4 Cholecystitis and Cholelithiasis Nursing Care Plans

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.