Nursing care plan cholecystitis with cholelithiasis

I. Pathophysiology—An acute or chronic inflammation of the
gallbladder associated with obstruction by gallstones
a. Common bile duct stones are formed in the bile duct
(primary) or formed in and transported from the gallbladder
(secondary).
b. Cholelithiasis is usually asymptomatic.
c. Cholecystitis can result if stone becomes lodged in one of
the ducts.

II. Etiology
a. Stones most often develop in and obstruct the common bile
duct or the cystic duct; also found in the hepatic, small bile,
and pancreatic ducts.
i. Ninety percent of cases involve stones in the cystic duct
(calculous cholecystitis), whereas the other 10% involve
cholecystitis without stones (acalculous cholecystitis)
(Gladden & Migala, 2007).
ii. Stones are made up of cholesterol, calcium bilirubinate,
or a mixture caused by changes in the bile composition.
b. Bile cultures are positive for bacteria in 50% to 75% of
cases; however, bacterial proliferation may be a result or
consequence of cholecystitis, but not the precipitating
factor (Gladden & Migala, 2007).
c. Other causes include stasis of bile or bacterial infection or
ischemia of the gallbladder.
d. Failure to remove impacted stone can lead to bile stasis or
bacteremia and septicemia causing cholangitis—a medical
emergency.

III. Statistics (Gladden & Migala, 2007)
a. Morbidity: Gallstones are two to three times more frequent
in females than in males; perforation occurs in 10% to
15% of cases, and 25% to 30% of clients either require
surgery or develop complications.
b. Mortality: An estimated 10,000 deaths occur annually;
about 7,000 deaths are a result of gallstone complications,
such as acute pancreatitis. With calculous cholecystitis,
there is an expected 4% mortality rate; with acalculous
cholecystitis, a 10% to 50% mortality rate.

Care Setting
Severe acute attacks may require brief hospitalization on a
medical unit. This plan of care deals with the acutely ill,
hospitalized client. Surgery is usually performed after symptoms
have subsided, but during the hospitalization, for acute
illness. (Refer to CP: Cholecystectomy.)

Related Concerns
Cholecystectomy
Fluid and electrolyte imbalances
Psychosocial aspects of care
Total nutritional support: parenteral/enteral feeding

Nursing Priorities
1. Relieve pain and promote rest.
2. Maintain fluid and electrolyte balance.
3. Prevent complications.
4. Provide information about disease process, prognosis, and
treatment needs.

Discharge Goals
1. Pain relieved.
2. Homeostasis achieved.
3. Complications prevented and minimized.
4. Disease process, prognosis, and therapeutic regimen
understood.
5. Plan in place to meet needs after discharge.

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