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

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.

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.

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.

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