4 Cholecystitis and Cholelithiasis Nursing Care Plans

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Cholecystitis is the inflammation of the gallbladder, usually associated with gallstones impacted in the cystic duct. Stones (calculi) are made up of cholesterol, calcium bilirubinate, or a mixture caused by changes in the bile composition. Gallstones can develop in the common bile duct, cystic duct, hepatic duct, small bile duct, and pancreatic duct. Crystals can also form in the submucosa of the gallbladder causing widespread inflammation. Acute cholecystitis with cholelithiasis is usually treated by surgery, although several other treatment methods (fragmentation and dissolution of stones) are now being used.

Cholelithiasisstones or calculi in the gallbladder, results from changes in bile components. Gallstones are made of cholesterol, calcium bilirubinate, or a mix of cholesterol and bilirubin. They arise during periods of sluggishness in the gallbladder due to pregnancy, hormonal contraceptives, diabetes mellitus, celiac disease, cirrhosis of the liver, and pancreatitis.

Nursing Care Plans

Nursing care planning and management for patients with cholecystitis include relieving pain and promoting rest, maintaining fluid and electrolyte balance, preventing complications, and provision of information about the disease process, prognosis, and treatment.

Here are four (4) nursing care plans and nursing diagnoses for cholecystitis (cholelithiasis): 

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  1. Risk for Deficient Fluid Volume
  2. Acute Pain
  3. Risk for Imbalanced Nutrition: Less Than Body Requirements
  4. Deficient Knowledge
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Risk for Deficient Fluid Volume

Patients with cholecystitis and cholelithiasis are at risk for deficient fluid volume due to excessive losses resulting from vomiting or diarrhea, limited intake due to nausea and anorexia, and altered clotting processes due to liver dysfunction. This can lead to dehydration and impaired perfusion, which can worsen the inflammatory response associated with these conditions and potentially lead to systemic complications.

Nursing Diagnosis

  • Risk for Deficient Fluid Volume

Risk factors may include

  • Excessive losses through gastric suction; vomiting, distension, and gastric hyper­motility
  • Medically restricted intake
  • Altered clotting process

Possibly evidenced by

  • Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

  • The client will demonstrate adequate fluid balance evidenced by stable vital signs, moist mucous membranes, good skin turgor, capillary refill, individually appropriate urinary output, and absence of vomiting.

Nursing Assessment and Rationales

1. Maintain accurate record of I&O, noting output less than intake, and increased urine specific gravity. Assess skin and mucous membranes, peripheral pulses, and capillary refill.
To provide information about the fluid status and circulating volume needing replacement.

2. Monitor for signs and symptoms of increased or continued nausea or vomiting, abdominal cramps, weakness, twitching, seizures, irregular heart rate, paresthesia, hypoactive or absent bowel sounds, and depressed respirations.
Prolonged vomiting, gastric aspiration, and restricted oral intake can lead to deficits in sodium, potassium, and chloride.

3. Assess for unusual bleeding: oozing from injection sites, epistaxis, bleeding gums, ecchymosis, petechiae, hematemesis, or melena.
Prothrombin is reduced and coagulation time is prolonged when bile flow is obstructed, increasing the risk of bleeding or hemorrhage.

Nursing Interventions and Rationales

1. Eliminate noxious sights or smells from the environment.
Reduces stimulation of vomiting center.

2. Perform frequent oral hygiene with alcohol-free mouthwash; apply lubricants.
Decreases dryness of oral mucous membranes; reduces the risk of oral bleeding.

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

4. Keep patient NPO as necessary.
Decreases GI secretions and motility.

5. Insert NG tube, connect to suction, and maintain patency as indicated.
To rest the GI Tract

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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.

NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

More nursing care plans related to gastrointestinal disorders:

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Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

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