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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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Interpretation and AnalysisResultNormsProcedureDate
Normal3250-4 min.HEMATOLOGY EXAM
Bleeding time
January 8,
2011
Normal4105-10 min.Clotting time
Interpretation and AnalysisResultNormsProcedureDate
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
AnalysisResultNormsProcedureDate
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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Interpretation and AnalysisResultNormsProcedureDate
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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Interpretation and AnalysisResultNormsProcedureDate
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
Interpretation and AnalysisResultNormsProcedureDate
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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Interpretation and AnalysisResultNormsProcedureDate
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
AnalysisResultNormsProcedureDate
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 ®enerate
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
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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
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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.