4 Cholecystitis and Cholelithiasis Nursing Care Plans

Risk for Imbalanced Nutrition: Less Than Body Requirements

Patients with cholecystitis and cholelithiasis are at risk for imbalanced nutrition, with less than the body’s requirements, due to dietary restrictions to avoid exacerbating symptoms, loss of nutrients from impaired digestion and absorption, impaired fat digestion and malabsorption, and pain and dyspepsia leading to decreased intake. These factors can lead to malnutrition and nutrient deficiencies, potentially worsening the inflammatory response and impairing overall healing.

Nursing Diagnosis

• Risk for Imbalanced Nutrition: Less Than Body Requirements

Risk factors may include

• Self-imposed or prescribed dietary restrictions, nausea/vomiting, dyspepsia, pain
• Loss of nutrients; impaired fat digestion due to obstruction of bile flow

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 report relief from nausea/vomiting.
• The client will demonstrate progression toward desired weight gain or maintain weight as individually appropriate.

Nursing Assessment and Rationales

1. Calculate caloric intake. Keep comments about appetite to a minimum.
Identifies nutritional deficiencies and/or needs. Focusing on a problem creates a negative atmosphere and may interfere with intake.

2. Weigh as indicated.
Monitors the effectiveness of the dietary plan.

3. Assess for abdominal distension, frequent belching, guarding, and reluctance to move.
Nonverbal signs of discomfort associated with impaired digestion, and gas pain.

4. Monitor laboratory studies: BUN, prealbumin, albumin, total protein, and transferrin levels.
Provides information about nutritional deficits or the effectiveness of therapy.

Nursing Interventions and Rationales

1. Consult with the patient about likes and dislikes, foods that cause distress, and preferred meal schedules.
Involving the patient in planning enables the patient to have a sense of control and encourages eating.

2. Provide a pleasant atmosphere at mealtime; remove noxious stimuli.
Useful in promoting appetite/reducing nausea.

3. Provide oral hygiene before meals.
A clean mouth enhances appetite.

4. Offer effervescent drinks with meals, if tolerated.
May lessen nausea and relieve gas. Note: May be contraindicated if the beverage causes gas formation/gastric discomfort.

5. Ambulate and increase activity as tolerated.
Helpful in the expulsion of flatus, and reduction of abdominal distension. Contributes to overall recovery and a sense of well-being and decreases the possibility of secondary problems related to immobility (pneumonia, thrombophlebitis).

6. Consult with a dietitian or nutritional support team as indicated.
Useful in establishing individual nutritional needs and the most appropriate route.

7. Begin a low-fat liquid diet after the NG tube is removed.
Limiting fat content reduces stimulation of the gallbladder and pain associated with incomplete fat digestion and is helpful in preventing recurrence.

8. Advance diet as tolerated, usually low-fat, high-fiber. Restrict gas-producing foods (onions, cabbage, popcorn) and foods or fluids high in fats (butter, fried foods, nuts).
Meets nutritional requirements while minimizing stimulation of the gallbladder.

9. Administer bile salts: Bilron, Zanchol, and dehydrocholic acid (Decholin), as indicated.
Promotes digestion and absorption of fats, fat-soluble vitamins, and cholesterol. Useful in chronic cholecystitis.

10. Provide parenteral and/or enteral feedings as needed.
Alternative feeding may be required depending on the degree of disability and gallbladder involvement and the need for prolonged gastric rest.