NURSING CARE PLAN ASSESSMENT INTERVENTION Subjective:Masakit angtagiliran ko asverbalized bypatient.Objective: Facial maskof pain. Guardingbehavior. Selffoucusing.

ng. V/S taken asfollows:T: 37.3 P: 80 R: 18 Bp: 110/90 DIAGNOSIS Acute painrelated toinflammationand distortionof tissues. INFERENCE Cholelithiasis isthe formation ofgallstones,which arecomposed ofcholesterol,calcium salts,and bilepigments.Whengallstonesblock the flowof bile, thegallbladderbecomesswollen, leading to thepossibility ofpain,inflammation,or infection.The signs andsymptoms ofcholelithiasisoften do notbegin until thegallstonecausesblockage in thebiliary system.They mayinclude,abdominalpain, usually in the upper rightquadrant of theabdomen, jaundice, fever.Tests andprocedures thatcan detectcholelithiasisinclude x-rays,CT scan,ultrasound,ERCP, and acholecystogram PLANNING After 8 hoursof nursinginterventions, the patientpain will berelieved orcontrolled. INTERVENTION Independent: Observe anddocumentlocation of pain,severity (0-10scale), andcharacter of pain. Promote bed rest,and in lowfowlers position. Use soft cottonlinens, calaminelotion, oil bathand cool or moistcompress asindicated. Controlenvironmentaltemperature. Encourage use ofrelaxationtechnique. RATIONALE Assist indifferentiatingcause of painand providesinformationabout diseaseprogression,development ofcomplicationsandeffectiveness ofintervention. Bed rest in lowfowlers positionreduces intraabdominalpressure. Reducesirritation,dryness of theskin and itchingsensation. Coolsurroundingsaid inminimizingdermaldiscomfort. Promotes rest,redirectsattention, mayenhancecoping. EVALUATION After 8hours ofnursinginterventions, thepatient painwas relievedorcontrolled.