Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is performed most frequently through laparoscopic incisions using laser. However, traditional open cholecystectomy is the treatment of choice for many patients with multiple/large gallstones (cholelithiasis) either because of acute symptomatology or to prevent recurrence of stones.
A cholecystectomy consists of excising the gallbladder from the posterior liver wall and ligating the cystic duct, vein, and artery. The surgeon usually approaches the gallbladder through a right upper paramedian or upper midline incision if necessary, the common duct may be explored through this incision. When stones are suspected in the common duct, operative cholangiography may be performed (if it has not been ordered preoperatively). The surgeon may dilate the common duct if it is already dilated as a result of a pathologic process. Dilation facilitates stone removal. The surgeon passes a thin instrument into the duct to collect the stones, either whole or after crushing them.
After exploring the common duct, the surgeon usually inserts a T-tube to ensure adequate bile drainage during duct healing (choledochostomy). The T-tube also provides a route for postoperative cholangiography or stone dissolution, when appropriate.
A conventional open cholecystectomy is indicated when a laparoscopic cholecystectomy does not allow for retrieval of a stone in the common bile duct and when the client’s physique does not allow access to the gallbladder. Occasionally, when a client is very obese, the gallbladder is not retrievable via laparoscopic instruments. Further, a surgeon may have difficulty accessing the gallbladder in an adult with a small frame and may need to perform the conventional open cholecystectomy.
Nursing Care Plans
Here are four (4) cholecystectomy nursing care plans (NCP).
- Ineffective Breathing Pattern
- Impaired Skin Integrity
- Risk for Deficient Fluid Volume
- Deficient Knowledge
- Preoperative Problem: Acute Pain
- Preoperative Problem: Fear
- Ineffective Breathing Pattern
- Risk for Aspiration
- Postoperative Acute Pain
- Activity Intolerance
- Impaired Physical Mobility
- Risk for Infection
- Other Possible Nursing Diagnoses
- See Also and Further Reading
Nursing Priorities
- Promote respiratory function.
- Prevent complications.
- Provide information about disease, procedure(s), prognosis, and treatment needs.
Discharges Goals
- Ventilation/oxygenation adequate for individual needs.
- Complications prevented/minimized.
- Disease process, surgical procedure, prognosis, and therapeutic regimen understood.
- Plan in place to meet needs after discharge.
Nursing Diagnosis
- Breathing Pattern, ineffective
May be related to
Possibly evidenced by
- Tachypnea; respiratory depth changes, reduced vital capacity
- Holding breath; reluctance to cough
Desired Outcomes
- Establish effective breathing pattern.
- Experience no signs of respiratory compromise/complications.
| Nursing Interventions | Rationale |
|---|---|
| Observe respiratory rate, depth. | Shallow breathing, splinting with respirations, holding breath may result in hypoventilation or atelectasis. |
| Auscultate breath sounds. | Areas of decreased or absent breath sounds suggest atelectasis, whereas adventitious sounds (wheezes, rhonchi) reflect congestion. |
| Assist patient to turn, cough, and deep breathe periodically. | Promotes ventilation of all lung segments and mobilization and expectoration of secretions. |
| Show patient how to splint incision. Instruct in effective breathing techniques. | Facilitates lung expansion. Splinting provides incisional support and decreases muscle tension to promote cooperation with therapeutic regimen. |
| Elevate head of bed, maintain low-Fowler’s position. | Maximizes expansion of lungs to prevent or resolve atelectasis. |
| Support abdomen when coughing, ambulating. | Facilitates more effective coughing, deep breathing, and activity. |
