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INTRODUCTION
Choledocholithiasis (stones in common bile duct) is one of the complications of
cholelithiasis (gallstones), so the initial step is to confirm the diagnosis of cholelithiasis.
Typically patients with cholelithiasis present with pain in the right upper quadrant of the
abdomen with the associated symptoms of nausea and vomiting, especially after a fatty meal.
The physician can confirm the diagnosis of cholelithiasis with an abdominal ultrasound that
shows the ultrasonic shadows of the stones in the gallbladder.
The incidence rate for gallstones is 10-20%. Approximately 600,000 cholecystectomies are
performed in the United States every year, and choledocholithiasis complicates 10-15% of these
cases. In Asian populations, infestation with a lumbricoides and C sinensis may promote stasis
by either blocking the biliary ducts or by damaging the duct walls, resulting in stricture
formation. Bactibilia is also common in these instances, probably secondary to episodic portal
bacteremia. Some authors have suggested that the stones are formed because of the bactibilia
alone and that the parasites' presence is just a coincidence. Choledocholithiasis occurs more
frequently in females than in males. Patients with choledocholithiasis may be completely
asymptomatic; in approximately 7% of cases, the stones are found incidentally during
cholecystectomy. Stones are seen in 1% of autopsies performed on individuals older than 60
years who died of unrelated causes. Approximately 25-50% of asymptomatic CBD stoneseventually cause symptoms and require treatment. Symptoms occur when the stones obstruct the
CBD. The clinical presentation varies depending on the degree and level of obstruction and on
the presence or absence of biliary infection.The management of choledocholithiasis remains in
evolution since the introduction of laparoscopic cholecystectomy. If the local surgical group is
adept at laparoscopic cholecystectomy and intraoperative cholecystectomy, then a laparoscopic
cholecystectomy with cholangiography may be the best approach. However, if CBD stones are
present, laparoscopic CBD exploration and stone removal is technically challenging and only the
most proficient and skilled laparoscopist can readily accomplish this operation. Note that an
endoscopic association loaded with skilled laparoscopists performed 1 of the above-mentioned
studies. On the other hand, if you have a well-trained endoscopist, then endoscopic stone
extraction is successful 90% of the time. Alternatively, preoperative magnetic resonance
cholangiopancreatography has been recommended to look for CBD stones.
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The group chose this case because more clinical skills will be developed by experiencing the
clinical management of this disease-condition and it will enhance ones knowledge in
implementing proper nursing intervention to the patient towards recovery.
Objectives
Nurse Centered:
General:
To enhance skills, comprehension and approach in the practice of nursing and be able to
establish knowledge on the risk factors, prognosis nursing management, current trends and
incidence of the disease condition that was chosen.
Specific:
To come up with a comprehensive presentation of the disease condition by means ofcorrect presentation of the data gathered through the use of nursing process.
To present the current trends about the disease condition; the reason for choosingsuch case for presentation; and the importance of the case study.
Patient Centered:
General:
To be able for the client to fully understand and recognize the disease condition,
emphasize the importance of making appropriate action and to guide the patient towards
recovery.
Specific:
To impart knowledge about the importance of healthy lifestyle. To render proper nursing management and medical regimen needed by the patient. To identify predisposing factors that aggregate the present condition of the patient.
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II.NURSING PROCESS
A. ASSESSMENT1. Personal Data
A. Demographic Data
Name: Patient X
Sex: Male
Age: 45 y/o
Civil Status: Married
Occupation: Farmer
Religious Affiliation: Roman Catholic
Position in the Family: Father
Address: Tarlac City
Date of Birth: January, 1964
Place of Birth: Tarlac City
Nationality: Filipino
Date of Admission: September 29, 2010
Health Care Financing: Phil health
Usual Source of Medical: Health center, Clinics, Hospital Care
Admitting Diagnosis: Choledocholithiasis
B. Environmental StatusPatient X lives at a barangay in Tarlac City.. According to him, their house is made up of
wood and cement with 2 windows and 2 doors: one in front of the house and one at the back.
Their water source is a Cartesian well located outside their house with a distance of 4 meters
from their kitchen. Their toilet is located 3 yards away from their kitchen. Their house has 2
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rooms, one room is used as a store room while the other one is their bedroom.. Their front yard
has irregular elevations with a muddy and slippery pathway leading to the kitchen.
Lifestyle
The patient wakes up at around 5:00 am and drinks a cup of coffee. After that he will
immediately proceed to his owned rice field to start his daily work consisting of plowing the
field and pulling out the weeds around. He usually eats fried eggs and tinapa and drinks coffee
for breakfast. His diet is usually composed of instant noodles, fried foods, and sometimes, if their
budget enough, he stated that he also likes to eat fatty foods. He goes to sleep at 9:00 and does
not observe evening hygiene.. He spends his leisure time by taking a nap.
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3. History of Past Illness:The patient had chicken pox and measles in her childhood. She also claimed that she
completed her immunizations. Patient X stated that she does not have any allergic reaction to
drugs, animals, or any other substances.
4. History of Present Illness:
Patient X stated that one month before the admission, she started experiencing abdominal
pain located at the right upper quadrant and radiates at the back. She described the pain as
"parang dinudurog ang tiyan ko. The pain occurred twice a week during the month, but became
intolerable and occurred almost everyday during the last week before her admission. During
these days, the pain was accompanied by occasional fever, anorexia, and nausea and vomiting.
According to the patient, the pain usually occurs during the afternoon up to the evening. During
the assessment, she graded the pain intensity as 8/10 prior to her operation. Patient X tried to
alleviate the pain by applying hot compress and splinting pillows at the site where the pain
originated, yet the pain did not subside. Patient X stated that the pain occur regardless of her
activity. She stated that she had several check-ups prior to her hospital admission. She was then
prescribed medications such as ibuprofen for pain. She was then admitted at Tarlac Provincial
Hospital because of her continuous pain in her abdomen, anorexia, fever, nausea, and vomitingand advised by the physician to undergo operation.
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3. Physical Assessment
THE THIRTEEN AREAS OF ASSESSMENT
1. SOCIAL STATUS
The patient is 45 years old and currently living at Tarlac City. He has a good relationship
with his family members. They help each other whenever they are in need and work in order to
support each family member. In his age, he still continues to work to provide the needs of his
family. Each of the members of their family performed their specific roles. If one of them got
problems, members are always there to support.
Norms:Family members should perform their roles. Good communication within the family must
be maintained to obtain a healthy relationship with one another. Social support is a perception
that one has emotional and tangible resource to call on when needed, perceived social support is
being followed by the family to express the love and care to the family. Financial aspect is one of
the normal constraints in the family. (Kozier , copyright 2004).
Analysis
The patient has a good social relationship with his family. If some problem arises, they
can still manage to handle it properly.
2. MENTAL STATUS
Client is oriented to time, place and person. He can identify things or names
being asked. He can recall recent and remote memories he experienced.
He can speak in Tagalog and Kapampangan .He is responsive and answers to the questions being
asked.
Norms: The patient should be oriented to time and place, can identify past and recent memories
and should be able to verbalize concrete messages. The patients ability to read and write should
match his educational level. The patient should be able to respond to questions and identify all
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the objects presented to him. (Estez, Health Assessment and Physical Examination, Third
Edition.)
Analysis: Being responsive and being able to answer questions accordingly are the
major determinants which indicate patients mental capabilities are still
functioning well.
3. EMOTIONAL SUPPORT
Prior to the procedure, client was first hesitant to communicate with the interviewer.
Although he stayed looking calm, he seemed to be anxious. When asked how he feels, he
admitted that he is quite nervous but he believed that the operation would be successful. Couple
of days after the operation, the patient talked and smiled every time he was interviewed.
Norms:
A persons emotional status depends much on his ability to cope up with the happening in
his/her life. He or she may not be in the right mood if some unnecessary things had happened.
(Nursing CEU.com, the process of human being).
Analysis
The patient has a strong confidence on himself and was able to cope up with his
condition. His emotional status was stable before and after the surgery. He had a strong belief to
survive, which made him not to worry too much during the operation.
4. SENSORY PERCEPTION
Sense of tasteThe patient is fond of eating foods. After the surgery, clients taste seems to be bitter.
However, as days passed by, he was able to taste the foods presented to him without any taste
abnormalities.
Norms
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Normal sensation would be accurate perceptions of sweet, salty, and bitter taste. (Estes,
Third Edition, Copyright 2006)
Analysis
After the operation, the patient remained NPO to prevent occurrence of aspiration. Bitter
taste he experienced after the operation is maybe mainly because of the effect of anesthesia given
to him at the time of operation.
Auditory Activity
Before the operation started, questions were repeatedly asked before the client was able
to answer. Loud voice was being introduced for him to be able to answer. Nevertheless, he was
able to answer the questions asked correctly.
Norms:
Patient should hear clearly and accurately. Ear must be free from lesions and masses.
Although there are many people that reach old age with acceptable hearing, the common
thing is for this ability to decline through time. In some old people this decline, called
presbycusis, is very strong and can originate in various physiological problems.
(http://en.latinsalud.com)
Hearing loss can start at 40 years of age in some people with hereditary preconditions. In
general, it advances slowly but progressively, until clearly manifesting at the age of 60.
(http://en.latinsalud.com)
Analysis
The clients auditory sense shows that he experiences hearing difficulty mainly because
of his age affecting his communication and social skills.
Sense of smell
The patients nostrils were symmetrically aligned. No lesions, swellings and redness were
noted.
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Norms
Patient must be able to identify different smell. Nose should be at the midline position of
the face, free from lesions, and intact nostrils.
Analysis
The patient has a normal sense of smell.
Sense of sight
Prior to the surgery, client claimed to experience blurring of vision. He admitted of using
an eyeglass. However, he couldnt remember what hes visual acuity was. No lesions, redness,
swelling and discharges were noted from her eyes.
Norms:
The normal patient has a visual acuity of 20/20 in a Snellen chart test is considered to
have normal vision acuity. (Estes, Third Edition, Copyright 2006).
Vision loss among the elderly is a major health care problem. Approximately one person
in three has some form of vision-reducing eye disease by the age of 65. The most common
causes of vision loss among the elderly are age-related macular degeneration, glaucoma, cataract
and diabetic retinopathy. (http://www.aafp.org)
Analysis
The clients blurring of vision is associated with his age. During old age, age-related
macular degeneration may happen, thus, impairing the vision of an individual which may
decrease ones ability to perform activities of daily living.
5. MOTOR STABILITY
Prior to the operation, the patient was in bed. He can move but in minimal circumstances
only because of the pain he felt on his right abdomen. After the operation, he was in complete
bed rest, but was able to progress through more complex movements as day passed by.
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Norms
Normal motor stability includes the ability to perform the different steps in doing range
of motion. It should be firm with smooth and coordinated movements. (Estes, Third Edition
2006)
Analysis
The patients motor stability prior to the surgery was abnormal due to the presence of
pain. Pain was associated with the said disease condition. After the procedure, the patients
motor stability corresponded to his condition postoperatively.
6. BODY TEMPERATURE
The following body temperatures were obtained:
Date Time Assessed Findings
September 29, 2010 4:10 PM 37.3 C
September 29, 2010 5:00 PM 38.4 C
5:15 PM 38.1 C
5:30 PM 37.6 C
6:00 PM 37.4 C
10:00 PM 37. 1 CSeptember 30, 2010 2:00 AM 37.0 C
6:00 AM 37.0 C
The client presented with fever during her admission until after the surgery. Her temperature
stabilized during the last 3 days of the assessment.
Norms:
36.5 to 37.5C is the normal body temperature (Kozier, Seventh edition, Copyright 2004)
Analysis
The client was febrile postoperatively because of the his bodys adaptation
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7. RESPIRATORY STATUS
The table below shows the respiratory rate of the patient.
Date Time Assessed Findings
September 29, 2010 4:10 PM 19 cpm
5:00 PM 26 cpm
5:15 PM 25 cpm
5:30 PM 23 cpm
6:00 PM 22 cpm
10:00 PM 23 cpm
September 30, 2010 2:00 AM 21 cpm
6:00 AM 20 cpm
No cyanosis, chest indrawing and use of accessory muscles was noted. The patients lung
sounds were clear upon auscultation.
Norms:
Normal respiratory rate for adults is 12-20 cpm. Average is 18. In terms of pattern,
normal respiration must be regular and even in rhythm. The normal depth of respiration is none
exaggerated and effortless (Health Assessment and Physical Examination 3rd
edition Mary Ellen
Zator Estes)
Analysis
The patients respiratory rate was elevated as a compensation for his fever.
8. CIRCULATORY SYSTEM
Date Time Pulse Rate Blood Pressure
September 29, 2010 4:10 PM 101 bpm 120/100
5:00 PM 98 bpm 100/70
5:15 PM 92 bpm 100/80
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5:30 PM 87 bpm 110/90
6:00 PM 89 bpm 100/90
10:00 PM 99 bpm 120/90
September 30, 2010 2:00 AM 97 bpm 120/98
6:00 AM 98 bpm 110/80
During the blanch test, the patients capillary refill was able to return in less than 2 seconds.
Norms:
The normal pulse rate rages from 60-100 bpm, and the normal blood pressure is 120/80.
Capillary refill in 2 seconds or less is expected in a healthy adult, which denotes proper
oxygenation of the blood.
Analysis
The clients pulse rate was elevated during the preoperative period due to the presence of
fever and pain. After the surgery, however, his pulse rate returned to the normal range. His blood
pressure and capillary refill was normal.
9. NUTRITIONAL STATUS
The patient claimed that his weight was 46 kilogram before the occurrence of his present
condition. His weight after the operation was 42 kilograms. he usually eats fried eggs and tinapa
and drinks coffee for breakfast and usually eats pinakbet, dinengdeng and fried fish at lunch. He
stated that he eats three (3) times a day. He claimed that he is also fond of eating junk foods such
as tokneneng and fishball and high fat foods such as sisig, chicharon and crispy pata. He has
no known allergies to foods and allergies. His computed BMI was 17.
Computation of the clients BMI:
Weight: 42 kg
Height: 5 (60 inches)
Formula: wt (kg) / ht (m2)
Solution:
42 kg / (1.52 m2)
BMI: 18.2 kg/m2
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Norms:
BMI is a measurement that indicated body composition. The degree of overweight or
obesity as well as the degree of underweight can be determined. (Estes, Third edition, Copyright
2006)
Standard Body Mass Index for Adults:
Underweight=
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color. Urine output of an adult is usually 1200-1500mL per day. (Kozier Seventh edition,
Copyright 2004)
Analysis:
The patient has a normal defecation pattern prior to and after the operation. His urinary
status was below the normal range after her operation, but was normal prior to it.
11. REPRODUCTIVE STATUS
* * PATIENT REFUSED TO THI S AREA OF ASSESSMENT
12. STATE OF PHYSICAL REST AND COMFORT
Prior to admission, the patient slept for 8 hours a day. During his stay in the hospital, he
was unable to sleep and had his rest for only 3 hours prior to his operation due to anxiousness
and pain. After the operation, the pain on his incision site limited his to 6 hours of rest until his
third day postoperatively when he was able to sleep for 12 hours.
Norms:
A normal sleep hours of an adult per day is 6 - 8 hours without being disturbed (Kozier,
Seventh edition, Copyright 2004)
Analysis:
The patients rest and comfort status was alteredprior to the surgery due to his condition
13. STATE OF SKIN AND SKIN APPENDIGES
The hair of the patient was properly distributed, black and free from infestations. The
scalp has no flakes and free from lesions. Before the operation, the patients skin wasslightly
dry. There were noted bruises and scars on his lower right leg. After the operation, his IV line
had infiltration and had to be removed. He also had his incision at the right side of her abdomen.
There were no discharges, swelling, redness and bleeding noted at her incision site.
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Norms:
Skin varies from light to brown from ruddy pink to light pink. Generally, uniform except
in areas exposed to the sun, areas of lighter pigmentation in palms, nail beds, and lips. The hair
should be evenly distributed, thick, shiny and free from infestation. The nails should be 160 and
smooth in texture. (Kozie, Seventh edition, Copyright 2004)
Analysis:
The patients skin was abnormal due to the presence of scars and bruises. The infiltration
and the presence of the incision site were also observed as an abnormal finding because it
disrupts the integrity of the skin.
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4. DIAGNOSTIC AND LABORATORY PROCEDURESDiagnostic/
Laboratory
Procedures
Date
Ordered and
date Result/s
In
Indication/s
or Purposes
Result/s Normal
Values
(Units used
in theHospital)
Analysis and
Interpretation
of results
CBC
>WBC
>LYM
>MID
>GRAN
>RBC
September
29, 2010
Result:
September
29, 2010
CBC is used asabroadscreening test
to determinethe values of
formedelements of the
blood.10.1
2.8
0.5
6.9
2.49
4.110.9 g/dL
0.64.1
0.01.8
2.07.8
4.20 6.30T/L
Normal>No indicative
abnormalitiesnoted.
Normal> No indicativeabnormalitiesnoted
Normal> No indicativeabnormalitiesnoted
Normal> No indicativeabnormalities
noted
Decreased>There is a
markeddecreased inRBC that may
indicatehypoxia.
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>HGB
>HCT
>MCV
>MCH
>MCHC
>PLT
69
0.209
83
32.0
355
258
120180 g/dL
0.370 0.510L/L
80.097.0 fl
26.032.0 pg
310360 g/dL
140 -440 g/L
Decreased
>There is amarked
decreased in
HGB thatindicates
hypoxia.
Decreased>There is a
markeddecrease in
HCT thatindicateshypoxia
Normal> No indicativeabnormalitiesnoted
Normal> No indicative
abnormalitiesnoted
Normal
> No indicativeabnormalitiesnoted
Normal> No indicativeabnormalities
noted
NURSING RESPONSIBILITIES:
Before:
Determine the clients understanding of the procedure Determine the clients response to previous testing
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During:
Ensure clients comfort until the procedure will be doneAfter:
Document the method of testing and results on the clients record Immediately reached the blood sample on the laboratory. Follow-up result from laboratory
Diagnostic/
Laboratory
Procedures
Date
Ordered and
date Result/s
In
Indication/s
or Purposes
Result/s Normal
Values
(Units used
in the
Hospital)
Analysis and
Interpretation
of results
BLOOD
CHEMISTRYSeptember,
29, 2010
Result:
September,
29, 2010
Blood tests
are used todetermine
physiological
andbiochemical
states such as
disease,
mineralcontent, drug
effectiveness,
and organfunction
FBS:
5.34
BUN:9.0
Creatinine:41
Uric acid:
None
Cholesterol:
6.25
Triglyceride:
.92
HDL:
44.6
LDL:
FBS:
3.9-6.1mmol/L
BUN:2.9-8.2
mmol/L
Creatinine:53-106
mmol/ l
Uric acid:None
Cholesterol:3.88-6.47
mmol/L
Triglyceride:.11-
Normal
Not normalincreased
levels of BUN
may be due the
presence ofinfection
Not normaldecreased
level of
creatinine may
be due todecreased
muscle mass
Normal
Normal
Normal
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180.62
Electrolytes
Na
150
K5.1
Cl
106.5
2.15mmol/L
HDL:
30-75mmol/L
LDL:66-
178mmol/L
Na
135-145mEq/L
K3.5-5.0mEq/L
Cl
98-106mEq/L
Normal
Not normalElevated LDL
may be due to
the clientsnutritional
preference
Not normal
elevated levelsof NA may be
due to thepresence of
infection
Not normalelevated levels
of K
Not normal
elevated levelsof Cl
Nursing responsibility:
Before:
Explain the purpose of the test and the procedure for collection of blood. Client mat experienceanxiety about the procedure, especially if it is perceived as being intrusive or if they fearunknown to the result. A clear explanation will facilitate cooperation on the part of the client.
Inform the client of the time period before the results will be available.During:
Use the correct procedure for obtaining the blood. Aseptic technique should be use in collection to prevent contamination that can cause inaccurate
results. Ensure correct labeling, storage and transportation of the specimen to avoid invalid test results.
After: Report results to the appropriate health team members. Compare the previous and current test results and modifies nursing interventions as needed
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5. ANATOMY AND PHYSIOLOGY
The anatomy of the biliary tree is a little complicated, but it is important to understand. The liver's cells (hepatocytes) excrete bileinto canaliculi, which are intercellular spaces between the liver cells. These drain into the right and left hepatic ducts, after which
bile travels via the common hepatic and cystic ducts to the gallbladder. The gallbladder, which has a capacity of 50 milliliters(about 5 tablespoons), concentrates the bile 10 fold by removing water and stores it until a person eats. At this time, bile is
discharged from the gallbladder via the cystic duct into the common bile duct and then into the duodenum (the first part of thesmall intestine), where it begins to dissolve the fat in ingested food.
The liver excretes approximately 500 to 1000 milliliters (50 to 100 tablespoons) of bile each day. Most (95%) of the bile tha t hasentered the intestines is resorbed in the last part of the small intestine (known as the terminal ileum), and returned to the liver for
reuse.
The many functions of bile are best understood by knowing the composition of bile:Bile Salts (cholates, chenodeoxycholate, deoxycholate): these are produced by the liver's breakdown of cholesterol. Theyfunction in bile as detergents that dissolve dietary fat and allow it to be absorbed. Hence, disruption of bile excretion disrupts the
normal absorption of fat, a process called malabsorption. Patients develop diarrhea because the fat is not absorbed (steatorrhea) ,and develop deficiencies of the fat-soluble vitamins (A, D, E, and K).Cholesterol and phospholipids-while only 4% of bile is cholesterol, the secretion of cholesterol and its metabolites (bile salts)into bile is the body's major route of elimination of cholesterol. Phospholipids, which are components of cell membranes,
enhance the cholesterol solubilizing properties of bile salts. Inefficient excretion of cholesterol can cause an increased serumcholesterol. This predisposes to vascular disease (heart attacks, strokes, etc.)Bilirubin-while this comprises only 0.3% of bile, it is responsible for bile's yellow color. Bilirubin is a product of the body'smetabolism of hemoglobin, the carrier of oxygen in red blood cells. Disruption of the excretion of this component of bile leads to
a yellow discoloration of the eyes and skin (jaundice).
Bile production and recirculation is the main excretory function of the liver. Tumors that obstruct the flow of bile from the livercan also impair other liver functions. Therefore, it is necessary to understand these other functions to understand the symptoms
that these tumors can cause. These include:
Metabolic functions, such as the maintenance of glucose (blood sugar) levelsSynthetic functions, such as the synthesis of serum proteins such as albumin, blood clotting (coagulation) factors, and
complement (a mediator of inflammatory responses)Storage functions, such as the storage of sugar (glycogen), fat (triglycerides), iron, copper, and fat soluble vitamins (A, D, E, andK)Catabolic functions, such as the detoxification of drugs
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PATHOPHYSIOLOGY (Book-Based)
RISK AND PREDISPOSING FACTORS
Obstruction of bile outflow
alteration
MODIFIABLE
Obesity, Cigarette smoking,
Alcoholism, Hypercholesterolemia/
fats intake, pregnancy
NON - MODIFIABLE
Age, Gender, Race, Diseases like
Diabetes Mellitus
Bile Stasis
Chemical Reaction
INFLAMMATION
- Epigastric pain
- Tenderness and rigidity
of Upper Right Quadrant
Decreased blood supply
and decreased lymphatic
drainage
Distension of bile duct
Proliferation of bacteria
Elevated temperature
Nausea and vomiting
Edema
- Tachycardia- Pallor- Diaphoresis
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PATHOPHYSIOLOGY (Patient-Based)
RISK AND PREDISPOSING FACTORS
Obstruction of bile outflow
alteration
MODIFIABLE
Obesity, Cigarette smoking,
Alcoholism, Hypercholesterolemia/
fats intake, pregnancy
NON - MODIFIABLE
Age, Gender, Race, Diseases like
Diabetes Mellitus
Bile Stasis
Chemical Reaction
INFLAMMATION
- Epigastric pain
- Tenderness and rigidity
of Upper Right Quadrant
Decreased blood supply
and decreased lymphatic
drainage
Distension of bile duct
Proliferation of bacteria
Elevated temperature
Nausea and vomiting
Edema
- Tachycardia- Pallor- Diaphoresis
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Assessment Diagnosis Scientific
Explanation
Planning Implementation Rationale Evaluation
S:
O:
Presenceof incision
grimace Pale and
Weak in
appearance
Reducedbody
movement
s Mild
erythemain the
operated
site
Risk for
infectionrelated to
surgicalincision
Due to
increased riskfor being
invaded by
pathogenicorganisms
therefore
possibleinfection can
occur.Contributing
factors suchas altered
peristalsis,
tissuedestruction,
increasedenvironmenta
l exposure,
trauma andinvasive
procedure.
Within 1 hour
of propernursing
interventions,
the client willknow ways on
how to prevent
complication ofinfection
Encouragedto practicegood hand
washing and
asepticwound care.
Inspectedincision anddressings.
Notedcharacteristic
s of drainagefrom wound
Assess anddocument for
any signs andsymptoms of
infection.
Ensureproper hand
hygiene byall caregivers
duringtouching and
making of
procedure.
To prevent andminimize thespread of
microorganism.
Prevents accessor limits spreadof infecting
organisms/cross-contamination.
To identify thecause of
infection anddetermine the
appropriate
nursingintervention to
be applied.
First linedefense againsthealth care
associatedinfection.
After 1 hour of
proper nursinginterventions,
the client was
able to knowways on how to
prevent
complication ofinfection
B. PLANNING- NURSING CARE PLANS
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Instruct theclient and thefamily about
the need forgood
nutrition,
especiallyprotein and
proper rest.
Optimalnutritional
statuscontributes to
healthmaintenance
and prevention
of infection.
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Assessment Diagnosis Scientific
Explanation
Planning Implementation Rationale Evaluation
S:
O:
dry mouth chapped
lips
withsurgical
incision atright upper
quadrant
Pale andWeak in
appearance
Restlessand
irritable
RBC HGB Na K
Risk for
fluid
volume
deficitrelated to
blood loss
Surgery
predisposesthe client to
lose massive
amounts ofblood which
predisposes
the client toshock, and
hypovolemia
Within 8 hours
of propernursing
interventions,
the client willbe able to
display
adequate fluidbalance AEB
stable vitalsigns, capillary
refill andappropriate
urine output.
Maintainedaccurate
record of
input andoutput.
Assessed skin/ mucous
membrane,peripheral
pulses andcapillary
refill.
Observe forsigns ofbleeding (e.g
hematemesis,
melena,petecchiae,
ecchymossis)
Providesinformation
about a needs
and organfunction.
Indicators ofadequacy of
circulatingvolume/perfusio
n.
Prothrombin isreduced andcoagulation
time prolonged
when bile flowis obstructed,
increased riskof
bleeding/hemor
rhage
Within 8 hours
of propernursing
interventions,
the client willbe able to
display
adequate fluidbalance AEB
stable vitalsigns, capillary
refill andappropriate
urine output.
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Provide freshwater and
oral fluids,prescribed
diet;offersnacks (e.g.
frequent
drinks, freshfruits and
fruit juice).
AdministerIV bloodproducts,
electrolytes
as indicated.
The oral routeis preferred for
maintainingfluid balance.
Maintainsadequate
circulatingvolume and aids
in imbalances
from woundlosses.
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Assessment Diagnosis Scientific
Explanation
Planning Implementation Rationale Evaluation
S: Masakit yungsuagt ko with
pain scale of 8/10
O:
Facialgrimace
Guardingat incisionsite
Restlessand
irritable
Observedself-
focusingor
narrowed
focus Self-
protectivebehavior
Limitedmovementnoted
Slightlydiaphoreti
c
RR28cpm
Acute
painrelated to
obstruction / ductal
spasm
It is
accompaniedby acute
localized
pain becauseof potential
tissue
damagewhich casue
inflammation, swelling
and rednessat the site.
Within 30
minutes of
proper nursing
interventions,
the clients pain
scale will
decrease from
8/10 to 5/10
Promoteadequate restand sleep.
Assist patientin use of
distractiontechniques.
Assist patientin
comfortableposition.
Providediversionaltechniques
such astalking to the
family
members.
Encouragepatient to do
deep
breathingexercise.
Supportpatient in useof
To restore bodystrength.
To control pain.
\
To facilitatecomfort.
To maximizerelaxation and
comfort.
To promoterelaxation.
Cognitivebehavioralstrategies can
After 30
minutes of
proper nursing
interventions,
the clients pain
scale was
decreased from
8/10 to 5/10
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nonpharmaco
-logicalmethods to
help contropain such as
imagery,
relaxationand
application ofheat and cold.
Administerpain
medication as
prescribed.
restore theclients sense f
self-control.
To minimizepain.
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Assessment Diagnosis Scientific
Explanation
Planning Implementation Rationale Evaluation
S:Nanghihina
ako.
O:
>Pale andweak in
appearance
>Reduced
bodymovement
>Reporteddysfunctional
eating patterns
Imbalanced
nutrition:
less than
body
requirementsrelated toimpaired fat
digestion due
to obstructionof bile flow
Due to
insufficientintake of
nutrients it
causes thebody not to
meetmetabolic
demands
because ofbiological,
psychological or economic
factors.
Within 8
hours ofproper nursing
interventions,
the client willdemonstrate
behaviours /lifestyle
changes to
regain andmaintain
appropriateweight.
Work with theclient todevelop a plan
for increased
activity andenergy.
Teachstrategies for
energy
conservation
such as
limiting of
talking to
others,
increased
number of rest
periods.
Providecompanionship
at mealtime.
Emphasizeimportance ofadequate rest
and sleep.
To increasepatientsappetite.
To prevent andminimize thespread of
microorganism.
To maximizepatientsstrength.
To encouragenutritional
intake.
For energyconservation.
After 8 hours of
proper nursing
interventions,
the client was
able todemonstrate
behaviours /
lifestyle
changes to
regain and
maintain
appropriate
weight.
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Encouragepatient to eat awell balanced
diet.
Encouragepatient to drinkatleast 8
glasses ofwater a day.
Offer frequentand small
quantities of
food.
To restorepatients
energy.
It is importantfor clients to
maintain intakeas much as
possible.
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Assessment Diagnosis Scientific
Explanatio
n
Planning Implementation Rationale Evaluation
S: Mainit ang
pakiramdam ko
O:
flushed skinwarm to touch
movements
with minimalbody
movements
weak inappearance
T38.4C
Altered
thermoreg
ulationrelated totissue
trauma
Due totissue
trauma it
causes thebody to
compensate
such asincreasing
thetemperature.
Within 1 hour
of proper
nursing
interventions,
the clients
temperature will
decrease from
38.4C to
37.8C
Monitoredclients
temperatur
e (degreeand
pattern).
Promotedsurface
cooling bemeans of
tepidsponge
bath.
Encouraged to
increasefluid
intake.
Providedhigh
caloricdiet such
as rich in
carbohydrates and
protein.
Maintained bed rest.
Administe
To be able toknow what
interventions to
be applied.
To helpmaintain a
normal bodytemperature.
To help replacefluid loss.
To help thebody to restore
strength andbody
temperature.
To help patientto conserve
energy. To help replace
After 1 hour of
proper nursing
interventions,
the clients
temperature was
decreased from
38.4C to
37.8C
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red
replaceme
nt fluidsand
electrolytes as
indicated.
Administeredmedication
s as
prescribedby the
physician.
fluid loss
To helpmaintain anormal body
temperature .
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C. Implementation
1. Medical Management
i. IVFs, BT, NGT feeding, Nebulization, TPN, Oxygen Therapy etc.
Prior: Understand why the therapy is needed. determine potential outcomes for the client understand the fluid and electrolyte and acid base status of the client provide an explanation to the client and gain cooperation select the appropriate IV set
Medical
Management/Treatm
ent
Date Ordered/ Date
Taken/
GivenDate Changed/ Date
Discontinued
General Description Indication/s, Purpose/s Client's reaction to
the treatment
IV Therapy
1L LRS (isotonic) with
oxytocin regulated at
15 gtts/min
1L D5NM(hypertonic) regulated
at 30 gtts/min
1L D5LRS
(hypertonic) regulatedat 30 gtts/min
Started on September 29,
discontinued on the same
date
September 29-September30
Started on September 30
discontinued on the samedate
IV Therapy is the giving of
liquid directly into a vein.
IV Therapy is usually
performed for fluid volumemaintenance, fluid volume
replacement, medication
administration, bloodadministration, total
parenteral nutrition andserves as an emergency line
The patient did not
reported pain in theIV site
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During: assess the following:
o right intravenous fluids infusingo right intravenous fluids for the cliento date on the tubingo right rate according to the rate prescribed and the clients conditiono absence of kinks in the tubing that could result in occlusion of the fluid flowo date on the intravenous access deviceo insertion site and vein access for evidence of pain, redness, warmth, or coolness, and swelling
After: Discard the administration set accordingly Document relevant data.
Prior: Determine the need for oxygen therapy, and verify the order for the therapy. Perform a respiratory assessment to develop baseline data if not already available. inform the client and support people about the safety precautions connected with oxygen use such as:
Avoiding materials that generate static electricity, such as woolen blankets and synthetic fabrics. Avoiding the use of volatile, flammable materials, such as oils, greases, alcohol, ether, and acetone. Provide an explanation to the client and gain cooperation.
Assist the client to a semi-Fowlers position.
Medical
Management/Treatm
ent
Date Ordered/ Date
Taken/
Given
Date Changed/ Date
Discontinued
General Description Indication/s, Purpose/s Client's reaction to
the treatment
Oxygen Therapy
2 L/min for 3 hoursvia nasal prong
September 29-30 Oxygen therapy is any
procedure in which oxygen is
administered to a patient torelieve hypoxia.
Clients who have difficulty
ventilating all areas of their
lungs, those whose gasexchange is impaired, or
people who have heartfailure may require oxygen
therapy to prevent hypoxia.
The patient tolerated
the administered
oxygen andverbalized relief from
DOB
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set up the oxygen equipment and the humidifierDuring: Check that the oxygen is flowing freely from the tubing. There should be no kinks in the tubing, and the connections should be
airtight. There should be bubbles in the humidifier as the oxygen flows through. Feel the oxygen at the outlets of the cannula.
Monitor the level of water in the humidifier. Set the oxygen at the flow rate ordered. if the cannula will not stay in place, tape it at the sides of the face
After: report significant deviation such as tracheal irritation and coughing, dyspnea, and decreased pulmonary ventilation
Medical
Management/Treatm
ent
Date Ordered/ Date
Taken/
Given
Date Changed/ Date
Discontinued
General Description Indication/s, Purpose/s Client's reaction tothe treatment
UrinaryCatheterization
September 29-30 Urinary Catheterizationis the introduction of a
catheter through the
urethra into the urinarybladder
Indications of urinarycatheterization includes relief
from discomfort due to bladder
distention or to provide gradualdecompression of a distended
bladder, to empty the bladdercompletely prior to surgery, to
facilitate accurate measurementof urinary output for critically
ill clients whose outputs need
to be monitored hourly, toprevent urine from contacting
an incision after perineal
surgery.
The client didntverbalize any
discomfort and have
adequate (>30cc/hr),amber colored urine
output.
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Prior: Determine the most appropriate method of catheterization based on the purpose and any criteria specified in the order such as
total amount of urine to be removed and size of catheter to be used. Use an indwelling catheter if the bladder must remain empty or continuous urine measurements/collection is needed. Assess the clients overall condition. Determine if the client is able to cooperate and hold still during the procedure and if the
client can be positioned supine with head relatively flat. Determine when the client last voided or was last catheterized. Percuss the bladder to check for fullness or distention.
During:
Ensure that there are no obstructions in the drainage. Check that there are no kinks in the tubing, the client is not lying on thetubing, and the tubing is not clogged with mucus or blood.
Check that there is no tension on the catheter or tubing, that the catheter is securely taped to the thigh, and that the tubing isfastened appropriately to the bedclothes.
Ensure that gravity drainage is maintained. Make sure that there are no loops in the tubing below its entry to the drainagereceptacle and that the drainage receptacle is below the level of the clients bladder.
Ensure that the drainage system is well-sealed or closed. Check that there are no leaks at the connection sites in open systems.Apply water proof tape around the connection site of the catheter and tubing.
Observe the flow of the urine every 2-3 hours, and note color, odor and any abnormal constituents. If sediments are present,check the catheter more frequently to ascertain whether it is plugged.
After:
Conduct appropriate follow-up such as notifying the primary care provider the catheterization results. Performed a detailed follow-up based on findings that deviated from normal for the client. Relate findings to previous assessment data if available
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ii. Drugs
Name/s of drugs
(generic and brand
name)
Date ordered/
Date taken/
Date changed
Route of
administration &
dosage &
frequency of
administration
Mechanism of
action
Indication/s
Purpose/s
Clients response
to medication with
actual side effect
Generic Name:
Cefuroxime Sodium
September 29, 2010 750 mg, IVF q 8hours
It is a anti- infectivedrug and its main
action is combat the
preset bacteria and
inhibit increased
growth.
Low respiratoryinfections,
Pharyngitis or
tonsillitis
The client did notexhibit any adverse
reactions from the
drug
Before: Check the expiration date of the drug Check the doctor's order Assess the client's understanding about the drug Assess for skin allergies
During: Reconstitute the drug with 8 ml of sterile water. Slowly inject the drug over 3 to 5 mins.
After: Evaluate the client for adverse effect. Report lack of response, persistent diarrhea or signs ad symptoms of Anemia.
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Name/s of drugs
(generic and brand
name)
Date ordered/
Date taken/
Date changed
Route of
administration &
dosage &
frequency of
administration
Mechanism of
action
Indication/s
Purpose/s
Clients response
to medication with
actual side effect
Generic Name:
KetorolacTromethamine
September 29, 2010 30 mg, IVF q 6
hours X 6 doses
Possesses anti-
inflammatory,
analgesics ad
antipyretic.
Completely
absorbed following
IM use.
Use for
management of
moderate ad severe
acute pain.
The client did not
exhibit any adverse
reactions from the
drug
Before:
Check the expiration date of the drug Check the doctor's order Assess the client's understanding about the drug
During: Do not mix IV ketorolac in a small volume with morphine sulfate. The IV bolus must be given over o less than 15 sec.
After: Monitor for adverse effect. Report any unusual bruising or bleeding, weight gain, swelling of feet/ ankles, increased joint pain, change in urine patterns.
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Name/s of drugs
(generic and brand
name)
Date ordered/
Date taken/
Date changed
Route of
administration &
dosage &
frequency of
administration
Mechanism of
action
Indication/s
Purpose/s
Clients response
to medication with
actual side effect
Generic Name:
Omeprazole
September 29, 2010 Q 12 hours X 2
doses
Hough to be a
gastric pump
inhibitor and that it
blocks the final step
of acid production.
By inhibiting the
Hydrogen/
Potassium ATP-ase
system at te
secretory surface of
the gastric parietal
cell.
Use for
management of
active duodenal
ulcer, gastric ulcer,
erosive esophagitis
and heartburn
The client did not
exhibit any adverse
reactions from the
drug
Before: Check the expiration date of the drug Check the doctor's order Assess the client's understanding about the drug
During: The capsule should be taken 30 minutes before eating and is to be swallowed whole. Antacid can be administered with Omeprazole.
After: Monitor for adverse effect. Report to the physician if chest pain, abdominal pain and fecal discoloration occurred
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iii. Diet
Type of Diet
Date ordered/
Date taken/
Date changed
General
Description
Indication/s
Purpose/s
Specific foods
Taken
Clients response
to medication with
actual side effect
NPO (nothing by
mouth)
September 29 A patient care
instruction advising
that the patient is
prohibited from
ingesting food,
beverages, or
medicine.
It is usually ordered
whenever the
patient wills
undergoes surgery
or other diagnostic
procedure requiring
that the digestive
tract be empty.
Foods, beverages
and medicine are
prohibited.
The client complied
with the prescribed
diet.
Before:
Explain to the client and significant others the purpose, indication and the duration of the diet. Assist the clients compliance ability to the diet.
During:
Advise the client to avoid foods. Provide frequent oral hygiene Monitor the compliance of the patient to the diet.
After:
Evaluate the effect of the diet to the client. Report excessive weight loss. Assess any nutritional disturbances and notify the physician.
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Type of Diet Date ordered, Date
started, Date
changed
General
description
Indication/s
Purpose/s
Specific Foods
Taken
Client s response
and/or response to
the diet
Clear liquid diet September 30, 2010 This client provides
the client with fluid
and carbohydrate
but does not supply
adequate protein,
vitamins, minerals,
or calories
This diet is
indicated for post
operative patients
first feeding when it
is necessary to fully
ascertain return of
gastrointestinal
function
Crackers
Sips of water and
tea
The client complied
with the prescribed
diet.
Prior:
Assess ability to feed self and prepare meals Determine need for special drinking cups, plates, or feeding utensils Explain the purpose of the diet Discussed allowed and prohibited foods
During: Assist the client to a comfortable position in bed or in a chair, whichever is appropriate Provide assistance of the client is unable to handle eating utensils or to open containers and packages Always allow ample time for the client to chew and swallow the food before offering more
After: After the client has completed the meal, observe how much the client has eaten and the amount of fluid taken, record the fluid
intake and calorie count as required
Provide hygiene measures after feeding Record any pain, fatigue or nausea experienced by client
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Type of Diet
Date ordered/
Date taken/
Date changed
General Description Indication/s
Purpose/s
Specific foods
Taken
Clients response
to medication with
actual side effect
Soft Diet October 1, 2010 A diet that is soft in
texture, low in residue,
easily digested and
well tolerated.
It provides nutrition
to the client who
has just undergone
surgery and client
who cannot tolerate
hard foods.
Sips of water, tea,
crackers
The client complied
with the prescribed
diet.
Before: Explain to the client and significant others the purpose, indication and the duration of the diet. Assist the clients compliance ability to the diet.
During: Position the client in a sitting or high or fowler position. Advise the client to consume foods that are easily digested. Monitor the compliance of the patient to the diet.
After: Evaluate the effect of the diet to the client. Assess any nutritional disturbances and notify the physician.
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Type of Diet Date ordered, Date
started, Date
changed
General
description
Indication/s
Purpose/s
Specific Foods
Taken
Client s response
and/or response to
the diet
Diet as tolerated
(DAT)
October 2, 2010 The patient can eat
any food as long as
tolerated
To increase rate of
healing
Rice
VegetablesCrackers
Eggs
Chicken
The client complied
with the prescribed
diet.
Prior
Caution patient to avoid food such as eggs, nuts, milk, sulfites, fish and chocolate that can trigger asthma attack.During:
Advise client to properly chew the food.After:
Advise patient to report any allergic reaction to the food taken.
iv. Activity / Exercise
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Type of
exercise
Date Ordered
Date Started
Date Changed
General Description Indications or
Purposes
Specific
exercise/activity
Clients response and/or
reaction to
the diet
Flat on bed
September 29
It is type of exercise
done after the surgical
procedure; the client
must be in a supine
position without using a
pillow. After 8 hours the
client must be able to
use pillow already.
To prevent
spinal
headache.
Complete bed
rest within 8
hours.
The client complied to the
ordered exercise
Turn from side
to sideSeptember 29
Patient will turn on the
right side then rotate to
the opposite side after 2
hours
To increase
blood
circulation and
preventpressure ulcer
Turn from side
to side every 2
hours
Patient was able to tolerate the
exercise but with a little
discomfort due to surgical
incision
Sitting on bed
October 01,
2010
It is a type of exercise
done after the client able
to turn side to side, and
the back of the client is
unsupported and legs
hanging freely
To increase
blood
circulation
Sitting on the
bed without
assistance
Patient was able to tolerate the
exercise but with a little
discomfort due to surgical
incision
Standing beside
the bedOctober 02,
It is a type of exercise
when the client is able to
stand by her own and no
To increase
blood
Standing in the
side of the bed
without
Patient was able to tolerate the
exercise but with a little
discomfort due to surgical
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Prior:
Learn passive ROM exercises from the person's caregiver. Practice the exercises with the caregiver first. The caregiver canmake sure you are doing the exercises right.
Raise the person's bed to a height that is comfortable for you. This will help keep you from hurting your back or other muscles.
Make sure the wheels of the bed or wheelchair are locked before you start the exercises.During
Do all ROM exercises smoothly and gently. Never force, jerk, or over-stretch a muscle. This can hurt the muscle or jointinstead of helping.
Move the joint slowly. This is especially important if the person has muscle spasms (tightening). Move the joint only to thepoint of resistance. This is the point where you cannot bend the joint any further. Put slow, steady pressure on the joint untilthe muscle relaxes.
Stop ROM exercises if the person feels pain. Ask the person to tell you right away if he feels any pain. Watch for signs of painif the person is unable to talk. The exercises should never cause pain or go beyond the normal movement of that joint
2010 significant others
assisted to her.
circulation assistance incision
Ambulation
October 03,
2010
Patient will walk
unaided on the side of
the bed and on the
hallway
To increase
blood
circulation
Walking on the
side of the bed
without
assistance
Patient was able to tolerate the
exercise but with a little
discomfort due to surgical
incision
ROM (Range ofMotion) October 01,
2010
A body action involvingthe muscles, joints, and
natural movements such
as abduction,
adduction, flexion,
extension, pronation,
supination, and
rotation.
Theseexercises
reduce stiffness
and help keepyour joints
flexible.
The clientparticipated in
the activity.
Patient was able to tolerate theexercise but with a little
discomfort due to surgical
incision
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After:
Make ROM exercises a part of the person's daily routine. Follow the caregiver's orders. The person's caregiver will tell you how many times per day you should do ROM exercises. The
caregiver will tell you how many repetitions (number of times) you should do exercises on each joint.
2. Surgical Management
Name ofProcedure
Date Performed Brief Description Indication/Purpose Clients response to theoperation
Cholecystectomy,
IOC, CBDE, T-
tube
Choledochostomy
September 29,
2010
Cholecystectomy is the
surgical removal of the
gallbladder.Despite the
development of non-
surgical techniques, it is
the most common method
for treating symptomatic
gallstones.
Intraoperative
cholangiography (IOC) -
The doctor places a small
tube called a catheter into
the cystic duct, which
drains bile from the
gallbladder into the
common bile duct.A dye
that blocks X-rays is
injected into the common
bile duct, and then X-rays
will be taken.
A cholecystectomy is
performed to treat
cholelithiasis and
cholecystitis.
Intraoperative
cholangiography (IOC)
may decreasethe risk of
common bile duct (CBD)
injury during
cholecystectomyby
helping to avoid
misidentification of the
CBD.
Common Bile Duct
Exploration is used to
remove large stones during
or after some gallbladder
operations when stones are
detected.
Choledochostomy is the
The patient complained of
difficulty of breathing and
reported little sensation on the
lower extremities upon
discharge from the PACU. It
was observed that the patient
was also drowsy.
http://en.wikipedia.org/wiki/Gallbladderhttp://en.wikipedia.org/wiki/Gallstonehttp://www.revolutionhealth.com/articles?id=stc123726http://www.revolutionhealth.com/articles?id=stc123726http://en.wikipedia.org/wiki/Gallstonehttp://en.wikipedia.org/wiki/Gallbladder7/22/2019 Grand Case Cholylithiasis
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A common bile duct
exploration is a procedure
used to see if a stone is
blocking the flow of bile
from the liver and
gallbladder to the intestine.
Choledochostomy:
Surgical formation of anopening (stoma) into the
COMMON BILE DUCT
for drainage or for direct
communication with a site
in the small intestine,
primarily the
DUODENUM or
JEJUNUM.
creation of an opening into
the common bile duct for
drainage.
Prior:
Always check to see if the informed consent has been given and that a signed form documents it. Ask the woman when she last had anything to eat or drink. Frequently, an antacid is given before surgery to reduce the risk of aspiration while the woman is under the effects of
anesthesia.
Ensure that an intravenous fluid is in place with a large bore catheter Ensure that an abdominal shave preparation is done immediately before surgery Ensure that a Foley catheter is in place Ensure that laboratory studies ordered are completed
During
http://www.wrongdiagnosis.com/medical/common_bile_duct.htmhttp://www.wrongdiagnosis.com/medical/duodenum.htmhttp://www.wrongdiagnosis.com/medical/jejunum.htmhttp://www.wrongdiagnosis.com/medical/jejunum.htmhttp://www.wrongdiagnosis.com/medical/duodenum.htmhttp://www.wrongdiagnosis.com/medical/common_bile_duct.htm7/22/2019 Grand Case Cholylithiasis
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The nurse supports the woman so that her back remains in a c-shaped curve during placement or a regional anesthesia by theanesthesiologist
The nurse assists the woman to the supine position on the O.R table The nurse places a wedge under one hip, and then places a warm blanket and safety strap on the womans legs Ensure that a sterile abdominal preparation with alcohol or Betadine is performed and a sterile drape is provided The nurse performs the second O.R count
After:
The nurse transfers the woman from the operative suite to the PACU Ensures connection of monitoring devices that will record the electrocardiogram, blood pressure, pulse, and oxygen saturation
of the blood Monitor vital signs and pulse oximetry reading every 5 minutes until the readings are stable, and then 15 to 30 minutes until
the patient has met predetermined criteria Monitor the patients urinary output to make certain it is at least 30 cc/hour
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D. EvaluationDischarge Planning
a. General condition of the client upon dischargeUpon clients discharge (October 04, 2010), the client appeared neatly dressed with no
apparent body odor. He was afebrile. He was able tolerate minimal levels of activity such as
walking, moving from place to place and transferring from sitting to standing position without
dizziness. He was able to take any food tolerated. He also does not perspire excessively or show
signs of emotional distress such as nail biting or avoidance of eye contact.
III. Conclusion
This case served as a realization for the group. It required thorough investigation about clients
condition against both theory and the large comparative environment. In this study, objectives
are important. Formulating objectives before conducting the study of Choledocholithiasis was
very challenging because it was very unfamiliar.
After doing this case study, the group attained the formulated nurse-centered objectives. They
were able to come up with a comprehensive presentation of the disease condition by means of
correct presentation of the data gathered through the use of nursing process. They were also ableto present the current trends about the disease condition, the reason for choosing such case for
presentation, and the importance of the case study.
By means of proper education rendered during the period of assessment and care, the client was
able to fully understand and recognize the disease condition. The client learned the importance of
healthy lifestyle and identified the predisposing factors that aggravated her condition.
IV. Recommendation
The group would like to convey the following recommendations that would enable to
facilitate the greater accumulation of knowledge and would improve the greater understanding of
the disease condition.
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To the Tarlac Province Health Divisions: Improve the awareness of disease in its towns and barangays, the common causes of it,
the clinical manifestations.
To the Nurses and Student - Nurses:
Complete assessment of the disease. Improve the knowledge of the client regarding disease condition
To the next researchers:
Continue establishing useful and latest trends about CHOLEDOCHOLITHIASIS. Validate the data found here with the latest studies
V. Bibliography
http://health.nytimes.com/health/guides/disease/gallstones/open-or-laparoscopic-common-bile-duct-exploration-(choledocholithotomy).html
http://en.wikipedia.org/wiki/Cholecystectomy http://jama.ama-assn.org/cgi/content/abstract/289/13/1639 http://www.med.umich.edu/1libr/aha/aha_commbd_crs.htm Kozier & Erbs Fundamentals of Nursing Michelle Zator Estez Health Assessment and Physical Examination Mosbys Drug Guide for Nurses 2009 Edition Mosbys Nurses Pocket Guide 11thEdition Mosbys Pocket Dictionary of Medicine, Nursing and Health Professions 5thedition Holes Essentials of Human Anatomy and Physiology
http://health.nytimes.com/health/guides/disease/gallstones/open-or-laparoscopic-common-bile-duct-exploration-(choledocholithotomy).htmlhttp://health.nytimes.com/health/guides/disease/gallstones/open-or-laparoscopic-common-bile-duct-exploration-(choledocholithotomy).htmlhttp://health.nytimes.com/health/guides/disease/gallstones/open-or-laparoscopic-common-bile-duct-exploration-(choledocholithotomy).htmlhttp://health.nytimes.com/health/guides/disease/gallstones/open-or-laparoscopic-common-bile-duct-exploration-(choledocholithotomy).htmlhttp://www.med.umich.edu/1libr/aha/aha_commbd_crs.htmhttp://www.med.umich.edu/1libr/aha/aha_commbd_crs.htmhttp://health.nytimes.com/health/guides/disease/gallstones/open-or-laparoscopic-common-bile-duct-exploration-(choledocholithotomy).htmlhttp://health.nytimes.com/health/guides/disease/gallstones/open-or-laparoscopic-common-bile-duct-exploration-(choledocholithotomy).html7/22/2019 Grand Case Cholylithiasis
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Republic of the Philippines
Collegio De Dagupan
College of Nursing
CASE STUDY
ON CHOLEDOCHOLITHIASIS
In Partial Fulfillment of the Requirements
Of the Course Nursing Care Management 102
Presented by:
Mallaca Angelica
Mostoles RobelynMurao Eden jane
Ordanza Marcelino Jr.
Paragna John Cristopher
Parayno Debbie
Pascua Deo Alfred
Pascua Rhodalyn
Pacis Arvelyn
Perido Jenica
February 09, 2012