I. INTRODUCTION

Cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining.

Cholecystitis is usually caused by a gallstone in the cystic duct, the duct that connects the

gallbladder to the hepatic duct. The presence of gallstones in the gallbladder is called

cholelithiasis. Cholelithiasis is the pathologic state of stones or calculi within the

gallbladder lumen. A common digestive disorder worldwide, the annual overall cost of

cholelithiasis is approximately $5 billion in the United States, where 75-80% of

gallstones are of the cholesterol type, and approximately 10-25% of gallstones are

bilirubinate of either black or brown pigment. In Asia, pigmented stones predominate,

although recent studies have shown an increase in cholesterol stones in the Far East.

Gallstones are crystalline structures formed by concretion (hardening) or accretion

(adherence of particles, accumulation) of normal or abnormal bile constituents.

According to various theories, there are four possible explanations for stone formation.

First, bile may undergo a change in composition. Second, gallbladder stasis may lead to

bile stasis. Third, infection may predispose a person to stone formation. Fourth, genetics

and demography can affect stone formation.

Risk factors associated with development of gallstones include heredity, Obesity,

rapid weight loss, through diet or surgery, age over 60, Native American or Mexican

American racial makeup, female gender-gallbladder disease is more common in women

than in men. Women with high estrogen levels, as a result of pregnancy, hormone

replacement therapy, or the use of birth control pills, are at particularly high risk for

gallstone formation, Diet-Very low calorie diets, prolonged fasting, and low-fiber/high-

cholesterol/high-starch diets all may contribute to gallstone formation.

Sometimes, persons with gallbladder disease have few or no symptoms. Others,

however, will eventually develop one or more of the following symptoms; (1) Frequent

bouts of indigestion, especially after eating fatty or greasy foods, or certain vegetables

such as cabbage, radishes, or pickles, (2) Nausea and bloating (3) Attacks of sharp pains

in the upper right part of the abdomen. This pain occurs when a gallstone causes a

blockage that prevents the gallbladder from emptying (usually by obstructing the cystic

duct). (4) Jaundice (yellowing of the skin) may occur if a gallstone becomes stuck in the

common bile duct, which leads into the intestine blocking the flow of bile from both the

gallbladder and the liver. This is a serious complication and usually requires immediate

treatment.

The only treatment that cures gallbladder disease is surgical removal of the

gallbladder, called cholecystectomy. Generally, when stones are present and causing

symptoms, or when the gallbladder is infected and inflamed, removal of the organ is

usually necessary. When the gallbladder is removed, the surgeon may examine the bile

ducts, sometimes with X rays, and remove any stones that may be lodged there. The ducts

are not removed so that the liver can continue to secrete bile into the intestine. Most

patients experience no further symptoms after cholecystectomy. However, mild residual

symptoms can occur, which can usually be controlled with a special diet and medication.

II. NURSING ASSESSMENT

A. Personal History

Mr. Aproniano Castro is a 56 year old male, a Filipino citizen who resides at Pulong

Santol, Porac Pampanga. He was born on January 22, 1950 at Pulong Santol, his

religious affiliation is Roman Catholic and he is married to Mrs. Brigida M. Castro. He

is a jeepney driver bound in Porac-Angeles route. He is also the president of their

jeepney’s association. Mr. Castro usually works for 10 to 12 hours a day usually around

7am to 7 pm. He always sleeps around 9 in the evening and wakes up at 6 in the morning.

His wife was the one who prepares him the breakfast and the snack. He has day-offs but

uses this day in working as the president of the jeepney association. He usually eats

instant food and love eating foods which has condiment like “patis”, vinegar and soy

sauce. He also love eating vegetable salads and fatty salty food. He is not also choosy on

the food he eats because he really eat a lots. He seldom drinks alcohol and smoke.

Regarding the finances about health he is using his wife’s PHILHEALTH card to

compensate the finances needed. Family Health and Illness History

B. Family Health and Illness History

According to Mr. Castro that the familial disease he knows that they have in their

family was the hypertension that is on his father’s side. His father died because of heart

attack and her mother died of natural cause. He also added that cholecystitis is prone to

their family, because of one of his siblings also had acquired this disease.

C. History of Past and Present Illness

This is the second time Mr. Castro been admitted into this hospital (Porac District

Hospital). On his first admission into this hospital he had undergone throidectomy

operation, which is almost 3 years ago. He had not experience any accident and injuries,

even though his job is prone to accident particularly vehicular accident. He also added

that he had an ashtma when he was 7 years old that lasts when he is 21 years old, his

ashtma just stopped when he start drinking alcohol beverages as he said.

As for his present illness, he was admitted into this hospital because of cholecystitis,

he was admitted last February 13, 2006. He was been diagnosed with cholecystitis with

multiple cholelithiasis a month prior to admission due to severe epigastric pain and

weight loss and was advised to remove his gallbladder. He just did not have his

cholecystectomy done immediately due to financial problem. When the money needed

for his operation was enough he then goes to Porac District Hospital last February 13,

2005 for his operation. He was diagnosed and surgically operated by Dr.

Serrano.According to Mr. Castro. Upon admission he had undergone some laboratory

examination such as UTZ, Chest X-ray, U/A, CBC, FBS, BUN,Creatinine and ECG. His

initial medication were H2bloc and Cefuroxime.

D. Physical Examination

Physical Assessment done by the attending physician reveals that patient is; afebrile with pink palpebral conjunctiva (-) cyanosis (+) NABS non tender abdomen

Vital Signs upon admission (February 13, 2006)BP- 130/90 RR-19 PR-84 Temp-36.5 oC Physical Assessment done by the student reveals that patient is;

afebrile with pink palpebral conjunctiva (+) dry lips (+) paleness (+) dryskin decreased skin turgor (-) bowel movement (-) weakness

Vital Signs taken and recorded as of February 15, 2006 are as follows;BP- 140/90PR- 85RR- 21Temp- 36.4 oC

III. ANATOMY AND PHYSIOLOGY

Gallbladder, muscular organ that serves as a reservoir for bile, present in most

vertebrates. In humans, it is a pear-shaped membranous sac on the undersurface of the

right lobe of the liver just below the lower ribs. It is generally about 7.5 cm (about 3 in)

long and 2.5 cm (1 in) in diameter at its thickest part; it has a capacity varying from 1 to

1.5 fluid ounces. The body (corpus) and neck (collum) of the gallbladder extend

backward, upward, and to the left. The wide end (fundus) points downward and forward,

sometimes extending slightly beyond the edge of the liver. Structurally, the gallbladder

consists of an outer peritoneal coat (tunica serosa); a middle coat of fibrous tissue and

unstriped muscle (tunica muscularis); and an inner mucous membrane coat (tunica

mucosa).

The function of the gallbladder is to store bile, secreted by the liver and transmitted

from that organ via the cystic and hepatic ducts, until it is needed in the digestive process.

The gallbladder, when functioning normally, empties through the biliary ducts into the

duodenum to aid digestion by promoting peristalsis and absorption, preventing

putrefaction, and emulsifying fat. Digestion of fat occurs mainly in the small intestine, by

pancreatic enzymes called lipases.  The purpose of bile is to; help the Lipases to Work,

by emulsifying fat into smaller droplets to increase access for the enzymes, Enable intake

of fat, including fat-soluble vitamins: Vitamin A, D, E, and K, rid the body of surpluses

and metabolic wastes Cholesterol and Bilirubin.

IV. PATHOPHYSIOLOGY

Risk factor

Heredity

Obesity

Rapid Weight Loss, through diet or surgery

Age Over 60

Female Gender

Diet-Very low calorie diets, prolonged fasting, and low-fiber/high-cholesterol/high-starch diets.Bile must become

supersaturated with cholesterol and calcium

The solute precipitate from solution as solid

crystals

Crystals must come together and fuse to form

stones

Gallstones

Obstruction of the cystic duct and common bile duct

Sharp pain in the right part of abdomen

Jaundice

Distention of the gall bladder

Venous and lymphatic drainage

is impaired

Proliferation of bacteria

Localized cellular irritation or

infiltration or both take place

Areas of ischemia may

occur

Inflammation of gall bladder

CHOLECYSTITIS

V. DIAGNOSTIC AND LABORATORY PROCEDURE

1. Complete Blood Count (CBC)

This is to determine blood components and the response to

inflammatory process and streptococcal infection.

Date Ordered: February 13, 2006

Date Result In: February 13, 2006

Results:

WBC - 10.9 g/l

RBC - 5.5 g/l

Lymphocyte - 27

Conclusion:

WBC is slightly elevated based on the normal value of 4.3-10 g/l which

confirms the presence of infection.

2. Fasting Blood Sugar

This is to measure the blood glucose levels.

Date Ordered: February 13, 2006

Date Result In: February 13, 2006

Results:

94.8 mg/dl

Conclusion:

The result is within normal range based on the normal value of < 126

mg/dl.

3. Creatinine

This is the indicator of the renal function

Date Ordered: February 13, 2006

Date Result In: February 13, 2006

Results:

1.0 mg/dl

Conclusions:

The result is within normal range based on the normal value of 0.60-1.7

mg/dl.

4. BUN

This is an indicator of renal function and perfusion, dietary intake of

CHON and the level of protein metabolism

Date Ordered: February 13, 2006

Date Result In: February 13, 2006

Results:

10.7 Mg/dl

Conclusions:

The result is within normal range based on the normal value of mg/dl.

5. Urinalysis

Urinalysis yields a large amount of information about possible disorders of

the kidney and lower urinary tract, and systematic disorders that alter urine composition.

Urinalysis data include color, specific gravity, pH, and the presence of protein, RBC’s,

WBC’s, bacteria, Leukocyte, esterase, bilirubin,glucose, ketones, casts and crystals.

Date Ordered: February 10, 2006

Date Result In: February 10, 2006

Results:

Color- yellow

Specific Gravity- 0.010

Sugar/ Albumin- negative

Pus cells- 0.1 hpf

Conclusions:

The results are normal but there is a presence of pus cells in the urine

which means that there is also the presence of infection.

VI. Patients Care

a. Nursing Care Plan

Preoperative NCP

1. Acute Pain

Cues Nursing Diagnosis

Scientific Explanations

Objectives Nursing Interventions

Rationale Evaluation

S

O- pain scale

of 7/10- difficulty in

moving as manifested by facial grimaces

- (+) pallor- (+) muscle

guarding- RR- 30- BP- 140/90

Acute pain related to inflammation and distortion of the gallbladder as evidenced by verbal reports of pain.

Due to the presence of stones in the gallbladder it causes some obstruction in the cystic duct which in turn causes a sharp acute pain on the right part of the abdomen.

After 4 hours of nursing intervention the patient will report relieve of pain.

1. Observe and document location, severity (0–10 scale),and character of pain (e.g., steady, intermittent, colicky).

2. Promote bedrest, allowing patient to assume position ofcomfort.

3. Control

- Assists in differentiating cause of pain, and providesinformation about disease progression/resolution,development of complications, and effectiveness ofinterventions.

- Bedrest in low-Fowler’s position reduces intra-abdominalpressure; however, patient will naturally assume leastpainful position.

- Cool surroundings

Is there a change on the patients;

a. Pain scale

b. RRc. BPd. Reports

of paine. Facial

expressions.

environmental temperature.

4. Encourage use of relaxation techniques, e.g., guidedimagery, visualization, deep-breathing exercises. Providediversional activities.

5. Make time to listen to and maintain frequent contact withpatient.

6. Administer analgesics as indicated

aid in minimizing dermal discomfort.

- Promotes rest, redirects attention, may enhance coping.

- Helpful in alleviating anxiety and refocusing attention,which can relieve pain.

- Relief of pain facilitates cooperation with othertherapeutic interventions,

2. Fluid Volume deficient

Cues Nursing Diagnosis

Scientific Explanations

Objectives Nursing Interventions

Rationale Evaluation

S

O- (+) pallor- (+) body

weakness- (+)

vomiting- with poor

skin turgor

- (+) dry skin

- (+) dry mouth

Fluid Volume Deficient related to vomiting

Because of vomiting excessive losses through normal routes occur thus causes Fluid Volume Deficient

After series of NI the pt. will maintain adequate fluid volume as evidenced by moist mucous membranes and good skin turgor,

1. Maintain accurate record of I&O, noting output less thanIntake, increased urine specific gravity. Assessskin/mucous membranes, peripheral pulses, and capillaryrefill.

2. Perform frequent oral hygiene

3. Provide skin and mouth care

- Provides information about fluid status/circulatingvolume and replacement needs.

- Decreases dryness of oral mucous membranes; reducesrisk of oral bleeding.

- Skin and mucous membranes are dry, with decreased

Is there still the presence of;

a. vomitingb. dry skinc. dry

mouthd. poor skin

turgore. body

weakness

4. Increase fluid intake

5. Ascertain patient’s beverage preferences, and set up a 24-hr schedule for fluid intake. Encourage foods with highfluid content.

6. Administer antiemetics, e.g., prochlorperazine(Compazine) as ordered by the physician.

elasticity, because of vasoconstriction and reducedintracellular water.- promotes hydration.

- Relieves thirst and discomfort of dry mucous membranesand augments parenteral replacement.

- Reduces nausea and prevents vomiting.

Post-operative NCP3. Knowledge Deficit

Cues Nursing Diagnosis

Scientific Explanations

Objectives Nursing Interventions

Rationale Evaluation

S “pwede bang maulit ang sakit ko” as verbalized by the patient

O- Frequently

asking question about his condition, treatment and diet

- With worried gaze

Deficient knowledge related to condition,prognosis, treatment, self-care, and discharge needs

There is this presence of knowledge deficit due to some unfamiliar information that causes some confusion to the client that needs to be discussed.

After an hour of nurse-patient interaction the patient will Verbalize understanding of disease process, prognosis, and potential complications.

1. Provide explanations of/reasons for test procedures andpreparation needed.

2. Review disease process/prognosis. Discuss hospitalizationand prospective treatment as indicated. Encouragequestions, expression of concern.

3. Review drug regimen, possible side effects.

- Information can decrease anxiety, thereby reducingsympathetic stimulation.

- Provides knowledge base from which patient can makeinformed choices. Effective communication and supportat this time can diminish anxiety and promote healing.

- Gallstones often recur, necessitating long-term therapy.

- Prevents/limits

- Does the patient understands and could recall all the teachings given?

- Is there a significant changes that occur on the patients knowledge regarding;

a. disease condition

b. dietc. treatmentd. medicatione. self-care

needs

4. Instruct patient to avoid food/fluids high in fats (e.g.,whole milk, ice cream, butter, fried foods, nuts, gravies,pork), gas producers (e.g., cabbage, beans, onions,carbonated beverages), or gastric irritants (e.g., spicyfoods, caffeine, citrus).

5. Suggest patient limit gum chewing, sucking on straw/hardcandy, or smoking.

recurrence of gallbladder attacks.

- Promotes gas formation, which can increase gastricdistension/discomfort.

b. Drug Study

Name of Drug Date Ordered

Route/ Dosage and Frequency

Action Indication Adverse Reaction

Nursing Consideration

GN: H2Bloc (Pepcidine)BN: Famotidine

02-13-06 PO20 mg tab at bedtime

- Anti-ulcer- competitively inhibits action of histamine on the H2 at receptor sites of parietal cells, decreasing gastric acid secretion

-for short term treatment of duodenal ulcer

- headache, dizziness, malaise, dry mouth

1. Check for doctor’s order2. not to be given in patients hypersensitive to drugs3. Inform the patient about the possible side effect of the drug4. Instruct patient to take drug with food5. Advised patient to take drug once daily usually at bed time6. Advise patient to report abdominal pain or blood in stools or is vomiting.

GN: CefuroximeBN: Zinacef

02-13-06 IV750 mg every 8o prior to OR (30 to 60 minutes before)

- anti-infective- a 2nd generation cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability

- perioperative prophylaxis

- Nausea and Vomiting

1. Check for doctor’s order2. Perform ANST prior to admission3. Should not be given if positive skin test4. Slow IV push5. Inform the patient about the possible side effect of the drug6. Advise patient to report any discomfort on the IV insertion site

Name of Drug Date Ordered

Route/ Dosage and Frequency

Action Indication Adverse Reaction

Nursing Consideration

GN: Clomipramine HClBN: Placil

02-13-06 PO10 mg tab, at 6 am

- Anti-depressants

- for depression and chronic pain

- headache, dizziness, malaise, dry mouth

1. Check for doctor’s order2. not to be given in patients hypersensitive to drugs3. Inform the patient about the possible side effect of the drug

GN: Gentamicin DulfateBN: Genticin

02-14-06 IV80 mg amp, every 80

- Anti-infective- inhibits protein synthesis

- endocarditis prophylaxis for GI or GU procedure or surgery

- Nausea and Vomiting, headache, dizziness

1. Check for doctor’s order2. Perform ANST prior to admission3. Should not be given if positive skin test4. Slow IV push5. Inform the patient about the possible side effect of the drug6. Advise patient to report any discomfort on the IV insertion site7. Monitor urine output, specific gravity, U/A, BUN and creatinine levels

Name of Drug Date Ordered

Route/ Dosage and Frequency

Action Indication Adverse Reaction

Nursing Consideration

GN: AmpicillinBN: Omnipen

02-14-06 IV1 g amp, every 80

- Anti-infective- inhibits protein synthesis

- endocarditis prophylaxis for GI or GU procedure or surgery

- Nausea and Vomiting, headache, dizziness

1. Check for doctor’s order2. Perform ANST prior to admission3. Should not be given if positive skin test4. Slow IV push5. Inform the patient about the possible side effect of the drug6. Advise patient to report any discomfort on the IV insertion site

GN: MgSO4 02-14-06 IV0.03% 7ml every 120

-anti-convulsant-replaces magnesium and maintains magnesium level

- magnesium supplementation

- drowsiness, hypotension

1. Use parenteral magnesium with extreme caution in patients with impaired renal function2. Test knee jerk and patellar reflexes before each additional dose3. check magnesium level after repeated doses4. Monitor fluid intake and output5. Monitor renal function

Name of Drug Date Ordered

Route/ Dosage and Frequency

Action Indication Adverse Reaction

Nursing Consideration

GN: Ketorolac TromethamineBN: Toradol

02-14-06 IV30 mg amp, every 60

- Anti-inflammatory - inhibits prostaglandin synthesis

- short term management of moderately severe, acute pain

- dizziness, sedation, headache, flatulence, nausea and vomiting

1. Check for doctor’s order2. Perform ANST prior to admission3. Should not be given if positive skin test4. Slow IV push5. Inform the patient about the possible side effect of the drug6. Advise patient to report any discomfort on the IV insertion site

Name of Drug Date Ordered

Route Action Adverse Reaction Nursing Consideration

GN: Lidocaine HCl 02-14-06 IV Anesthetic drugs

-lethargy, hypotension

1. Monitor BP, PR, and RR before and after giving the medication

2. Monitor patient for toxicity

Anesthetic drug

c. Medical/ Surgical Management

1. Chest X-ray- this is used to rule out respiratory causes of referred pain.

2. Intake and Output- I&O measurement provide an other means of

assessing fluid balance. This data provide insight into the cause of

imbalance such as decrease fluid intake or increase fluid loss. These

measurement are not that accurate as body weight, however, because of

relative risk of errors in recording.

3. Electrocardiogram- The ECG is an essential tool in evaluating cardiac

rhythm. Electrocardiography detects and amplifies the very small

electrical potential changes between different points on the surface of

the body as a myocardial cell depolarize and repolarize, causing the

heart to contract.

4. O2 Inhalation- Oxygen therapies are used to provide more oxygen to the

body into order to promote healing and health.

5. Intravenous Rehydration- when the fluid loss is severe or life

threatening, intravenous (IV) fluids are used for replacement.

6. ultrasound (Also called sonography.) - a diagnostic imaging technique

which uses high-frequency sound waves to create an image of the

internal organs. Ultrasounds are used to view internal organs of the

abdomen such as the liver spleen, and kidneys and to assess blood flow

through various vessels.

7. hepatobiliary scintigraphy - an imaging technique of the liver, bile ducts,

gallbladder, and upper part of the small intestine.

8. cholangiography - x-ray examination of the bile ducts using an

intravenous (IV) dye (contrast).

9. percutaneous transhepatic cholangiography (PTC) - a needle is

introduced through the skin and into the liver where the dye (contrast) is

deposited and the bile duct structures can be viewed by x-ray.

10. endoscopic retrograde cholangiopancreatography (ERCP) - a procedure

that allows the physician to diagnose and treat problems in the liver,

gallbladder, bile ducts, and pancreas. The procedure combines x-ray and

the use of an endoscope. A long, flexible, lighted tube. The scope is

guided through the patient's mouth and throat, then through the

esophagus, stomach, and duodenum. The physician can examine the

inside of these organs and detect any abnormalities. A tube is then

passed through the scope, and a dye is injected which will allow the

internal organs to appear on an x-ray.

11. computed tomography scan (CT or CAT scan) - a diagnostic imaging

procedure using a combination of x-rays and computer technology to

produce cross-sectional images (often called slices), both horizontally

and vertically, of the body. A CT scan shows detailed images of any part

of the body, including the bones, muscles, fat, and organs. CT scans are

more detailed than general x-rays.

12. Cholecystectomy- removal of the gallbladder. This procedure may be

performed to treat chronic or acute cholecystitis, with or without

cholelithiasis, to remove a malignancy or to remove polyps.

13. Cholecystotomy- the establishment of an opening into the gallbladder to

allow drainage of the organ and removal of stones. A tube is then placed

in the gallbladder to established external drainage. This is performed

when the patient cannot tolerate cholecystectomy.

14. Choledochoscopy- the insertion of a choledoscope into the common bile

duct in order to directly visualize stones and facilitate their extraction.

VII. Clients Daily Progress

DAYS ADMISSION2/13/06

DAY 22/14/16

DAY 32/15/16

DISCHARGE2/16/06

Nursing ProblemAcute pain * *

Fluid Volume Deficient * *Knowledge Deficit * *

Vital Signs BP- 130/90PR- 84RR- 19Temp- 36.5 oC

BP- 140/90PR- 82RR- 21Temp- 36.2 oC

BP- 140/90PR- 85RR- 21Temp- 36.4 oC

BP- 130/90PR- 83RR- 20Temp- 36.1 oC

Dx & Lab ProceduresCBC *U/A *FBS *BUN *

Creatinine *Medical & Surgical Management

Chest X-ray *12-L ECG *

O2 inhalation *D5LRS, 1Lx 30-31

gtts/min* *

D5NM, 1Lx 30-31 gtts/min

* *

DrugsH2 Bloc *

Cefuroxime * * *Ketorolac * *Ampicillin * *Gentamicin * *

MgSO4 * *Lidocaine * *

Placil * * *Diet

NPO *Clear liquid *

Soft Diet *DAT *

Activity & ExerciseFOB *

Sit on Bed *Ambulation as Tolerated * *

* First started and indicates the duration it was done and taken.

VIII. DISCHARGE PLANNING

M - Instructed the patient to continue medication as ordered

1. Cephalexin 500 mg cap 3 x day (8am-1pm-8pm) for 1 week

2. Mefenamic Acid 500 mg cap 3 x day (am-1pm-8pm) for 1 week

E - Instructed the patient to do exercise as tolerated such as walking

T - Instructed the patient to continue the medication

H - 1. Encouraged patient to increase fluid intake

2. Encouraged patient to eat foods rich in Vitamin and Nutritious foods

3. Encourage patient to avoid salty and fatty foods

4. Encourage patient to have enough rest

O - Instructed to come back for follow-up check-up on February 23, 2006,

Thursday.

D - Advised the patient to a diet as tolerated but preferably avoiding salty and

fatty foods.

IX. Conclusion

Our patient, Mr. Aproniano Castro has a chief complaint of epigastric pain. He

was admitted in Porac District Hospital and he was diagnosed of having a

cholecystitis with multiple cholelithiasis based on the diagnostic procedure conducted

in him like the CBC, U/A, 12-L ECG, FBS, BUN, Crea, X-ray and UTZ. Due to the

result the surgeon decided for a surgery to remove the gallbladder which is known as

the cholecystectomy. We are happy to say that most of our group mates witness the

operation. The following day we were given the chance to visit and assess our

patient’s condition. Fortunately, the patient had recovered at once he is no longer

complaining of epigastric pain. What he was complaining is if he could already eat

his food for he is on a liquid diet! And of course the pain of his operative site which is

just normal for several days after undergoing the operation.

Since cholecystitis is the inflammation of the gall bladder which is usually

accompanied by gallstones or cholelithiasis these gallstones may block the way of

toxic substances that really needs to go out, but due to this blockage this toxic

substances are not then being expelled and are just being stored in the bladder for a

period of time. This then causes inflammation of the gallbladder. The treatment

usually done is the cholecystectomy.

In order to lower the risk of having this kind of condition each and every one of

us must be conscious in our diet. We should try to avoid foods which are rich in salt

and fats, especially those foods which contains many seasonings. Though there is a

saying that ”Mas masarap pag bawal” which always pertains to the food were eating

we should still be conscious on our health especially if we want to live longer and

also to avoid those life-threatening diseases which not only shorten our life but causes

us some financial problem. Remember also the saying “Mahal ang magkasakit”.

Just like on what our patient had experience he still has to collect money for the

operation he had underwent causing them to have debt with different persons. Let us

not enjoy ourselves with the delicious food were eating that is rich in salts and fats

but we should enjoy living because we have a healthy condition.

X. BIBLIOGRAPHY

Books

Joyce M. Black,PhD, RN, CPSN, CWCN & Jane Hokanson Hawks, DNSc, RN, BC, “Medical- Surgical Nursing” 7th edition, pg.1302-1314.

Nursing 2004 Drug Handbook, 24th edition

Doenges, Moorhouse, & Murr,” Nurse’s pocket guide” 9th edition.

Online Resources

www.facs.org

http://tjsamson.client.web-health.com/web-health/topics/GeneralHealth/generalhealthsub/generalhealth/liver&gallbladder/what_gallbladder.html

http://www.emedicine.com/emerg/topic97.htm

http://www.emedicine.com/radio/topic163.htm

http://www.healthsystem.virginia.edu/uvahealth/adult_liver/chole.cfm

http://www.emedicine.com/EMERG/topic98.htm

Microsoft Encarta 2004

Nursing Care Plan Content CD-ROM