Cholecystitis

• What are the risk factors for cholecystitis?

  • obesity
  • female
  • Age > 40
  • Rapid weight loss
  • Fatty foods
• What does the labs look like for a patient experiencing cholecystitis?

  increased WBC, LFTs, amylase, lipase
• What are the symptoms of cholecystitis?

  • RUQ pain radiates to R shoulder [sharp, colicky]
  • onset after high fat or large meal (1 - 6 H)
  • Nausea & vomiting
  • belching, bloating
  • Fever
• What are the initial goals of treatment for cholecystitis?

  Restore fluid and electrolyte balance --> pain ---> antibiotics
• What is the priority nursing dx that should be treated in cholecystitis?

  Fluid volume deficit

  • treat with IVF for rehydration
  • antiemetics
• What is the treatment plan for a patient with cholecystitis?

  • NPO (bowel rest) = allows GB to relax, stop spazzing
  • Knowledge deficit: low fat diet after attack & F/U w/ GI consult  
  • Pain: non-pharm/pharm methods  
  • Abx to dec inflammation and tx possible bile infection 
• How does the nurse manage post-op laparoscopic cholecystectomy risk for infection?

  • Monitor incisions 
  • Monitor for peritonitis** most serious  
• What are the main nursing dx to consider when caring for post-op laparoscopic cholecystectomy?

  • Risk for Infection 
  • Pain
  • Knowledge Deficit = Educate/Discharge instructions 
• How does the nurse relieve pain r/t laparoscopic cholecystectomy?

  Walking or heating pad to relieve gas under diaphragm referring to shoulder
• What are some teaching to provide the post-op laparoscopic cholecystectomy patient?

  • Low fat diet required for 4 - 6 weeks
  • Shower after 1 – 2 days; no tub baths  
  • Lap consent includes option for open repair if needed 
  • Home same day; resume normal activity within 3 days; work within 1 week  
  • Sx to call MD [fever, sx of peritonitis or wound infection] 
• What are some nursing dx and care to consider for post-op open cholecystectomy?

  • Risk for infection 
  • Pain ~ administer pain meds as ordered for incisional pain 
  • DVT prevention 
  • Monitor for BM until bile enter duodenum, first post-op stool may be clay colored  
•  What is some nursing care to be provided If there is a T-tube in post-op open cholecystectomy?

  • Maintain pt in Semi-fowlers 
  • Monitor drainage [serosang first 24H but should be bile] 
  • Clamp 1 – 2 H ac & pc  
  • Client Education for home care 
  • Sx of infection or dislodgement (jaundice, peritonitis) 
  • Avoid tugs at site, keep drain dependent 
  • May shower but no baths