Clinical Reasoning Assessment for Post-Operative Cholecystitis and Cholylithiasis Patient Introduction Data about patient are always collected to provide basis for decision-making among nurses. Nursing diagnosis have taken relevant developments the past decades as the legal ban on diagnosis was altered making nurses accountable for decisions in diagnosis of health problems (Malen, 1986)…
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Diagnosis is an abstraction of signs, symptoms, and inferences based on the patient assessment and scientific knowledge of the attending nurse (Malen, 1986). This paper will provide the nursing diagnosis and the supporting evidence for postoperative cholecystitis and cholylithiasis patient. The patient is Cicek Olcay, 53 years old, Turkish, and admitted at Day Procedure Unit or DPU (Bullock and Henze, 1999). All admission requirements had been collected and indicated, the checklist completed. Her gall bladder has been removed and pain was only experienced during a transition or transfer to the ward from the post anaesthetic recovery room or P.A.R.U. Pathophysiology of cholecystitis and cholelithiasis – it is an acute inflammation of the gall bladder associated with obstruction of by the gall stones. The causes can be that common bile duct stones were formed in the bile duct, or they may be formed in and transported from the gall bladder (Doenges et al, 2010). It was suggested that Cholelithiasis is usually asymptomatic while Cholecystitis can result if stone becomes lodged in one of the ducts (Cuschieri, Dubios, Mouiel, Mouret, Becker, Buess, G, et al, 1991). Etiology The stones usually develop in and obstruct the common bile duct or the cystic duct; it is also found in the hepatic, small bile, and pancreatic ducts. 90% of cases involve stones in the cystic duct or calculous cholecystitis, and the other 10% involve cholecystitis without stones or acalculous cholecystitis according to Gladden & Migala (2007). The stones are made up of cholesterol, calcium bilirubinate, or a mixture caused by changes in the bile composition. Bile cultures are positive for bacteria in 50% to 75% of cases but bacterial proliferation may be a result or consequence of cholecystitis, but never the cause (Gladden & Migala, 2007). Other causes include stasis of bile or bacterial infection or ischemia of the gallbladder. The failure to remove impacted stone can lead to bile stasis or bacteremia and septicemia causing cholangitis which is considered a medical emergency. The statistics for morbidity of gallstones are two to three times more frequent in females than in males. The perforation occurs in 10% to 15% of cases, and 25% to 30% of clients either require surgery or develop complications (Gladden & Migala, 2007). Mortality was indicated that about 10,000 deaths occur annually; about 7,000 deaths result from gallstone complications, such as acute pancreatitis. There is 4% mortality rate for calculous cholecystitis and about 10-50% rate for acalculous cholecystitis. Care Setting Severe acute attacks of cholecystitis and cholelithiasis usually require brief hospitalization. This type of care is applicable for the acutely ill, hospitalized client and surgery is usually performed after symptoms for the illness have subsided (Bisgaard et al, 1999). Nursing Priorities The priority for the nurse during the care for patient with cholecystitis and cholelithiasis is to relieve pain and promote rest. In addition, the patient should be assisted to maintain fluid and electrolyte balance, prevent complications, and provided with information about disease process, prognosis, and treatment needs (Doenges et al, 2010, 498). The following are subjective data, objective data, vital sign, nursing
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