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8 Cholecystectomy Nursing Care Plans

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By Matt Vera, BSN, R.N.
Cholecystectomy Nursing Care Plans
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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

Nursing care plans for patients who underwent cholecystectomy includes promoting optimal respiratory function, preventing complications, management of pain, and provision of information about disease, procedures and treatment needs.

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Here are 8 nursing care plan (NCP) and nursing diagnosis for cholecystectomy:

  1. Ineffective Breathing Pattern
  2. Impaired Skin Integrity
  3. Risk for Deficient Fluid Volume
  4. Deficient Knowledge
  5. Preoperative Problem: Acute Pain
  6. Preoperative Problem: Fear
  7. Ineffective Breathing Pattern
  8. Risk for Aspiration

1. Ineffective Breathing Pattern

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Ineffective Breathing Pattern

Nursing Diagnosis

May be related to

  • Pain
  • Muscular impairment
  • Decreased energy/fatigue

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 InterventionsRationale
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 the patient how to splint incision. Instruct effective breathing techniques.Facilitates lung expansion. Splinting provides incisional support and decreases muscle tension to promote cooperation with the therapeutic regimen.
Elevate the 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.
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1. Ineffective Breathing Pattern

Recommended Resources

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See also

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Matt Vera, BSN, R.N.
Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
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