Download - Chole Power Point

Transcript
Page 1: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 1/58

CHOLECYSTECTOMY CHOLECYSTECTOMY 

Page 2: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 2/58

INTRODUCTIONINTRODUCTION

Page 3: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 3/58

-- is theis the inflammationinflammation of theof the gall bladdergall bladder..

CholecystitisCholecystitis is often caused byis often caused bycholelithiasischolelithiasis (the presence of (the presence of cholelithscholeliths,,

or gallstones, in the gallbladder), withor gallstones, in the gallbladder), with

cholelithscholeliths most commonly blocking themost commonly blocking the

cystic ductcystic duct directly. This leads todirectly. This leads to

inspissationinspissation (thickening) of (thickening) of bilebile, bile, bile

stasisstasis, and secondary infection by gut, and secondary infection by gut

organisms, predominantlyorganisms, predominantly E. coli  E. coli andand Bacteroides Bacteroides species.species.

Page 4: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 4/58

Stones in the gallbladder may causeStones in the gallbladder may causeobstruction and the accompanying acuteobstruction and the accompanying acute

attack.attack.

The patient might develop a chronic, lowThe patient might develop a chronic, low--

level inflammation which leads to alevel inflammation which leads to a

chronicchronic cholecystitischolecystitis, where the, where the

gallbladder is fibrotic and calcified andgallbladder is fibrotic and calcified and

the need to undergo surgery is advisedthe need to undergo surgery is adviseddue to the severe symptoms that are feltdue to the severe symptoms that are felt

by the patient.by the patient.

Page 5: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 5/58

Cholecystectomy is an operation toCholecystectomy is an operation toremove the gallbladder. Surgical removalremove the gallbladder. Surgical removal

of the gallbladder along with the stonesof the gallbladder along with the stones

has been the standard of care forhas been the standard of care for

gallstones.gallstones.

The gallbladder is not a necessary organThe gallbladder is not a necessary organ

and patients are not expected to incurand patients are not expected to incurpermanent functional impairment afterpermanent functional impairment after

its removal.its removal.

Page 6: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 6/58

AMERICAAMERICA PHILIPPINESPHILIPPINES

WITH A DIAGNOSIS OFWITH A DIAGNOSIS OF

CHOLECYSTITISCHOLECYSTITIS/ / CHOLELITHIASISCHOLELITHIASIS 5050--75%75% 2020--40%40%

SICKLE CELL DISEASE PATIENTS WHO SICKLE CELL DISEASE PATIENTS WHO 

DEVELOPED DEVELOPED CALCULOUSCALCULOUS CHOLECYSTITISCHOLECYSTITIS 3434-- 70%70% 3030--37%37%

Statistical basis:

#1 Occurrence of CalculousCholecystitis

Page 7: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 7/58

LCLC OCOC

DUR ATION OF OPER ATION 64 MINUTES DUR ATION OF OPER ATION 64 MINUTES 81.4 MINUTES 81.4 MINUTES 

(R ANGE: 42 TO 1(R ANGE: 42 TO 103 MINUTES) (R ANGE: 5503 MINUTES) (R ANGE: 55--125 MIN)125 MIN)

SPAN OF R ECOVERY  WITHIN 24 HOUR S POST OP  TOSPAN OF R ECOVERY  WITHIN 24 HOUR S POST OP  TO 5 DAYS POST OP5 DAYS POST OP

#2 Duration of Operation vs. R ecovery days of 

LC and OC

Page 8: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 8/58

Page 9: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 9/58

Anatomy and PhysiologyAnatomy and Physiology

Page 10: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 10/58

The gallbladder is a small, pear-

shaped pouch, non-vital organ in the

upper-right part of your abdomen(tummy) that aids in the digestive

 process and stores bile produced in

the liver .

Page 11: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 11/58

It is divided into three sections:fundus, body, and neck. The neck 

tapers and connects to the biliary

tree via the cystic duct, which then

 joins the common hepatic duct to

 become the common bile duct.

Page 12: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 12/58

The adult human gallbladder storesabout 50 mL of  bile, which is

released when food containing fat

enters the digestive tract, stimulatingthe secretion of cholecystokinin

(CCK). The bile, produced in the

liver , emulsifies fats in partly

digested food.

Page 13: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 13/58

After being stored in the gallbladder,

the bile becomes more concentratedthan when it left the liver , increasing

its potency and intensifying its effect

on fats. Bile is made fromcholesterol, bile salts and waste

 products. When these substances are

out of balance, small, hard stones

called gallstones can form.

Page 14: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 14/58

Gallbladder obstructedGallbladder obstructed

by gallstonesby gallstones

Page 15: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 15/58

DiagnosticProcedures

Page 16: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 16/58

Cholecystitis is usually diagnosed by a

history of presenting symptoms as well

examination findings:fever (usually low grade in uncomplicated

cases)

tender right upper quadrant +/- Murphy'ssign

Page 17: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 17/58

Laboratory tests CBC and liver function test)

frequently show raised hepatocellular liver 

enzymes with a high white cell count (WBC).

Sonography is a sensitive and specific modality

for diagnosis of acute cholecystitis; adjusted

sensitivity and specificity for diagnosis of acutecholecystitis are 88% and 80%, respectively.

Page 18: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 18/58

CT scan findings are in the range of 90-95%. CT

is more sensitive than ultrasonography.

X ray of the gallbladder and biliary channels,

following the administration of a radiopaque dye,

one of the techniques of diagnostic imaging. In

oral cholecystography, the dye is ingested,

absorbed by the intestine, and concentrated by the

gallbladder, which normally appears well opacifiedin the X ray.A bnormalities (e.g., gallstones) may

 be demonstrated by radiolucent areas.

Page 19: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 19/58

The electrocardiogram (ECG) is a graphicrecording of the electrical activity of the heart

detected at the body surface and amplified. The

ECG is of greatest use in diagnosing cardiac

arrhythmias, acute and prior myocardial

infarctions, pericardial disease, cardiac

enlargement (atrial and ventricular), and various

electrolyte disturbances and drug effects.

Page 20: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 20/58

Urinalysis - Laboratory examination of a sample

of urine to obtain clinical information. Most of the substances normally excreted in the urine are

metabolic products dissolved or suspended in

water.A deviation from normal in the

concentration of urinary constituents or the

abnormal presence of specific substances may

thus be indicative of bodily disorders. Changes in

urine colour, specific gravity, and volume mayalso provide evidence of a specific disease or 

 body injury.

Page 21: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 21/58

Cardiopulmonary Clearance or CP clearance is an additional diagnostic test to

rule out other disease a patient may have. It

is often used to patients who exhibit risk factors such as old age >40, gender, etc. that

may consider them as candidates for 

developing such diseases affecting the heartand lungs.

Page 22: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 22/58

Cholangiogram or injecting of 

dye during the procedure to detect

some stones

Page 23: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 23/58

OR  

OR  TECHNIQUESTECHNIQUES

Page 24: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 24/58

OR  Techniques

There are two ways of performing acholecystectomy:

Laparoscopic (keyhole) cholecystectomyThis is the most common way of having

your gallbladder removed. The operation is

carried out using a tiny camera and surgicalinstruments that are inserted through small

incisions (cuts) in your abdomen.

Page 25: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 25/58

The laparoscopic approach has been

 proven to be superior to conventional

open cholecytectomy because of less pain, quicker recovery, fewer 

 problems with incisions and better 

cosmetic appearance.

Page 26: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 26/58

It has even been proven to be safe for 

 pregnant patients if certain precautions aretaken. It must be emphasized that both

laparoscopic and open cholecystectomy

may have complications such as bile ductinjury, bleeding, bile spillage, hernia,

spillage of stones, missed bile duct stones

and complications related to general

anesthesia.

Page 27: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 27/58

In the US and in most advanced centers

elsewhere, laparoscopic cholecystectomyhas become the gold standard. In the

Philippines, the laparoscopic approach is

slowly but surely replacing the open or conventional cholecystectomy as the

 procedure of choice.

 Length of hospital stay: Eighty-eight percent of the patients were discharged

within 24 hours of operation.

Page 28: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 28/58

Open cholecystectomy

The gallbladder is removed through onelarge cut in your abdomen. This technique

is called open surgery. It is a more

invasive operation than keyhole surgery,

you need to be in hospital for longer and

it takes longer to recover. Open surgery isa traditional approach and is rare in

modern practice.

Page 29: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 29/58

A traditional open cholecystectomy is a major 

abdominal surgery in which the surgeon

removes the gallbladder through a 10-18 cm (4-

7 inch) incision. The surgeon will make a 5 to 7

inch incision in the upper right part of your 

 belly, just below your ribs. The surgeon will cut

the bile duct and blood vessels that lead to the

gallbladder. Then your gallbladder will be

removed.Open gallbladder removal surgery takes about

an hour.

Page 30: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 30/58

 Length of hospital stay: Patients usually

remain in the hospital overnight and mayrequire several additional weeks to

recover at home.

It takes a minimum of 7 to 15 days to

complete the treatment although in some

cases, the patient can take as long as 30days to fully complete treatment.

Page 31: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 31/58

Instruments: The most commonly used

instruments in surgery are still thescalpel (knife), hemostatic forceps,

flexible tissue-holding forceps, wound

retractors for exposure, crushing andnoncrushing clamps for intestinal and

vascular surgery, and the curved needle

for working in depth, and additional

television to view the field if a

laparascope is used.

Page 32: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 32/58

Before the Procedure

Always tell your doctor or nurse:

If you are or might be pregnantWhat drugs, vitamins, and other 

supplements you are taking, even

ones you bought without a prescription

Page 33: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 33/58

During the week before your surgery:

You may be asked to stop taking aspirin,ibuprofen (Advil, Motrin), vitamin E,

warfarin (Coumadin), and any other drugs

that make it hard for your blood to clot.Your doctor may ask you to "clean out"

your colon or intestines.

Ask your doctor on which drugs you shouldstill take on the day of your surgery.

Page 34: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 34/58

On the day of the surgery:

Do not eat or drink anything after midnight the night before your surgery.

Take the drugs your doctor told you to

take with a small sip of water.Shower the night before or the morning

of your surgery

Your doctor or nurse will tell you when

to arrive at the hospital.

Page 35: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 35/58

A.A. Open CholecystectomyOpen Cholecystectomy B. LaparoscopicB. Laparoscopic

CholecystectomyCholecystectomy

Illustration of human gallbladder undergoing LC 

& OC Cholecystectomy

Page 36: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 36/58

After the Procedure

People usually stay in the hospital for 2

to 6 days after open gallbladder removal

 but for laparoscopic it only takes 24-48hours. During that time:

The nurse will help you sit up in bed,

hang your legs over the side, and thenstand up and start to walk.

Page 37: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 37/58

At first you will receive fluids intoyour vein through an intravenous tube

(IV). Soon, though, the doctors and

nurses will ask you to start drinkingliquids and then eat other foods.

You will be able to begin showering

again while you are still in the hospital.

Page 38: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 38/58

You may be asked to wear pressure

stockings on your legs to help prevent

a blood clot from forming. These help

keep your blood circulating well.

If there were problems during your

surgery, or if you have bleeding, a lotof pain, or a fever, you may need to

stay in the hospital longer.

Page 39: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 39/58

DRUG

 S

TUDYDRUG

 S

TUDY

Page 40: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 40/58

Generic Name: Cefuroxime

Brand Name: Zinacef 

R oute & Dosage: IV

, 750

mg30

-60

minutespre-op.

Action: anti-infective

Indication: perioperative prophylaxisAdverse R eaction: nausea & vomiting

Page 41: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 41/58

Nursing Considerations:

1.Check for doctor¶s order.2.Perform ST first.

3.Should not be given if positive to skin test.

4.If negativeS

T, administer it by slow IV

push.5.Inform the patient regarding possible side

effects of the drug.

6.Advise patient to report any discomfort on

the IV insertion site.7.Do not mix Zinacef with other solutions like

aminoglycosides.

Page 42: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 42/58

Generic Name: Gentamicin Sulfate

Brand Name: Gentamicin, Alcomicin

Route &D

osage:IV

, 80 mg/ ampuleAction: anti - infective

Indication: prophylaxis for GIT

surgery/procedureAdverse Reaction: headache, dizziness,

nausea, and vomiting

Page 43: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 43/58

Nursing Considerations:

1. Always check for doctor¶s order.2. Perform Skin Test.

3. Do not give if positive to skin test.

4. If negative to skin test, administer it byslow IV push.

5. Inform the patient about the side effects of 

the drug.

6. Advise patient to report any discomfortafter administering the drug.

7. Do not mix with other drugs for

parenteral use.

Page 44: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 44/58

Generic Name: Ampicillin

Brand Name: Omnipen

Route & Dosage: IV, 1g./amp

Action: anti - infectiveIndication: prophylaxis for GIT

surgery/procedure

Adverse Reaction: headache, dizziness,

nausea, and vomiting

Page 45: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 45/58

Nursing Considerations:

1. Always check for doctor¶s order.

2. Perform Skin Test.3. Do not give if positive to skin test.

4. If negative to skin test, administer it by

slow IV push.

5. Inform the patient about the side effects

of the drug.

6. Advise patient to report any discomfort

after administering the drug.7. Do not mix with other drugs for

parenteral use.

Page 46: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 46/58

Generic Name: Clomipramine HCL

Brand Name: Placil

Route & Dosage: PO, 10mg tab

Action: anti- infammatory

Indication: for chronic pain

Adverse Reaction: headache, dizziness,malaise, dry mouth

Page 47: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 47/58

Nursing Considerations:

1. Check for doctor¶s order

2. Not to be given to patients with

hypertension3. Inform the patient about the

adverse effects.

4. Instruct to take it w/meals toavoid GI irritation.

Page 48: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 48/58

Generic Name: K etorolac

TromethamineBrand Name: Toradol

Route & Dosage: IM, 30mg/ampAction: anti ± inflammatory, analgesic

Indication: short ± term management of 

moderate to severe pain.Adverse Reaction: headache, dizziness,

nausea, and vomiting, flatulence, sedation.

Page 49: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 49/58

Nursing Considerations:

1.Always check for doctor¶s order.

2. Perform Skin Test.3. Do not give if positive to skin test.

4. Do not mix w/ morphine sulfate.

5. Give IM slowly and deeply into the

muscle.6. Protect the injection site from light.

7. Inform the patient about the side effects of 

the drug.8.Advise patient to report any discomfort

after administering the drug.

9. Do not mix with other drugs for parenteral

use.

Page 50: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 50/58

Generic Name: Lidocaine HCL

Brand Name:X

ylocaine,X

ylocard

Route & Dosage: IV, 30mg./amp

Action: produces anesthesia, increases pain ± threshold

Indication: anesthesia for surgery.

Adverse Reaction: headache, dizziness,nausea, and vomiting, flatulence,

sedation

Page 51: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 51/58

Nursing Considerations:1. Do not add lidocaine to blood transfusion.

2. Do not mix with epinephrine if patient needs epinephrine.

3. Reduce IV bolus dosage for patients 70 y/o, with CHF, or 

liver disease.

4. Note for any hypersensitivity to amide-local anesthetics.

5. Document CNS status.

6. Monitor liver, and renal function studies.

7. Closely watch for adverse effects involving respiratory

depression.

8. Monitor if malignant hyperthermia develops

(tachycardia-earliest sign).

Page 52: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 52/58

NUR SING CAR E NUR SING CAR E 

PLANPLAN

Assessment Nursing Planning Interventions Rationale Evaluation

Page 53: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 53/58

Assessment Nursing

Diagnosis

Planning Interventions Rationale Evaluation

S ² ´ masakit yungnaoperahan sa akin,µ asverbalized by the

patient.With a pain scale of 7/10

O ² difficulty of movingas manifested by facialgrimace

(+) muscle guarding

T: 36.9 RR-19 bpmPR-90 bpmBP-130/09mmHg

Acute pain related tooperation done (opencholecystectomy) as

evidenced by surgicalincision.

After 3 hours of nursing intervention,the patient will report

relieve of pain from7/10 to 3/10.

1. Observe anddocument the location

and character of pain,2. Promote bed rest,

allowing patient toassume comfort

position.3. Control

environmentaltemperature.4. Encourage use of 

relaxation techniques(e.g. deep ² breathingexercises, diversionalactivities, guidedimagery).5. Administer analgesicsas ordered.

6. Observe non-verbalcues of pain for patientswho cannot

communicate well.7. Provide comfort

measures (e.g.repositioning,

assurance, and nurse·spresence).8. Make time to listen

and maintain frequentcontact with the patient.

- assists in differentiatingcause and severity of 

pain.- bedrest in low-

fowler·s positionreduces intra-abdominal

pressure; thus, reducespain.

- cool surroundings aidin minimizing dermaldiscomfort.

- promotes rest,redirect attention, andmay enhance coping.-relief of pain facilitatescooperation with othertherapeutic regimen.-Observations are not

always congruent withverbal description; thusit will serve as

indicators of pain fornurses· assessment.

-it promotes non-pharmacological pain

management-helpful in alleviatinganxiety and refocusing

attention w/c canrelieve pain.

After 3 hours of nursing intervention,

the patient hadreported relieved of pain from 7/10 to 3/10.

Assesment Nursing Diagnosis Planning Interventions Rationale Evaluation

Page 54: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 54/58

g g g

S- ´Nasusuka ako satuwing maiisip ko naooperahan ako,µasverbalized by the

patientO- (+) vomiting (5x) in6 hours(+) body weakness(+) pallor

Poor skin turgor(+) dry skin(+) dry mouthT: 37.6

PR: 98bpmRR: 22bpmBP: 140/90mmHg

Fluid Volume Deficientrelated to vomiting asmanifested by poorskin turgor, pallor, dryskin, body weakness,and dry mouth

After 4 hours of nursinginterventions, thepatient will maintainadequate fluid volume

as evidenced by goodskin turgor, regain bodystrength, (-) pallor, (-)dry mouth, and (-) dryskin.

1. Maintain accuraterecord of I&O.2. Perform frequentoral hygiene.

3. Increase fluid intake.4. Encourage patient toeat foods with fluidcontent.5. Administer anti-

emetics as ordered.6. Limit intake of alcohol and caffeinatedbeverages.

7. Assess vital signs(note: pulse andrespiration may be

elevated in fluid volumedeficit).

8. Administer fluids andelectrolytes asprescribed.

(hypotonic/hypertonicdepending on the typeof dehydration present)

-Provides informationabout fluid status/circulating volume andreplacement needs.

-decreases dryness of oral mucousmembranes, reducesrisk of oral bleeding.-promotes hydration

-relieves thirst andminimizes the use of parenteral replacement.-reduces nausea and

prevents vomiting.-These beverages areavoided due to its

diuretic effect.-to evaluate degree of 

fluid deficit.-to correct/replace fluidlosses abruptly.

After 4 hours of nursinginterventions, thepatient had maintainedadequate fluid volume

as evidenced by goodskin turgor, regainedbody strength, (-) pallor,(-) dry mouth, and (-)dry skin.

Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation

Page 55: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 55/58

S- ´Pwede bang maulit

ang sakit ko?µasverbalized by thepatient

O- Frequently asking

questions about his/hercondition and dischargeneeds with worriedgaze.VS taken as followsT: 37.0 PR: 80bpmRR: 19bpm

BP: 120/80mmHg

Deficient knowledge

related to condition,prognosis, treatment,discharge needs and

self-care as evidenced

by frequent asking withworried gaze.

After 3 hours of nurse-

patient interactions, thepatient will be able toverbalize understanding

of disease process,

prognosis, proper diet,and potentialcomplications.

1. Determine blocks to

learning (languagebarrier and literacyskills).

2. Review disease

process/ prognosis, andencourage questioningabout the topic.3. Review drug regimen,possible side effects.4. Determine client·smost urgent need fromboth clients·s and

nurse·s view point.

5. Use short simplesentences and concepts.

Repeat and summarizeas needed.

6. Instruct patientregarding proper dietand foods to be avoided

like fatty foods, wholemilk, ice cream butter

etc.7. Include theAffective goals (e.g.reduction of stress).8. Provide explanations/

reasons for testsprocedures and

preparation needed.

-to identify factors that

may hinder the learningprocess.-provides knowledge

base from which patient

can make informedchoices.-Gallstones often recur.Necessitating long termtherapy.-to establish priorities inconjunction w/ client·sneed.

-to facilitate fast

learning.-Prevents/ limits

recurrence of gallstoneformation

-to develop/ formulatelearning objectivesfaster.

-information candecrease anxiety.

After 3 hours of nurse-

patient interactions, thepatient had verbalizedunderstanding of 

disease process,

prognosis, potentialcomplications, andproper diet by restatingthe teachings givenearlier.

Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation

Page 56: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 56/58

S- ´Wala akong ideya

kung anong gagawin kosa sugat ko,µ asverbalizes by the

patient.O- Anxiety and fear of handling thedressing/incision site.VS taken as followsT: 37.1 PR: 85bpm

RR: 19bpmBP: 120/80mmHg

Knowledge Deficient

related to condition andself-care as evidencedby fear of handling the

dressing/incision site.

After 3 hours of nurse-

patient interactions, thepatient will be able toverbalize understanding

of the therapeuticregimen and will be ableto demonstrate dressingchange and cleaning of the incision site.

1. Review disease

process, surgicalprocedure.2. Demonstrate care of 

incision or dressing.3. Determine client·sability/readiness andbarriers to learning.4. Identify outcomes(results) to be achieved.5. Involve the client/s by

using age-appropriatematerials tailored to

client/s literacy skills.6. Provide positivereinforcement.

7. Provide writteninformation/ guidelines

and self-learningmodules for client torefer to as necessary.

8. Review activity

limitations depending onindividual situation.

-provides knowledge

base on which patientcan make informedchoices.

- promotesindependence of careand reduce risk of having infection.- individual readinessvaries at this time(Physically, emotionally,

and mentally).-to meet learner·s (not

instructors) needspromptly.-to facilitate easy

learning/recall.-encourage continuation

of efforts.-it allows clients/s toproceed at own pace

and establishes

independency.- Resumption of usualactivities is normally

accomplished w/in 4-5weeks.

After 3 hours of nurse-

patient interactions, thepatient had verbalizedunderstanding of the

therapeutic regimen anddemonstrated dressingchange and cleaning of the incision site.

Page 57: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 57/58

GROUP IIIGROUP III

Page 58: Chole Power Point

8/8/2019 Chole Power Point

http://slidepdf.com/reader/full/chole-power-point 58/58

GROUP IIIGROUP III

BSNBSN 3B23B2--55

REMIGIOREMIGIO,, ANGELIEANGELIEA.A.

SANTOSSANTOS. DIANNE. DIANNE

VEQUISOVEQUISO,, ELIZABETHELIZABETH

RILLERARILLERA,, ZARAHZARAH MAEMAERIVERARIVERA, MATT , MATTARNOLDARNOLD

FACELOFACELO,, JENNYLYN JENNYLYN

TEVESTEVES,, CARLOCARLO

KAWIKAWI,, KARENKARENVALEZAVALEZA,, ELAINEELAINE

SEBASTIAN, MA.SEBASTIAN, MA. JUBELLE JUBELLE

BOLOSANBOLOSAN,, OLIVEROLIVER