4 Cholecystitis and Cholelithiasis Nursing Care Plans

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): 

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

Acute Pain

Patients with cholecystitis and cholelithiasis may experience acute pain due to obstruction of the gallbladder or bile ducts by gallstones, inflammation and irritation of the gallbladder wall, and tissue ischemia resulting from impaired blood flow to the affected area. The pain is often located in the right upper quadrant of the abdomen and may be accompanied by other symptoms such as fever, nausea, and vomiting.

Nursing Diagnosis

  • Acute Pain

May be related to

  • Biological injuring agents: obstruction/ductal spasm, inflammatory process, tissue ischemia/necrosis

Possibly evidenced by

  • Reports of pain, biliary colic (waves of pain)
  • Facial mask of pain; guarding behavior
  • Autonomic responses (changes in BP, pulse)
  • Self-focusing; narrowed focus

Desired Outcomes

  • The client will report relief or control of pain.
  • The client will demonstrate the use of relaxation skills and diversional activities as indicated for the individual situations.

Nursing Assessment and Rationales

1. Observe and document location, severity (0–10 scale), and character of pain (steady, intermittent, colicky).
Assists in differentiating causes of pain, and provides information about disease progression and resolution, development of complications, and effectiveness of interventions.

2. Note the response to medication, and report to the physician if the pain is not being relieved.
Severe pain not relieved by routine measures may indicate developing complications or a need for further intervention.

Nursing Interventions and Rationales

1. Promote bedrest, allowing the patient to assume a position of comfort.
Bedrest in low-Fowler’s position reduces intra-abdominal pressure; however, the patient will naturally assume the least painful position.

2. Use soft or cotton linens; calamine lotion, oil bath; cool or moist compresses as indicated.
Reduces irritation and dryness of the skin and itching sensation.

3. Control the environmental temperature.
Cool surroundings aid in minimizing dermal discomfort.

4. Encourage the use of relaxation techniques. Provide diversional activities.
Promotes rest, and redirecting attention may enhance coping.

5. Make time to listen to and maintain frequent contact with the patient.
Helpful in alleviating anxiety and refocusing attention, which can relieve pain.

6. Maintain NPO status, insert and/or maintain NG suction as indicated.
Removes gastric secretions that stimulate the release of cholecystokinin and gallbladder contractions.

7. Administer medications as indicated:

  • 7.1. Anticholinergics: atropine, propantheline (Pro-Banthı-ne)
    Relieves reflex spasms and smooth muscle contraction and assists with pain management.
  • 7.2. Sedatives: phenobarbital
    Promotes rest and relaxes smooth muscle, relieving pain.
  • 7.3. Narcotics: meperidine hydrochloride (Demerol), morphine sulfate
    Given to reduce severe pain. Morphine is used with caution because it may increase spasms of the sphincter of Oddi, although nitroglycerin may be given to reduce morphine-induced spasms if they occur.
  • 7.4. Monoctanoin (Moctanin)
    This medication may be used after cholecystectomy for retained stones or for newly formed large stones in the bile duct. It is a lengthy treatment (1–3 wk) and is administered via a nasal-biliary tube. A cholangiogram is done periodically to monitor stone dissolution.
  • 7.5. Smooth muscle relaxants: papaverine (Pavabid), nitroglycerin, amyl nitrite
    Relieves ductal spasm.
  • 7.6. Chenodeoxycholic acid (Chenix), ursodeoxycholic acid (Urso, Actigall)
    These natural bile acids decrease cholesterol synthesis, dissolving gallstones. The success of this treatment depends on the number and size of gallstones (preferably three or fewer stones smaller than 20 min in diameter) floating in a functioning gallbladder.
  • 7.7. Antibiotics
    To treat infectious processes, reducing inflammation.

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.

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.

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 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:

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.

Leave a Comment

Share to...