4 Cholecystectomy Nursing Care Plans

Deliver effective care to patients with cholecystectomy this nursing care plan and management guide. Gain insights into nursing assessment, interventions, goals, and diagnosis customized for their specific needs. Enhance your ability to provide specialized care for cholecystectomy.

What is Cholecystectomy?
Nursing Care Plans and Management
See also

What is Cholecystectomy?

Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is performed most frequently through laparoscopic incisions using a 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 the 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 and Management

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

Nursing Problem Priorities

The following are the nursing priorities for patients with cholecystectomy:

Manage postoperative pain and discomfort effectively.
Monitor for and prevent complications, such as bile leakage or infection.
Promote wound healing and prevent surgical site infections.
Administer appropriate antibiotics perioperatively.
Educate patients on postoperative care, including dietary modifications and activity restrictions.
Provide support for early mobilization and respiratory care.

Nursing Assessment

Assess for the following subjective and objective data:

Tachypnea; respiratory depth changes, reduced vital capacity
Holding breath; reluctance to cough
Disruption of skin/subcutaneous tissues

Nursing Diagnosis

Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with cholecystectomy based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.

Nursing Goals

Goals and expected outcomes may include:

The client will establish an effective breathing pattern.
The client will experience no signs of respiratory compromise/complications.
The client will achieve timely wound healing without complications.
The client will demonstrate behaviors to promote healing/prevent skin breakdown.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with cholecystectomy may include:

1. Promoting Effective Breathing Pattern

Observe respiratory rate and depth.
Shallow breathing, splinting with respirations, and 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 the 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 the 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 the bed, and maintain a low Fowler’s position.
Maximizes expansion of lungs to prevent or resolve atelectasis.

Support the abdomen when coughing, and ambulating.
Facilitates more effective coughing, deep breathing, and activity.

2. Maintaining Skin Integrity and Wound Care

Observe the color and character of the drainage.
Initially, drainage may contain blood and bloodstained fluid, normally changing to greenish brown (bile color) after the first several hours.

Observe for hiccups, abdominal distension, or signs of peritonitis, or pancreatitis.
Dislodgment of the T-tube can result in diaphragmatic irritation or more serious complications if bile drains into the abdomen or the pancreatic duct is obstructed.

Observe skin, sclerae, and urine for changes in color.
Developing jaundice may indicate obstruction of bile flow.

Note the color and consistency of the stools.
Clay-colored stools result when bile is not present in the intestines.

Investigate reports of increased or unrelenting RUQ pain; development of fever, tachycardia; leakage of bile drainage around the tube or from a wound.
Signs suggestive of abscess or fistula formation, requiring medical intervention.

Monitor puncture sites (3–5) if the endoscopic procedure is done.
These areas may bleed, or staples and Steri-Strips may loosen at puncture wound sites.

Change dressings as often as necessary. Clean the skin with soap and water. Use sterile petroleum jelly gauze, zinc oxide, or Karaya powder around the incision.
Keeps the skin around the incision clean and provides a barrier to protect the skin from excoriation.

Apply Montgomery straps.
Facilitates frequent dressing changes and minimizes skin trauma.

Use a disposable ostomy bag over a stab wound drain.
Ostomy appliances may be used to collect heavy drainage for more accurate measurement of output and protection of the skin.

Place the patient in a low- or semi-Fowler’s position.
Facilitates drainage of bile.

Check the T-tube and incisional drains; make sure they are free-flowing.
T-tube may remain in the common bile duct for 7–10 days to remove retained stones. Incision site drains are used to remove any accumulated fluid and bile. Correct positioning prevents the backup of the bile in the operative area.

Maintain T-tube in a closed collection system.
Prevents skin irritation and facilitates measurement of output. Reduces the risk of contamination.

Anchor drainage tube, allowing sufficient tubing to permit free turning and avoid kinks and twists.
Avoids dislodging tube and/or occlusion of the lumen.

Clamp the T-tube per schedule.
Tests the patency of the common bile duct before the tube is removed.

Administer antibiotics as indicated.
Necessary for treatment of abscess and/or infection.

3. Optimizing Fluid Volume

Monitor I&O, including drainage from the NG tube, T-tube, and wound. Weigh the patient periodically.
Provides information about replacement needs and organ function. Initially, 200–500 mL of bile drainage may be expected via the T-tube, decreasing as more bile enters the intestine. Continuing large amounts of bile drainage may be an indication of unresolved obstruction or, occasionally, a biliary fistula.

Monitor vital signs. Assess mucous membranes, skin turgor, peripheral pulses, and capillary refill.
Indicators of the adequacy of circulating volume, and perfusion.

Observe for signs of bleeding: hematemesis, melena, petechiae, and ecchymosis.
Prothrombin is reduced and coagulation time is prolonged when bile flow is obstructed, increasing the risk of bleeding or hemorrhage.

Monitor laboratory studies: Hb/Hct, electrolytes, prothrombin level, or clotting time.
Provides information about circulating volume, electrolyte balance, and adequacy of clotting factors.

Use small-gauge needles for injections, and apply firm pressure for longer than usual after venipuncture.
Reduces trauma, and risk of bleeding or hematoma.

Have the patient use cotton or sponge swabs and mouthwash instead of a toothbrush.
Avoids trauma and bleeding of the gums.

Administer IV fluids, and blood products, as indicated
Maintains adequate circulating volume and aids in the replacement of clotting factors.

Administer Electrolytes as indicated.
Corrects imbalances resulting from excessive gastric losses.

Administer Vitamin K as indicated.
Provides replacement of factors necessary for the clotting process.

4. Initiating Patient Education and Health Teachings

Identify signs and symptoms requiring notification of healthcare provider: dark urine; the jaundiced color of eyes, and skin; clay-colored stools, excessive stools; or recurrent heartburn, or bloating.
Indicators of obstruction of bile flow or altered digestion, require further evaluation and intervention.

Review disease process, surgical procedure, and prognosis.
Provides a knowledge base on which patients can make informed choices.

Demonstrate care of incisions, dressings, and drains. Promote good hand hygiene.
Promotes independence in care and reduces the risk of complications.

Recommend periodic drainage of the T-tube collection bag and recording of output.
Reduces the risk of reflux, and strain on the tube, or appliance seal. Provides information about the resolution of ductal edema and return of ductal function for appropriate timing of T-tube removal.

Emphasize the importance of maintaining a low-fat diet, eating frequent small meals, and gradually reintroduction of foods or fluids containing fats over a 4- to 6-month period.
During the initial 6 mo after surgery, a low-fat diet limits the need for bile and reduces discomfort associated with inadequate digestion of fats.

Discuss the use of medication such as florantyrone (Sancho) or dehydrocholic acid (Decholin).
Oral replacement of bile salts may be required to facilitate fat absorption.

Discuss avoiding or limiting the use of alcoholic beverages.
Minimizes risk of pancreatic involvement.

Inform the patient that loose stools may occur for several months.
Intestines require time to adjust to the stimulus of the continuous output of bile.

Advise the patient to note and avoid foods that seem to aggravate diarrhea.
Although radical dietary changes are not usually necessary, certain restrictions may be helpful; e.g., fats in small amounts are usually tolerated. After a period of adjustment, the patient usually will not have problems with most foods.

Review activity limitations depending on the individual situation.
Resumption of usual activities is normally accomplished within 4–6 wks.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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