Calculus Cholecystitis

7/31/2019 Calculus Cholecystitis

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Calculus Cholecystitis

Prepared by:

Edderlyn Lamarca


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I. Biographic Data


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Name : Patient A.B Address : Mayondon Los Banos

Laguna

Age : 30 years old Gender : Female Room and Bed No. : Bed 34 Chief Complaint : Yellow discoloration of the

skin and severe itchiness

Provisional Diagnosis : Calculus Cholecystitis Admission Date : January 5, 2011 Attending Physician : Dr. Bryan Banatlao Religious Affiliation : R. Catholic


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II. Nursing History


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Past Health History

The patient had an incomplete immunizations thevaccine that she only received was BCG. The patientalso stated that during her childhood she is always inthe hospital because of weak resistance andimmunity, she easily acquired a disease likebronchopneumonia, and influenza, she always hadcough and colds. She has no any allergies. Sheundergone two caesarian deliveries.

The patient admitted that she had diagnosed withhepatitis A before about 5 years ago, and was treatedwith unrecalled medications.


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Until one week prior to admission the patient noticed graydiscoloration of her stool and tea-colored urine, consultationmade at nearest clinic. Ultrasound made and the analysiswas the patient has Calculous Cholecystitis. She was thenreferred to consult in the hospital for further laboratory work-ups. However, due to financial insufficiency the consultationdeferred.

One day prior to admission the patient experiencedpersistent extreme itchiness that she cant tolerate. On the

day of admission, the attending physician subjected her to aurinalysis and other blood chemistries and fecalysis andprescribed the following medicines:

Vitamin K 1 tab BID Cefuroxine 500mg BID

Iterax 25 mg BID Multivitamin OD Omeprazole 25 mg OD

Liverine 1 cap TID


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C. Family History

LEGEND:

AW

KF KFPt.

AW

AW AW AWAW

-Male

-Female

AW Alive and Well

KF Kidney failure

Pt - patient


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From the above genogram, both the parentsof the patient are alive and living healthy. Thepatient is the eldest with liver disease, her two

sisters have kidney failure and all her fourbrothers are alive and well.


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III. Patterns of Functioning


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Coping Patterns

The patient has a strong faith that she will be fine with the help of medicalstaffs. Shes trying to comply on her treatment and medications. To divert her

attention from itchiness and her situation the patient preferred to talk with otherpatients and ambulate frequently around the hospital hallways.

Interaction Patterns

During nursing interactions the patient was able to verbalize and convey

her feelings and answer questions relevantly with moderate voice and paysattention to the interviewer very well

A. Psychological Health


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Cognitive Patterns

The patient was able to retrieve those remote and current memoriessuch as her childhood illnesses, name of school she has entered. The

patient cooperated in decision making regarding her care with collaborationof her family

Self- Concept

The patient shows a positive self concept, she was able to adjust and

accept his situation particularly the changes in her appearance due toher condition. She did not portray any guilt or anger about her situation,shes still able to socialized with other people and appears cheerful andlively.

Emotional Patterns

The patient is able to convey ones emotion. She verbalizes that shereally missed her two children especially her 1 year old baby.

S lit


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Sexuality

The patient has two children, the eldest is two years old and theyoungest is one year old. Both were delivered in caesarian section. Shesvery vocal about sexuality and confessed that they still practice it even

before confinement.

-- Family Coping Pattern

Her mother is the one taking care of her during stay in the hospital andher husband is the one taking care of their children at home. The patients

mother verbalizes that they were able to adjust with some changes in theirfamily role pattern and her other children are willing to help them in financialneeds.

Interpretation:From the above information gathered about psychological health the

patient was able to adopt with changes in his role and functions, and wasable to cope up well with these changes psychologically along with his familyand significant others.


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B. Socio- Cultural Patterns

1. Cultural Patterns

2. Significant Relationship

The patient and her family is living with her mother, they have

a good bond relationship. She said that she is very gratefulbecause her mother is always at her side to take care of her eversince. Her other siblings were also willing to help her and herfamily to cope up with his condition.

3. Recreational PatternsAfter her household chores, the patient watches television and

take some rest, playing with her children is part of her recreationalactivities.


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4. Environment

They resided in a small town in Los Banos Laguna, a crowded anda government own property. They are living with her mothers house,

with an adequate space for them and with complete facilities.

5. Economic

The patients family has no enough income to provide and support

all her hospital bills since her husband is the only one working for theirfamily.

Interpretation:

They do not have sufficient income to support all their family needsand other expenses. However their other relatives are willing to help

them in finances. This may be a hindrance to maintain health, and incompliance with treatment and medications.


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C. Spiritual Patterns

Religious Beliefs and Practices

They are a Catholic members, they go to church and worship Godevery Sunday, their religious affiliation doesnt interfere in healthmaintenance and practices. The patient verbalizes that he believed in Godand in his power. They also believe in supernatural powers and folk healersto cure illnesses.

Values and Valuing

They give value on health; however due to financial inconsistencieshealth is being set aside and become the least priority.

Interpretation:They have a good relationship with the almighty God and were able to

find time to worship him in spite of their busy schedule. Financial stabily istheir major problem in maintaining health.


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IV. Activities of Daily Living


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Interpretation and AnalysisDuring HospitalizationBefore HospitalizationADL

Biliary colic is noticeable

several hours after heavy

meals it is caused by

contraction of the gallbladder

that brings abdominal pain to

the patient, small frequent

feeding is more

recommended to decrease

contraction.

The patient still has a good

appetite even during

hospitalization, however she

consumed less amount of

rice than usual because she

experienced abdominal pain

when she ate too much. She

also avoid too much MSG as

she considered it as the cause

of her illness.

The patient had a good

appetite and able to eat 2 cup

of rice every meal; she added

that she is fund to eat food

with MSG, she always put

magic sarapin her rice. She

consumed only 4-5 glasses

of water every day.

1. Nutrition

Bile products cannot enter

into the intestine due toobstruction, therefore gray-

colored is due to absence of

bile pigments in the stool.

Instead of passing into the

intestine, the bile absorbed

into the blood therefore bile

is being associate with the

urine which brings tea-

colored.

During hospitalization her

elimination patternsparticularly the color of her

urine and stool were back

into its normal color and

experienced no difficulties.

One week prior to

hospitalization the patientexperienced alteration in her

elimination pattern. She

noticed a gray-colored stool

and tea-colored urine which

are unusual but with no

difficulties

2. Elimination

Exercises such as activeDuring hospital stays theDoing household tasks are3 Exercise


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Exercises such as active

range of motions prevent

muscle atrophy or muscle

weakness due to

confinement.

During hospital stays the

patient felt slightly weak

maybe due to her condition.

However she makes some

walks around the hallways

every morning.

Doing household tasks are

her form of exercise prior to

confinement.

3. Exercise

The patient is prone to

infection due to poor hand

hygiene, and since she has a

multiple lesions and frequent

scratching, bacteria caneasily acquire.

During hospitalization the

patient took a bath at least

twice a day to relieve

itchiness. However hand

washing sometimes is beingignored

He took a bath everyday and

practice hand washing

especially before meals.

4. Hygiene

5. Substance Use

Because of present conditionsleeping pattern is

interrupted. Itchiness is due

to bile salts accumulating in

her skin.

The patients sleeping hoursis being disturbed because of

severe itchiness, that she can

not tolerate that usually

become extreme at night.

The patient usually sleeps 8-9 hours at night without

disturbance; with no day

nap-time. Watching TV and

sleeping were his form of

rest.

6. Sleep and Rest


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V. Physical Assessment

Interpretation and AnalysisActual FindingsNorms


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Interpretation and AnalysisActual FindingsNorms

-Normal

-Due to obstruction bile cannotpass through to the duodenum;

instead absorbed into the blood

that brings yellow discoloration

of the skin (jaundice)

-Dirty nails is due to too much

scratching and poor hand hygiene

Normal

Maybe due to stress and thediscoloration of the skin

Normal

Normal

-stand straight, and walk straight

- appeared jaundice all over her

body

-wears clean dress, with dirty

nails

-body weight and height is

congruent with his/her age-Appears 5 years older than her

age

-speaks not too loud and not too

low, and respond accordingly

-able to convey non verbal cues

through facial expression

-stand straight, walk straight

-fair color complexion

-with clean dress, and clean hair

and nails.

-body weight and height iscongruent with his/her age

-Appearance is proportional with

his/her age

-speaks not too loud and not too

low, and respond accordingly

-gestures and facial expression

General Appearance

1.Posture/ Gait

2.Skin Color

3.Personal Hygiene/ Grooming

4.Nutritional Status

5.Age Appropriateness

6.Verbal Behavior

7.Non-verbal Behavior


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Within normal

within normal

within normalwithin normal

36.5 ^C

80 bpm

17cpm100/70 mmhg

unable to assessed

unable to assessed

36.5-37.5^C

60-100 bpm

12-20 cpm120/80

Measurements

1.Temperature

2.Pulse Rate

3.Respiratory Rate4.Blood Pressure

5.Weight

6.Height


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Interpretation and

AnalysisActual FindingsNormsBody Part

(Technique used)

due to bile saltaccumulation in the

skin, and jaundice is

due to obstructed

bile flow

Normal

NormalEnlarged liver due to

inflammation.

round, with multiplecrust lesions,

jaundiced.

5 gurgling sound

tympanic sound

with palpable liver

and tenderness uponlight palpation

round, smooth andwith fair complexion

gurgling sounds 3-

15/min

tympanic sound over

the stomach

soft on expiration, notenderness, liver

should not be

palpable

AbdomenInspection

Auscultation

Percussion

Palpation


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Interpretation and

AnalysisResultProcedureDate

Impression:

Consider liver

parenchymal

disease

Calculous

cholecystitis with

non-dilated billary

tree.

No evident ascites

The liver is normal in size with smooth

contour

It measures 12.9 cm at the right

midclavicular line

Liver parenchyma shows coarsened

echopattern with periportal brightening.

No evident focal mass nor billary ectasia

noted

No evident fluid collection in themorisons fossa and perihepatic spaces

Gallbladder is normal in size and

configuration measuring 5.6 x 2.2 cm (Lx

AP)

Its walls are thickened measuring 0.47

cm. There are multiple mobile shadowing

intraluminal echoes noted

Measuring 0.31 ccm, 0.49 cm, 0.29 cm,

0.31 cm, and 0.44 cm

Negative sonographic Murphys sign. No

pericholecystic fluid noted.

Common bile duct and intrahepatic ducts

are not dilated. CBD measures 0.29 cm.

ULTRASOUND

(LIVER,

GALLBLADDER

)

December

12, 2010


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Interpretation

and AnalysisResultNormsProcedureDate

Normaldark yellowAmber toyellow

URINALYSIS

ColorJanuary 3,

2011

Normalslightly hazyclearTransparency

Normal7.05-8.0pH

Normal1.0101.005-1.030

Specific grav.

0-1RBC

1-3Pus cellmoderateEpithelial cells


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Interpretation and AnalysisResultNormsProcedureDate

Normal87.560-100mg/dl

BLOOD

CHEMISTRY

Fasting blood

sugar

January 4,

2011

Normal188.5100-200mg/dl

Cholesterol

Increased. Increase risk for

atherosclerosis165.030-150

mg/dlTriglycerides

Increased. Signifies kidneyproblem

28.58-20 mg/dlBUN

High levels of creatinine

often mean that the kidneys

are not doing a good job of

clearing waste products andtoxins from the blood.

3.00.7-2.0mg/dl

Creatinine

Normal5.02.9-.5 mg/dl(F)

Uric acid

Normal31.88-40 u/dlSGOT (AST)

Normal22.45-30 u/dlSGPT (ALT)


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Normal3250-4 min.HEMATOLOGY EXAM

Bleeding time

January 8,

2011

Normal4105-10 min.Clotting time


Non- reactive0.1400.150Anti- HAV IgMJanuary 10,2011

Non-reactive0.0460.105HBc Ab IgM

Interpretation and

AnalysisResultNormsProcedureDate

Normal497150-500 x

10^9/L

HEMATOLOG

Y EXAMPlatelet

January 10,

2011

Normal2000-4 min.Bleeding time

Normal4405-10 min.Clotting time


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Interpretation and


Increased. May signifieshepatic disease.

134.1025.0-90.0lu/L

CLINICALCHEMISTRY

Alk phos

January 11,2011

Normal146.00135-155mEq/L

Sodium

Normal3.023.4-5.3mEq/L

Potassium

Increased. Biliary

obstruction18.69up to 1.0

mg/dLTotal Bilirubin

Increased. Biliary

obstruction

12.30up to 0.2

mg/dL

Direct Bilirubin

Increased.

Hepatocellular damage6.39up to 0.8

mg/dLIndirect

Bilirubin


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Prolonged. Due to deficiency

in clotting factors II, V, VIII,

IX, X, XI

15.6 sec11-14 secCOAGULATION FACTOR

PT

January 11,

2011

Prolonged. Due to deficiency

in clotting factors II, V, VIII,

IX, X, XI

1.360.8-1.2INR

Normal70%70-120%% ACTIVITY

Normal13.3 sec10.4-16.1sec

CONTROL

Normal28.6 sec27-34 secPTT

Normal1.000.8-1.2RATIO

33.4 secCONTROL


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Normal116120-150 g/LHEMATOLOGYHemoglobin

January 11,

2011

Normal0.350.37-0.47Hematocrit

Increased. Due to inflammatory

response of the body13.105-10^9/LWBC

Increased. May signify bacterial

infection.0.800.30-0.70Segmenters

Normal0.200.20-0.30Lymphocytes


Non- reactive0.6031.000HEPATITISPROFILE

HBsAg

January 13,

2011

Reactive. It siginifies positive

hepatitis B284.010.00Anti- HBs

Non-reactive1.321.000Anti-HBe

Non-reactive0.1271.000HBeAg


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Normal142.3135-155meq/L

CLINICAL

CHEMISTRY

(Electrolytes)

Sodium

January 13,

2011

Normal3.793.4-5.3 meq/LPotassium

Normal106.496-106 meq/LChloride

8.5-11.0

mg/dlCalcium

Interpretation and


NormalbrownYellow to

brown

FECALYSIS

color

January 14,

2011Normalsoftsoftconsistency

normalNo intestinal parasitesAbsenceOva or parasites


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Nsg.

Responsibiliti

es

ContraindicationIndicationClassificationTreatment/

Infusion

1.Explain the

purpose of the

IVF to the

patients

family

2.Checks the

doctor orderbefore looking

the IVF

3.Frequently

check the IVF

site for

infiltration,

dislodge andinflammation

IVF is an essential

when patient

are unable to

take enough

food and

fluids orally.

It is effectiveand efficient

method of

supplying

liquids

directly into

the IVF

compartmentand replacing

electrolyte

losses.

Isotonic SolutionINTRAVENOUS

FLUID PNSS

1000ml/12

hours (27.28

gtts/min.)

C


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1. Provide a clear and

concise information

regarding surgery

prior to O.R

2. Instruct NPO 6-8 hrs.prior

3. Teach proper splinting

and breathing

exercises

3. Discuss ones feeling

and emotion

regarding surgery, to

alleviate anxiety

4. Observe wound

drainage after surgery

and its characteristics

5. Advise frequent

ambulation in firstday after surgery

6. Progress diet as soon as

peristalsis resume.

patient with

altered

clotting

mechanism,

hemophilia.

indicated in the

presence of

gallbladder

trauma,

gallbladdercancer, acute

cholecystitis,

and other

complication

s of

gallstones.

removal of the

gallbladderCholecystectom

y

Cont. treatment


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VII. Medication, IV Infusions,

Blood Transfusions, Treatments

Given


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Nsg. ResponsibilitiesSide EffectsContraindication

IndicationClassification Dosage/Frequency

Generic/ Trade

Name

>Monitor for

severe reaction

>Monitorlaboratory

results esp.

PT/INR

>Monitor vitamin

K toxicity

such as

thrombosis,

vomiting,

kidney tubule

degeneration,

and jaundice

>Avoidance of

significantincrease in

daily intake of

vitamin K-rich

foods such as

green-leafy

veg., liver,

tomatoes

facial

flushing

,dizzines

s,

headach

e,

gastric

upset,

peculiar

taste

sensatio

n

Hyperse

nsiti

vityto

any

compon

ent

of

this

medicati

on.

Anticoagulant-

induced

prothrombindeficiency caused

by coumarin or

indanedione

derivatives;

hypoprothrombine

mia secondary to

factors limiting

absorption or

synthesis of

vitamin K, e.g.,

obstructive

jaundice, biliary

fistula, sprue,ulcerative coilitis,

celiac disease,

intestinal

resection, cystic

fibrosis of the

pancreas,

andregional

Vitamin5 mg tablet1 tab BID

Vitamin K

(Phytonadi

one)Trade

name:

Mephyton,

Vitamin K

Nsg.Responsibilitie

Side EffectsContraindication

IndicationClassification

Dosage/Frequen

Generic/Trade


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Responsibilitie

sononFrequen

cyTrade

Name

>Before giving

drug, ask

patient if he is

allergic to

penicillins orcephalosporins.

>Monitor

patient for

signs and

symptoms of

superinfection.

>Perform

culture and

sensitivity tests

before

initiation of

therapy

>Report onset

of loose stools

and diarrhea

> diarrhea

>nausea

>impetigo

>Contraindicate

d in patients

hypersensitive

to drug or other

cephalosporins.>Use cautiously

in patients

hypersensitive

to penicillin

because of

possibility of

cross-sensitivity

with

other beta-

lactam

antibiotics.

>Use cautiously

in breast-

feeding

women and inpatients with

history of

colitis or renal

insufficiency.

> Serious lower respiratory

tract

infection, UTI, skin or

skin-structure

infections, bone or jointinfection,

septicemia, meningitis,

and

gonorrhea

> Perioperative prevention

> Bacterial exacerbations

of chronic

bronchitis or secondary

bacterial

infection of acute

bronchitis

> Acute bacterial maxillary

sinusitis

> Pharyngitis and

tonsillitis> Otitis media

> Uncomplicated skin and

skin

structure infection

> Uncomplicated UTI

> Uncomplicated

gonorrhea

> Early Lyme disease

Antibiotic500mgIV BID

Cefuroxime

Zinacef


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Nsg.

Responsibi

lities

Side

EffectsContraindic

ationIndicationClassificat

ionDosage/

Frequenc

y

Generic/

Trade

Name

>Evaluate

alertness.

Drowsiness

may occur

but

disappear

few days of

continuedtherapy

>Monitor

condition of

oral

membrane

Dry

mouth,

drowsines

s,

tremors,

convulsio

n

Hypersensiti

vity to

cetirizine &

other

piperazine

derivatives.

Intermittent

acuteporphyria.

Symptomatic

treatment

ofanxiety, prurit

us of allergic

origin

Antihistam

ine25 mg

tablet

BID

Hydroxyzin

e

dihydrochlo

ride

Iterax
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Nsg.

ResponsibilitiesSide

EffectsContraindic

ationIndicatio

nClassificat

ionDosage/

Frequen

cy

Generic/

Trade

Name

>Assess patient

for signs of

nutrition

deficiency prior

to and throughout

therapy

>Instruct to

notify side effectsof medication

>Encourage to

comply on

medication

>Explain that the

best source of

vitamins is a well

balanced diet

with foods from 4

basic food group

Allergic

reactionhypersensiti

vity to

preservative,

colorants,

and

additives,

including

tartrazine,saccharine,

aspartame

treatment

and

preventio

n of

vitamin

deficienc

y

Vitamin1 capOD

Multivitami

n

Theravim


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Nsg.

Responsibilities

Side

Effects

Contrain

dication

IndicationClassifica

tion

Dosage/

Frequency

Generic/

TradeName

Treatment

of acute or

chronic he

patitis;

protect &regenerate

liver cells;

improves

liver

functions.

Cholagogu

es,

Cholelitho

lytics &

HepaticProtectors

1 cap TIDLiverine
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VIII. Pathophysiology

Precipitating factors


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Precipitating factors:- Poor nutritional diet (high fats, high sodium)

Decrease synthesis of bile acid and increase cholesterol

synthesis

Bile supersaturated with cholesterol

inflammation- compressed blood vessels of gallbladder

Chemical reaction: autolysis

Stone (obstructs the bile flow)

Bile cannot go into the duodenum;absorbed into the blood

Bile salts formation in the skin

Jaundice, tea-colored urine, clay-colored stool

Abd.pain

Pruritus


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Signs and symptoms:

Clinical manifestation:Manifested by pt:

RUQ abd. Pain radiating to

shoulder or back

-contraction of the gallbladder

Jaundice

-bile absorbed into the blood

Pruritus

-bile salt formation into the skin

Change in color of urine and stool

-bile cannot flow into the duodenum;

bile pigments being afiltered in the

kidney

Vitamin deficiency

-obstruction interferes

absorption of fat soluble vit. A,D,

E, K

Jaundice (generalized)

Icteric sclera

Pruritus

Crust lesions

Abdominal tenderness at RUQ

radiating to the back

Gray-colored stool

Tea-colored urine

X Prioritized List of Nursing


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X. Prioritized List of Nursing

ProblemsJustificationCuesNursing Problems IdentifiedDate

Acute pain is due toinflammation of the

gallbladder that causes

alteration in comfort

which I consider as the

highest priority.

Obstruction in the bile flow

may cause deficiency in

vitamin absorption and

clotting factors, the

patient is prone to

bleeding.

Pruritus is due to

accumulation of bile saltsin the skin which causes

itchiness, and I

considered it as least

priority among the three

identified problems

pain scale 7/10 with facial

grimace

with body malaise

with guarding

behavior

increased PT and

INR

multiple crust

lesions all over the

body

puritus

body malaise

1. Acute pain related toinflammation of the

gallbladder secondary to

biliary obstruction as

evidenced by abdominal

tenderness upon palpation

2. Risk for bleeding related to

altered clotting mechanism

as evidenced by prolonged

prothrombin time

3. Impaired skin integrity

related to accumulation of

bile salts in the skin as

evidenced by pruritus.

January 24,2011


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EvaluationRationaleNursing InterventionsGoal/

Objectiv

AnalysisCues


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Objectiv

es

Exhibits

bleeding-

free.

- to prevent falls and

injuries

- to avoid cuts and

bleeding

- permits detection ofbleeding in

gastrointestinal

tract

- May indicate early

signs of bleeding

and shock

-indicate alteredclotting

mechanisms

- provide badseline

and evidence of

hypovolemia, and

hemorrhagic

shock.

-promotes clotting byproviding fat-

soluble vitamin

necessary for

clotting

Provide safe

environment such

as side rails

Avoid sharp

objects, or use softbristled toothbrush

Observe each stool

for color,

consistency, and

amount

Be alert for

symptoms ofanxiety, epigastric

fullness, weakness,

and restlessness

Observe for

hemorrhagic

manifestations:

ecchymosis,

epistaxis,petechiae, and

bleeding gums

Record vital signs

at frequent

intervals

Administer vitamin

K as prescribed

After long-

term

nursing

interventi

ons theoccurren

ce of

bleeding

will be

prevente

d.

Risk for bleeding

related to

altered

clotting

mechanismas

evidenced

by

prolonged

prothrombin

time

S> hindi pa ko

maoperahan

kasi baka

daw ako

duguin asverbalized by

the patient.

O>

increased PT

and INR

With multiple

crust lesions No bleeding

noted

EvaluationRationaleNursingGoal/ ObjectivesAnalysisCues


47/48

EvaluationRationaleNursing

Interventions

Goal/ ObjectivesAnalysisCues

Exhibit comfort and

free from

complication

Assist in

determining

appropriate

interventions

Providesbaseline for

detectiong

changes and

evaluating

effectiveness

of

interventions.

Prevent skin

excoriation

and infection

from

scratching

Removes

waste products

from skin

while

preventingdryness of skin

May decrease

skin irritation

and need for

scratching

Prevent

infection

Minimizeitchiness

Assess degree

of discomfort

related to

pruritus

Note andrecord degree

of jaundice

Keep patients

fingernails

short and

smooth

Provide

frequent skin

care; avoid use

of irritating

soap and

alcohol based

lotion

Recommend

avoiding use

of harsh

detergents Emphasized

frequent hand

washing

Administer

anti histamine

After 6 hours of

nursing

interventions

the patients

comfort willincrease and

will verbalized

understanding

to prevent

complication

such as

infection

Impaired skin

integrity

related to

accumulation

of bile salts inthe skin as

evidenced by

pruritus.

S> Nangangati

parin ako as

verbalized by

the patient

O> multiple crust

lesions all over

the body

puritus

with body

malaise

with icteric

sclera

with

generalized

jaundice


48/48

XII. DISCHARGE PLAN:M-edication

Patient has to continue his medication. Vitamin K 1 tab twice a day every 6 am and 6 pm,Iterax 25 mg twice a day (6pm, 6am), Multivitamin once a day at 6pm, Liverine 1 cap threetimes a day every 6 am, 12 nn, 6 pm

E-xerciseThe patient was advised to have complete bed rest until strength is regained. Have turn side to

side every 2 hours to prevent bed sores. Have ROM exercise on to enhance client's bodyfunction. Proper wound splinting is advised when moving to control pain and preventwound evisceration after surgery.

T-reatmentAdvise to continue all treatments and medications prescribed at home.H-ealth teachingTeach the client how to have a healthy lifestyle. Teach patient the foods to eat and the foods to

avoid. Teach the family members how to prepare low sodium and low fat diet. Insist dietmodification.

O-ut Patient

The client was advised to have a follow-up check-up, as indicated by the physician.D-ietPatient was instructed to maintain the low salt and low fat diet. The low salt diet is designed to

induce a loss of sodium and water from the body or avoid sodium retention. A low fat diethelp prevent cholesterol stone formation that may aggravate previous condition.

Documents

Calculus Cholecystitis