris
visible. Pupils are black, equal in size, round and have smooth border with
round iris. They constrict when illuminated with a penlight. They constrict
when looking at near objects and they dilate when looking at far objects.

Ears: Auricles are symmetrical, aligned with the outer cantus of the eye and
have the same color as the facial skin. They are mobile, firm, not tender, and
recoil after being pulled or folded. No cerumen noted. Client can hear voice
tones.
Nose and Sinuses: Nose is symmetric and straight. There is no discharge,
flaring, lesions and tenderness.

Mouth: Lips is pale, soft, moist, smooth and symmetrical in contour. Client is
able to purse lips. There is the presence of dental plaque and caries. Tongue
is at the center, pink, moist slightly rough with thin whitish coating. It moves
freely without tenderness.

NECK

Neck Muscles: Muscles are equal in size and head centered. Head
movements are coordinated and smooth with no discomfort.

Lymph Nodes: They are not palpable.

UPPER EXTREMITIES

Skin and Nails: Skin is yellowish in color and moist in skin folds with no scars
of lesions noted. When pinched, skin goes back to previous state. Nail plates
are convex, colorless and smooth in texture. No dirt is accumulated under
the nails.

Muscle Strength and Tone: Muscles are equal in size on both sides of the
body without tremors. They are firm with coordinated movements.

Bones and Joints: There are no deformities, tenderness or swelling noted.

CHEST

Heart: Client has regular heartbeat pattern (strong).

ABDOMEN

Skin: Skin is yellowish color and there are no scars noted.

LOWER EXTREMITIES

Skin and Toenails: Skin is yellowish and moist in skin folds with no dryness
noted at the sole of the feet. When pinched, skin goes back to previous
state. Nail plates were convex, colorless and smooth in texture. No dirt is
accumulated under the toenails.

Muscle Strength and Tone: Muscles are equal in size on both sides of the
body without tremors. They are firm with coordinated movements.

Bones and Joints: There are no deformities, tenderness or swelling noted.

 IV. D I A G N O S T I C AND LABORATORY PROCEDURES

Diagnostic/ Indications or Date Ordered Results Normal Values Analysis and

Laboratory Purpose Date Results (units used in Interpretation of
Procedure were released the hospital) Results

HBT—Pancreas To detect D.O= 08/05/08 Abnormally Normal size, Abnormally

–Ultrasound pancreatitis, contracted position, contracted
evidenced by gallbladder with contour and gallbladder with
pancreatic a lithiasis at the texture of the a lithiasis at the
enlargement neck. pancreas. neck.
with increased
echoes. Intrahepatic Just tell what
and lithiasis is and
To detect extrahepatic how it affect the
pancreatic ducts are not gallbladder
cancer, defined dilated.
mass of a mass
in the head of Unremarkable
the pancreas liver and
that obstruct pancreas.
the pancreatic
 duct. (-) for ascites

To detect
anatomic
abnormalities
as a
consequence of
pancreatitis.

Hematology To determine D.O= 08/05/08 41.4 % M=40-54 % The result is

the percentage F=37-47 % within the
Hct of total blood normal values.
volume
composed of
RBC

Platelet To test the D.O= 08/05/08 304 x 109/L 140- 440 x The result is
ability of the 109/L within the
blood to clot normal values.
WBC Used to detect D.O= 08/05/08 7.7 x 109/L 4.3- 10 x 109/L The result is
infection, it within the
determines normal values.
number of
circulating
WBC’s per cubic
millimeter of
blood

Granulocytes Phagocytes D.O= 08/05/08 73 % 44.2- 80.2 % The result is

present in within the
circulation that normal values.
kills bacteria
during infection

Lymphocytes Produce D.O= 08/05/08 27 % 28.0- 48.0 % The results is

antibodies below the
responsible for normal values.
immune It means that
responses. the blood has
low antibodies
 that are
responsible for
immune
responses.

Hgb To determine D.O= 08/05/08 13.0 g/dL M=14 -18 g/dL The result is
the oxygen F= 12 – 18 g/dL within the
carrying normal values.
capacity of the
blood. It
evaluates the
hemoglobin
content of
erythrocytes.

NURSING RESPONSIBILITIES

Hematology

Prior:
1. Verify doctor’s order
2. Explain the importance of the procedure
3. Explain the procedure to the patient
4. Tell the patient that no fasting is required
5. Assure him that collecting blood sample take less than 3 minutes
6. Inform the patient that he will be experiencing mild pain on the site of injection

During:
1. Assist the patient.

After:
1. Apply pressure or a pressure dressing to the punctured site
2. Check the venipuncture site for excessive bleeding
3. Fill up the laboratory form properly and sent it to the laboratory for testing
3. Instruct patient not to take anything per orem 2 hours prior to blood extraction
4. Inform that he will be experiencing mild pain on the site where the needle is inserted

HBT- Pancreas- Ultrasound

Prior:
1. Inform the patient that the procedure assesses the pancreas.
 2. Inform the patient that the procedure is performed in a specialized area by a technologist and
usually takes approximately 30 to 60 minutes. The room may be darkened for better visualization of
the pancreas.
3. Obtain the history of suspected or existing disease of the pancreas.
4. Obtain the results of tests and procedures done to diagnose disorders or treatments to the pancreas.
5. Inform the patient that the procedure is painless and carries no risks.
6. Note recent administration of barium because residual barium can obscure the organ to be
examined. There should be a 24-hour waiting period between administration of barium and this test.
7. Inform the patient to withhold food for 8 hours, but to drink increased amounts of fluids to distend
the stomach before and during the procedure.

During:
1. Ask the patient to put on a hospital gown.
2. Place the patient in a supine position on the examining table; other position may be used during the
examination.
3. Expose the abdomen and drape the patient.
4. Apply conductive gel to the epigastric area and move the transducer over the skin; the sound wave
images are projected on the screen and stored electronically for future viewing or reproduced on a film.
Ask the patient to lie still during the procedure because movement produces unclear images.
5. If necessary for better visualization of the pancreas and abdominal organs, ask the patient to inhale
deeply, regulate breathing, hold her breath or drink water.
After:
1. When the study is completed, remove the gel from the skin.
2. Instruct the patient to resume normal activity, medication, and diet, unless otherwise indicated.
3. Inform the patient that an abnormal examination may indicate the need for additional studies.
4. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Diagnostic/ Indications or Date Ordered Results Normal Values Analysis and

Laboratory Purpose (units used in Interpretation of
Procedure the hospital) Results

Hematology To determine D.O: 08 /06/ 08 13.1 g/dl M=14 -18 g/dL The result is
Hgb the oxygen F= 12 – 18 g/dL within the
carrying normal values.
capacity of the
blood. It
evaluates the
hemoglobin
content of
erythrocytes.

Hct To determine D.O: 08 /06 /08 43.4 g/dl M=40-54 % The result is
 the percentage F=37-47 % with in the
of total blood normal values
volume
composed of
RBC

Platelete To test the D.O: 08 /06/ 08 307x109/L 140-440x4/L The result is

ability of the with in the
blood to clot normal values

WBC Used to detect D.O: 08 /06 /08 12.2x109/L 4.3-10.0x9/L The result is
infection, it above the
determines normal values.
number of It indicates
circulating infection
WBC’s per cubic
millimeter of
blood

Granulocytes Phagocytes D.O: 08 /06 /08 71% 44.2-80.2% The result is

present in with in the
circulation that normal values
kills bacteria
 during infection

Lymphocytes Produce D.O: 08/ 06/ 08 27.6% 28.0-48.0% The result is

antibodies below the
responsible for normal values.
allergic It means that
reactions the blood has
low antibodies
that are
responsible for
immune
responses
 IV. T H E PATIENT AND HIS ILLNESS

Anatomy and Physiology

The gallbladder stores bile, which is released when food containing

fat enters the digestive tract, stimulating the secretion of cholecystokinin
(CCK). The bile emulsifies fats and neutralizes acids in partly digested
food. After being stored in the gallbladder, the bile becomes more
concentrated than when it left the liver, increasing its potency and
intensifying its effect on fats.

The anatomy of the biliary tree is a little complicated, but it is

important to understand. The liver's cells
(hepatocytes) excrete bile into canaliculi, which
are intercellular spaces between the liver cells.
These drain into the right and left hepatic ducts,
after which bile travels via the common hepatic
and cystic ducts to the gallbladder. The
gallbladder, which has a capacity of 50 milliliters
(about 5 tablespoons), concentrates the bile 10 fold by removing water
and stores it until a person eats. At this time, bile is discharged from the
gallbladder via the cystic duct into the common bile duct and then into
the duodenum (the first part of the small intestine), where it begins to
dissolve the fat in ingested food.

The liver excretes approximately 500 to 1000 milliliters (50 to 100

tablespoons) of bile each day. Most (95%) of the bile that has entered the
intestines is resorbed in the last part of the small intestine (known as the
terminal ileum), and returned to the liver for reuse.

The many functions of bile are best understood by knowing the

composition of bile:

1. Bile Salts (cholates, chenodeoxycholate, deoxycholate): these are

produced by the liver's breakdown of cholesterol. They function in
bile as detergents that dissolve dietary fat and allow it to be
absorbed. Hence, disruption of bile excretion disrupts the normal
absorption of fat, a process called malabsorption. Patients develop
diarrhea because the fat is not absorbed (steatorrhea) , and develop
deficiencies of the fat-soluble vitamins (A, D, E, and K).
2. Cholesterol and phospholipids-while only 4% of bile is cholesterol,
the secretion of cholesterol and its metabolites (bile salts) into bile
is the body's major route of elimination of cholesterol.
Phospholipids, which are components of cell membranes, enhance
the cholesterol solubilizing properties of bile salts. Inefficient
excretion of cholesterol can cause an increased serum cholesterol.
This predisposes to vascular disease (heart attacks, strokes, etc.)
3. Bilirubin-while this comprises only 0.3% of bile, it is responsible for
bile's yellow color. Bilirubin is a product of the body's metabolism of
hemoglobin, the carrier of oxygen in red blood cells. Disruption of
 the excretion of this component of bile leads to a yellow
discoloration of the eyes and skin (jaundice).
4. Protein and miscellaneous components

Bile production and recirculation is the main excretory function of

the liver. Tumors that obstruct the flow of bile from the liver can also
impair other liver functions. Therefore, it is necessary to understand
these other functions to understand the symptoms that these tumors
can cause. These include:

Metabolic functions, such as the maintenance of glucose (blood

sugar) levels

Synthetic functions, such as the synthesis of serum proteins such

as albumin, blood clotting (coagulation) factors, and complement (a
mediator of inflammatory responses)

Storage functions, such as the storage of sugar (glycogen), fat

(triglycerides), iron, copper, and fat soluble vitamins (A, D, E, and K)

Catabolic functions, such as the detoxification of drugs

The gallbladder has an epithelial lining characterized by

recesses called Aschoff's recesses, which are pouches inside the lining.
Under the epithelium there is a layer of connective tissue, followed by a
muscular wall that contracts in response to cholecystokinin, a peptide
hormone secreted by the duodenum.
 PATHOPHYSIOLOGY(BOOK BASED)

Predisposing Factors Precipitating factors

Hormonal Gender Old Age Race Genetics Physical Obesity Diet

factors in (female) (>40 yrs (Native Activity
pregnancy old) Americans Prolonged
Immobility
Sedentary Weight
lifestyle loss
dieting,
Increase in Increase High level High fat, decrease
estrogen in of lowfiber diet caloric
level estrogen Decrease choleste- intake
contractility rol in the
of the body
gallbladder
Decrease
Increase in contractility
cholesterol Gallbladder Gallbladder of the
and bile and stasis stasis gallbladder
decrease in and spasm
gal;lblader of the
movement sphincter

Gallbladder
Alteration in the composition of the bile stasis

Bile become supersaturated with cholesterol

of calcium, deficient bile salts and lecithin
 Solute precipitate from solution as solid
crystals

Crystals fuse to form stones

Unconjugated bilirun from insoluble Bile contains relative high proportion of Cholesterol gallstones become colonized
precipitates with calcium and enter bile cholesterol and becomes supersaturated with with bacteria and can illicit gallbladder
together with other electrolytes it and crystals form mucosal inflammation

Lytic enzyme from bacteria and leukocytes

Calcium bilirubinate crystallizes into and hydrolyze bilirubin conjugates and fatty acids
forms jet black stones Cholesterol
stones

Cholesterol stones may accumuilate a substantial

Pigment proportion of calcium bilirubinate and other
stones calcium salts

Mixed stons
Perscence of gall
stones

Obstruction in the
gall bladder Obstruction in the
common bile duct
Prescence of food in the
gastrointestinal tract stimulates Jaundice
gallbladder to contract against an
obstructing gallstone
 Obstruction of bile
flow in the intestine
Increase pressure
within gallbladder

Decrease bile flow in the intestines(bile salts) Decrease bile flow in the intestine(bile acids)
Pain in right
upper
quadrant Decrease secretion of water in the intestine Decrease digestive
function(emulsification of fats)

Guarding
behavior Decrease peristalsis Unable to metabolize fats

Intolerance to fatty foods

Waste and gas couldn't move along
and out of the body
Indigestion

Flatulence(prescence of an
axcessive amount of air or gas in
the stomach and intestinal tract
Nausea and vomiting(compensatory
mechanism of the body to relieve feeling of
indigestion by throwing up stomach content by
mouth

Distension of organs
Bloated feeling

pain Belching(compensatory
mechanism of the body by
expelling or releasing gas from the
stomach through the mouth
b. Synthesis of the disease

Cholelithiasis, the presence of stones of calculi (gallstone) in the

gallbladder resolves from changes in bile components. Gallstones are
made of cholesterol, calcium bilirubinate, or a mixture of cholesterol and
bilirubin pigment. They arise during periods of sluggishness in the
gallbladder resulting from pregnancy, use of oral contraceptive, diabetes
mellitus, Cron’s disease, and cirrhosis of the liver, pancreatitis, obesity,
and rapid weight loss. Up to 25% of all people have gallstones
(cholelithiasis), composed of cholesterol, lecithin and bile acids. These can
cause colicky shooting abdominal pain, usually in relation with the meal,
as the gallbladder contracts and gallstones pass through the bile duct.
Surgery (cholecystectomy, removal of the gallbladder) is the most
common treatment for gallstones. It can be performed laparoscopically,
and it is in fact one of the most common procedures done through the
laparoscope.

Causes, incidence, and risk factors:

Cholelithiasis is usually discovered by routine X-ray study, surgery, or

autopsy. Virtually all gallstones are formed within the gallbladder. Bile is
a solution composed of water, bile salts, lecithin, cholesterol and some
other small solutes. Changes in the relative concentration of these
components may cause precipitation from solution and formation of a
nidus, or nest, around which gallstones are formed.

While these stones may be as small as a grain of sand, they may become
as large as an inch in diameter depending on how much time has elapsed
from their initial formation. In addition, depending on the main substance
that initiated their formation (e.g., cholesterol), they may be yellow or
otherwise pigmented in color.
Cholelithiasis is a common health problem worldwide with an approximate
incidence of 1 out of 1,000 people. The prevalence is greater in women,
Native Americans, and people over the age of 40.

People traditionally considered at an increased risk of cholelithiasis are

people who are 4 F's:

• Female
• Fat (obesity)
• Fair (Caucasian, but this is disputed by recent studies)
• Forty (middle-aged)

Bilary colic

This is when a gallstone blocks either the common bile duct or the
duct leading into it from the gallbladder. This condition causes severe
pain in the right upper abdomen and sometimes through to the upper
back. It is described by many doctors as the most severe pain in
existence, between childbirth and a heart attack. Other symptoms are
nausea and vomiting, diarrhea, bleeding caused by continuous vomiting,
and dehydration caused by the nausea and diarrhea. Another more
serious complication is total blockage of the bile duct which leads to
jaundice, which if it is not corrected naturally or by a surgical procedure
can be fatal as it causes liver damage. The only long term solution is the
removal of the gall bladder.

Predisposing factors:
Age - elderly people are prone to gallstone formation because of
weakened immune system and deteriorating body organs.
Diabetic - are prone to gallstone formation because of impaired protein
synthesis and fatty acid storage.
Genetic - family with a history of cholelithiasis has a high risk of acquiring
the disease condition.

Precipitating factor:
Increase cholesterol intake- can trigger gallstone formation because too
much cholesterol alters the bile composition resulting to gallstone
formation.

Risk Factors
• Family history of gallstones.
• Genetic factors. Some ethnic groups are more susceptible, such as
Native Americans and Hispanics.
• Obesity.
• Excess alcohol consumption
• Oral contraceptives.
• High fat, low fiber diet.
• Rapid weight loss.
• Women who have had many children.(multiparity)
• Hemolytic disorders such as sickle cell anemia, hereditary
spherocytosis.
• Liver cirrhosis.
• Diabetes.
• Female gender.
• Inflammatory bowel disease such as crohns.

Signs and symptoms:

Symptoms usually manifest after a stone, which is greater than 8 mm,

blocks the cystic duct, or the common bile duct.
Biliary colic- right upper quadrant pain that feels like cramping, which is
cause by a block in the opening of the gallbladder.

Cholangitis- If the common bile duct is blocked for a period of time,

certain bacteria may grow in the stagnant bile producing symptoms of
cholangitis.

Jaundice- a yellow pigmentation of the sclerae, skin, and deeper tissues

cause by excessive accumulation of bile pigments in the blood. The
accumulation is due to the continuous blockage of bile to the intestines
where it is partly excreted as waste.

Pancreatitis- stones blocking the lower end of the common bile duct
where it enters the duodenum may obstruct secretion from the pancreas
producing pancreatitis.

Note: Often there are no symptoms.

Additional symptoms that may be associated with this disease:

 stools, clay colored- bilirubin is secreted in the system and not

excreted
 nausea and vomiting- compensatory mechanism of the body to
relieve feeling of indigestion by throwing up stomach content by mouth
 heartburn- because of vomiting
 gas/flatus, excessive - decrease in peristalsis because of decrease
in water in the intestine.
 abdominal indigestion- decrease ability to emulsify fats,intolerance
to fatty foods leading to indigestion
 abdominal fullness, gaseous-decrease in peristalsis because of
decrease in water in the intestine.
 PATHOPHYSIOLOGY(CLIENT CENTERED)

Predisposing/Non Modifiable Precipitating/Modifiable

Increase
Bile become saturated with cholesterol/
cholesterol intake of
fatty foods,
Age
low fiber

Changes of bile composition

Gender

Race

Decreased capacity to dissolve fats

Decreased digestion and Fat

absorption of fats intolerance

Nausea and
buildup of bile vomiting
constituents (June, 2008)
Concretion of bile constituents
 Crystalline structures are formed

Indigestion of fats

Stimulates the secretion of

Cholecystokinin

RUQ colicky pain

Stimulates the gallbladder to (January, 2008
produce more bile. June 2008,
August 2-3, 2008)

Cholelithiasis

Bile stasis become a medium

for bacterial growth

Infection

Endogenous
pyrogens Inflammation

obstruction
Release of chemical
mediators
Reset of Conjugated bilirubin
hypothalamus

Escape from liver into

the blood strea,m
Fever
(August4 ,
2008) Jaundice
(August 4, 2008)
Predisposing

 Age
Cholesterol Stauration increases with age, usually 20 to 60
year old persons are at more risk(black,2005). As an individual gets
older, more and more cholesterol accumulates in the body system-
as a result of increased hepatic cholesterol secretion and derease
bile acid and lecithin synthesis, thereby increasing the chances of
developing gallstones(Smeltzer)

 Gender
The usual adult female ratio roughly four times more women
than men develop gallstones(Phipps, 1995) presumably in part
because the effect of estrogen on cholesterol metabolism.

 Race
Highest rate for occurrence of gallstones are in the US and the
Philippines. A majority of native Americans have gallstones by the
age of 60(Phipps,1995). Among the Filipinos, 70 percent of men and
women have had gallstones by age 30

Also a lithogenic gene is hypothesized to exist in all racial

group ethnicity.

Precipitating factors

 Increase cholesterol/ intake of fatty foods, low fiber.

e.g. meat, egg, butter, cheese, salad dressing, steak and fried
foods.
 This leads to further increase of cholesterol produced by the
bile( increased hepatic cholesterol secretion) making it more prone
to develop stones

Signs and symptoms with rationale

 Nausea and vomiting(June 2008)

Because of changes in bile concentration(supersaturation with

cholesterol versus the decreased amount of lecithin and bile salts),
fats that are needed to be emulsified in the small intestine are not
properly digested and absorbed leading to indigestion manifested
by nausea and vomiting especially after a heavy meal of fried foods.

 Right upper quadrant pain(January, 2008, June 2008August 2-3,

2008)

Along with the subsequent formation of stones in the

gallbladder, mucosal irritation of the latter occurs with the
supersaturated bile and as a result, the gallbladder contract in
trying to expel the stones

 Fever(August 4, 2008)

A common response to inflammation caused by the

stimulation of the hypothalamus by endogenous pyrogens, which
are released from circulating neutrophils and macrophages.
 Jaundice( August 4, 2008)

With the obstruction of the common bile duct, bile backflows

into the liver where conjugated bilirubin enters into the
bloodstream. Ther will be increased serum bilirubin as manifested
by yellowish skin discoloration ranging from mild to moderate
depending to the extent of obstruction
 SURGICAL MANAGEMENT

Pre-operative diagnosis: Cholecystolithiasis

Proposed Operation: Cholecystectomy

Date of the procedure done: August 05, 2008

Since the first recognized case of cholelithiasis over 1500 years ago,
numerous treatments have been used. These are primarily medical and
surgical.

Bile salts taken orally may dissolve gallstones in those with a functioning
gallbladder, but the process may take 2 years or longer, and stones may
recur after the therapy is discontinued.

Medical dissolution, using both high-dose and low-dose

chenodeoxycholic acids (CDCA, chenediol) was an approach
investigated in the early 1980s. However, it was successful in only around
14% of cases, required a long period of administration as well as a
lifetime of maintenance therapy.

Urodeoxycholic acid (UDCA, ursodiol), a more contemporary medical

therapy, is successful in only 40% of cases. Both CDCA and UDCA
therapies are useful only for gallstones formed from cholesterol.

Other chemical methods include contact dissolution in which a catheter is

passed through the abdominal wall and into the gallbladder and methyl
tert-butyl ether, a volatile chemical, is then instilled. This chemical
rapidly dissolves cholesterol stones but potential toxicity, stone
recurrence, and other complications limit its utility.

Electrohydraulic shock wave lithotripsy (ESWL) has also been

employed to treat cholelithiasis. The principal underlying this modality is
that electromagnetically produced high-energy shock waves, when
focused on a specific point in a liquid medium, can produce
fragmentation. However, its application is limited if there are a large
number of stones present, if the stones are very large, or in the presence
of acute cholecystitis or cholangitis. It can also be used in association with
UDCA to improve its effect.

Despite these medical approaches, modern advances in surgical

management have revolutionized the treatment of cholelithiasis. In
general, surgery is indicated for symptomatic disease only.

In the past, open cholecystectomy was the usual procedure for

uncomplicated cases. This operation necessitated a medium to large
abdominal surgical incision just below the right lower rib in order to gain
access to the gallbladder. After this operation, a patient typically spent 3-
5 days in the hospital recovering.

Currently, laparoscopic cholecystectomy is the gold standard for care

of symptomatic cholelithiasis and is one of the most common operations
performed in hospitals today. Using this approach, a patient with
symptomatic cholelithiasis may have their gallbladder removed in the
morning and be discharged from the hospital on the same evening or the
next morning.

In addition, gallstones blocking the common bile duct may be visualized

and removed during the laparoscopic procedure. The impact of this
surgical treatment method has supplanted medical approaches to the
treatment of gallstones, because it has a complication rate of less than
1%.

Incision
Laparoscopic surgical techniques uses narrow instruments,
including a camera, which is introduced into the abdomen through small
puncture holes. If the procedure is expected to be straightforward,
laparoscopic cholecystectomy may be used. A laparoscopic camera is
inserted into the abdomen near the umbilicus (navel). Instruments are
inserted through 2 more small puncture holes. The gallbladder is found,
the vessels and tubes are cut, and the gallbladder is removed.
 Laparoscopic Cholecystectomy as seen through laparoscope
Procedure
If the gallbladder is extremely inflamed, infected, or has large
gallstones, the abdominal approach (open cholecystectomy) is
recommended. A small incision is made just below the rib cage on the
right side of the abdomen. The liver is moved to expose the gallbladder.
The vessels and tubes (cystic duct and artery) to and from the gallbladder
are cut and the gallbladder is removed. The tube (common bile duct) that
drains the digestive fluid (bile) from the liver to the small intestine
(duodenum) is examined for blockages or stones. A small flat tube may be
left in for several days to drain out fluids if there is inflammation or
infection.

Nursing responsibilities prior operation:

• Monitor vital signs for signs of developing shock

• Check for the type of blood
• Assess the women emotional state and coping abilities
• Determine the couples informational needs
• Instruct the patient to stop smoking (if smoking)
• Instruct the patient not to eat or drink
 • Gather some info. About client’s health history and allergies
• Instruct the pt. to remove glasses, contact lenses, dentures,
hearing aids, jewelry and hair ornaments

Nursing responsibilities during operation:

• Be aware on what is to be done during the course of operation

• Ready for troubleshooting of problems
• Alertness in exchanging sterile instruments use by the doctor
or surgeon
• Familiarity with the emergency procedures

Nursing responsibilities after operation

• Most patients who undergo laparoscopic cholecystectomy can

go home the day of surgery or the next day, and resume a
normal diet and activities immediately. Most patients who
undergo open cholecystectomy require 5-7 days of
hospitalization, are able to resume a normal diet after one
week, and normal activities after 4-6 weeks
 V. T H E P A T I E N T AND HIS CARE

1. Medical Management

a. Intravenous Fluid
Indication(s) or Date Client’s Response to
Medical Management General Description
Purpose(s) Ordered the Treatment

D5LRS 1L x D5LRS (5% dextrose in Enable to maintain 08-04-08 The patient was
30gtts/min Lactated Ringer’s hydration and for fluid hydrated.
Solution belongs to the and electrolyte
hypertonic solutions; a imbalance. Is the patient
combination of two dehydrated? Isn’t it
solutions (D5 W and LR). the fluid was just for
preoperative
procedure?

Nursing Responsibilities:
 Before:
1. Verify doctor’s order.
2. The 10 rights of the patient must be observed when administering medication.
3. Explain the procedure to the patient and why it has to be done.

During:
1. Instruct patient to relax especially the hand where the needle is to be inserted (to avoid reinsertion
and facilitate easy insertion)
2. Check IV level and the patency of the tubing if it is infusing well.

After:
1. Press the site where the needle was inserted and secure it with micropore.
2. Check the site of hand where the needle is inserted if bulging is not visible. If so, reinsertion is to be
undertaken.
3. Advice patient to avoid scratching the site less movement of the hand where the needle was
inserted to keep it in place.
4. Instruct patient and significant others to inform the nurse on duty if bulging of the site is visible, if
there is back flow of blood of if IVF is not infusing well.
5. Observe the IV site at least every hour for signs of infiltration or other complications fluid or
electrolyte overload and air embolism.
6. IVF regulation should be checked and monitored upon receiving patient.
7. Always check the doctor’s order for new orders regarding the IVF supplement of the patient.
8. Always check if the IVF is infusing well and intact.
9. Monitor the patient’s skin integrity.
b. Drugs

Name of Drugs Date Client’s

General Action Indication or Purpose
Ordered Response

Paracetamol Antipyretic/Analgesic To relieve fever. 08-04-08 The patient’s

Responsible for temperature
reduction of fever. decreases to its
normal.
Antacid
Omeprazole Acts in the acidic Decreased the 08-04-08 The patient was
conditions of the amount of acid in the relieved. From
stomach destroying stomach in which the what? How about
the ability of the patient will be ready no complaint of
parietal cells to for the surgical epig pain was
produce gastric acid. procedure. made? =)
Analgesic/ Antipyretic .
Nubain A synthetic narcotic To relieve discomfort. The patient was
agonist-antagonist 08-04-08 comforted.
analgesic of the (focus on pain
phenanthrene series. scale)
Antibiotic
Cefazolin Inhibits the final To control bacterial 08-05-08 The patient was
transpeptidation step infections. relieved? from
of peptidoglycan the drug which
synthesis in bacterial controlled the
cell wall, thus infection.
inhibiting biosynthesis Just state the
and arresting cell wall manifestations of
assembly resulting in infxn
bacterial cell death.
Anti-emetic
Plasil Increases the tone and To moderate nausea 08-05-08 The patient was
amplitude of gastric and vomiting. restrained to
(especially antral) nausea and
contractions, relaxes vomiting.
the pyloric sphincter
and the duodenum and You may just say
jejunum, resulting in no complaint of
accelerated gastric nausea.
emptying and
intestinal transit. It
increases the resting
 tone of the lower
esophageal sphincter.
Analgesic
Parecoxib Reduce mediators of To control pain or 08-06-08 The patient was
pain and inflammation. discomfort. relieved from
pain.
Cefalexin Cephalosporin To destroy the 08-06-08 The patient was
Antibiotic formation of bacteria. free from the
Kills bacteria by invasion of
interfering with the bacteria.
ability of bacteria to
form cell walls. The
bacteria therefore
break up and die.
Celestamine Antihistamine/ To prevent allergic 08-06-08 The patient
Antiallergics reactions. complimented
combines the anti- with allergic
inflammatory and anti- reactions.
allergic effects of the
corticosteroid You may say
betamethasone (a itchiness was
derivative of relieved
 prednisolone) with the
antihistaminic activity
of dexchlorphenamine
maleate.
Stugeron Anti-emetic To moderate nausea 08-06-08 The patient was
interfering with the and vomiting restrained to
signal transmission nausea and
between vestibular vomiting.
apparatus of the inner
ear and the vomiting
centre of the
hypothalamus. The
disparity of signal
processing between
inner ear motion
receptors and the
visual senses is
abolished, so that the
confusion of brain
whether the individual
is moving or standing
 is reduced.
Ranitidine Antacid/ Anti-ulcerant 08-06-08 The patient was
relieved.
Competitively inhibits Decreased the
action of histamine on amount of acid in the Epig pain?
the H2 at receptor stomach.
sites of parietal cells,
decreasing gastric acid
secretion.

Nursing Responsibilities

Prior:
1. Verify doctor’s order.
2. Remember the 10 Rights of giving medication.
3. Explain to patient the importance and purpose of drugs.
4. Document the indication for therapy, onset of symptoms, other agents used and anticipated treatment
period.
5. Assess stomach pain, noting characteristics frequency of occurrence and things that alter it.
During:
1. Check patient identification before administering the drug.
2. Recheck the order and note the expiration date of the drug.
3. Give the drug and stay with the patient’s side while taking the drug in order to make if the patient
comply with medication prescribed.

After
1. Monitor vital signs
2. Maintain adequate hydration.
3. Report as scheduled to determine extent of healing and expected length of therapy
4. Document the drug given.
c. Diet
Date Client’s response
Type of Diet Ordered General Description Indication(s) or and/or reaction to the
Date Purpose(s) activity/exercise
Started
Date
Changed

NPO 08/04/08 to Nothing Per To prevent aspiration The patient complies

08/05/08 Orem/Nothing Via of food and fluid with the diet.
Mouth. A patient before and during
care instruction surgery
advising that the (Cholecystectomy).
patient is prohibited
from ingesting food,
beverage, or
medicine. It is
usually posted above
the bed of a patient
who is about to
undergo surgery or
special diagnostic
 procedures requiring
that the digestive
tract is empty or who
is unable to tolerate
food and fluids by
mouth (MOSBY’S
DICTIONARY of
medicine, nursing
and allied health).

Soft Diet 08/06/08- A diet that is soft in To provide the The patient complies
08/07/08 texture, low in essential nutrients with the diet.
residue, easily need by the body in
digested, and well the form of liquids
tolerated. The diet and semisolids such
is most commonly as milk, fruit juices,
intended for patient eggs cheese and etc.
who undergone The soft diet is
surgery designed to decrease
(Cholecystectomy). peristalsis and avoid
irritation of the
 gastrointestinal tract.

Nursing responsibilities:

Prior:
1. Food and fluid intake should be avoided when NPO.
2. Verify doctor’s order
3. Discuss the importance of the ordered diet

During:
1. Provide comfort measures such as stretching of bed linens and assist the client to a comfortable
position
2. Support the patient if he/she has hard time it taking diet.

After:
1. Monitor client’s reaction
2. Assess for patient’s condition, how he respond to the diet
3. Record procedure done
 D. Activity
Date Client’s response
Type of Exercise Ordered General Description Indication(s) or and/or reaction to the
Date Purpose(s) activity/ exercise
Started
Date
Changed

Complete Bed Rest 08/04/08- Lying on bed and no To facilitate relaxation The patient complies
08/05/08 ambulation and comfort to the with the
patient after surgery. exercise/activity.

Deep Breathing 08/06/08- Movements used to To improve ventilation The patient complies
Exercise 08/07/08 improve pulmonary and gas exchange. with the
gas exchange or exercise/activity.
maintain respiratory To promote lung
function, especially expansion
after prolonged
inactivity or general
anesthesia.
Incisional pain after
surgery in the chest
or abdomen often
inhibits normal
respiratory
movements
(MOSBY’S
DICTIONARY of
medicine, nursing
and allied health).
Nursing Responsibilities:

Prior:
1. Check the doctor’s order.

During:
1. Provide comfort measures such as stretching of bed linens.
2. Assess patient’s level of the patient.
3. Assure the safety of the patient.
4. Stop the exercise immediately if there are any physiologic changes.
5. Let the patient take a rest a few minutes to prevent fatigue.

After:
1. Assess patient responses to the exercise/activity.
 VII. N U R S I N G CARE PLANS

1. Impaired Physical Mobility

Cues Nursing Scientific Objective Nursing Rationale Evaluation

Diagnosis Explanation Interventions
S: 0 Impaired Cholecystecto After 2-3 Established To gain trust After 2-3
physical my, the hours of rapport and hours of
O: the patient mobility surgical nursing confidence of nursing
may manifest related to removal of the intervention, patient interventions,
pain as gallbladder, the patient Monitor and the patient
Limited range evidenced by performed to will be able to record vital Provide a will
of motion discomfort treat participate in signs baseline data participate in
cholelithiasis activities that of the patient activities that
Inability to and can provide Identify can provide
perform cholecystitis. safety diagnosis that Ascertain safety
simple Under general measures contributes to contributing measures
activities anesthesia, through the immobility or causative through the
without the the gallbladder health factors health
aid of other is excised and teachings. Assess teachings.
people such cystic duct degree of To determine
as turning ligated; the pain by patient's
and moving common duct listening to description of
is searched, patients pain felt
Uncoordinate and any description of
d movements cholecystecto pain during
resulting from my is done as movement
slow activities a laparoscopic
performed procedure. Determine To identify
This procedure degree of individual
Verbalization can cause pain immobility therapeutic
of difficulty in on the RUQ treatment
moving and due to the appropriate to
performing surgical the client
simple incision after based on his
activities the surgery. level of
immobility
Identify a pain Encourage
scale of 8 (0- verbalization To assess
10) being of feelings patients
perceived by and thoughts understandin
the patient g of disease
during condition
movement Observe non-
verbal cues To note any
Irritability and and incongruence
facial movements with reports
grimaces in of abilities
doing little
movements Assist patient To aid
to reposition patients
self on a comfort
more ability despite
comfortable disease
position condition

Support
affected body To maintain
parts with position and
pillow, reduce risk of
mattress and pressure
water bed. ulcers

Provide rest
periods in To prevent
between fatigue and
while conservation
performing of energy
therapeutic
treatment
regimen

Discuss To motivate
discrepancies patient in
in movement practicing the
when patient provided
is aware and treatment
aware of regimen
observation
and methods
in dealing
with
immobility
due to pain
felt
 2. Impaired Tissue Integrity

Cues Nursing Scientific Objective Nursing Rationale Evaluation

Diagnosis Explanation Interventions

S=∅ Impaired Impaired After 3 hours Assist with To promote Patient was
Tissue Tissue of nursing general comfort and a able to do
O=patient Integrity Integrity intervention hygiene and sense of well- the desired
may related to occurs when the patient comfort being. activities
manifest: cholecystecto there is will be able measures. with
my as disruption of to assistance.
pain and evidence by skin and participate To avoid
numbness destruction of tissues. Due willingly in Warn against potential for
on the skin and to activities tampering infection.
surgical tissue layers. cholecystecto that can with the
incision site. my, a surgical promote wound or
Chilling, removal of the healing and dressings. To reduce the
Perspiration gallbladder it prevent risk of
, Dyspnea, is done to complication Maintain spreading
Immobility, remove with infection disease.
Restlessnes gallstones or assistance. control
to remove an standards
s infected of and
inflamed emphasize
gallbladder in the These
order to importance of measures
relieve pain handwashing. reduce
and infection. pressure,
promote
Position circulation
patient for and avoid
comfort and skin
minimal breakdown.
pressure on
bony To avoid skin
prominences. injury.

Change her To prevent

position at the spreading
least every 2 of
hours. microorganis
ms.
Monitor
frequency of To avoid skin
turning and injury.
skin
condition. To prevent
Remind the spreading
patient not to of
scratch. microorganis
ms.
Clean and
dress the
surgical
incision site
using the
principles of To hasten
sterility or wound
medical healing and
asepsis. increase
resistance.
Encourage
patient to
 increase
protein and
vitamin C
intake.

3.Knowledge Deficit

Cues Nursing Scientific Objective Nursing Rationale Evaluation

Diagnosis Explanation Interventions

S=O Knowledge Deficiency of After 2 hours Ascertain To know the Patient was
deficit cognitive of nursing level of level of able to
O = The related to information intervention knowledge knowledge of participate in
patient may unfamiliarity related to the patient including the patient activities on
manifest with specific topic will be able anticipatory how to follow
inaccurate information to make to participate needs accurate
follow resources as inform in activities To give instruction.
through of evidenced by choices on how to Identify health
instruction, lack of regarding follow support teaching to
inadequate immediate condition, accurate person/ SO the SO if the
performance recognition of treatment, instruction. requiring patient is not
of test the patient’s lifestyle intervention that coherent
condition change.
Provide an Providing
environment good
that is environment
conducive to to the patient
learning enables him
or her
participate
and can
easily
understand
and
Give health comprehend
teachings health
about the teachings
illness, in the
level of To give
patient’s health
understandin teaching in a
g simple
manner in a
way that the
patient will
understand it
to his/her
level of
capabilities
4.Risk for Infection

Cues Nursing Scientific Objective Nursing Rationale Evaluation

Diagnosis Explanation Interventions

S=O Risk for Risk for After 2 hours Establish To gain The patient
infection infection of nursing rapport patient’s was able to
O = The related to means that interventions trust and participate in
patient may post surgical the person , the patient cooperation activities
manifest procedure has increased will be able that will
possibility of to participate Monitor and To have verbalize
fever, being in activities record vital baseline data understandin
Chills, invaded by that will signs on the g of different
flushed skin, pathogenic verbalize treatment intervention
diaphoresis, microorganis understandin process to reduce the
the wound m. It will g of different risk for
may be cause intervention Assess To note for infection.
inflamed, decrease to reduce the patient’s etiology
with edema, production of risk for condition precipitating
erythema, WBC leading infection. factors that
and pus to weak causes risk
draining. immune for infection
defenses.
Broken skin To assess
or Note for signs contributing
traumatized and factors and
tissues or symptoms of immediately
stasis of body sepsis ( fever, provide the
fluids in the chills, necessary
wound diaphoresis intervention
predisposes and altered
the person to level of To reduce
invasion of consciousness existing risk
pathogens factors
coming from Maintain
environment, sterile
thus technique in To maintain
increasing cleansing the aseptic
the risk for wound technique
infection.
Stress proper
hand washing
techniques by
all caregivers To hasten
between wound
therapies healing and
increase
Encourage resistance
patient to
increase
protein and
vitamin C
intake
5.Risk for Ineffective Breathing Pattern

Cues Nursing Scientific Objective Nursing Rationale Evaluation

Diagnosis Explanation Interventions

S = “mika Risk for Most acute After 2 hours Establish To gain Patient was
allergy ku, ineffective pulmonary of nursing rapport patient’s able to
mengalbag breathing deterioration interventions trust and participate in
ya ing lupa pattern is preceded , the patient cooperation activities
ku related to by a change will be able that will help
. allergy as in breathing to participate Monitor and To have her to be
O = The evidenced pattern. in activities record vital baseline data free from any
patient the presence Respiratory that will help signs on the further
manifested of swelling. failure can be her to be treatment allergic
swelling on seen with a free from any process reactions.
face change in further
especially respiratory allergic Provide To protect
eyes, rate, change reactions. comfort the pt. from
itchiness on in normal measures having
wrist. abdominal such as wrinkled bed
and thoracic stretching of sheets, this
patterns for bed linens can lead to
inspiration bed sore.
and
expiration, To note for
change in Assess etiology
depth of patient’s precipitating
ventilation condition factors that
(Vt), and causes risk
respiratory for
alternans. ineffective
Breathing breathing
pattern pattern
changes may
occur in a To assess
multitude of Note for signs contributing
cases from and factors and
hypoxia, symptoms of immediately
heart failure, alterations in provide the
diaphragmati depth of necessary
c paralysis, breathing. intervention
airway
obstruction, To assist
infection, client to
neuromuscul Instruct the explore
ar pt. to put a methods for
impairment, pillow to alleviation or
trauma or support the control of
surgery incision site pain
resulting in when
musculoskele coughing or
tal sneezing & to
impairment turn side to
and/or pain, side. To limit the
cognitive impact on
impairment Instruct to client’s
and anxiety, avoid eating breathing
metabolic foods(seafood that may
abnormalities s) and require
(e.g., diabetic exposing self avoidance or
ketoacidosis to modification
[DKA], environmental of lifestyle
uremia, or factors(dust, and
thyroid severe environment.
dysfunction), weather,
peritonitis, perfumes,
drug animal fur,
overdose, household
and pleural chemicals,
inflammation. second-hand
smoke) that
will trigger the
allergic
reaction and
to be aware of
NSAID’s (Non
Steroidal Anti-
Inflammatory
Drugs)
 VII. H E A L T H TEACHINGS

Cholelithiasis is the fifth leading cause of hospitalization among adults

and accounts for 90% of all gallbladder and duct diseases (Disease hand
book; Lippincott Williams and Wilkins). No one is exempted from acquiring
the disease no matter what is your race, gender or status in life.

The group provided some health teachings and ways to prevent

complications and to prevent acquiring cholelithiasis. First dietary change,
diet is very important in maintaining a healthy body. Proper diet and right
information about healthy foods is a great help in maintaining healthy body
and gallbladder. As certain saying goes “What you eat, is what you get”. If
proper diet is maintained and nutritious foods are only being taken by
individuals they are least likely to acquire the disease and other kind of
diseases.

Cholesterol is the primary ingredient in most gallstones. Some doctor’s

also suggest avoiding eggs, either because of their high cholesterol content.
A recent study of residents of southern Italy found that a diet rich in sugars
and animal fats and poor in vegetable fats and fibers was a significant risk
factor for gallstone formation. Eggs, pork, and onions were also reported to
be the most common triggers.

Most studies report that vegetarians are at low risk for gallstones. In
some trials, vegetarians had only half the gallstone risk compared with meat
eaters. Vegetarians often eat fewer calories and less cholesterol. They also
tend to weigh less than meat eaters. All of these differences may reduce
gallstone incidence

Coffee increases bile flow and therefore might reduce the risk of
gallstones. In a large study of men, those drinking two to three cups of
regular coffee per day had a 40% lower risk of gallstones compared with
men who did not drink coffee. In the same report, men drinking at least four
cups per day had a 45% reduced risk. People at risk for gallstones who wish
to consider increasing coffee drinking to reduce risks should talk with a
doctor beforehand.

Constipation has been linked to the risk of forming gallstones. When

constipation is successfully resolved, it has reduced the risk of gallstone
formation. Wheat bran, commonly used to relieve constipation when
combined with fluid, has been reported to reduce the relative amount of
cholesterol in bile of a small group of people whose bile contained excessive
cholesterol (a risk factor for gallstone formation). The same effect has been
reported in people who already have gallstones. Doctors sometimes
recommend two tablespoons per day of unprocessed Miller’s bran; an
alternative is to consume commercial cereal products that contain wheat
bran. Bran should always be accompanied by plenty of fluid.

Second, Lifestyle also adds up on the possibility of acquiring the

disease. Obese women have high risk of forming gallstones compared with
women who are not overweight. Weight loss plans generally entail reducing
dietary fat but it should be done gradually. Exercise also help in maintaining
appropriate body figure that lessen the susceptibility of having the disease.

Third, Vitamin intake, Vitamin C is needed to convert cholesterol to bile

acids such conversion reduce gallstone risk. Fourth, herbs may also be
helpful to reduce gallstone formation. Milk thistle extracts in capsules or
tablets may be beneficial in preventing gallstones. In one study, silymarin
(the active component of milk thistle) reduced cholesterol levels in bile,
which is one important way to reduce gallstone formation. People in the
study took 420 mg of silymarin per day.
 VIII. L E A R N I N G DERIVED

It is important that one has knowledge about the body’s function and
responses toward certain stimuli in the environment; this is to understand
how different factors affect health and wellness of a person. Health teaching
is a vital care to clients/patients, and a nurse must understand the conditions
affecting the human body to initiate appropriating teaching plans.

In this study, it is focused on the Colelithiasis which is one of the

most common gastrointestinal disorders. It is the presence of gallstones in
the gallbladder. It can occur anywhere within the biliary tree, including the
gallbladder and the common bile duct. It is caused by stones form when
there is too much cholesterol or bilirubin in the bile. Other stones form if
there are not enough bile salts or if the gallbladder fails to empty properly.
Symptoms usually start after a large stone blocks the cystic duct or the
common bile duct. Stones blocking the lower end of the common bile duct
(where it enters the duodenum) may obstruct secretion from the pancreas,
producing pancreatitis. This condition can also be serious and may require
hospitalization.

Modern advances in surgery have revolutionized the treatment of

gallstones. In general, surgery is used only if you have symptoms. In the
past, open cholecystectomy (gallbladder removal) was the usual procedure
for uncomplicated cases. Today, a minimally-invasive technique called
laparoscopic cholecystectomy is most commonly used. This procedure uses
smaller surgical cuts, which allows for a faster recovery.

This study helped the students understand the importance of taking

care of one self, each part belongs to an intersystem of physiologically
functioning body- the human body. Furthermore, it is stressed that person
should be aware on whatever they feel within their body. Every individual
should be conscious to what is happening within their environment that can
be a factor of getting any diseases that could harm them.

The student nurses were able to meet their objectives. They were able
to understand the pathophysiology of the disease which is the Colelithiasis
and its pharmacology. They had also gathered data upon assessment that
had helped in the accomplishment of the study. This case study contributed
a lot in the knowledge of the student nurses which can be helpful for their
intended course.
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Stedman's Medical Spellchecker, © 2006 Lippincott Williams & Wilkins.

Professional Guide to Diseases (Eighth Edition), Copyright © 2005

Lippincott Williams & Wilkins. Professional Guide to Diseases (Eighth Edition),

Copyright © 2005 Lippincott Williams & Wilkins.

Medical-Surgical Nursing: Health and Illness Perspectives by Wilma J. Phipps

www.wrongdiagnosis.com/medical/cholecystolithiasis.htm

http://medical-dictionary.thefreedictionary.com/cholecystolithiasis

http://answers.yahoo.com/question/index?qid=20060831234007AAwH6VA