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  • 8/9/2019 CHOLECYSTITIS CASE STUDY Version 2.0.docx


    I I N T R O D U C T I O N

    Description of the Disease

    The gallbladder is a small pear-shaped organ which aids in the digestive

    process. Its function is to store and concentrate bile - a digestive liquid continually

    secreted by the liver. The bile in turn emulsies fats and neutralizes acids in partly

    digested food. Despite its importance in the digestion of fat, many people are

    unaware of their gallbladder. ortunately enough, the gallbladder is an organ that

    people can live without. !erhaps, this fact contributes to the la"ity of the ma#ority.

    The gallbladder tends to be ta$en for granted % ignored of the proper care and

    conditioning. &ifestyle together with heredity, se", race and age are #ust some

    factors that leave a room for gallbladder complications to occur.

    's dened, cholecystitis is the in(ammation of the gall bladder. It came from

    the gree$ word )cholecyst* which means )gallbladder* and the su+" )itis* which

    means in(ammation. The in(ammation occurs mainly because of an obstruction of

    the cystic duct by a stone. loc$age of the cystic ductwith gallstonescauses

    accumulation of bile in the gallbladderand increased pressure within the

    gallbladder. oncentrated bile, pressure, and sometimes bacterial infection irritate

    and damage the gallbladder wall, causing in(ammation and swelling of the

    gallbladder. In(ammation and swelling of the gallbladder can reduce normal blood

    (ow to areas of the gallbladder, which can lead to cell death due to insu+cient

    o"ygen. ot everyone who has gallstones will go on to develop cholecystitis. !eople

    with history of gallstones are at high ris$ for having cholecystitis, as well as those

    who are obese and those with sedentary lifestyle. The most common presenting

    symptom of cholecystitis is upper abdominal pain. /owever, this may appear

    asymptomatic, initially. !hysical e"aminations may reveal fever, tachycardia, and

    tenderness in the 012 or epigastric region, often with guarding behaviour.

    Recent Trends, Innovations, and/ or Renements in Treatment

    Robotic Scarless Gallbladder Sr!er" # ScienceDail" $Dec% &&, '(&') *+

    3assar 3oussef, 4.D., is the rst surgeon in altimore ity to perform gallbladder

    surgery using #ust one incision and the da 5inci 6urgical 6ystem. ecause the single

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    incision of about an inch is made in the patient9s navel, he or she is left without a

    noticeable scar. 'dditional patient benets are less pain, less blood loss and a faster

    recovery compared even with minimally invasive gallbladder removal that requires

    multiple incisions. This is good news for the one million 'mericans who need theirgallbladders removed each year, most of whom are candidates for this single-site,

    robotic approach.

    4ore than any other hospital in 4aryland, 6inai /ospital has made technologic

    investments in its da 5inci 6urgical 6ystem: in addition to having da 5inci 6ingle-6ite

    instruments that enable 3oussef to perform gallbladder removal, the hospital has

    two da 5inci units, an e"tra console allowing two surgeons to operate in tandem on

    a patient, and other advanced instruments. 6inai9s sister hospital, orthwest, alsohas its own da 5inci 6urgical 6ystem. 3oussef has plans to train other surgeons on

    the da 5inci, including those in 6inai9s surgical residency program. 6inai /ospital is a

    part of &iferidge /ealth, one of the largest, most comprehensive providers of

    health services in northwest altimore. &iferidge /ealth also includes orthwest

    /ospital, &evindale /ebrew ;eriatric enter and /ospital, ourtland ;ardens

    ursing < 0ehabilitation enter, and related subsidiaries and a+liates.

    Statistics $ocal - International)

    'bout 7=->=? of 'mericans have gallstones, and as many as one third of

    these people develop cholecystitis. @n the other hand, Indian and 6candinavian

    people have the highest prevalence of cholecystitis, it aAected >=.B million people

    with a record of appro"imately C,=== deaths in >=7>. /ospitalizations total up to

    E,=== in the same year and over B==,=== have undergone cholecystectomies.

    In the !hilippines alone, B, =CE, =F= people are aAected by the disease last >=77.

    ;enerally, the incidence of cholecystitis increases with age and it is >-E times more

    frequent in females than in males.

    Ob.ectives of the Std"

    % General Ob.ective

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    'fter the entire hospital rotation at 0afael &azatin 4emorial 4edical /ospital, the

    student nurses will be able toG

    Hnow and understand the disease process and concept of holecystitis.

    0% Specic Ob.ectives

    'fter the entire hospital rotation at 0afael &azatin 4emorial 4edical /ospital, the

    student nurses will be able toG

    Co!nitive 0eview the !roper !hysical 'ssessment I!!'J and how to do them e+ciently:

    1nderstand the Disease !rocessG the causes, eAects,

    management, treatment, and possible preventions:

    Determine the !athophysiology of the condition with their rationale for

    occurrence of each manifestation:

    Determine why certain management and medications are given and provided

    for the condition:

    1nderstand how and why certain diagnostic tests are done for the condition,


    0eview the concepts about the 'natomy and !hysiology with regards to thedisease condition.


    !erform proper physical assessment I!!'J to the patient e+ciently:

    !erform thorough health history from patient and signicant others:

    !articipate in the course of care of patient:

    !rovide health teachings to the patient about certain interventions in the

    maintenance of healthcare.


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    Kstablish rapport and therapeutic interaction with the patient and signicant

    others to obtain necessary information and positive compliance to care being


    !rovide care and health teachings necessary for the betterment of the

    condition of the patient.

    6hare the learning acquired to co-student-nurses to increase awareness and

    help them if ever they will encounter patient with the same condition.

    I% N U R S I N G 3 I S T O R 4

    0io!raphic Data

    This is a case of a F years old ilipino named 4r. aguit who was born on the

    >Cth day of ebruary 7LC. /e is currently living at 'ngeles ity. The client is

    married and has si" children and one grandchild all of which lives under the same

    roof with him and his wife. The clientMs main language for communication is

    Hapampangan but he also $nows how to spea$ Tagalog and Knglish as well.

    's stated by the patient, he e"perienced dizziness and an intolerable sharp

    stabbing pain in his abdominal area on the day of his hospitalization which made

    him decide to go to the hospital. /e was brought by his wife and was admitted at

    @spital ing 'ngeles last ovember 7L,>=7E at CGFBpm with the diagnosis of

    )holecystitis: 'nemia to be considered* under the care of the admitting physician

    Dr. ala#adia.

    1ast 5edical 3istor"

    During the one on one interview of the student nurse with the client, the

    client stated that he has complete immunization as child and had e"perienced only

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    a couple of minor illnesses for the past years such as cough, common colds, and


    The patient had no record of previous hospitalizations and that this was his

    rst time to be conned in a hospital. 'lthough on the year of >==N, he had

    e"perienced an accident wherein he fell down from the stairs in the ;rotto in

    amban, Tarlac which gave him a sprain in his left foot but the client said that it was

    not that serious and did not required hospitalization.


    @ur client usually wa$es up at BG== in the morning so as to help his wife

    prepare his children to go to school, after which he gets ready to go to wor$ as well.

    /e wor$s N hours a day as a driver of dump truc$s under the management of the

    government. /e wal$s to and from his wor$ which basically becomes his daily form

    of e"ercise. The patient eats E times a day, brea$fast, lunch and dinner respectively,

    and he mentioned that he loves to eat food high in cholesterol such as ried !or$,

    and hicharon. /e said that he is not pic$y when it comes to food but he en#oys

    eating and get to eat a lot when heMs eating fatty foods because it gives the food

    more (avor and ma$es it savory.

    /e has no vices, although he used to smo$e and drin$, according to him he

    decided to stop smo$ing ve months ago and was able to continue that change until

    now. 's for his alcohol consumption, the client said that he only drin$s alcoholic

    beverages during special occasions but in light to moderate consumption only. @ne

    of his ways to manage stress is to play with his grandchild,who for the client, gives

    #oy to the whole family and brighten up everyoneMs day in th