Download - CHOLECYSTITIS CASE STUDY Version 2.0.docx

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

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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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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 the aguitMs residence.

1resent 3istor" of Illness

Chief Complaint6 Di77iness and bdominal 1ain on the RU8

' month prior to admission, 4r. aguit e"perienced right upper quadrant pain

associated with a sense of bloatedness and dizziness. The pain was tolerable so he

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7&, at the level of B== cc, H5@, infusing well at his left hand. !atient was on !@ and

complains of pain, with a pain scale of CQ7=. !atient was in good grooming wearing

white shirt and maong pants.

5ital 6igns ta$en are as followsG

S=in6

6$in was warm to touch, sli!htl" dr", ro!h,and with good s$in turgor.

either #aundice nor cyanosis observed. o bruises or discolorations

observed. o edema noted.

3ead6

6$ull and face were symmetrical with an equal distribution of hair. /air was

blac$ in color. There was no dandruA or infestation present. o lesions,

lacerations, tenderness, masses and depressions noted.

:"es6

The client has straight normal eye condition: >ith sli!ht icteric sclera.

!upil is brown in color and equal in size: reactive to light and accomodation.

/ave thin eyebrows.

:ars6

6$in color is same as facial s$in, auricle aligned with outer canthus of eye,

mobile, rm, and not tender: pinna recoils after it is folded: presence of

cermen noted%

NoseG

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9INDINGS I51R:SSION

0OOD 1R:SSUR: 7>=QN=

mm/g

ormal

1US: RT: CL bpm ormal

R:S1IRTOR4 RT: 7 cpm ormal

T:51:RTUR: EC.7 R

Qa"illa

ormal


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ose is uniform in color and has sli!ht dischar!es: there are no masses or

tenderness upon palpation.

5oth and Throat6

&ips are pale: tongue is at the center and has no discharge: @ral cavity has

no sores and lesions.

Nec=

ec$ was symmetrical with no masses or swelling noted. o #ugular vein

distention was noted. 0ange of motion was normal and moves easily without

discomfort upon rotation, (e"ion, e"tension and hypere"tension.

Thora? and n!s6

0espiratory rate was 7 cycles per minute with regular breathing pattern.

6ymmetrical chest e"pansion was observed during respiration. o use of

accessory muscles during breathing observed. hest wall was intact: no

tenderness and masses noted. 1niform temperature also noted. o

adventitious breath sounds heard upon auscultation. o cough present. o

dyspnea, hemoptysis, hiccups noted.

bdomen6

bdomen >as sli!ht" enlar!ed and !loblarwhen patient was in supine

position. Tenderness noted on the ri!ht pper @adrant >hen

palpated%

GenitoA Urinar"6

1nable to perform inspection in the genitourinary region. /owever, patient

verbalized that he had not seen any discharges from her genitalia nor

presence of papules or ulcerations. The patient voided with a yellow colored

urine.

0ac= - :?tremities6

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6ymmetrical shoulder movement observed during respiration. 6pine was

located at the midline with no discrepancies noted. 6houlders, arms, elbows

and forearms were free from nodules and deformities. 1pper e"tremities were

not edematous. 0adial and brachial pulses were present. /ip #oint and thighswere symmetrical with no deformities present. o edema noted at both legs.

o in(ammation noted in the lower e"tremities

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IB% D I G N O S T I C S N D 0 O R T O R 4 R : S U T S

Dia!nostic/aborator"procedres

Dateordered/

Datereslt$s)

in6

Indication$s)

or1rpose$s)

Reslt

Normalvale$nits

sed inthe

hospital)

nal"sisand

Interpretation of

Reslts

3emo!lobin

D@G 77-7C-7ED0G 77-7C-

7E

D@G 77->=-7ED0G 77->=-

7E

To measureprotein usedby red blood

cell todistributeo"ygen tothe othertissue andcell in thebody

NC

E

7F=-7N=gmQ&

There is lowhgb level.The patient is

possible tohave anemia.This indicatesthat thepatient haspoor blood9sability tocarry o"ygenthroughouthis body.

3ematocrit D@G 77-7C-7ED0G 77-7C-7E

D@G 77->=-7ED0G 77->=-7E

To measurethe amountof blood thatis occupiedby the redblood cell

=.>

=.7L

=.F=-=.BF&Q&

There is lowhct level.This meansthat there isinsu+cientblood volumecomposed of0s, which

are theresponsiblefor carryingo"ygen in thebody.

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R0C cont D@G 77-7C-7ED0G 77-7C-7E

D@G 77->=-7ED0G 77->=-7E

To measurethe numberof red bloodcells pervolume of

blood anddeterminefor presenceofpolycythemia,dehydration,and anemia.

E.=E

>.>7

F.B-.E"7=7>Q&

Decreasedlevel of 0may indicatepresence ofanemia.

Decreasedlevel of 0may indicatepresence ofanemia.

0C ContD@G 77-7C-7ED0G 77-7C-7E

D@G 77->=-7ED0G 77->=-7E

To determineinfectionQin(ammation< also todetermineand evaluatethe bodyMsphysiologiccapacity toresist andovercomeinfection.

7B.=

7>.

B-7= "7=Q&

The elevatedvalue of theOs isindicative ofa bacterialinfectionwhich maybe due to thein(amedgallbladder.

NetrophilsD@G 77-7C-7ED0G 77-7C-7E

To determinepossiblepresence ofinfectionsand tissuenecrosis

=.N7

=.C

.F=-CF? eutrophillevel is abovenormalrange. Itcouldsuggest thatthere is apresence ofviralinfection,tissuenecrosis,

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is in thenormal rangethis meansthat thereare lesschances of

developinghemorrhage.

0lood T"pe D@G 77->=-7ED0G 77->=-7E

' bloodtype is usedto classifybloodbasedon thepresence orabsence ofinheritedantigenic6ubstanceson thesurfaceof red bloodcells0sJ.

Type )'*0/ DJG!ositive

!atientMsblood type istype ', 0/positive.

Nrsin! Responsibilities

efore During 'fter

Chec= for the specic

test ordered b" thedoctor%:?plain the test and >h"is it needed%

Knsure that the blood

sample is not ta$en from avein in the hand or armwith an intravenous line./emodilution withintravenous or plasma willlower the hematocrit valuefalsely.

Instruct the 6@ to apply

pressure to the puncturesite until bleeding stops.'ssess for hematomaformation.Document the testperformed

:?plain to the patientthat it is normal for thepatient to feel pain and

some discomforts >hileperformin! theprocedre%

:?plain to the client thatan amont of blood >illbe e?tracted from thebrachial arm%

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Dia!nostic/aborator"

procedres

Date

ordered/Date

reslt$s)

in6

Indication$s

)

or

1rpose$s)

Reslt

Normal

vale

$nits

sed in

the

hospital)

nal"sis andInterpretatio

n of Reslts

0lood Urea

Nitro!en

$0UN)

D@G 77->=-

7E

D0G 77->=-

7E

To assess

renal

functions

and the

ability of

$idneys toe"crete urea

and protein.

TraditionalG

E=.=

6.IG

7=.C7

TraditionalG

L- >=mgQdl

6.IG

E.>-

C.7mmolQ&

'n increase in

the level of

1 indicates

an impaired

$idney

function.

SG1T

$Serm

Gltamic

1"rvicATransaminas

e)

D@G 77->=-

7E

D0G 77->=-

7E

6;!T is a

specic

indicator of

liverdysfunction.

6.IG

EC.=

6.IG

>7-C> ulQl

The result is

within normal

range.

0U D@G 77->=-

7E

D0G 77->=-

7E

Determines

how much

uric acid is

present in

your blood.The test can

help

determine

how well

your body

produces

TraditionalG

7B.F

6.IG

L7.E

TraditionalG

E.B-

N.BmgQdl

6.IG

>=N-B=umolQ&

'n increase in

the level of

1 indicates

a impaired

$idneyfunction.

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and removes

uric acid.

30s!

$3epatitis 0

srfaceanti!en

screenin!)

D@G 77->=-

7E

D0G 77->=-7E

Diagnosis of

acute,recent, or

chronic

hepatitis

infection

Determinatio

n of chronic

hepatitis

infection

status

on

0eactive

on

0eactive

NTIA 3CB

Screenin!

D@G 77->=-

7E

D0G 77->=-

7E

Diganosis of

/epatitis

5irus.

on

0eactive

on

0eactive

Nrsin! Responsibilities

efore During 'fter

Chec= for the specictest ordered b" thedoctor%

Oipe with cotton balls andalcohol the site whereinsertion is done

Tell the 6@ when the needlewill be inserted for them toget prepared

Instruct the 6@ to applypressure to the puncturesite until bleeding stops.

:?plain the test and >h"is it needed%

'ssess the site forhematoma formation.

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Inform that there are nofood or id restrictions

Inform that the testre@ires blood sample,

tell >ho >ill do the testand >hen

Tell that there >ill bediscomfort from theneedle that >ill beinserted and pressrefrom the torni@et%

If the patient is bein!treated for infection,advise that the test >illbe repeated severaltimes to maintain thepro!ress%

Document the testperformed.

:?plain to the client thatan amont of blood >illbe e?tracted from thebrachial arm%

!urpose 0esult Interpretation

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3O:

0DO5INUTRSOUND

4edical test that uses high-

frequency sound waves to

capture live images from

the inside of your body,

which help the military

detect planes and ships

also allows doctor to see

problems with organs,

vessels, and tissues without

needing to ma$e an

incision.

Ri!ht iver obeG 7F.= " 77.N " 7=.B cmeft iver obe G E.LN " F.LB " E.C7 cmGallbladder G N.7= " >.B cmSpleen G 77.> " E.N cm1ancreas G =.LB " 7.7> " =.Lcm / "

" TJRi!ht Eidne" G L.FC " F.FF cmCortical Thic=ness67.L cmeft Eidne" G L.> " B.>7 cmCortical Thic=nessG 7.LL cm1rostate G >.N7 " >.N " >.CLcm 77.CgramsJ

The liver and spleenare slightly enlarged.It has smooth contour and homogenousparenchymal echo pattern.

The !allbladderis slightly dilated. The wallsare thic$ened o.BN cmJ There are severalhigh lever echoes noted within, measuringan average of =.FLcm. The c"stic dct is7=mm with an 77mm shadowingcalcication at the pro"imal segment.

1ancreas is normal in size. !arenchymalechopattern is uniform. 1ancreatic dctsare not dilated.

Urinar" bladder is adequately distended.o intravesical echoes seen. The prostate!land is not enlarged. !arenchymalechopattern is homogenous.

@bstructed biliarydisease with the

presence of stonesin the cystic duct.Intrahepatic ductsare dilated and gallbladder isdistended. onsiderhocystitis.

Nrsin! Responsibilities $hole abdominal Ultrasond)6

1reprocedral Care6

7. hec$ for the specic test ordered by the doctor.>. hec$ for materials needed.E. 6ecure a laboratory request.

F. K"plain the procedure to the 6@.

B. Inform that there the patient is not allowed to eat and can only drin$

with small amount of water in ta$ing medicines.

. Inform the patient about the procedure. Tell himQher that there will be

no discomfort while doing the procedure.

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Drin! the test patient care.

7. 'ssisting to adhere to standard precautions.

>. !rovide emotional support.

E. 'ssist the patient and the physician during the procedure

1ostprocedral Care6

7. @btain results and secure it to the patientMs chart.

>. 0efer the results to the physician.

E. Document the test performed.

Dia!nostic/aborator"procedres

Dateordered/

Datereslt$s)

in6

Indication$s)or

1rpose$s)

Reslt

Normalvale$nits

sed inthe

hospital)

nal"sis andInterpretation

of Reslts

URIN4SIS D@G 77-7C-

7ED0G 77-7C-

7E

The

diagnostictest is

performed

for the

general

evaluation

of the

patientMs

health. It

helps in

identifyingmetabolic

and

systemic

diseases or

olorG 3ellow 6traw to

dar$yellow

0esult indicates

normal nding.

Transparency

6lightly

turbid

lear

0esult may

indicate the

presence of

particulate

matters such as

bile, bacteria, pus

and hemolysis.

p/G .B

'cidicJ

p/ .B %

N.=

0esult indicates

normal nding.

reshly voided

urine is normally

somewhat acidic

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disorders

that aAect

the $idney

and

urinary

tract.

1rinalysis

is ordered

to identify

any

deviation

that may

indicate

the

diagnosisof the

patient.

6p. ;r.G 7.=>= 7.==B %

7.=EB

0esult is within

normal range.

'lbuminG SE

Trace

egative

%J

unctionalalbuminuria maybe present duringacute illness butis #ust temporary.This may alsoindicate 0enaldisease

6ugarGegative %J

egative%J

0esult indicatesnormal nding.

5ICROSCO1IC 9INDINGS

!us cellsG

=.>Qhpf

Kpithelial

ellsGew

one 0esult may

indicate urinary

tract infection

alterations in$idney function.

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NURSING R:S1ONSI0IITI:S6

1re procedral care6

7. hec$ the doctorMs order.

>. K"plain to the patient and 6@ the procedure and purpose of

urinalysis.

E. !rovide clean specimen cup.

F. K"plain to the patient to obtain midstream urine.

B. 'dvise the patient to wash urinary meatus prior to collecting the

specimen to avoid contamination.

. Inform the patient that there is no (uid and food restriction

needed.

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The biliary system consists of the organs and ducts bile ducts, gallbladder,

and associated structuresJ that are involved in the production and transportation of

bile. The transportation of bile follows this sequenceG

Ohen the liver cells secrete bile, it is collected by a system of ducts

that (ow from the liver through the right and left hepatic ducts.

These ducts ultimately drain into the common hepatic duct.

The common hepatic duct then #oins with the cystic duct from the

gallbladder to form the common bile duct, which runs from the liver to

the duodenum the rst section of the small intestineJ.

/owever, not all bile runs directly into the duodenum. 'bout B=

percent of the bile produced by the liver is rst stored in the

gallbladder, a pear-shaped organ located directly below the liver.

Then, when food is eaten, the gallbladder contracts and releases

stored bile into the duodenum to help brea$ down the fats.

9nctions of the 0iliar" S"stem

The biliary system9s main function includes the followingG

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a. to drain waste products from the liver into the duodenum

b. to help in digestion with the controlled release of bile

0ile is the greenish-yellow (uid consisting of waste products, cholesterol, and bile

saltsJ, required for the digestion of food. It is secreted by the liver cells to perform

two primary functions, including the followingG

a. to carry away waste products, and

b. to brea$ down fats during digestion

ile salt is the actual component which helps brea$ down and absorb fats. Oithout

adequate bile, our body cannot metabolize fats which can result in a deciency ofthe fat-soluble vitamins ', D, K and HJ. Oe may also have problems digesting the

essential fatty acids. 'mongst other symptoms we could have trouble utilizing

calcium, have dry s$in, peeling on the soles of your feet, etc. @ne way we can tell

we have trouble digesting fats is if we have e"cessive burping that starts shortly

after eating a meal that has fat in it. Oe might feel nauseous or e"perience gas and

bloating. ile, which is e"creted from the body in the form of feces, is what gives

feces its dar$ brown color.

G0DD:R

The gallbladder is a small pouch that sits #ust under the liver. The gallbladder or

cholecyst or gall bladderJ is a small non-vital organ that aids in the digestive

process and stores bile produced in the liver. It stores bile produced by the liver.

'fter meals, the gallbladder is empty and (at, li$e a de(ated balloon. efore a meal,

the gallbladder may be full of bile and about the size of a small pear.

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C4STIC DUCT

The cystic duct is the short duct that #oins the

gall bladder to the common bile duct. It usually

lies ne"t to the cystic artery. It is of variable

length. It contains a 9spiral valve9, which does

not provide much resistance to the (ow of bile.

ile can (ow in both directions between the

gallbladder and the common hepatic duct andthe commonJ bile duct. In this way, bile is

stored in the gallbladder in between meal times

and released after a fatty meal.

CO55ON 3:1TIC DUCT

The common hepatic duct is the duct formed by the convergence of the righthepatic duct which drains bile from the right functional lobe of the liverJ and the

left hepatic duct which drains bile from the left functional lobe of the liverJ. The

common hepatic duct then #oins the cystic duct coming from the gallbladder to form

the common bile duct.

PATHOPHYSIOLOGY

(Book Based)

>B 8 ! a g e

Precipitating Factors:

Diet

Medications and Oral Contraceptives

Obesity

Rapid Weight Loss

Spinal Cord Injury

Primary iliary Cirrhosis

Diabetes Mellitus

!emolytic Syndromes

Ileal Disease" Resection and ypass

iliary In#ection

Predisposing Factors:

$ender

%ge

Race

!eredity

Pregnancy

acterial

hydrolysis

of lecithin

1ncon#ug

ilirubin t

to form

insolubprecipita

ormatio

alciuilirubin

&iver e"

som

uncon#u

bilirubinbile

alcium e

bile pass

along w

otheelectroly

Increase in

uncon#ugate

d bilirubin 0elease offatty acids

The bacteria

hydrolyze

con#ugated

bilirubin

Invasion

ofbacteria

&iver

e"crete

con#ugated

bilirubin intobile

&iver e"crete

relatively high

proportion of

cholesterol inthe bile

&iver cells

also

secrete

bile salts0esidual ormation ofmi"ed micelles

6ome of the

unilamellarvesicles

&iver cells secrete

cholesterol into bile

along with

phospholipid in the

form of unilamellarvesicles


26/57

> 8 ! a g e

ucleation of

cholesterol

cr stals

ormation of

rystals

ile is

supersaturated

with cholesterol

The cholesterol

carrying capacity

of the micelles

and residual

vesicles is

Cholesterol

Gallstones

5i?ed

Stones

leu$ocyte

s

hydrolyze

bilirubin

con#ugate

s and

'ttractionof

&eu$ocyte

acteriarelease

lytic

enzyme

0ro>n

1i!ment

Gallstones

ormation of

alcium

ilirubinate

A fatty acids fo

comple" wi

0lac

1i!me

Gallsto


27/57

>C 8 ! a g e

6Q6

Indigestion,

5it 'DKH

deciency,ibrosis

&iver irrhosis

Irritation of th

gallbladder w

/ydrolization of lecithin

intolysolecithinDamages muco

cells due to dete

action of bile sa

0elease of

phospholipase from the

epithelium of the

Disruption of mu

coat of the gallbla

epithelium

/epatomegaly

6Q6 #aundice,

ecteric sclera,

pruritus, dar$

urine

U levels of

bilirubinQbile

pigments in the

circulation

'bsence of ile

in the duodenum

!rolong

holestasis

holestasis

@bstruction of the

common bile duct by

gallstones

holedocholelithiasi

s

@bstruction o

cystic duct

gallstone

;allstone tries to

go out of the

C3O:IT3ISIS


28/57

>N 8 ! a g e

6Q6 iliary olic,

Tenderness,

4urphyMs sign,

nausea and

vomiting, fever,

elevated wbc

K0esistance to

portal blood (ow

ibrous nodules distorts

the architecture of the

CUT:

C3O:C4ST

0elease of prostagla

within the gallblad

F

!ortal /ypertension

Increase

pressure in

Kdema, hemorrhag

suppuration of t

gallbladder wa

acteria invade

in#ured gallblad

through the blo

lymphatic or b

ducts form ad#a

organs

Kmpyema of

gallbladder

K"tern

surface o

gallbladd

scarred

layered

brino

e"udates

distend

I @T T0K'T

;@@D !0@;@6I6

I T0K'TKDG

@pen holecystectomy

&aparoscopic

holecystectomy

&itotripsy

1rsodeo"ycholicacid


29/57

>L 8 ! a g e

Gangrenos

!"o#ec$stitis

ecrosis

1lcerations of the

mucosa

Ischemia

ompromised blood

(ow to the mucosa

and lymphatic stasis

IncreasedIntraluminal pressure

ompression of

blood vessels


30/57


31/57


32/57

E> 8 ! a g e

F

loc$age or increase

pressure in the portal veincauses blood to bac$(ow to

the diAerent vessels located

near the esophagus and ;ITluid shifting fro

the portal vein t

peritoneal cavit

Increase pressur

peritoneal capill

6pleen enlarges to

compensate

decreased liver

6hunting of blood

into the splenic vein

&iver is unable to

convert the

protein byproduct

ammonia into

&iver failure


33/57

EE 8 ! a g e

/ypovolemi

/ypovolemic

Death

6

D

6eptic

6Q6

Thrombocyto

penia,

anemia,

leu$openia

Death

Increases in blood

waste product since

spleen is not able

to properly destroy

0Ms

Increase in sizedecreases the

spleenMs ability to

function properly or

loss of function

6Q6

'steri"i

6Q6 eve

diarrhea

abdomin

6pontaneo

acterial !erit

Invasion ofbacteria fro

the blood, o

lymph or

through the

's

0upture

;astroesophageal

5arices

6plenomegal

6Q6 'nore"ia, ausea,&iver tenderness,aundice

/K!'TI

Development of a

large pale nucleus,

a prominent

nucleolus, and

margination of

'strocytes become

swollen

'strocytes may

undergo 'lzheimer

type II astrocytosis

4orphologic

changes in

'mmonia enters

general circulation


34/57

S"nthesis of the Disease6holecystitis is dened as in(ammation of the gallbladder that occurs most

commonly because of an obstruction of the cystic duct from cholelithiasis. It is

caused by an obstruction of the cystic duct, leading to distention of the gallbladder.

's the gallbladder becomes distended, blood (ow and lymphatic drainage are

compromised, leading to mucosal ischemia and necrosis.

1redisposin! 9actors6

Gender6 Oomen have twice the ris$ as men of developing cholesterol gallstones

because estrogen increases biliary cholesterol secretion. efore puberty this ris$ is

negligible, and beyond menopause the increased ris$ disappears.

EF 8 ! a g e

erebral edema

Increased

intracranial

rain /ernation

/epatic oma

D:T3
http://emedicine.medscape.com/article/171886-overviewhttp://emedicine.medscape.com/article/171886-overview


35/57

!e6The incidence increases with age. &ess than B-? of the population under age

F= have stones, in contrast to >B-E=? of those over N=.

Race6 !revalence highest in orth 'merican Indians, hilean Indians, and hilean

/ispanics, greater in orthern Kurope and orth 'merica than in 'sia, lowest in

Vapan: familial disposition: hereditary aspects

3eredit"6 amily history alone imparts increased ris$, as do a variety of inborn

errors of metabolism that lead to impaired bile salt synthesis and secretion or

generate increased serum and biliary levels of cholesterol, such as defects in

lipoprotein receptors hyperlipidemia syndromesJ, which engender mar$ed

increases in cholesterol biosynthesis.

1re!nanc"6 !regnancy is an independent ris$ factor for cholesterol gallstones. Theris$ increases with increasing parity, especially with more than two children. During

pregnancy, elevated estrogen and progesterone levels increase biliary cholesterol

secretion. Klevated progesterone also inhibits gallbladder contractility. F=? of

women develop biliary sludge in their gallbladder and 7>? of women form their rst

stones during pregnancy. The incidence of gallstones is higher in women with

multiple pregnancies.

1recipitatin! 9actors6

Diet $3i!h 9at, 3i!h Sodim)6Increased inta$e of calories, rened carbohydrate,

cholesterol, and saturated fats has all been postulated to cause cholesterol

gallstones. !atients with cholesterol gallstones secrete a greater fraction of dietary

cholesterol into bile than do normal sub#ects.

5edications and Oral ContraceptivesG /ypolipidemic agents clobrate,

gembrozilJ that lower serum cholesterol by increasing biliary cholesterol secretion

increase the ris$ of cholesterol gallstones by twofold to threefold. ompetitive

inhibitors of E-hydro"y-E-methylglutaryl coenzyme ' /4;o'J reductase

lovastatin, simvastatin, pravastatinJ decrease biliary cholesterol saturation.

Kstrogen therapy is associated with an increased ris$ of developing cholesterol

EB 8 ! a g e


36/57

gallstones. @ral contraceptive steroids increase biliary cholesterol secretion and

saturation but do not aAect gallbladder motility.

Obesit"G @besity is strongly associated with increased gallstone prevalence. The

ris$ is proportional to the increase in total body fat. @bese people synthesize more

cholesterol in both hepatic and nonhepatic tissues, transport it to the liver, and

secrete more of it into the bile, leading to bile that is often greatly supersaturated

with cholesterol.

Rapid ei!ht oss6@bese patients undergoing rapid weight loss 7->? of body

weight or appro"imately 7-> $gQwee$J, either by very low caloric dieting or gastric

stapling, have a >B-F=? chance of developing gallstones within F months. During

rapid weight loss, biliary cholesterol saturation increases acutely as cholesterol is

mobilized from adipose tissue and s$in and secreted into bile.

Spinal Cord In.r"6!atients with spinal cord in#ury have 7=? incidence of forming

gallstones within the rst year after in#ury. This high ris$, which is >= times normal,

is believed to be secondary to abnormal gallbladder motility and probably biliary

hypersecretion of cholesterol from the progressive reduction in body mass.

1rimar" 0iliar" Cirrhosis6!atients with primary biliary cirrhosis have an increased

prevalence of gallstones. 6tone analysis has not been performed, but the elevated

cholesterol saturation of bile in these patients suggest that they form cholesterol

stones.

Diabetes 5ellits6Despite obesity and increased total body cholesterol synthesis

and decreased gallbladder motility seen in patients with diabetes, diabetes mellitus

itself does not appear to be an independent ris$ factor for cholesterol gallstone

disease.

3emol"tic S"ndromes6 Inherited hemolytic anemia, sic$le cell disease,

sphericytosis, thalassemia, chronic hemolysis associated with articial heart vavles,

and malaria dramatically increase the ris$ of pigment stone formation because of

increased biliary secretion of total bilirubin con#ugates, especially bilirubin

monoglucoronide, at the e"pense of the bilirubin diglucuronide, the predominant

con#ugate in healthy individuals.

E 8 ! a g e


37/57

Ileal Disease, Resection and 0"pass6 !atients with ileal dysfunction have a

stri$ingly increased ris$ for developing gallstones. ;allstones develop in E=-B=? of

patients with ileal hronMs disease: the ris$ correlates positively with the e"tent and

duration of ileal dysfunction, 'lthough ilieal disease or resection leads to cholesterol

supersaturation and cholesterol stone formation in some patients , careful studies

now show that most patients with ilieal dysfuncyion form blac$ pigment, not

cholesterol stones.

0iliar" Infection6 rown pigment stones are frequently found in the intrahepatic

bile ducts and are always associated with infection by colonic organisms usually

K.coli, or parasitic infestation 'scaris lumbricoides, or other helminthesJ.

Intraductal stones developing after cholecystectomy are invariable associated with

bile stasis, biliary tree infection, andQor retained suture material.

Si!ns and S"mptoms6

0iliar" Colic/ 5oderate to Severe 1ain6The most common symptom is in pain

the right upper part of the abdomen or epigastrium. This can cause an attac$ of

abdominal pain, called biliary colic, whichG develops quic$ly, is severe, lasts about

one to three hours before fading gradually, isn9t helped by over-the-counter and

isn9t helped by passing wind. The pain may radiate to the bac$, right scapula or

shoulder. The pain often begins suddenly following a meal. The pain of biliary colic is

caused by the functional spasm of the cystic duct when obstructed by stones,

whereas pain in acute cholecystitis is caused by in(ammation of the gallbladder

wall.

Tenderness6 !alpation of the abdomen frequently elicits localized tenderness in the

right upper quadrant which is associated with guarding and rebound tenderness.

5rph"s Si!n6The patient with acute in(ammation of the gallbladder might have

a positive 4urphyMs sign, which is inspiratory arrest during deep palpation in the

right upper quadrant.

EC 8 ! a g e


38/57


39/57

EL 8 ! a g e

Irritation of the Spersaton of 0i

Srface chan!es9ormation

small

Increased mcos

Cr"stal

enlar!es

Increased

mcos

Obstrction of

2ectation and Obstrction

of the

Common 0ile Dct

0acterial

invasion

iver

Impairme


40/57

S"nthesis of the Disease6;allstones can form anywhere in the biliary tree, however the point of origin is

within the gallbladder. ;allstones develop when an individual eats too much fatty

and salty foods that causes an increase in bile cholesterol, therefore, causing an

irritation of the gall bladder. The surface changes within the gallbladder and mucous

secretion increases as a form of a compensatory mechanism. The bile, however,

becomes more viscous ma$ing hard for the gallbladder to contract and secrete bile.

6mall crystals form and enlarges into visible stones. These stones or what we

commonly call )gallstones* tries to get out of the gallbladder. The stone then passes

on the cystic and common bile ducts which later on causes an obstruction. 6ince

there is an obstruction, the gallbladder can no longer secrete bile causing

indigestion, vitamin ',D,K and H deciency and gray stool. There will also be an

increase in the levels of bilirubinQbile pigments in the circulation, thus, ma$ing the

F= 8 ! a g e

Inammation

HUNDIC: N:5RU8 pain

$) 5rph"s

Increase

d 0C

C3O:C4STITIS


41/57

sclera and the s$in yellowish in color. 'lso, this obstruction causes an irritation in

the gallbladder wall, and an in(ammatory response happens through the release of

prostaglandins. Ohen prostaglandins are released, symptoms such as tenderness,

012 pain, murphyMs sign, nausea, vomiting, anore"ia and an elevated wbc

happensQmanifests. Thus, cholecystitis happens.

1redisposin! 9actors6

!e6The incidence increases with age. &ess than B-? of the population under age

F= have stones, in contrast to >B-E=? of those over N=.

1recipitatin! 9actors6

Diet $3i!h 9at, 3i!h Sodim)6Increased inta$e of calories, rened carbohydrate,

cholesterol, and saturated fats has all been postulated to cause cholesterol

gallstones. !atients with cholesterol gallstones secrete a greater fraction of dietary

cholesterol into bile than do normal sub#ects.

Si!ns and S"mptoms6

Tenderness6 !alpation of the abdomen frequently elicits localized tenderness in the

right upper quadrant which is associated with guarding and rebound tenderness.

5rph"s Si!n6The patient with acute in(ammation of the gallbladder might have

a positive 4urphyMs sign, which is inspiratory arrest during deep palpation in the

right upper quadrant.

Nasea and Bomitin!6These signs and symptoms may accompany a gallbladder

attac$. !ain is usually accompanied by nausea and vomiting.

oss of appetite and nore?ia6The pain often begins suddenly following a large

or rich meal. !eople tend not to eat, especially fatty or oily foods, in order not to

e"perience that pain. at absorption is also impaired for the lac$ of bile salts, 's a

result, rapid loss of weight and anore"ia can occur.

F7 8 ! a g e


42/57


43/57

RR0(? cpm

Problem : Activit! Intolerance

Cues Nursing Diagnosis Scientific Explanation Planning Intervention

Subjective Cues:

%"Maniat mi$ala

ku hospital

mangalamut naku!"

,s verali#e$ y the

patient!

Objective Cues:

%Difficulty in

changing e$

position

%@enerali#e$+eakness

%Aimite$ range of

motion

%Nee$s assistance

+hen $oing ,DA

:e!g! going to toilet8

changing clothes!;

%.ital Signs

/P0 (1)'2)mm3g

4emp0 5&!(C

PR0 &6 pm

RR0(? cpm

%,ctivity Intolerance

relate$ to general

+eakness!

%,ctivity intolerance is

affecte$ y any $isor$er

that impairs the aility

of the nervous system8

musculoskeletal

system8 car$iovascular

system8 respiratory

system an$ vestiular

apparatus!

,fter < hours of

nursing

interventions the

client +ill e ale

to0

%I$entify

alternative +ays

to maintain

$esire$ activity

level!

%,sk the client aout the

usual level of energy!

%I$entify factors8 such as

age an$ painful

con$itions!

%Instruct the client in

unfamiliar activities an$

in alternate +ays of

$oing familiar activities!

%Discuss +ith client'S9

the relationship of illness

' $eilitating con$ition to

inaility to perform

$esire$ activities!

%I$entify an$ $iscuss

symptoms for +hich

client nee$ to see

me$ical assistance or

evaluation!

FE 8 ! a g e


44/57

Problem ": Ris# $or %e$icient &lui% 'olume


Subjective Cues:

%"Mana+a ku pong

$anum" ,s

verali#e$ y the

patient!

Objective Cues:

%Dry skin

%@eneral +eakness

%Dry lips

%.ital Signs

/P0 (1)'2)mm3g

4emp0 5&!(C

PR0 &6 pm

RR0(? cpm

Risk for $eficient

flui$ volume relate$

to ina$e>uate flui$

intake

Deficient *lui$ .olume

is $ecrease$

intravascular8

interstitial8 an$'or

intracellular flui$! 4his

refers to $ehy$ration8

+ater loss alone

+ithout change in

so$ium!

,fter < hours of

nursing

intervention the

client +ill e ale

to0

%Demonstrate

ehaviors or

lifestyle changes

to prevent

$evelopment of

flui$ volume

$eficit!

%Evaluate nutritional

status8 noting current

intake8 type of $iet!

%Monitor I'9 alance8

eing a+are of altere$

intake or output!

%Estalish in$ivi$ual

flui$ nee$s ' replacement

sche$ule!

%Provi$e supplemental

flui$s8 as in$icate$!

Problem (: )no*le%+e ,e$icit


Subjective Cues:

%"Nanu +ari

talagang kun$isyun

ku " ,s verali#e$

y the patient!

Objective Cues:

Deficient kno+le$ge

relate$ to con$ition8

prognosis8 treatment8

self-care an$

$ischarge nee$s!

4here is this presence

of kno+le$ge $eficit

$ue to some unfamiliar

information that causes

some confusion to the

client that nee$s to e

$iscusse$!

,fter < hours of

nursing

intervention the

client +ill e ale

to0

%.erali#e

%Provi$e explanations

of'reasons for test

proce$ures an$

preparation nee$e$!

%Revie+ $isease

process'prognosis!

FF 8 ! a g e


45/57

%*re>uently asking

>uestion aout his

con$ition8 treatment

an$ $iet!

%orrie$ ga#e

un$erstan$ing of

$isease process8

prognosis an$

potential

complications!

Discuss hospitali#ation

an$ prospective

treatment as in$icate$!

Encourage >uestions8

expression of concern!

%Revie+ $rug regimen8

possile si$e effects!

%Instruct patient to avoi$

foo$'flui$s high in fats

or gastric irritants!

%Suggest patient to limit

gum che+ing8 sucking

on stra+' har$ can$y orsmoking!

T"pe of IB9 General Description Indication/

1rposes

Date

Ordered/D

ate

Started/Da

te

Chan!ed

Clients

Response to

Treatment

FB 8 ! a g e


46/57


47/57

Nursing Prolems0

(! ,cute pain

1! ,ctivity

intolerance

5! Imalance nutrition0

Aess than o$yre>uirements

.ital Signs

4EMP!

PR :pm;

RR:pm;

/P:mm3g;

5?!& C22

1)

())'?)

5?!6 C2=

(2

(()'&)

5&!( C&6

(?

(1)'2)

Diagnostic an$ Aaoratory

Proce$ure

3ematology

/loo$ chemistry

Me$ical Management0(!I.*

1! Drugs

9mepra#ole

Meperi$ine

3y$rochlori$e

Metocloprami$e Ceftriaxone So$ium

Brso$iol

Aactulose

5! Diet

D=ARs (A

NP9 except me$ication

C/R +' /RP

D=ARs (A

PNSS (A

PNSS (A

NP9

C/R +' /RP

PNSS (A

Soft Diet

May sit up on e$

1TI:NT ND 3IS CR:6 DI:T

FC 8 ! a g e


48/57

T"pe of:?ercise

GeneralDescription

Indication /1rposes

Clients Response and/orReaction to the Diet

Complete0ed Rest >ith0athroom1rivile!es

5a" sit p on

bed

!atient should beon bed most of thetime to decreaseo"ygen demandand to lessen thefeeling of pain buthe can go to thebathroom whenneeded.

' type of e"ercisewherein the patientis being0epositioned every7-> hours.

This was orderedto conserveenergy, promoterecovery andprovide rest toprevent fatigueand feeling ofpain. It is alsoordered todecrease o"ygendemand.

To improvecirculation, toprevent venousstasis,thrombophlebitis,respiratorycomplications ands$in brea$down.

The patient was $ept in bed mostof the time and was able toconserve energy through bedrest as evidenced by patientMsverbalization of decreasedfatigue and wea$ness.

!atient did not manifest pain in

the calf upon dorsi(e"ion on thefoot and maintained s$inintegrity.

1TI:NT ND 3IS CR:6 CTIBIT4

T"pe of Diet GeneralDescription

Indication /1rposes

DateOrdered

Clients

Responseand/or

Reaction tothe Diet

FN 8 ! a g e


49/57

N1O $Nothin!1er Orem)

Soft Diet

!@ orders are nothingper orem diets whichmeans that the patientis not allowed any typeof food or drin$.

This is to introduce adiet that is easy todigest and allow the ;Itract to be ad#ustedwith limitation of foodsrich in fats.

To assess theclientMs labresultswithout anyvariance of

aAected food.

6oft diet wasordered toallow the ;Itract toreceive foodsthat are easyto digest soas to preventgastricirritation andto promoteeasierdigestion

ovember7L, >=7E

ovember>7, >=7E

'dministration ofI5 preventedthe patient fromdehydration. Thepatient

cooperated wellwith theprescribed diet.

;I discomfortli$e abdominalpain waslessenedbecause of thedecreasedcontraction ofthe gallbladder

CI:NTS DRUG T3:R134

Name

Dosa!e,

Rote

and

9re@enc

"

General ctionIndication /

1rpose

Date ordered,

Date

performed,

chan!ed or

D/C

C

Res

me

>it

side

0rand Name6!rilosec,

0apine",

Wegerid, &osec.

Generic

Name6

@meprazole.

Dosa!eMF=mg

Rote

M

Intravenou

s

MThought to be agastric pump

inhibitor in that it

bloc$s the nal

step of acid

production by

inhibiting the

/SQHS 'T!ase

M6hort % termtreatment of active

duodenal ulcer.

Xwith clarithomycin

to treat duodenal

ulcer associated

with H.pylori.

Date Ordered6ovember 7L,

>=7E

Date

1erformed6

ovember 7L,

>=7E

CNS/ead

Dizzi

GI6 '

!ain,

3em

FL 8 ! a g e


50/57

Classication6

!roton !ump

Inhibitor

9re@enc

"

M@nce a

day

system at the

secretory surface

of the gastric

parietal cell. oth

basal and

stimulated acid

secretions are

inhibited.

X6hort-term

treatment of active

benign gastric

ulcer.

X&ong-term

treatment of

hypersecretory

conditions.

X0educe ris$ of

upper ;I leeding

in critically ill

clients.

Date Chan!ed6

Q'

Discontine6

Q'

6

/em

'nem

5isc

!ain,

mala

Name

Dosa!e,

Rote

and

9re@enc

"


1rpose

Date ordered,

Date

performed,

chan!ed or

D/C

C

Res

me

>it

side0rand Name6

Demerol

Dosa!e

M>Bmg

X@ne-tenth as

potent an

analgesic as

X'nalgesic for

moderate to severe

pain.

Date Ordered6

ovember 7L,

>=7E

N

e2e

B= 8 ! a g e


51/57

Generic

Name6

4eperidine

/ydrochloride

Classication6

arcotic

'nalgesic

Rote

M

Intravenou

s

9re@enc

"

M's

needed

morphine. Its

analgesic eAect is

only one-half when

given !@ rather

than parenterally.

/as no antitussive

eAects and does

not produce

miosis. &ess

smooth muscle

spasm,

constipation, and

antitussive eAect

than than

equianalagesic

doses of morphine.

Date

1erformed6

ovember 7L,

>=7E

Date Chan!ed6

Q'

Discontine6

Q'

ma

b" t

Name

Dosa!e,

Rote

and

9re@enc

"


1rpose

Date ordered,

Date

performed,

chan!ed or

D/C

C

Res

me

>it

sid

B7 8 ! a g e


52/57


53/57

" D/C>it

sid0rand Name6

0ocephin

Generic

Name6

eftria"one

6odium

Classication6

ephalosporin

Dosa!e

M7g

Rote

MIntraven

ous

9re@enc

"

MqN

X Oor$s by

inhibiting the

mucopeptide

synthesis in the

bacterial cell wall.

The beta-lactam

moiety of eftri"one

binds to

cabo"ypeptidases,

endopeptidases, and

transpeptidases in

the bacterial

cytoplasmic

membrane. These

enzymes are

involved in cell-wallsynthesis and cell

division. y binding

to these enzymes,

eftria"one results

in the formation of

defective cell walls

and cell death.

XIntra-abdominal

infections due to

K.coli, H.

penumoniae, .

fragilis, lostridium

species most

strain of . di+cle

are resistantJ and

!eptostreptococcus

species.

Date Ordered6

ovember 7L,

>=7E

Date

1erformed6

ovember 7L,

>=7E

Date

Chan!ed6

Q'

Discontine6

Q'

No

e2e

man

b" t

BE 8 ! a g e


54/57

Name

Dosa!e,

Rote

and

9re@en

c"


1rpose

Date ordered,

Date

performed,

chan!ed or

D/C

Cl

Resp

med

>ith

side0rand Name6

1sosan

Generic

Name6

1rsodiol

Classication6

;allstone

solubilizing

drug

Dosa!e

M>==mg

7

capsuleJ

Rote

M@ral

9re@en

c"

Mid

Xaturally occurring

bile acid that inhibits

the hepatic

synthesis and

secretion of

cholesterol: it also

inhibits intestinal

absorption of

cholesterol. 'cts to

solubilize cholesterol

in micelles and to

cause dispersion ofcholesterol as liquid

crystals in aqueous

media. 'bout L=? is

absorbed in the

small intestine after

!@ administration.

1ndergoes a

signicant rst-pass

eAect where it is

con#ugated with

either glycine or

taurine and then

secreted into hepatic

bile ducts.

XDissolution of

gallstones in clients

with radiolucent,

non-calcied

gallstones in whom

elective surgery

would be ris$y or in

those who refuse

surgery.

Date Ordered6

ovember 7L,

>=7E

Date

1erformed6

ovember 7L,

>=7E

Date Chan!ed6

Q'

Discontine6

Q'

GI6

aus

vom

abdo

pain

chole

CNS

/ead

fatig

BF 8 ! a g e


55/57

Name

Dosa!e,

Rote

and

9re@en

c"


1rpose

Date ordered,

Date

performed,

chan!ed or

D/C

C

Res

me

>it

side0rand Name6

ephulac,

hronulac,

onstilac,

onstulose

Generic

Name6

&actulose

Classication6

ephalosporin

Dosa!e

ME= cc

Rote

M@ral

9re@en

c"

Monce a

day at

bed

time.

XIn the colon,

&actulose is bro$en

down primarily to

lactic acid.

4etabolized in the

colon by bacteria.

XTreatment of

constipation:

prevention and

treatment of portal-

systemic

encephalopathy,

including stages of

hepatic precoma

and coma.

Date Ordered6

ovember 7L,

>=7E

Date

1erformed6

ovember 7L,

>=7E

Date Chan!ed6

Q'

Discontine6

Q'

GI6 '

disco

and

aus

5om

BB 8 ! a g e


56/57

BII% CONCUSION

@ur gallbladder is one of the important organs in our body. /owever, ma#ority of

us tend to forget its function and importance. holecystitis or the in(ammation of

the gallbladder because of an obstruction is a disease that requires a medical

attention. It adds on the morbidity and mortality rate of gall stone diseases. Thus, it

is one of the common diseases in our country since one contrubuting factor is the

food that we eat. This obstruction needs immediate attention because it may cause

many complications. The harm that gallstones could give is that they may leave the

gallbladder and enter the small intestine which causes the patient to e"perience

abdominal pain.

Through this study, everyone will become aware of hisQher health and daily

lifestyles. Therefore, we conclude that in order to lower the ris$ of having this $indof condition, each and every one of us must be conscious on our diet especially

when it comes to our food preferences. Though there is a saying that, )4as

masarap pag bawal*, we should still be cautious of the foods served in our dining

table % especially if itMs high in sodium and fat. 's Dr. /arry Vohnson stated that the

secret to good health lies in every decision that human beings ma$e.

B 8 ! a g e


57/57

BIII% R:CO55:NDTIONS

To the !hilippine ;overnment, they may be aware of increasing incident of thedisease condition in our country and that they may help those who are less

fortunate by ma$ing the health care services more aAordable and acceptable:

or the students who will study holecystitis as their case, that they may $now

the diAerent causes of the said condition and understand the pathology of the

disease and how the signs and symptoms manifest. That they may also $eep in

mind the importance of the patientMs information which could be obtained on the

chart.

or student nurses who will be handling patients with this condition, health

education must always be done during nurse-patient interaction. Teaching patients

proper ways in maintaining healthy lifestyle and importance of proper nutrition.

or patients with ris$ factors in developing any of the conditions that lead to

biliary obstruction, awareness of the signs and symptoms can improve chances for

early diagnosis and improved outcome.