Cholecystits/Cholelithiasis

PATHOPHYSIOLOGY medical checkup Diagnosis Cholecystitis/Cholelithiasis Nursing Diagnosis Activity intolerance r/t laparoscopic type AB incisions AEB SOB during ambulation, increased respirations at 38, O2 sat 80% direction air after walking 50 ft. Normal Physiology The gall bladder is locate inferior to the coloured. The gallbladder is a structure that functions as a retentiveness space for bile that is produced in the liver. The liver produces and secretes bile into the gallbladder from the veracious and left hepatic duct join together to become the park hepatic duct then into the gallbladder via the cystic duct.During the digestion of fatty food, the gallbladder releases bile that passes through the parking lot bile duct and into the duodenum through the sphincter of Oddi to break down fat into fatty acids to be absorbed by the small intestine to be aimd as energy and storage of energy for metabolic take ups of the body. Pathophysiology Cholecystitis, and inflammation of the gallbladder, is a condition which stop be caused by cholelithiasis, the formation of gallstones. Most stones ar formed of cholesterol. extra cholesterol in bile is associated with obesity, high cholesterol discloset and drugs that are prescribed to lower cholesterol take aims.The repletion saturation of cholesterol pile petabyte to the formation of stones. This invitee had an elevated LDL and low alpha-lipoprotein levels that do state the node had excess cholesterol. Biliary stasis, which is slow change of the gallbladder, ass also cause the formation of stones. An inflammation of the gallbladder allows for excess water and bile salt reabsorption which call also lead to the formation of stones. This guest did have wall thickening and distention of the gallbladder that indicates a inflammation of the gallbladder oer a period of time.This is the atomic number 16 time the lymph gland came to the ER with torture in a 6 week period. Potential Complications If a g allstone migrates out of the gallbladder into the ducts, it butt end lead to cholangitis which is an inflammation of the duct. Obstruction of the common bile duct may cause bile reflux into the liver causing pain, jaundice, and liver damage. The customers ALT, liver function test was elevated indicating liver disease process and in this clients case it is due to the back-up of bile into the liver from obstruction in the common bile duct.The client can also have pancreatitis due to the unfitness of the pancreas to secrete digestive enzymes through the pancreatic duct. The client had mild pancreatitis affirm by CT scan. Complications of the cholecystitis/cholelithiasis can lead to a collection of septic fluid within the gallbladder, gangrene, and perforation resulting in peritonitis or abscess formation. A fistulous withers into adjacent organs can for such as in the duodenum the colon or stomach. During the laparoscopic cholecystectomy, the clients gallbladder was noted with g angrene save no perforation, peritonitis, fistula or abscess formation was noted.If this condition goes untreated, death can result from hemorrhage, peritonitis, hypovolemic shock, septicemia and septic shock. The client did not die because treatment and surgery was performed. Nursing Interventions & Rationales Independent 1. Ambulate with client 11 assist. The client should not ambulate alone. The client is at peril for falls for injury to do her activity intolerance for SOB and lessen O2 sats. This lead break the client does not fall and if she does become worn out or unstable it go away reduce the injury. . Place the client in semi-fowler during resting time in bed. This will decrease orthopnea and champion the client steer remediate by decreasing pressure on the diaphragm allowing for better expansion of the lungs. 3. Monitor respiratory status and auscultate lung sound each 4 hours. This will succor assess interventions and any changes needed for their respiratory s tatus. Dependent 4. Monitor and assess clients clients O2 sat level and administer O2 at 2L NC per physicians orders. The clients O2 Sat had been at 80% room air nd after activity with O2. This will help monitor client needs and evaluate the need for any changes this client may need for a decrease or increase in O2 delivery. 5. assign morphine sulfate 1-5 mg IV push as needed q2h over 2 minutes. Administering pain meds can help decrease pain associated with the client needing to cough and deep breath and will help the client ambulate. Although the client has not indicated much pain, giving prior to activity will help the client tolerate ambulation, cough and deep breath and spirometer. 6.Administer Cefoxitin 1 gm in 100mg/NaCl 0. 9% over 1 hr q8h per physicians orders. The administration of antibiotics will reduce the client chance for peritonitis from gangrene of the gallbladder and risk of infection form the surgery. This will also help with healing of the clients mild pancreat itis noted on CT scan Interdependent 7. Collaborate with dietician to meet with the client regarding diet. In a client with the removal of the gallbladder, the client needs to be better on the types of food to avoid after surgery.This will help mention what types of foods the client can continue to enjoy and those that will facilitate abdominal problems post cholecystectomy. Ensuring the family is also involved when the dietician is present will help increase the likelihood of adhering to a new diet holding the client accountable for food choices. 8. Collaborate with respiratory therapy to assess the need for respiratory assistance such as the need for nebulizer treatment or the need for portable O2 for ambulatory purposes. The clients O2 quickly drops after winning D/C of O2. 9.Collaborate with occupational therapy to assess the ability for the client to go hearthstone. The client is an elderly lady and may need to be evaluated prior to discharge to assess ADLs since she lives on her own. This will ensure the client can safely return home or may need to be transferred to rehab prior to going home and educate the client on throw rugs, shower use and other in home dangers that elderly clients are at risk for. invitee Teaching take the client on the need to cough and deep breath and spirometry. The client has had SOB post op and decreased O2 saturation.The client has atelectasis in her right pep pill lobe with diminished lung sounds throughout with decreased expiratory effort. I educated the client on coughing and deep breathing every hour x10 and how to use the pillow for splinting her abdomen due to abdominal pain post operatively. Client understood and demonstrated this very well and prior to end of throw I assessed the client and had her demonstrate what I had taught her prior to leaving and she performed right on and also stated she had been doing it every hour as instructed. Textbook Signs & Symptoms . Pain, keen onset, severe and steady 2. Pain radiate to the back, right scapula and lift lasting from 12-18 hours 3. Nausea, vomiting and anorexia 4. Chills and fever 5. Abdominal guarding Risk Factors 1. Female over age of 65 2. Family history 3. Native American northern European heritage 4. Obesity 5. Hyperlipidemia 6. Use of oral contraceptives 7. Biliary stasis pregnancy, self-control or prolonged parenteral nutrition 8. Diseases or condition DM cirrhosis ileal disease or resection sickle cell anemiaReferences Domino, F. n. d. ). 5-minute clinical chew the fat Powered by Skyscape (Ipod). Lippincott, WIlliams & Wilkins. LeMone, P. , Burke, K. , & Bauldoff, G. (2011). Medical-surgical nursing care critical thinking in patient care (5th ed. ed. ). Upper Sadle River, NJ Pearson Education. Martini, F. H. , & Neth, J. L. (2009). Fundamentals of anatomy and physiology (Eight ed. ). San Fransisco Pearson gum benzoin Cummings. Pagana, K. , & Pagana, T. (2009). Mosbys diagnostic and laboratory test reference (Ninth ed. ). St. Lo uis, Missouri, United States Mosby Elsevier.