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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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http://en.wikipedia.org/wiki/Cystic_ducthttp://en.wikipedia.org/wiki/Gallstoneshttp://en.wikipedia.org/wiki/Gallbladderhttp://en.wikipedia.org/wiki/Gallstoneshttp://en.wikipedia.org/wiki/Gallbladderhttp://en.wikipedia.org/wiki/Cystic_duct

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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,

and

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

1s"chomotor

!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.

2ective

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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

provided:

!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

fever.

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.

ifest"le

@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