Calculous Cholecystitis

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Transcript of Calculous Cholecystitis

Calculous CholecystitisA Case Study Presented to the Faculty, Ateneo de Davao Universi ty College of Nursing

Submitted to: Daphny Grace Peneza, R.N., R.M., M.N. Clinical Instructor Panelist for the Case Study Submitted by: Gino Gregor Palaca Marvin Rey Andrew Pepino Rio Remonde Kevin Melvin Roa Krystle Rustia BSN-3H-4a

May 25, 2010

TABLE OF CONTENTS

I.Introduction ................................................................................................ 1 II.Objectives (General & Specific) ................................................................. 3 III.Patients Data.............................................................................................. 6 IV.Family Background and Health History ................................................... 7 V.Definition of Complete Diagnosis............................................................... 14 VI.Developmental Data ................................................................................... 17 VII.Physical Assessment ................................................................................... 26 VIII.Anatomy and Physiology ............................................................................ 34 IX.Etiology and Symptomatology ................................................................... 37 X.Pathophysiology .......................................................................................... 47 XI.Doctors Order ............................................................................................ 50 XII.Diagnostic Exam ......................................................................................... 62 XIII.Drug Study .................................................................................................. 72 XIV.Procedural Report ...................................................................................... 87 XV.Nursing Theories ........................................................................................ 94 XVI.Nursing Care Plan ...................................................................................... 100 XVII.Discharge Plan (M. E. T. H. O. D.) & Prognosis ....................................... 123 XVIII.Recommendation ........................................................................................ 130 XIX.References ................................................................................................... 133

ACKNOWLEDGMENT

The Group 4-1 of section 3H, would like to acknowledge the contributions of the following groups and individuals to the development of this case presentation. To the Almighty God for blessing them with wisdom, competence and genuine passion and giving them the strength to finish this presentation. The group dedicates to Him the fruits of their hard-earned achievement. To the staff of the Davao Medical School Foundation Hospital-3C for being accommodating to the students and for giving them additional teachings during their exposure in the said hospital. They have also been very willing to allow the students to obtain records necessary for this presentation. To their respected clinical instructor for this rotation, Daphny Grace Peneza, R.N., R.M., M.N., for her support and guidance to the group. She has imparted knowledge that would furthermore enhance the students understanding of their patients case, thus making them ready to present this case presentation. To their client, Meg, and her family, for being open and generous enough to

disclose personal information that would be helpful for this study. The group would also like to thank them for their patience throughout the duration of the study and for giving the group the opportunity to care for Selecta and apply what they have learned. To the proponents respective family and friends for their prayers as well as their financial support. They have also been a source of inspiration of the students. To the members of this group for working hard and giving their efforts, time and resources in conducting the study and for the completion of the written output.

INTRODUCTION One of the body organs that we can live without is the gallbladder. However, does this mean it is of no use to the body? The gallbladder is a pearshaped organ situated underneath the liver. Its function is to store bile and release it as needed for digestion. Bile emulsifies the fats in food, breaking them to small fragments so they can be further digested and absorbed in the small intestine. If the gallbladder is not working as it should, the digestion of fats can be seriously impaired. One of the common gallbladder diseases is calculous cholecystitis. Calculous cholecystitis is a condition wherein gallstones obstruct the gallbladder outlet leading to poor drainage of bile. Trapped bile can irritate and inflame the walls of the bladder, thus leading to inflammation. Calculous cholecystitis is the cause of more than 90% of cases of acute cholecystitis (Feldman, Friedman & Brandt, 2006). It affects women more often than men and is more likely to occur at the age of 20-50 or over 60. Asians are also more prone to develop pigment stones. Moreover, people who are obese and those who had had low fat diet are at an increased risk for developing cholelithiasis. In the United States, it is estimated that 6.3 million men and 14.2 million women aged 20 to74 had gallbladder disease (Everhart, Khare, Hill, Maurer, 1999). In the Philippines, an extrapolated prevalence of 5, 073, 040 people are affected by the disease (http://digestive.niddk.nih.gov/statistics). Gallstones that do not cause symptoms do not require treatment. However, if gallstones cause, disruptive, recurring episodes of pain, surgical removal of the gallbladder is recommended. Recently, the Group 3H-4a had a patient who was diagnosed with symptomatic calculous cholecystitis and underwent laparoscopic

cholecystectomy. The group chose this case for they see it fit for their perioperative concept. Rarely do they interact with patients who had minimally invasive surgery. The proponents are hoping that through this case study, they will be more knowledgeable and aware about such gallbladder disorder and the surgical procedure done for the said disease. They are also interested to knowPage | 1

the proper and necessary nursing management that will be given to a patient affected by the disease. Moreover, they would also like to impart their learning to their families and their community regarding the prevention and care if ever such condition will arise in the scenario. As nursing students, they are hoping that this study will help them become more efficient and better nurses in the future. The student nurses also hope to apply their learning in taking care not only of their patients but of themselves as well.

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OBJECTIVES General objective: Within 2 weeks exposure to various clinical areas, the group should have been able to present a comprehensive case study which explains the pathology, the treatment and the appropriate medical and nursing management regarding the condition of their chosen client. The group also aims to perform the necessary nursing interventions to help alleviate the patients condition and improve her health. Specific Objectives: The proponents also created certain aims that will help them in achieving their general objectives. Within 2 weeks of exposure, the proponents aim to: Cognitive: Gather pertinent data regarding the past and present health history of the patient through interview and assessment; Draw the family genogram of the patient; Define the complete diagnosis of the patient by directly citing it from three different sources; Ascertain the patients developmental status using the theories of Robert Havighurst, Erik Erikson and Lawrence Kohlberg; Conduct a thorough cephalocaudal assessment obtained from the client; Review the anatomy and physiology of the organs affected in the patients disease; Present the etiology and symptomatology of the disease; Trace the pathophysiology of the patients disease; Obtain the doctors orders and make rationales for each order;

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Obtain, analyze and interpret laboratory and diagnostic procedures done on the patient and include the normal and abnormal values and findings for comparison, and the specific nursing responsibilities associated with each diagnostic procedure; Make drug studies on each drug given to the client, correlate them with the disease process, explain why such drugs were ordered, and present important interventions in administering the drug; Identify three nursing theories that can be applied to the patients condition; Present specific, measurable, attainable, realistic, and time-bounded nursing care plans for the patient; Correlate the different nursing theories with the nursing care plans that are presented in this case study; Make a discharge plan for the patient with the use of M.E.T.H.O.D.; Validate patients prognosis according to the following categories: onset of illness, duration of illness, precipitating factors, willingness to take medications and treatment, age, environmental factors and family support; Broaden our scope of knowledge about the disease and the appropriate Nursing Care for the patient with the disease; Psychomotor: Find a patient who will be the subject of their case presentation; Render health teachings to the patient and her significant others to promote health; Provide care based on the various nursing care plans formulated by the researchers and the patient herself;

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Share information about calculous cholecystitis and the factors that cause the development of such disease and its complications; Share how the disease affects those affected by it and the systems involved in its occurrence; Affective: Establish rapport with the patient and significant others;