V. Medical Management
Teach the client about planned treatments.
• Chenodeoxycholic acid is administered to dissolve gallstones. It is effective in dissolving about 60% of radiolucent gallstones. Pigment gallstones cannot be dissolves and must be excised.
• Nonsurgical removal, such as lithotripsy or extracorpeal shock wave therapy, may be implemented.
Surgical treatment may be ordered.
Laparoscopic cholecytectomy (usually outpatient surgery) is performed through a small incision made through the abdominal wall in the umbilicus.
• Assess incision sites for infection. Instruct the client to notify the health care provider if loss of appetite, vomiting, pain, abdominal distention, or fever occur.
• Advise the client that he will need assistance at home for 2 to 3 days.
Cholecystectomy is removal of the gallbladder after ligation of the cystic duct and artery. Inform the client that a T-tube will be inserted to drain blood; serosanguineous fluids, and bile and that the T-tube must be taped below the incision
Choledochostomy is an incision into the common bile duct for calculi removal.
Cholecystomy is the surgical opening of the gallbladder for removal of stones, bile, or pus, after which a drainage tube is placed.
VI. Nursing Diagnosis
• Acute pain secondary to biliary obstruction
• Ineffective coping related to nausea
• Deficient knowledge related to diagnosis
• Impaired gas exchange related to high abdominal surgical incision.
• Impaired skin integrity related to altered biliary drainage after surgical incision.
• Imbalanced nutrition related to inadequate bile secretion.
VII. Nursing Management
Provide nursing interventions during an acute gallbladder attack.
• Intervene to relive pain; give prescribed analgesics
• Promote adequate rest
• Administer IV fluids, monitor intake and output
• Monitor nasogastric tube and suctioning
• Administer antibiotics if prescribed.
Provide adequate nutrition.
• Assess nutritional status. Encourage a high-protein, high-carbohydrate, low-fat diet.