12 Cholecystectomy Nursing Care Plans

July 14, 2013

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.

Here are 12 nursing care plan (NCP) and nursing diagnosis for cholecystectomy:

Ineffective Breathing Pattern

Ineffective Breathing Pattern: Inspiration and/or expiration that does not provide adequate ventilation

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 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 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.