Past Medical History
Obesity, multiparity, infection, cancer, extensive fasting, pregnancy
History of present illness
Most patients with acute cholecystitis describe a history of biliary pain. Some patients may have documented gallstones.
indigestion, moderate-severe pain, fever, jaundice, abdominal tenderness, nausea, vomiting, restlessness, diaphoresis, leukocytosis, abdominal rigidity.
elderly and critically ill patients.
Inflammation is the major pathophysiologic condition. Gallbladder becomes edematous and hyperemic. It becomes distended with bile and pus. The wall of the gallbladder becomes scarred after an attack and decreased functioning occurs
Prolonged immobility, fasting, prolonged parenteral nutrition, diabetes mellitus, E. coli, streptococci, salmonellae, adhesions, neoplasms, anesthesia and opioids.
small frequent meals, diet low in saturated fats and high in fiber & calcium.
analgesics, anticholinergics, fat-soluble vitamins, bile salts, morphine,
Ultrasonography, ERCP, percutaneous transhepatic cholangiography, liver studies, white blood cell count, serum bilirubin
Imbalanced Nutrition: less than body requirements r/t impaired fat digestion due to obstruction of bile flow
Consult with patient about likes and dislikes.
Provide oral hygiene before meals
Assess for abdominal distention, frequent belching, guarding or reluctance to move
Ambulate and increase activity as tolerated
Advance diet as tolerated, usually low-fat, high fiber food.
Risk for deficient fluid volume r/t distention and gastric hypermotility
Maintain an accurate record of I&O and assess skin and mucous membranes, peripheral pules and capillary refill.
Monitor for signs and symptoms of increased or continued nausea, vomiting, abdominal cramps, weakness, hypoactive or absent bowel sounds.
Perform frequent oral hygiene.
Keep patient NPO status as indicated.
Eliminate noxious sights or smells from environment.
Acute Pain r/t inflammation process
Observe and document location, severity and characteristic of pain.
Promote bedrest, allowing patient to assume position of comfort.
Control environmental temperature.
Encourage use of relaxation techinques.
Maintain NPO status if indicated.