1

I. INRODUCTION
A. Overview of the case

Cholecystitis is inflammation of the gall bladder. It is commonly due to impaction

or sticking of a gallstone within the neck of the gall bladder that leads to inspissation of
bile, bile stasis, and infection by gut organisms. Cholecystitis may be a cause of right
upper quadrant pain. The pain may actually manifest in the right flank or scapular region
at first. Acute cholecystitis classically presents with acute pain in the right upper quadrant
of the abdomen, nausea or vomiting, and fever. On physical examination, the patient may
have Murphy's sign, spasm of the diaphragm (due to the intense pain) when the region of
the gallbladder is palpated by the examiner. There may be a previous history of gallstone
attacks.
Laboratory values may be notable for an elevated alkaline phosphatase, possibly
an elevated bilirubin and possibly an elevation of the WBC count. CRP (C-reactive
protein) is often elevated. The degree of elevation of these laboratory values may depend
on the degree of inflammation of the gallbladder. Patients with acute cholecystitis are
much more likely to manifest abnormal laboratory values, while in chronic cholecystitis
the laboratory values are frequently normal.
In severe cases, the gall bladder can rupture and form an abscess or it may lead to
a life-threatening infection of the liver called ascending cholangitis. In other cases, it may
lead to a stable inflammatory state termed chronic cholecystitis. Cholecystectomy is the
surgical removal of the inflammed gall bladder. Despite the development of non-surgical
techniques, it is the most common method for treating symptomatic gallstones, although
there are other reasons for having this surgery done. Each year more than 500,000
Americans have gallbladder surgery. The conventional method of removing the gall
bladder was through a six inches incision in the right upper abdomen wich is the standard
procedure or the open cholecystectomy it is an older more invasive procedure, but now
with the advances in surgery we have the additional laparoscopic method where the
surgery can be carried out through 3 or 4 tiny key-holes incisions called laparoscopic
cholecystectomy.
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B. Objectives of the study:

The objectives of this study are intended to identify health problems encountered

by my patient and further understand the extent of the case. As a student nurse,

this would serve as a tool and preparation for my training from what I have

learned in classroom discussions and be able to apply these in real clinical area

such as this case.

This case study focuses to accomplish the following objectives:

a. To establish rapport from the client and also to his significant other

b. To determine the content on the nursing assessment, diagnosis, planning,

implementation, and evaluation for this specific disease condition

c. To know the underlying causes and health history on the clients medical

diagnosis upon admission

d. To search the medical management as being ordered based upon the clients

diagnostic and laboratory results

e. To compare & contrast the ideal and actual nursing care management for this

specific disease condition: and

f. To evaluate the effectiveness of the interventions and detect any progress of

the clients condition.

The purpose of the study is to understand thoroughly the clients disease

condition, the factors involving the processes and the causes of the disease

condition, which is cholecystitis.

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In general, this study aims to develop the skills and learning of the students

through performing actual procedures, wherein students are exposed and able

to learn the genuine hospital setting in every case that they encounter.

Enhancing ones understanding and competence is important to impart the best

possible care to the client.

C. Scope and limitation:

The scope of the study includes the overall gathered data during the two

days assessment as manifested by the patient and its complaints. It deals with

some factors observed within the time span given by our clinical instructor. After

assessing the patient’s condition an interview followed. To the extant, there was

some nursing and medical management done depending on the patients needs

during his confinement in the hospital and some health history was asked for the

completion of the study.

The limitations depends upon the time and duration of my care given to

the patient and the sources of the data coming from significant others. The

study was completed all together by interaction with the patient and actual

hands-on exposure learned during our return demonstration and lecture class

during our two days hospital duty.

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II. Health History

A. PATIENT’S PROFILE

Name: CPL. Armando Ubaob

Sex: male

Status: married

Birth date: May 28, 1976

Age: 34 y/o

Weight: 60 lbs.

Religion: roman Catholic

Nationality: Filipino

Address: Damulog, Bukidnon

Allergy: no known food and drug allergy

Informant: Mrs. Ruth Ubaob (wife)

Date of admission: December 28, 2009

Chief complaint: pain at right upper quadrant

Vital signs:

Temperature: 37.8˚ C

Pulse rate: 74 bpm

Respiratory rate: 22 cpm

BP: 100/70 mmHg

Diagnosis: Colecystitis

Attending Physician: Dr. Borungawan

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B. Family and personal health history

According to Mr. Ubaob the familial disease he knows that they have in their

family was the hypertension that is on his father’s side. His father died because of

heart attack and her mother died because of natural cause.

C. History of present illness

This is the first time Mr. Ubaob admitted to the hospital. He also added that he

had an asthma when he was 7yrs.old that last when he was 21yrs.old, his asthma

just stopped when he start drinking alcohol beverages as he said.

As for his present illness, he was admitted in to this hospital because of

cholecystitis, he was admitted last December 28,2009. He was been diagnosed

with cholecystisis prior to admission due to severe epigastric pain and weight loss

and was advised to removed his gallbladder. He just not have his cholecestectomy

done immediately due to financial problem.

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III. DEVELOPMENTAL TASK

 Erik Erickson’s Eight Stages of Human Development

Each stage is characterized by a different conflict that must be resolved by

the individual. When the environment makes new demands on people, the
conflicts arise. 'The person is faced with a choice between two ways of coping
with each crisis, an adaptive or maladaptive way. Only when each crisis is
resolved, which involves a change in the personality, does the person have
sufficient strength to deal with the next stages of development. If a person is
unable to resolve a conflict at a particular stage, they will confront and struggle
with it later in life.
Mr. Armando Ubaob 34 years old he is on the middle adulthood stage
wherein the basic conflict is generativity vs, stagnation, the important event in this
stage is parenting in which Mr. Ubaob Had met because he is a father. In this
stage, each adult must find some way to satisfy and support the next generation.

 Sigmund Freud’s Stages of Development

Freud's theory has three main parts, the stages of development, the
structure of the personality, and his description of mental life. He advanced a
theory of personality development that centered on the effects of the sexual
pleasure drive on the individual psyche. At particular points in the developmental
process, he claimed, a single body part is particularly sensitive to sexual, erotic
stimulation. These erogenous zones are the mouth, the anus, and the genital
region. The child's libido centers on behavior affecting the primary erogenous
zone of his age; he cannot focus on the primary erogenous zone of the next stage
without resolving the developmental conflict of the immediate one.
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IV. MEDICAL MANAGEMENT

A. Medical orders and rationale

Doctors order rationale

December 28, 2009

• Please admit under the service of • For medical management of the

Dr. Borungawan patient’s condition

• Secure consent to care • For legal purposes

• TPR every 4 hours • To obtain baseline data and note for

any abnormalities in vital signs

• DAT • Proper diet avoid worsening of the

patient’s condition

• Start IVF D5LR @ 30gtts/min • To replace the fluids lost from

insensible sources and decreased

• Medications: oral intake

Nalbuphine (Nubain)
Pain reliever
Ketorolac (Toradol)
Anti-inflammatory

reducing stomach acid production

Ranitidine (Zantac)
cephalosporin antibiotic
Cefuroxime (Ceftin)
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B. DRUG STUDY

• Nalbuphine (Nubain)

USES: This medication is a narcotic pain reliever. It is used to treat moderate to

severe pain and to boost the effects of anesthesia

HOW TO USE: This medication is given by injection under the skin or into a

vein or muscle by a health care professional. How much and how often you use

this is based on your condition and response. Use this medication exactly as

directed by your doctor. Do not increase your dose, use it more frequently or use

it for a longer period of time than prescribed because this drug can be habit-

forming. Also, if used for an extended period, do not suddenly stop using this

drug without your doctor's approval. Over time, this drug may not work as well.

Consult your doctor if this medication isn't relieving the pain sufficiently.

SIDE EFFECTS: Drowsiness, dizziness, sweating, headache, nausea,

restlessness, itching, vomiting, dry mouth or constipation may occur. If these

effects persist or worsen, contact your doctor or pharmacist promptly. Tell your

doctor immediately if any of these unlikely but serious side effects occur:

depression, confusion, mood changes, hallucinations, trouble breathing, blurred

vision, seizures. A serious allergic reaction to this drug is unlikely, but seek

immediate medical attention if it occurs. Symptoms of a serious allergic reaction

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include: rash, itching, swelling, severe dizziness, trouble breathing. If you notice

other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Before taking nalbuphine, tell your doctor or pharmacist if

you are allergic to it; or if you have any other allergies. Tell your doctor if you

have: heart problems, liver problems, kidney problems, lung diseases, brain

disorders, a history of drug dependence, drug allergies. Limit use of alcohol while

using this medication. Use caution driving or performing task requiring alertness

as this medication may cause drowsiness or dizziness. This drug should be used

with caution in elderly persons. Use of nalbuphine in children under 18 years of

age is not recommended. Tell your doctor if you are pregnant before using this

medication. Nalbuphine is not recommended for prolonged use or in high doses at

the end of pregnancy. It is not known is nalbuphine is excreted into breast milk.

Consult your doctor before breast-feeding.

STORAGE: Store this at room temperature between 59 and 86 degrees F (15 to

30 degrees C), away from heat, light and moisture. Do not store in the bathroom.

Keep out of the reach of children

• Ketorolac (Toradol)

MECHANISM OF ACTION: The primary mechanism of action responsible for

Ketorolac's anti-inflammatory/antipyretic/analgesic effects is the inhibition of

prostaglandin synthesis by competitive blocking of the the enzyme

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cyclooxygenase (COX). Like most NSAIDs, Ketorolac is a non-selective

cyclooxygenase inhibitor.

INDICATION: Ketorolac is indicated for short-term management of pain (up to

five days).

CONTRAINDICATION: Contraindicated against patients with a previously

demonstrated hypersensitivity to ketorolac, and against patients with the complete

or partial syndrome of nasal polyps, angioedema, bronchospastic reactivity or

other allergic manifestations to aspirin or other non-steroidal anti-inflammatory

drugs (due to possibility of severe anaphylaxis). As with all NSAIDs, ketorolac

should be avoided in patients with renal dysfunction. (Prostaglandins are needed

to dilate the afferent arteriole; NSAIDs effectively reverse this.) The patients at

highest risk, especially in the elderly, are those with fluid imbalances or with

compromised renal function (e.g., heart failure, diuretic use, cirrhosis,

dehydration, and renal insufficiency).

CAUTION: Ketorolac is not recommended for pre-operative analgesia or co-

administration with anesthesia because it inhibits platelet aggregation. OT is not

recommended for obstetric analgesia because it has not been adequately tested for

obstetrical administration and has demonstrable fetal toxicity in laboratory

animals.Ketorolac has been co-administered with meperidine and morphine

without apparent adverse effects.IT is not recommended for long-term chronic

pain patients
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• Ranitidine (Zantac)

DRUG CLASS AND MECHANISM: Histamine is a natural chemical that

stimulates the stomach cells to produce acid. Ranitidine belongs to a class of

medications, called H2-blockers,that block the action of histamine on stomach

cells, thus reducing stomach acid production.

PREPARATIONS: Tablets (150 mg, 300 mg), Capsules (150 mg, 300 mg);

Syrup (15 mg/ml)

STORAGE: Should be stored at room temperature in a tightly closed container.

PRESCRIBED FOR: Ranitidine blocks the action of histamine on stomach cells,

and reduces stomach acid production. Ranitidine is useful in promoting healing of

stomach and duodenal ulcers, and in reducing ulcer pain. Ranitidine has been

effective in preventing ulcer recurrence when given in low doses for prolonged

periods of time. In doses higher than that used in ulcer treatment, ranitidine has

been helpful in treating heartburn and in healing ulcer and inflammation of the

esophagus resulting from acid reflux (reflux esophagitis).

DOSING: May be taken with or without food. Since ranitidine is excreted by the

kidney and metabolized by the liver, dosages of ranitidine need to be lowered in

patients with significantly abnormal liver or kidney function.

DRUG INTERACTIONS: Antacids may decrease the absorption of ranitidine.

Safety of ranitidine in children has not been established. Ranitidine is not habit
 12

forming. Ranitidine can interfere with the metabolism of alcohol. Patients taking

ranitidine who drink alcohol may have elevated blood alcohol levels.

SIDE EFFECTS: Minor side effects include constipation, diarrhea, fatigue,

headache, insomnia, muscle pain, nausea, and vomiting. Major side effects are

rare; they include: agitation, anemia, confusion, depression, easy bruising or

bleeding, hallucinations, hair loss, irregular heartbeat, rash, visual changes, and

yellowing of the skin or eyes.

• Cefuroxime (Ceftin)

DRUG CLASS AND MECHANISM: Cefuroxime is a semisynthetic

cephalosporin antibiotic, chemically similar to penicillin. It is effective against a

wide variety of bacteria organisms, such as Staphylococcus aureus, Streptococcus

pneumoniae, Haemophilus influenzae, E. coli, N. gonorrhoeae, and many others.

PREPARATIONS: Tablets: 125 mg, 250 mg, 500 mg. Suspension: 125 mg per 5

ml teaspoon.

STORAGE: Tablets should be stored at room temperature in a tightly closed

container. The oral suspension should be stored in the refrigerator in a tightly

closed container.

PRESCRIBED FOR: Cefuroxime is effective against susceptible bacterias

causing infections of the middle ear, tonsillitis, throat infections, laryngitis,

bronchitis, and pneumonia. It is also used in treating urinary tract infections, skin
 13

infections, and gonorrhea. Additionally, it is useful in treating acute bacterial

bronchitis in patients with chronic obstructive pulmonary disease (COPD).

DOSING: Should be taken with food.

DRUG INTERACTIONS: Cefuroxime should be avoided by patients with a

known allergy to cephalosporin type antibiotics. Since cefuroxime is chemically

related to penicillin, an occasional patient can have an allergic reaction

(sometimes even anaphylaxis) to both medications. Treatment with cefuroxime

and other antibiotics can alter the normal bacteria flora of the colon and permit

overgrowth of C. difficile, bacteria responsible for pseudomembranous colitis.

Patients who develop pseudomembranous colitis as a result of antibiotics

treatment can experience diarrhea, abdominal pain, fever, and sometimes even

shock. Probenecid may increase the blood levels of cefuroxime. Cefuroxime can

be used by children. It is not habit forming.

SIDE EFFECTS: Cefuroxime is generally well tolerated and side effects are

usually transient. Reported side effects include diarrhea, nausea, vomiting,

abdominal pain, headache, rash, hives, vaginitis, headache, and mouth ulcers.
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LABORATORY RESULTS

Ultrasound Report

• Liver is normal in size & shows hemogenous echotexture

• Gall bladder is distended with thickened wall measuring 0.63cm

Right Kidney Left Kidney

Length 8.8cm 8.4cm

Cortex 1.1cm 1.1cm

• Both kidneys are normal in size and show smooth outlines.

• Urinary bladder is slightly distended with non-thickened walls
Impression:
- Thickened GB wall may be due to adenomyomatosis with sludge.
Cannot totally rule out chronic cholecystitis.

Complete Blood Count 04-13-‘07

Normal Values

Clotting Time 3’37” Venous: 5-15 min

Capillary: 3-15 min

Bleeding Time 3’06” Capillary: 3-5 min

Blood Chemistry 04-11-‘07

Normal Values
Fasting Blood Sugar 80.3 70-105 mg/dL
Creatinine 0.3 0.4-1.4 mg/dL
Alkaline PO4 83 U/L 100-290 U/L
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Serology

HbAsg Non-Reactive

V. ANATOMY & PHYSIOLOGY

Anatomy of the gall bladder

The gall bladder is a small pear shaped organ (sac) for the storage of bile. It is
located on the underside of the liver in the right side of the upper abdomen. The main
purpose of the gall bladder is to store and concentrate bile. Bile is manufactured in the
liver and secreted through the hepatic duct partly into the gall bladder via the cystic duct
and partly into the small intestine (duodenum) via the common bile duct. The
concentrated bile stored in the gall bladder is released through the common bile duct into
the duodenum whenever fatty foods are eaten. One of the functions of bile is to aid the
digestion of fatty foods.

Gallstones are crystallized bile formed in the gallbladder because of the excessive
level of cholesterol in the bile. These stones can travel and block the flow of bile
resulting in pain in the right upper abdomen. It is also possible for a small stone to lodge
in the opening of the common bile duct into the duodenum. This is a more serious
 16

condition where the stone can also block the flow of the pancreatic juice from the
pancreatic duct that joins the common bile duct. This may result in pancreatitis
(inflammation of the pancreas). Gallbladder problems are very common and if they cause
pain, medical attention is usually needed.

PATHOPHYSIOLOGY

Predisposing Factors Precipitating Factors

· Overweight. · Escherichia coli

· High blood cholesterol level · Alcohol abuse

· Family history of gallbladder disease · Severe illness

· People who eat fatty foods · Tumor in the gall bladder

Obstruction of the cystic duct

A gallstone usually causes the obstruction (calculous cholecystitis)

Inflammation may be sterile or bacterial

Obstruction may be acalculous or caused by sludge

Gallbladder distention, gallbladder wall edema, ischemia, and necrosis

Inflammatory mediators, specifically prostaglandins are released

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Increased gallbladder inflammation

Chronic Cholecystitis

VI. Nursing Assessment (System Review and Nursing

Assessment)

A. Physical assessment
Name CPL. Armando Ubaob
BP: 100/70 mmHg T: 37.8˚ C PR: 74 bpm RR: 22cpm Weight: 60lbs
EENT:
[ ] Impaired vision [ ] blind
[ ] pain redden [ ] drainage
[ ] gums [ ] hard of hearing [ ] deaf
[ ] burning [ ] edema [ ] lesion teeth
[ ] assess eyes ears nose
[ ] throat for abnormality [ ] no problem
RESP:
[ ] Asymmetric [ ] tachypnea [ ] barrel chest
[ ] apnea [ ] rales [ ] cough
[ ] bradypnea [ ] shallow [ ] rhonchi
[ ] sputum [ ] diminished [ ] dyspnea
[ ] orthopnea [ ] labored [ ] wheezing
[ ] pain [ ] cyanotic
[ ] assess resp. rate, rhythm, pulse blood
[ ] breath sounds, comfort [ ] no problem
CARDIOVASCULAR:
[ ] arrhythmia [ ] tachycardia [ ]numbness
[ ] diminished pulses [ ] edema [ ] fatigue
[ ] irregular [ ] bradycardia [ ] mur mur
[ ] tingling [ ] absent pulses [ ] pain
Assess heart sounds, rate rhythm, pulse, blood
Pressure, circ., fluid retention, comfort
[ ] no problem
GASTROINTESTINAL TRACT:
[ ] obese [ ] distention [ ] mass
[ ] dysphagia [ ] rigidity [ ] pain
[ ] assess abdomen, bowel habits, swallowing
[ ] bowel sounds, comfort [ ] no problem
GENITO – URINARY AND GYNE
[ ] pain [ ] urine [ ] color [ ] vaginal bleeding
[ ] hematuria [ ] discharge [ ] nocturia
[ ] assess urine frequency, control, color, odor, comfort
[ ] gyne bleeding [ ] discharge [ ] no problem
NEURO:
[ ] paralysis [ ] stuporous [ ] unsteady [ ] seizure
[ ] lethargic [ ] comatose [ ] vertigo [ ] tremors
[ ] confused [ ] vision [ ] grip
[ ] assess motor, function, sensation, LOC, strength
[ ] grip, gait, coordination, speech [ ] no problem
MUSCULOSKELETAL and SKIN:
[ ] appliance [ ] stiffness [ ] itching [ ] petechiae
[ ] hot [ ] drainage [ ] prosthesis [ ] swelling
[ ] lesion [ ] poor turgor [ ] cool [ ] flushed
[ ] atrophy [ ] pain [ ] ecchymosis [ ] diaphoretic moist
[ ] assess mobility, motion gait, alignment, joint function
Skin colo , texture, turgur,integrity ( ) no problem
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NURSING ASSESSMENT II
 19

SUBJECTIVE OBJECTIVE
SKIN INTEGRITY: SUBJECTIVE [ ] dry [OBJECTIVE
] cold [ ] pale
[ ] dry Comments: “.ok raman raman [ ] flushed [X] warm
[ ] itching
Communication: ” as verbalized by . [[ ] ]glasses
moist [ ][cyanotic
] languages
other loss the
[ ] hearing patient. “wala man ko’y
Comments: [*rashes,
] contactulcers,
lens decubitus
[ ] hearing(describe
aid size,
deniedchanges problema sa pandungog ug
[ ] visual location, R drainage)
L None
[ ] denied sa akong panlantaw” as Pupil Size: 4mm [ ] speech difficulties
Verbalized by the patient. Reaction: Pupils Equally Round Reactive to
Light and Accommodation.
ACTIVITY/ SAFETY:
Oxygenation: [ ] LOC and orientation: client is oriented to
convulsion
[ ] dyspnea Comments.”wala
Comments: “walaman mankopud
nag
time and place
Resp. [X] regular [ ] irregular
[ ]]smoking
[x dizzinesshistorylisod
ko giugubo
lihok ug maka
karon” lakaw
as ver- Describe: Symmetrical Breathing
[ ]]limited
cough motion sab ko” asbyverbalized
balized by the
the patient. Gait: [ ] walker [ ] cane [ ] other
[ of joints
] denied patient. R : Right symmetrical to the left lung
Limitation in L[ x: ]Left
steady
symmetrical [ ] unsteady ______
to the right lung
Ability to [ ] sensory and motor losses in face
Circulation:
[ ] ambulate Heart Rhythm None
or extremities [ x ] regular [ ] irregular
[[ ]] chest
bathe pain
self Comments: “wala man nag- Ankle
[ ] ROM Edema : None inability to ambulate by
limitations:
[[ ]] legotherpain sakit akong dughan” as . self and has limited motions due to its
[[ ]] numbness
denied of verbalized by the pts. Pulse Car. Rad. DP
muscle weakness. Fem*
extremities R + + + +
[ ] denied L + + + +
COMFORT/SLEEP/AWAKE: Comments:
[ ] facial grimacepulses are palpable in all areas
[ ] pain Comments: “mayo naman *If applicable
[ ] guarding
Nutrition:
(location, frequen- akong pag tulog” as [[ ]] dentures
other signs of pain: [X] none
the patient is
Diet: Diet As Tolerated
cy, remedies) verbalized by the patient” restless.
[[ ]] N [ ]V
nocturia Comments:
. “mayo man ko Full Partial with Patient
Character
[ ] sleep difficulties mokaon sad’ as verbalized Upper [ ]
[ ] siderail release form [ ]signed (60+ [ ]years)
[[ ]] recent
denied change in .by the patient
weight, appetite Lower [ ] [ ] [ ]
[ ] swallowing
Difficulty -
COPING: Observed non-verbal behavior:
[ ] denied
Occupation: Corporal The patient appears to be fair and good.
Members of Household:None The person and his phone number that can
Elimination: Comments: The Bowel Sounds:
Most Supportive Person: None be reached any time: ruth ubaob
Usual bowel pattern [ x ] urinary frequency patient has Normoactive bowel
1 x a day 3-7x Normoactive bowel sounds
[ ] urgency sounds occuring Abdominal Distention
SPECIAL PATIENT INFORMATION (USE LEAD PENCIL)
[ ] constipation [x] dysuria every 5-10 seconds Present [ ] yes [ ] no
60lbs Daily Weight N/A PT/OT .
remedy [x] hematuria Urine* (color,
100/70mmhg BP q Shift N/A Irradiation
No constipation [ ] incontinence consistency, odor)
N/A Neuro vs N/A Urine Test .
[ ] polyuria – the patient is not in
N/A CVP/SG Reading N/A 24°urine collection
Date of Last BM [ ] foly in place foley bag catheter.
01/15/10 [ ] denied
[ ] diarrhea character *if they are in place?
Date
None Diagnostic/Laboratory Date Date I.V. Not in foleyDate
catheter
ordered exams done ordered fluids/blood done
MGT. OF HEALTH ILLNESS: Briefly describe the pt.’s ability to follow
[ 12/30/09
] alcohol COMPLETE BLOOD
[ ] denied 12/30/10 12-28-09
treatments D5LR
(diet, meds, etc.) for chronic
01/12/10
(amount, frequency) COUNT 01/12/10 health problems (if present).
_________________________________ 01/12/10
01/17/10 Urinalysis Patient has proper compliance of
Fecalysis
_________________________________ 01/17/10 medications and on therapeutic regimen as
[ ] SBE Last Pap Smear N/A supervised by her family members.
LMP: N/A
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B. ACTUAL NURSING MANAGEMENT (SOAPIE)

SUBJECTIVE:
S “ Sakit akong tiyan diri dapit sa akong kilid ” as verbalized by the
patient.

O - Facial grimace
- Guarding
- Restlessness

A Alteration in comfort pain related to inflammation and distortion of the

tissue

P After 8hrs of nursing interventions the patient pain will be relieved or

controlled

Assess pain noting location, characteristics and intensity. (0-10 scale).

I
-bed rest in low fowlers position

-encourage use of relaxation technique

-use soft cotton linens

Goal fully met, patients abdominal pain was relieved and controlled.
E
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VIII. EVALUATION AND COMPLICATIONS

Since cholecystisis is the inflammation which is usually accompanied by the

gallstones may block the way of toxic substance that really needs to go out but due to this

blockage this toxic substance are not then being expelled are just being stored in the

bladder for a period of time. This then causes inflammation of the gallbladder. The

treatment usually done is the cholecystectomy.

In order to lower risk of having this kind of condition each of every one of us must be

conscious on our diet. We should try to avoid foods in which in rich of salts and fats,

especially those foods contain many seasonings. We should be conscious on our health if

we want to live longer and also to avoid those lives threatening disease which not shorten

our lives but causes us some financial problem.

 24

. BIBLIOGRAPHY

 Bare & Smeltzer, Medical-Surgical Nursing 10th edition Volume 2

 Phillips, Berry & Kohn’s Operating Room Technique 10th edition

 Doenges et. al., Nurses Pocket Guide 10th edition

 http://www.medicinenet.com/nalbuphine

 http://www.laparoscopic-surgeon.co.uk/cholecystectomy.htm ne-

_injection/article.htm

 http://www.medicinenet.com/cefuroxime/article.htm

 http://www.medicinenet.com/cholecystectomy/article.htm
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