202-rle cases cholecystitis
TRANSCRIPT
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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.
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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.
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
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Diagnosis: Colecystitis
Attending Physician: Dr. Borungawan
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
Dr. Borungawan
Secure consent to care
TPR every 4 hours
DAT
Start IVF D5LR @ 30gtts/min
Medications:
Nalbuphine (Nubain)
Ketorolac (Toradol)
Ranitidine (Zantac)
For medical management of the
patient’s condition
For legal purposes
To obtain baseline data and note for
any abnormalities in vital signs
Proper diet avoid worsening of the
patient’s condition
To replace the fluids lost from
insensible sources and decreased
oral intake
Pain reliever
Anti-inflammatory
reducing stomach acid production
cephalosporin antibiotic
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Cefuroxime (Ceftin)
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
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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
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)
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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
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
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without apparent adverse effects.IT is not recommended for long-term chronic
pain patients
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.
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DRUG INTERACTIONS: Antacids may decrease the absorption of ranitidine.
Safety of ranitidine in children has not been established. Ranitidine is not habit
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.
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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
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
Blood Chemistry 04-11-‘07
Normal Values
Normal Values
Clotting Time 3’37” Venous: 5-15 minCapillary: 3-15 min
Bleeding Time 3’06” Capillary: 3-5 min
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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
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.
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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
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
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Inflammatory mediators, specifically prostaglandins are released
Increased gallbladder inflammation
Chronic Cholecystitis
VI. Nursing Assessment (System Review and Nursing
Assessment)
A. Physical assessmentName CPL. Armando UbaobBP: 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 problemCARDIOVASCULAR:[ ] arrhythmia [ ] tachycardia [ ]numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] mur mur[ ] tingling [ ] absent pulses [ ] painAssess heart sounds, rate rhythm, pulse, bloodPressure, circ., fluid retention, comfort [ ] no problemGASTROINTESTINAL TRACT:[ ] obese [ ] distention [ ] mass[ ] dysphagia [ ] rigidity [ ] pain[ ] assess abdomen, bowel habits, swallowing[ ] bowel sounds, comfort [ ] no problemGENITO – URINARY AND GYNE[ ] pain [ ] urine [ ] color [ ] vaginal bleeding[ ] hematuria [ ] discharge [ ] nocturia[ ] assess urine frequency, control, color, odor, comfort[ ] gyne bleeding [ ] discharge [ ] no problemNEURO:[ ] paralysis [ ] stuporous [ ] unsteady [ ] seizure[ ] lethargic [ ] comatose [ ] vertigo [ ] tremors
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[ ] confused [ ] vision [ ] grip[ ] assess motor, function, sensation, LOC, strength[ ] grip, gait, coordination, speech [ ] no problemMUSCULOSKELETAL 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 functionSkin colo , texture, turgur,integrity ( ) no problem
NURSING ASSESSMENT IISUBJECTIVE OBJECTIVE
Communication:[ ] hearing loss Comments: “wala man ko’y [ ] visual changes problema sa pandungog ug [ ] denied sa akong panlantaw” as Verbalized by the patient.
[ ] glasses [ ] languages[ ] contact lens [ ] hearing aid R LPupil Size: 4mm [ ] speech difficultiesReaction: Pupils Equally Round Reactive to Light and Accommodation.
Oxygenation:[ ] dyspnea Comments: “wala man pud [x ]smoking history ko gi ubo karon” as ver-[ ] cough balized by the patient.[ ] denied
Resp. [X] regular [ ] irregularDescribe: Symmetrical Breathing
R : Right symmetrical to the left lung L : Left symmetrical to the right lung
Circulation:[ ] chest pain Comments: “wala man nag-[ ] leg pain sakit akong dughan” as .[ ] numbness of verbalized by the pts.extremities [ ] denied
Heart Rhythm [ x ] regular [ ] irregularAnkle Edema : None
Pulse Car. Rad. DP Fem*R + + + +L + + + +Comments: pulses are palpable in all areas*If applicable
Nutrition:Diet: Diet As Tolerated[ ] N [ ] V Comments: “mayo man koCharacter mokaon sad’ as verbalized[ ] recent change in .by the patient weight, appetite [ ] swallowing Difficulty -[ ] denied
[ ] dentures [X] none
Full Partial with PatientUpper [ ] [ ] [ ]
Lower [ ] [ ] [ ]
Elimination:Usual bowel pattern [ x ] urinary frequency 1 x a day 3-7x [ ] urgency[ ] constipation [x] dysuriaremedy [x] hematuria
Comments: The Bowel Sounds: patient has Normoactive bowel Normoactive bowel soundssounds occuring Abdominal Distentionevery 5-10 seconds Present [ ] yes [ ] no Urine* (color,
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No constipation [ ] incontinence [ ] polyuria –Date of Last BM [ ] foly in place 01/15/10 [ ] denied[ ] diarrhea characterNone
consistency, odor) the patient is not in foley bag catheter. *if they are in place? Not in foley catheter
MGT. OF HEALTH ILLNESS:[ ] alcohol [ ] denied(amount, frequency)__________________________________________________________________ [ ] SBE Last Pap Smear N/ALMP: N/A
Briefly describe the pt.’s ability to follow treatments (diet, meds, etc.) for chronic health problems (if present).Patient has proper compliance of medications and on therapeutic regimen as supervised by her family members.
SUBJECTIVESKIN INTEGRITY:[ ] dry Comments: “.ok raman raman[ ] itching ” as verbalized by .[ ] other the patient.[ ] denied
OBJECTIVE[ ] dry [ ] cold [ ] pale[ ] flushed [X] warm [ ] moist [ ] cyanotic*rashes, ulcers, decubitus (describe size, location, drainage) None
ACTIVITY/ SAFETY:[ ] convulsion Comments.”wala man ko nag[ ] dizziness lisod ug lihok ug maka lakaw[ ] limited motion sab ko” as verbalized by the of joints patient.Limitation in Ability to [ ] ambulate[ ] bathe self[ ] other[ ] denied
[ ] LOC and orientation: client is oriented to time and place
Gait: [ ] walker [ ] cane [ ] other
[ x ] steady [ ] unsteady ______[ ] sensory and motor losses in faceor extremities None[ ] ROM limitations: inability to ambulate by self and has limited motions due to its muscle weakness.
COMFORT/SLEEP/AWAKE:[ ] pain Comments: “mayo naman (location, frequen- akong pag tulog” as cy, remedies) verbalized by the patient”[ ] nocturia .[ ] sleep difficulties [ ] denied
[ ] facial grimace[ ] guarding[ ] other signs of pain: the patient is restless.
[ ] siderail release form signed (60+ years)
COPING:Occupation: Corporal
Observed non-verbal behavior: The patient appears to be fair and good.
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Members of Household:NoneMost Supportive Person: None
The person and his phone number that can be reached any time: ruth ubaob
SPECIAL PATIENT INFORMATION (USE LEAD PENCIL) 60lbs Daily Weight N/A PT/OT . 100/70mmhg BP q Shift N/A Irradiation N/A Neuro vs N/A Urine Test . N/A CVP/SG Reading N/A 24°urine collection
Date ordered
Diagnostic/Laboratory exams
Date done
Date ordered
I.V. fluids/blood
Date done
12/30/0901/12/1001/17/10
COMPLETE BLOOD COUNT
UrinalysisFecalysis
12/30/1001/12/1001/12/1001/17/10
12-28-09 D5LR
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B. ACTUAL NURSING MANAGEMENT (SOAPIE)
S SUBJECTIVE: “ 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
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I Assess pain noting location, characteristics and intensity. (0-10 scale).
-bed rest in low fowlers position
-encourage use of relaxation technique
-use soft cotton linens
E Goal fully met, patients abdominal pain was relieved and controlled.
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.
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. BIBLIOGRAPHY
Bare & Smeltzer, Medical-Surgical Nursing 10 th edition Volume 2
Phillips, Berr y & Kohn’s Operating Room Technique 10 th edition
Doenges et. al., Nurses Pocket Guide 10th edition
http://www.medicinenet.com/nalbuphi ne
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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