Nursing Diagnosis For Cholelithiasis - Nurse Practitioner Life

Cholelithiasis, or the formation of gallstones, is a common biliary disorder that affects bile ducts in the upper right quadrant of the abdomen. Composed of specific components such as cholesterol, calcium salts, and bile pigments, gallstones can block bile flow leading to painful signs and symptoms such as abdominal pain, jaundice, and fever. They are often diagnosed with x-rays, CT scans, ultrasounds, ERCP, or by performing a cholecystography. Risk factors include being a woman over the age of 40 or being overweight; however, this pathology can affect men and people from all walks of life. Treatment generally includes laparoscopic cholecystectomy or common bile duct evaluation to surgically remove gallstones where necessary.

Nursing Diagnosis: Deficient knowledge

Causes of Related Factors:

Gallbladder dysfunction, known as Acute cholecystitis, occurs when bile is not able to move freely through the bile ducts. This bile is typically produced in the liver and stored in the gallbladder before moving down the bile duct, into the duodenum to assist in digesting food.
When there is an obstruction or mechanical blockage of bile due to difficulty emptying bile out of the gallbladder, it can cause the formation of stones that build up which can worsen this condition. Risk factors for cholecystitis include consuming a diet high in fatty or greasy foods, being obese, having diabetes, and having pancreas diseases such as pancreatitis.

Possibly evidenced by the:

Questions; request for information
Clarification of a common misunderstanding
Incorrect implementation of the instructions Leads to the development of issues that may have been avoided

Defining Characteristics

1. Pain in your upper belly, often on the right, just under your ribs

Cholelithiasis is a common condition, characterized by the presence of gallstones in the flow of bile within the biliary system. Pain is often a defining characteristic, with many individuals experiencing a steady ache or localized area of intense pain in their upper abdomen, to the right and just below their ribs. The character of pain may be worsened through activities such as deep breathing or coughing, and it may even wake individuals up during the night. Diagnosis of cholelthiasis can be confirmed through blood tests and imaging tests, and subsequent treatment typically involves changes in diet as well as possible interventions to remove gallstones and/or re-establish flow through the biliary system. As everyone’s case can vary, it is important to work closely with a healthcare provider to ensure an individualized care plan is developed for best outcomes.

2. Pain in your right shoulder or back

Cholelithiasis is marked by the presence of stones in the flow of bile within the biliary system. This can cause a range of symptoms, most notably pain which can be felt in the right shoulder or back and may radiate to the right arm. Typically, this pain is characteristically sharp, accompanied with pressure, and intense. It often increases when one bends forward or takes a deep breath. In order to create an effective care plan for cholelithiasis it is important to properly characterize the type of pain experienced. Early intervention through diet and lifestyle changes functions best in preventing fatal issues associated with cholelithiasis such as infection, pancreatitis or cholangiocarcinoma.

3. An upset stomach

Cholelithiasis is characterized by the presence of stones in the flow of bile, primarily from the gallbladder. The character of pain associated with cholelithiasis can range from mild to sharp and may often come on suddenly after eating or at times of stress. A proper care plan must also consider the patient’s history and lifestyle, as poor dietary habits or medical conditions that obstruct flow in the biliary system may contribute to complications. Proper diagnosis and tailored intervention are essential for developing an effective treatment plan for a patient suffering from cholelithiasis.

4. Vomiting

Cholelithiasis is a condition characterized by the presence of gallstones that block the flow of bile from the gallbladder. Common symptoms include abdominal pain, nausea, vomiting and jaundice. The character of the pain typically worsens as an attack progresses. Other associated signs/symptoms may include fever and/or chills, lightheadedness upon standing up from a lying down position, mental confusion, chest pains that worsen when taking deep breaths, colic-like pain, and dark urine. A care plan is required to manage cholelithiasis long-term which can include dietary changes, lifestyle habits, and medical intervention.

5. Other digestive problems, including indigestion, heartburn, and gas

Cholelithiasis is the medical term for gallstones and typically presents itself with bloating and pain in the upper-right side of the abdomen. The flow of bile and its character of pain as it relates to cholelithiasis can vary significantly from patient to patient and should be addressed accordingly, as part of a comprehensive care plan. As this condition can often be associated with other digestive issues such as indigestion, heartburn, gas, constipation, and diarrhea, a holistic medical intervention is important to ensure that all the different symptomatology are included in the care plan. Understanding these defining characteristics of cholelithiasis can help health professionals craft an individualized treatment plan to improve patients’ comfort levels while they undergo treatment for this common biliary system disorder.

6. Cholelithiasis is a condition characterized by the formation of calculi or stones in the flow of bile.

These stones are formed in the gallbladder and biliary system when components such as cholesterol, bilirubin, and calcium precipitate and accumulate. The character of pain associated with cholelithiasis is often described as dull or aching, starting in the upper right quadrant of the abdomen and radiating out to other areas like the back or shoulder. It can last for several hours and sometimes increases intensity with movement. To confirm diagnosis, your doctor might order blood tests, imaging scans, and other exams to determine the extent of blockage within the flow of bile. Based on the results, your healthcare provider will tailor a care plan for you which could include medication, lifestyle changes, or surgical intervention.

7. Fever and chills

Fever is a common symptom of cholelithiasis. It is often associated with inflammation and may indicate an infection.
Chills are also common in patients with cholelithiasis; they can be a sign of infection or other complications, such as sepsis (a potentially life-threatening condition in which bacteria invade the bloodstream) or peritonitis (inflammation of the peritoneum).

8. Yellow skin or eyes

Yellow skin or eyes can be a sign of jaundice. Jaundice is caused by an excess of bilirubin in the blood, which turns your skin, eyes, and urine yellow. Bilirubin is produced as part of the body’s normal process to rid itself of dead red blood cells. The liver converts bilirubin into a substance called albumin that’s excreted through urination or bile production (which helps digest fats).

If your liver doesn’t work properly–for example if you have hepatitis or cholestasis–your body may not be able to produce enough albumin, causing harmful levels of unconverted bilirubin to build up in the bloodstream. This can lead to jaundice (also known as icterus).

Nursing Assessment: Rationale

Nurses must be familiar with risk factors and diagnosis of cholelithiasis. Tests help assess the progression and size of stones, as well as the risk for common bile duct involvement. Considering the risk factors associated with cholelithiases, such as gender, age over 40 years, and obesity, it is important to understand the importance of nursing diagnosis for correct treatment. The most common diagnostic test recommended consists of abdominal ultrasound, CT scan, and blood tests. Additionally, an endoscopic retrograde cholangiopancreatography is conducted if a stone is seen in the common bile duct or during laparoscopic cholecystectomy. Moreover, if any test needs to be done beforehand or as part of a preparation process, it is important to explain this leading up to the diagnosis so that patient anxiety is kept at bay and sympathetic stimulation does not become an issue.

Nursing diagnosis for cholelithiasis involves risk assessment and teaching related to the disease process, prognosis, and potential treatments.

Common risk factors for the condition include gallstones in the common bile duct and historic episodes of gallbladder inflammation. For severe and complex cases, hospitalization may be indicated with prospective treatments including antibiotics and laparoscopic cholecystectomy. As a nurse working with patients who are dealing with this condition, it is important to provide knowledge that enables them to make informed choices while also providing effective communication and support. This will help to reduce their anxiety levels and promote healing. When interacting with these patients it is important to have an empathetic yet professional dialogue whilst encouraging questions or expressions of concern.

Nursing diagnosis for cholelithiasis focuses on risk factors, such as dietary habits, sedentary lifestyle, or family history, that can predispose a patient to develop this disorder.

A common risk factor associated with cholelithiasis is an obstruction of the common bile duct, which can cause an increased risk of infection and pancreatitis. Treatment requires removal of the gallbladder through laparoscopic cholecystectomy to remove all stones and prevent a recurrence. Additionally, a review of the patient’s drug regimen should include an assessment for possible side effects such as diarrhea or cramps. This is especially important for women of childbearing age to be counseled regarding birth control to avoid the risk of fetal hepatic damage should pregnancy occur. After treatment, it is essential to understand that although gallstones may not recur immediately, long-term follow-up care is still necessary due to the high risk of reoccurrence.

Nursing diagnosis for cholelithiasis requires risk assessment, especially regarding risk factors associated with gallstone formation.

Common risk factors include age, gender, high cholesterol levels, family history, and obesity. Obese individuals have an increased risk of developing cholelithiasis and its complications, such as cholecystitis and obstruction of the common bile duct. Therefore, discussing weight reduction programs may be beneficial in the medical management of the condition. Other treatments for cholelithiasis include ursodeoxycholic acid and surgical intervention such as laparoscopic cholecystectomy. Management of cholelithiasis then becomes a collaborative effort between the patient and healthcare provider to determine a course of treatment best suited to the individual’s needs.

If a patient has been diagnosed with cholelithiasis, one of the first steps taken in their care plan is risk factor reduction.

Diet plays a huge role in the risk factors associated with this condition; to help reduce any risk and limit or prevent the recurrence of gallbladder attacks, it’s important to avoid high-fat foods such as pork, gravies, nuts, fried foods, butter, whole milk, and ice cream, as well as gas producers like cabbage, beans, and onions plus gastric irritants like spicy food, caffeine, and citrus. It’s also important to note that long-term risk factors from bile stones existing within the common bile duct can be managed surgically by laparoscopic cholecystectomy.

Recognizing early risk factors and signs of cholelithiasis is key, as it is the most common risk factor for developing complications.

Common risk factors include age, gender, obesity, diet, genetics, and existing mortality risk factors. Common presenting symptoms include persistent nausea, vomiting, and fever; jaundice in skin or eyes; dark urine; pain on the right side of the abdomen; itching due to bile salt accumulation; clay-colored stools; and blood in urine, stools, and vomitus or bleeding from mucous membranes. These could indicate a risk for further development of risk of obstructing the common bile duct that can lead to other diseases like pancreatitis. In light of this diagnosis, treatments such as medications (pain relief) or laparoscopic cholecystectomy may be presented to the patient to alleviate or remove any risk for further progression of the disease process.

Nursing diagnosis for cholelithiasis is typically based on risk factors, signs and symptoms.

Common risk factors include cholesterol and bilirubin levels in the bile, an enlarged common bile duct, and possible infections of the gallbladder. Signs and symptoms include abdominal pain, bloating, vomiting, and fever. As a preventive measure in managing cholelithiasis, we recommend resting in a semi-Fowler’s position after meals as this helps promote the flow of bile from the liver to the small intestine, aiding digestion and bringing overall relaxation. In more severe cases laparoscopic cholecystectomy may be necessary to remove gallstones.

Nursing diagnosis for cholelithiasis is an important aspect of risk management and prevention.

Common risk factors include obesity, diabetes mellitus, and rapid weight loss through a diet. It is important to be aware of habits that could increase risks, such as frequent gum chewing, sucking on hard candy or straws, and smoking. These activities can promote gas formation in the stomach and lead to gastric distension and discomfort. Cholelithiasis often requires laparoscopic cholecystectomy as a treatment to remove the gallstone from the common bile ducts. All healthcare providers involved in risk management and diagnosis should be informed about the potential risk factors associated with cholelithiasis.

Nursing diagnosis for cholelithiasis includes risk factors such as avoidance of aspirin-containing products and cases where physical activities like the forceful blowing of the nose, straining for bowel movement, or contact sports can reduce the risk of bleeding related to changes in coagulation time and trauma. Common bile duct stones are usually caused due to gallstones blocking the cystic duct which can lead to laparoscopic cholecystectomy. Nevertheless, Nurses should understand the risk factors associated with cholelithiasis for accurately diagnosing patients that may be at risk of suffering from this condition.

As part of the nursing diagnosis for cholelithiasis, risk factors such as gallstones blocking the common bile duct should be addressed.

Additionally, certain lifestyle changes and modifications can help reduce the risk of further complications during laparoscopic cholecystectomy. Implementing preventive measures like using a soft toothbrush and an electric razor can reduce the risk of bleeding related to changes in coagulation time, mucosal irritation, and trauma. Taking these precautions can contribute to a successful outcome of treatment and recovery.

Desired Goals/Outcomes:

Verbalize understanding of disease process, prognosis, and probable complications.
Express your comprehension of the therapeutic requirements.
Make the appropriate adjustments to your way of life and cooperate fully with the prescribed treatment.

References:

Gallstones (Cholelithiasis). (2023). Retrieved 17 February 2023, from https://www.webmd.com/digestive-disorders/gallstones

Cholelithiasis and Cholecystitis Nursing Care Plan & Management. (2015). Retrieved 17 February 2023, from https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/cholelithiasis-and-cholecystitis-nursing-management/

Jones, M., Genova, R., O’Rourke, M., & Carroll, C. (2022). Acute Cholecystitis (Nursing). Statpearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK568804/

Nursing Care Plan (NCP) for Cholecystitis | NRSNG Nursing Course. (2023). Retrieved 17 February 2023, from https://nursing.com/lesson/nursing-care-plan-for-cholecystitis