I.

Medical-Surgical Management

DIAGNOSTIC EXAMS
Urinalysis
Function Characteristics Result Clinical Significance Nursing
responsibilities

November 20, 2009 Urine color change can Explain that this test is
result from diet, drugs, to look for problems
This test is Color Dark Yellow and many diseases. with the urine and the
executed to (Straw-dark yellow) Together with the organs that help form
provide valuable color, appearance, pH, it.
information Appearance and specific gravity
about the (Clear) Clear indicate the condition Advise the client to
integrity of renal of the urinary system wash the perineal area
and urinary Sugar and the patient¶s prior to collecting the
function and (none) (-) hydration status. specimen to avoid
also serve as Normal urine may contamination.
sensitive Albumin exhibit a few RBCs
indicators of (none) trace without any significant Inform client that a
overall health. It pathologic cause. An specimen from the first
also helps in elevated WBC count in morning urination is

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 detecting PH 5.0 the urine indicates preferred since it is
metabolic or (4.5-8) pyuria (pus in the usually concentrated
systemic urine) with that, it and more likely to
disease related Specific Gravity 1.030 indicates the presence reveal abnormalities
to renal (1.005 to 1.035) of an ongoing infection. and formed substance.
disorders.
Pus Cells 8-10 Describe the
procedure for
RBC collecting a clean
(0-2/high-power 4-6 catch or midstream
field) specimen if indicated.

Sq. Epithelial cells few

(0-5/high-power
field)

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 BASIC TESTS WITH CLINICAL
DATE RATIONALE RESULT NSG. INTERVENTION
NORMAL VALUES SIGNIFICANCE

November Complete Blood A complete blood

20, 2009 Count count (CBC) 1. Explain to the
provides important patient that hgb
information about test is used to
the kinds and detect Anemia or
number of cells in to assess his
the blood response to
especially red treatment.
blood cells and 2. Tell the patient that
platelets. a blood sample will
be taken. Explain
A complete blood who will perform
count may be done the venipuncture
as part of a routine and when.
of physical 3. Explain to the
examination. A patient that she
blood count can may feel slight
provide valuable discomfort from the
information about needle puncture
the general state of and the tourniquet.
the patient¶s 4. Monitor vital signs.
health. 5. Tell the patient that
he needs not
To supply figures, restrict foods and
for computing the fluids.
erythrocytic
indices, which

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 reveal RBC size PRE:
and hemoglobin
content. To j Explain that this
determine infection test measures a
or inflammation. To part of the blood
determine the need that carries oxygen
for further tests. j Explain that this
test also helps to
assess the body¶s
ability to fight
infection, to tell the
difference between
allergy and
Hemoglobin: Measure the 134 g/dl Levels decreased with infection.
M: 140-180 g/dL amount of (normal) reduced RBC
F: 120-160 g/dL Hemoglobin found production, blood loss,
in a deciliter (dL or and hemolysis. Levels POST:
100 mL) of whole may appear decreased
blood. when hemoglobin is j Apply pressure
abnormal. The (direct digitalis) to
hemoglobin level is the arterial
usually approximately puncture site for at
one third of the least 5 minutes
hematocrit; variations then apply a
in this relationship may pressure bandage
indicate intervening j Observe site for
variables affecting the hematoma or
accuracy of one test or bleeding
the other. j Encourage rest
periods for client
experiencing
fatigue

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 j Monitor VS and I &
O

Erythrocyte: Measures the 4.19x 10^12/L Decreased Level:

M: 4.5-5.0x 10^12/L degree of (normal) Anemia,
F: 4.0-5.0x 10^12/L erythrocyte settling Hemoglobinopathies,
in the blood cirrhoris, bone marrow
sample during a failure, renal disease,
specified period. elevated in acute
infection disease, and
This determines in the lymphocytic and
the number of monocytic fractions in
circulating WBC¶s viral disease, allergy,
per cubic millimeter and intestinal
of whole blood. parasitosis. Elevated in
acute leukemia,
following menstruation,
and following surgery
of trauma,
agranulocytosis and by
toxic agents such as
chemotherapeutic
agents used in treating
malignancy.

Increased Level:
Hemorrhage, acute
infection, epithelial
cancer and

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 splenectomy.

Leukocytes: More than half the 6.1 x 10^9/L Elevated in acute

5.0-10 x 10^9/L white cells in the (normal) infections disease, and
peripheral in the lymphocytic and
circulation are monocytic fractions in
neutrophils, viral disease, allergy,
because they intestinal parasitosis.
quickly kill Elevated in acute
significant leukemia, following
quantities of menstruation,a nd
microorganism. It following surgery or
is the body¶s first trauma,
line of defense agranulocytosis and by
against infection. toxic agents such as
chemotherapeutic
agents used in treating
malignancy.

Eosinophils: A cell containing 0.01% Decreased Level:

0.01-0.05% granules that are (normal) May indicate anemia or
easily stained by hemodilution.
eosin or other acid
dyes, especially a
type of white blood
cell.

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 Basophils: A cell especially a 0.00% Increased level:
0.000-0.005% white blood cell 
 
Leukemia and other
that stains readily pathologic alterations
with a basic dye. A in bone marrow
white blood cell production may give
having basophilic rise to an increase in
granules in the basophils.
cytoplasm.
Important in Decreased Level:
humoral cell May indicate drug
mediated toxicity, anemia,
immunity, cancer, and viral
lymphocytes are diseases.
produced in the
lymph nodes,
spleen, thymus,
tonsils and
lymphoid tissues of
the gut. Together
with the neutrophils
they make up the
majority white cells
in the peripheral
blood.

Lymphocytes: Increased Level:

0.15%
0.25-0.40% May indicate infection,
 
ischemic necrosis,
metabolic disorders,
stress response or
inflammatory disease.

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 Monocytes: The body¶s second Decreased Level:
0.02-0.06% line of defense, May signal drug toxicity
monocytes arrive 0.04% and bone marrow
at infection sites in (normal) infiltration. Pre-test:
smaller numbers 1. Explain to the
than neutrophils. Increased level: client the results
They are generally are most reliable if
unaltered in an the specimen is
infectious process but it obtained upon
is increasing during arising in the
parasitic infections. morning, after
Increased in leukemia urine has
and other pathologic accumulated in the
alterations in bone bladder.
marrow production may 2. Teach the client
give rise to an increase the proper way to
in basophils. collect the
specimen.
3. The client should
be provided with
the proper
specimen contain
or bottle.

Post-test:
1. The care and
assessment after
the test include
observing the
color, appearance
and odor of the
Hematocrit: The volume of the Increased level: sample when it is
M: 0.40-0.48 red cells, Suggests polycythemia obtained.

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 F: 0.37-0.45 (erythrocytes) in 0.38 or hemoconcentration 2. Label the container
the blood, (normal) caused by blood loss. with the patient¶s
expressed the name, the time,
fraction of the total Decreased level: and the date of
volume of the May indicate anemia or voiding.
blood. Centrifuging hemodilution. 3. 3. Arrange for
the blood in the transport of the
tube and specimen to the
measuring the laboratory as soon
height of the blood as possible,
in the tube and because the most
measuring the accurate results
height of the red are obtained from
cell column as the warm, fresh
fraction of the total specimen.
determine it.
Pre:

Thrombocytes: A disc shaped Platelets or Fat-free supper the

150.0-300.0x 10^9/L structure, 1-2mm in Thrombocytes play an night before the
diameter present in 322 x 10^9/L essential role in the exam. Nothing to
blood. With (high) control of bleeding. In eat or drink after
romanovsky stains short, they were midnight. Arrive 20
platelet appear as responsible for the minutes before
fragments of pale clotting factor of the appointment time
blue cytoplasm injured site. If there to complete
with neutrophils . were low platelet count registration.
in the body, there will
be no platelet or there
will be a delayed
platelet plug in the site
of injury. That is why
low platelet count may
promote bleeding.

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 Sonography - A painless The gallbladder To visualize or
medical test that normally examine many body
November helps physician¶s distended. parts
21, 2009 diagnoses and Chongena foci To produce a - NPO post midnight
treat medical are noted within photograph or a - Explain the
conditions. the distal moving image on a procedure to the
-medical diagnostic shrouding. The television. patient, that it is
technique in which largest roughly painless and non-
very high measures invasive
frequency sound is 2.1cm. Liver is
directed into the normal in size
body and shows a
homogenous
parenchymal
echopattern.
Intra-hepatic
duct are not
dilated.
Pancreas is
normal.

Impression:
Cholelithiasis

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 BLOOD CHEMISTRY

METHOD RESULTS NORMAL VALUE NURSING

INTERVENTION

November Glucose GGB-DAD 3.00 4.2-6.4mmol/^/L Tell client that a small

20, 2009 Substance
amount of blood will be
extracted using a needle
Cholesterol CHOD-DAD 5.44 5.7 mmol/^/L
Imbalance where she may feel pain
like being stung by an
Uric Acid Enzymatic- 496.61 140- 340mmol/^/L ant. This is to make the
colorintis
patient anticipate the
pain in advance. Also,
Creatinine Folin WO 121.15 53-97 mmol/^/L
tell the client that this is

Triglyceride 1.73 1.16 mmol/^/L done for the diagnosis of

her condition.
HDL 1.84 0-1.21 mmol/^/L

LDL 2.82 0-3.9 mmol/^/L





 II. Surgical Technique

POSITION Rationale INCISION Rationale SUTURES Rationale INSTRUMENTS

1. SUPINE ® for better TRANSVERSE ® To facilitate ATR-3 Vicryl is an GRASPING

visualization, easy removal of -VICRYL absorbable suture
manipulation and the Gall Bladder. and is very A) CLAMPS-11
removal of FREE SILK appropriate for the -fine curves-8
gallbladder. TIE-1 closure of the -Straight clamps-3
® It is the best internal soft B) Allis-6
® To prevent position for the tissues. C) Tissue Forceps with
aspiration after the removal of the Teeth- 1
surgery Gall Bladder Silk tie is used to D) Thumb Forceps- 1
because it can tie the bleesders. E) Bobcock- 2
provide better F) Mixter-4
visualization. G) Needle Holder-1
H) Long thumb-1
I) Towel clips-4
J) Ovum forceps-1

RETRACTING

A) Richardson-2
B) Army Navy-2
C) Malleable-1
D) Deaver-1





 CUTTING

A) Knife-1
B) Mayo-1
C) Metz-2
D) Long Metz-1
E) Suture-1

Others:

A.) Freer-1
B.) Suction tip
C.) Stapler
D.)





 Drawing of Instruments

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 III. Drug Study

Generic name: co-amoxiclav (amoxicillin trihydrate and

clavulanate potassium)

Brand name: Augmentin

Classification: Anti-infectives, Penicillins

Date Ordered: November 23, 2009

Ordered Dose: 1.2 g IVTT ANST(-) every 8 hours

Suggested Dose: 250 mg P.O. every 8 hours or 500 mg every 12 hours or 875 mg every 12
hours.

Mode of action:
Prevents bacterial cell wall synthesis during replication. Increases amoxicillin effectiveness by
inactivating beta ± lactamases, which destroy amoxicillin.

Indication:
Recuurrent of persistent acute otitis media caused by ÷
  
  

  

 

in patients exposed to antibiotics for the last 3
months; Lower respiratory tract infections, sinusitis, skin and skin structure infections, and UTI¶s;
Community-acquired pnuemonia or acute bacterial sinusitis.

Contraindication: sensitivity to drug or other penicillins and in those with a history of cholestatic
jaundice or hepatic dysfunction; hemodialysis and those with creatinine clearance less than 30
ml/minute; use cautiously to patients with other drug allergies, in breastfeeding women, and in
hepatically ill patients.

Side effects: agitation ,anxiety, insomnia, confussion, behavioral changes, dizziness,

indigestion, gastritis, stomatitis, glossitis, black hairy tongue, enterocollitis, muocutaneous





candidiasis, abdominal pain, vaginitis, vaginal candidiasis, anemia, eosinophilia, rash, urticari,
pruritus, overgrowth of nonsusceptible organisms, serum sickness-like reaction.

Adverse effects: pseudomembraneous colitis, thrombocytopenia, thrombocytopenia purpura,

anaphylaxis, angioedema.

Drug interaction:
Drug ± drug: Allopurinol: may increase risk of skin rash.
Hormonal contraceptive: May decrease hormonal contraceptive effectiveness.
Probenecid: may increase levels of amoxicillin and other penicillins.

Nursing intervention:
' Before giving, ask patient about allergic reactions to penicillin.
' Obtain results of culture and sensitivity tests before giving first dose.
' Monitor patient for superinfection when large dose is given especially for elderly,
debilitated and immunosuppressed.
' Don¶t interchange oral suspension because of varying clavulanic acid contents.
' Monitor patient for rash.
' After reconstitution, refrigerate the oral suspension; discard after 10 days.
' Advise use of additional use of contraception during penicillin therapy.
' Tell patient to take entire quantity of drug exactly prescribed, even after feeling
better.
' Instruct patient to take drug with food to prevent GI upset. If he¶s taking the oral
suspension, tell him to keep drug refrigerated, to shake it well before taking and to
discard remaining after 10 days.
' Tell patient to call prescriber if rash develops because rash is a sign of allergic
reaction.





Generic name: ranitidine hydrochloride

Brand name: Zantac

Classification: Antiulcer drugs

Date Ordered: November 23, 2009 2:30am

Ordered Dose: 50 mg every 8 hours IVTT

Suggested Dose: 50 mg I.V. every 6 to 8 hours

Mode of action:
Competitively inhibits action of histamine on the H2 at receptor sites of parietal cells, decreasing
gastric acid secretion.

Indication: Duodenal and gastric ulcer, Zollinger ± Ellison syndrome,

Contraindication: hypersensitivity to drug, acute porphyria. Use cautiously in patients with

hepatic dysfunction and impaired renal function.

Side effects: vertigo, malaise headache, blurred vision, jaundice, burning and itching at injection
site.

Adverse effects: anaphylaxis and angioedema

Drug interaction:
Drug ± drug: Antacids: May interfere with ranitidine absorption. Stagger doses, if possible.
Diazepam: may decrease absorption of diazepam.
Glipizide: May increase hypoglycemic effect. Adjust glipizide dosage.
Procainamide: May decrease renal clearance of procainamide. Monitor patient
for toxicity.
Warfarin: May interfere with warfarin clearance.





Nursing intervention:
U Assess patient for abdominal pain. Note presence of blood in emesis, stool or gastric
aspirate.
U Instruct patient on the proper use of OTC preparation as indicated.
U Remind patient to take once-daily prescription drug at bedtime for best results.
U Instruct patient to take without regard to meals because absorption isn¶t affected by
food.
U Urge patient to avoid cigarette smoking because this may increase gastric acid
secretion and worsen disease.
U Advise patient to report abdominal pain and blood in stool or emesis.





Generic name: ketorolac tromethamine

Brand name: Toradol

Classification: Nonsteroidal anti-inflammatory drugs (NSAIDS)

Date Ordered: November 23, 2009 2:30 am

Ordered Dose: 30 mg every 6 hours IVTT

Suggested Dose: Initially, 10-30 mg IM/IV bolus followed by 10-30 mg IV bolus 6 hourly. Max:
120 mg total/day.

Mode of action: Unknown. May inhibit prostaglandin synthesis, to produce anti-inflammatory,

analgesic, and antipyretic effects.

Indication: Management of acute pain following major abdominal, orthopedic, dental or

gynecologic surgery. Short term management of moderate-severe pain that requires analgesia
at the opioid level.

Contraindication: Dehydration or hypovolemia from any other cause. Moderate or severe renal
impairment, history of hemorrhagic diatheses including coagulation disorders. Patients on
anticoagulants including low dose heparin.

Side effects: Drowsiness, headache, dizziness nausea, vomiting, constipation

Adverse effects: Stomatitis, ulceration, diaphoresis, flatulence, pruritus, purpura, decreased

platelet adhesion

Drug interaction:
Drug to drug: ACE Inhibitor: May cause renal impairment, particularly in volume depleted
patients. Avoid using together in volume-depeleted patients.
Anticoagulants, salicylates : May increase salicylate or anticoagulant levels in the
blood. Use together with extreme caution and monitor patient closely.





 AntiHypersensitives, Diuretics: May decrease effectiveness. Monitor patient
closely.
Lithium: May increase lithium level. Monitor patient level closely.

Nursing intervention:
1. Correct hypovolemia before giving Ketorolac.
2. Use in children age 2 and older is for single dose only.
3. Don¶t give drug epidurally or intrathecally because of alcohol content.
4. Carefully observe patient with coagulopathies and those taking anticoagulants.
5. NSAIDS may ask signs and symptoms of infection because of their antipyretic and anti-
inflammatory actions.
6. Warn patient receiving drug I.M. that pain may occur at injection site.
7. Teach patient signs and symptoms of GI bleeding, including blood in vomit, urine or
stool. Tell him to notify prescriber immediately if any of these occurs.





Generic Name: tramadol hydrochloride

Brand Name: Tramal

Classification: Opioid analgesic drugs

Date Ordered: November 23, 2009 2:30 am

Ordered Dose: 50 mg every 6 hours IVTT

Suggested Dose: initially, 25 mg P.O. in the morning. Adjust by 25 mg every 3 days to 100
mg/day (25 mg q.i.d.). Thereafter, give 50 mg

Mode of Action: Unknown. A centrally acting synthesis analgesic compound not chemically
related to opioids. Thought to bind to opioid receptors and inhibit reuptake of norepinephrine
and serotonin.

Indication: For moderate to severe acute or chronic pain and in painful diagnostic or therapeutic
measures.

Contraindication: Hypersensitivity to tramadol; acute intoxication with alcohol, hypnotic

analgesics or, sedatives or psychotropic drugs; Narcotic or withdrawal treatment; patients
receiving MAOI.

Side Effects: dizziness, vertigo, headache, somnolence, CNS stimulation, asthenia, anxiety,
confusion, coordination disturbance, euphoria, nervousness, sleep disorder, malaise,
vasodilation, visual disturbances, nausea, constipation, vomiting, dyspepsia, dry mouth,
diarrhea, abdominal pain, anorexia, flatulence, urine retention, urine frequency, menopausal
symptoms, proteinuria, pruritus, diaphoresis, rash.

Adverse Effects: seizure, hypertonia, respiratory depression,

Drug Interaction:





Drug to drug: Carbamazepine: May increase tramadol metabolism.
CNS depressants: May cause additive effects.
Cyclobenzaprine, MAOI, neuroleptics, other opoids, tricyclic antidepressants:
May increase risk of seizures. Monitor patient closely
Quinidine: May increase level of tramadol.
SSRIs: May increase risk of serotonin.

Nursing Interventions:
1. Assess for any hypersensitivity reaction to tramadol.
2. Control environment if sweating or CNS effects occur.
3. Instruct the patient to take medication before pain becomes severe.
4. Monitor patient¶s vital signs thoroughly.
5. Inform patient about the possible side effects of the drugs.
6. Instruct patient to report severe nausea, dizziness, severe constipation.





Generic Name: captopril
Brand Name: Capoten
Classification: ACE inhibitors
Date Ordered: November 20, 2009
Ordered Dose: 25 mg SL
Suggested Dosage: 25 mg P.O. b.i.d or t.i.d.
Mode of action: Inhibits ACE, preventing conversion of angiotensin I to angiotensin II, a potent
vasoconstrictor. Les angiotensin II decreases peripheral arterial resistance, decreasing
aldosterone secretion, which reduces sodium and water retention and lowers blood
pressure. of Capoten should not be exceeded.
Capoten should be generally used in conjunction with a diuretic and digitalis. Therapy must be
initiated under very close medical supervision.
Indication: hypertension, congestive heart failure

Contraindication: Pregnancy, lactation, hypersensitivity, history of angioedema

Side effects: dizziness, fainting, headache, malaise, fatigue, fever, tachycardia, hypotension,
angina pectoris, abdominal pain, anorexia, constipation, diarrhea, dry mouth, dyscrasia, nausea,
vomiting, anemia, hyperkalemia, dyspnea, dry, persistent, nonproductive cough, uricarial rash,
maculopapular rash, pruritus, alopecia

Adverse effect: leucopenia, agranulocytosis, pancytopenia, thrombocytopenia, angioedema.

Drug Interaction:
Drug to drug: Antacids: May decrease captopril effect
Digoxin: May increase digoxin level by 15 - 30%
Diuretucs, other hypertensives:May cause excessive hypotension
Insulin, oral antidiabetes: May cause hypoglycemia when captopril therapy is
started.
Lithium: May increase lithium level and symptoms of toxicity possible.
NSAIDs: May reduce antihypertensive effect.
Potassium sparing diuretics: May cause hyperkalemia.
Drug ± food: Salt substitues conaining potassium: May cause hypokalemia





Nursing Interventions
1. Assess any allergy to the drug.
2. Monitor patient¶s vital sings closely.
3. Administer 1 hour before meals.
4. Reduces dosage in patients with impaired renal function.
5. Inform client about possible side effects of drug.
6. Instruct client to report any unusualities such as chest pain, sore throat.

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 IV. Nursing management

Peri ± operative nursing

Pre ± operative nursing

Legal preparations
o Witnessing the exchange between the client and the surgeon; witnessing the client¶s
signature; Establishing that the client really did understood.

Psychological preparation
o Explore client¶s feelings
o Allow client to speak openly about fears and concerns.
o Give empathetic support.
Physiological preparation
o See normalcy or at least no contraindications noted in the results of the routine exam for
CP clearance such as ECG, CBC, CXR, PFT, FBS, U/A
Physical preparation
o Teach deep breathing exercises (diaphragmatic /abdominal breathing), coughing
exercises, splinting site when coughing, leg, ankle and foot exercise.
o Render client¶s stomach empty by restricting client from eating.
o Prepare the skin.
o Instruct the client to have a full bath in the morning before having the operation.
o NPO post midnight
o Prepare for anesthesia ± avoid alcohol and cigarette smoking at least 24 hours prior to
surgery
o Promote rest and sleep ± administer sedatives as ordered.
On the day of surgery
EARLY MORNING CARE
' Awaken 1 hour before preoperative medications
' Instruct to have morning bath and mouth wash
' Provide clean gown
' Remove hair pins; raid long hair and cover hair with cap
' Remove dentures, foreign materials, (chewing gum), colored nail polish, hearing aid,
contact lens, wedding ring( tie with gauze and fasten around the wrist) and underwear.





 ' Take baseline VS before preoperative medication
' Check ID band
' Check special orders such as enema, tube insertion, IV line etc.
' Have client void before preoperative medication
' Administer preoperative drugs as ordered 60 to 90 minutes before induction of
anesthesia

Intra ± operative nursing

' In all you do, observe asepsis
' Perform medical hand washing
' Open the sterile pack
' Prepare additional instruments
' Do Surgical had washing
' Wear gown
' Done surgical gloves (close gloving)
' Prepare mayo table
' Serve surgeon's gown and gloves
' Assist in induction of anesthesia.
' Anticipate all necessities for the operation (circulating nurse)

Post ± operative nursing

' Continuously assess patient (I.e. skin color, air exchange, neurologic status, vital signs,
incision site, dressing, ALDERETE)
' Perform safety checks (I.e. positioning, side rails)
' Ensure maintenance of patent airway and adequate respiratory function
' Lateral position with neck extended to prevent aspiration
' Keep airway (Naso /oropharyngeal airway) I pace until fully awake
' Suction secretions
' Administer humidified oxygen as ordered.
' Encourage deep breathing
' Make a pot ± anesthesia admission report which includes general information, patient
history, intraoperative management, intraoperative course
' Manage pain





 ' Anticipate an prevent complications such as hypotension, cardiac arrhythmias, shock,
hemorrhage, thrombophlebitis, atelectasis, pneumonia, paralytic ileus and wound
infections
' Anticipate ad prevent / manage Post operative psychological disturbances such as
delirium and Acute confusional state.





 V. Reading

Title: Why Women Face Significantly Greater Risk for Gallstones

Bibliography: Barnes, H. Ñ
 
 Manila, Philippines: Philippine Journalists, Inc. ©
2006. pp. 20.

Summary:

It is said that gallstones are most common and expensive amongst digestive diseases
known. Risks for both male and female are just but the same but because of multiple
pregnancies, obesity and rapid weight loss it had increased its risks of acquiring such. It thus
affects the normal functioning of the gallbladder and that is to store bile produced by the liver,
aid in digestion and absorption of fats. Those gallstones are 80 to 90 percent cholesterol
gallstones from crystallized cholesterol that had accumulated.
Gallstones are mostly visible and would most likely to occur to going ones for choosing
fast foods than home-made ones. Mostly it is evident to fat, female, fertile and flatulent. Evident
symptoms include abdominal bloating, recurring intolerance of fatty foods, colic belching, gas,
indigestion. But if sweating, chills, low-grade fever, yellowish color of the skin or whites of the
eyes and clay-colored stools. There are some asymptomatic and ³silent stones´. Some
treatments include traditional and alternative ones. Cholecystectomy was once most common
treatment that may need large abdominal incision to remove the bladder. It does cause severe
pain and traumatic to recover from, operation that required at least five days in hospital and six
weeks for recovery. But nowadays, laparoscopic cholecystectomy is widely used for it requires a
small incision only. On the other hand some alternative treatments and this includes oral bile,
acid dissolution therapy, contact solvent dissolution, mechanical extraction through a catheter
placed into the gallbladder and fragmentation through shock-wave lithotripsy.
By means of modifying diet will decrease the risk especially dietary fibers for it controls
cholesterol solubility in bile. Eating of fruits and vegetables will be a good source of fiber diet.
Moreover, coffee drinking has reduced risks according to research. We can also have
exercises like jogging, running, sports and brisk walking for thirty (30) minutes, these activities
aids in making the blood sugar level normal and as well as insulin levels. Others also claim that
taking NSAIDS would be a great help in reducing gallstones.
Thus, factors like risks symptoms, treatments and ways of reducing its risk should be
discussed in detail.





Reaction:

Nowadays, women are being negligent of their health. We all know that pregnancy has
greater risk of acquiring some disease like gallstones. Women have greater risks of acquiring
gallstones. Gallstones are lumps of solid material in the gallbladder. They can be small as
grains of sand or as large as pebbles. Most are made up of cholesterol; others consist of chalk,
calcium and red blood cells.
As student nurses, we should explain the precipitating and predisposing factors of the
disease to our patient in order to prevent the existing complications that our patient might
encounter. Accurate and appropriate health teachings should be rendered to our patient about
the diet, lifestyle, medications and some factors that may aggravate the condition of the patient.
For post operative care, the student nurse should monitor the vital signs, pain, diet, activity like
ambulation and especially the incision site if there are signs of infection. These factors will help
in the fast recovery of the patient for close monitoring is necessary on patient who undergone
surgery. Diet has to do great on the formation of cholelithiasis. For the discharge of the patient,
nurse should advice the patient to modify his or her diet like water-soluble fibers, found in
barley, rice, corn, oats, legumes, apples, pears, citrus fruits, bananas, carrots, dried plums,
cranberries, seeds, and seaweed, have been shown to help regulate blood sugar and lower
blood cholesterol. Water-insoluble fibers assist with the elimination of bile acids, preventing the
formation of gallstones.
The implication of the reading to nursing practice is to impart new things and to enhance
their existing skill in patient assessment and patient care of each family member, through case
studies. This provides information in the perception of the disease condition or the family
problem in the community. Since nurses spent most of the time with the patient or the family,
thorough understanding of the problem serve as an essential guide in how to cope up with a
family problem (disease prevention and treatment).
The implication of the reading to nursing education is gaining additional knowledge in the
pursuit of delivering quality of care is what nurses are always do. Nursing students will be given
new information and have an enhanced knowledge on the handling of patient with cholelithiasis.
Nursing students will be informed about how to make an objectives, interventions and course of
plans on how to solve the family problem or the community problem in terms to the extent of a
student nurse.





 The implication of the reading to nursing research is to impart the discoveries, new
innovation and learning regarding cholelithiasis or cholecystectomy. It has indeed contributed to
the nursing profession. It provides integral information to improve the practice and to provide
more effective care to the individual patient needs. Nurses developed new techniques which
increase the quality of patient comfort is the key helping the patient.





Title: Lessons From The Surgery Room
Bibliography: Buenaventura, E. Ñ
 
 Manila, Philippines: Philippine Journalists,
Inc. © 2006.pp. 14-15.

Summary:
³It was as easy as having one¶s ears pierced.´
Ella preferred to engage herself with eating fatty foods that looked to be so inviting and
delicious at the same time. This was the time she pretended to be not in need of having her
gallbladder removed. She gave her surgeons varied excuses just to avoid such surgery until she
decided to have her problem solved. It was April then when she had the surgery after being
educated by her surgeon regarding to what would be done unto her. It was through a
laparoscopic surgery and yes it was a successful one. It was not risky and truly fast. Moreover,
her surgeon even compared it to having an ear pierce or even a tattoo, but still, it was not that
easy for her even had lots of thoughts.
Prior to the said operation, she had herself busy with doing some research regarding
human body especially the gallbladder to alleviate her anxiety. It was all from internet and
inquiries as well, this undeniably impressed her on the creation, thus realizing God¶s wonderful
masterpiece. Everything is in its proper place, without much effort our organs will find their
respective places inside our body. And so, our bodies are like awesome machines perfected
and organized well. So, having them over worked for us would weaken them and we in return
will suffer for such. Therefore, we should take good care of them.
It gave her assurance having Dr. Kim Shi Tan as the surgeon. He did even explained the
procedure he had, detailed each step in a jolly manner not making it as a tragic one. In relation
with the surgery itself, a hole was made to insert the camera in the navel, another hole just
below the heart for the hand apparatus and the third one just below the right rib. Afterwards, cut
nearby tissues covering the gallbladder, secured the gallbladder duct, cut and tied it with a knot.

Reaction:
³Some lessons on human anatomy ± in everyday life.´
It is impressive to know that there were efforts made by the client to be clarified and be
more knowledgeable with regard to cholecystectomy and the gallbladder. It is sometimes helpful
if you know the parts and functions of your organs especially if you will undergo operation. This
is not only to lessen your fear or being anxious but also it would help you fully understand why





this procedure will be done and why it happened. Being a nursing student, it is very important
that we familiarize the different systems and parts of our body for us to trace the disease
process of a disease. The interventions depend on the signs and symptoms presented by the
disease itself. It is nice to know that many people nowadays are now curios about their health
and also they are now more knowledgeable that they went to the hospital to seek medical
health. Human as we are has the freedom to know what the surgeons did to our body. It is a
wonderful thing that we have modern technologies today that would treat different kinds of
diseases. An example of this is the endoscopy that was used to the client. She can visualize the
actual operation in a television screen. This is an improvement in the field of medicine and is a
great help for all of us. The story portrays that we should not be afraid of the word operation or
surgery because it is a way that we could be treated because of our illness. Cholelithiasis or
having gallstones in your gallbladder doesn¶t mean that your system has been altered to
function but it only means that you should watch out for your diet because one of the
precipitating factors of this disease is eating foods rich in cholesterol. Sometimes, having illness
would make us a better person or we will have a discipline in ourselves. We took care of
ourselves the way we do not took care of it when we do not acquire the disease yet.
The implication of this reading to nursing practice is that it would help the health care
provider to be more competent in their work and also it would lead in the development of skills
especially in caring for the patients with cholelithiasis and who undergone cholecystectomy.
This reading would stimulate each member of the health care team as well as student nurses to
formulate the proper interventions to give to the client.
The implication of this reading to nursing education is that it would increase the
knowledge of the students about the disease and also the operation being done. This would
enhance the learnings of each one of us in the field of nursing and would also use as an added
information to be imparted to every nursing students as well as the members of the health care
team.
The implication of this reading to nursing research is that it would be a basis for further
study and it would serve as an instrument to improve the technologies and skills of the health
care team as well as student nurses.





TITLE: CASE NOTE: Unexpected bile duct stones formed around surgical clips 4
Years after laparoscopic cholecystectomy.

BIBLIOGRAPHY:
http://proquest.umi.com/pqdweb?did=1828809441&sid=1&Fmt=3&clientld=63315&RQT
=309&Vname=PQD

SUMMARY:

A 65 year old women was diagnose for symptomatic Cholecystolithiasis . She underwent
elective laparoscopic Cholecytectomy. Five days after surgery the patient complaints of
cramping abdominal pain and subfebrile temperature. The procedure revealed a pus-filled cavity
located in the right paracolic gutter.
Four years later, the patient was rushed at the emergency department with colicky right
abdominal pain, without fever or jaundice. Endoscopic Retrograde Cholangiopacnreatography
showed two gallstones formed around cholecystectomy clips. Sphincterotomy was performed
and moved the clips into common bile duct. After the procedure the patient¶s cholcestatic
parameter normalized and she recovered well.
The first choice for treatment of Cholecystolithiasis is Laparoscopic Cholecystectomy.
Possible perio-operative complications are major bleeding, wound infection and bile leakage.
Long term complications owing to bile duct stones that are retained post-operatively.
Clip induced bile duct stones is an emerging complications ever since clip came into
surgery . Abdominal Ultrasound is the most accurate method to reveal bile stones. Most often,
clips stones are not diagnosed until ERP is done.
Once the clips are in the common bile duct, Clips serve as a nidus for stone formation.
Stone formation has proven t be difficult to prevent. The surgeon should apply clips carefully
and use minimum number of clips as possible.

Reaction:

The article is very informative for us student-nurses, what we have learned in this article
will help us to be a efficient nurse in the future. If we encountered a patient with the same
disease we are now confident enough to know the proper intervention that should apply.
Through this article, As student-nurse we can now share the things that we have
learned,like Laparoscopic Cholecytectomy is the first choice of treatment for symptomatic
cholecystolithiasis. The most accurate method to reveal bile duct stones is Adominal ultrasound.
During the surgery, Health care team members especially the Surgeon should limit the
use clips because it is one of the factor that may trigger the development of the disease. We
should promote proper lifestyle, diet and regular exercise because as what we know ³Prevention
is better that cure´.
The implication of this reading to nursing practice is that it would strengthen the skills of
every health care provider and also it would enhance the competency of the nurse as well as
student nurses.
The implication of this reading to nursing that it will improve the quality of care of the
nursing profession. This article provide information that will strengthen the relationship of the
health care team and the patient.





 VI. Bibliography

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Edition.
Smeltzer, S.C, Bare, B.G. !
 
"
#  
$
 
 . 10th
Edition.
McConell T.H. %  
 &
 
 . 2007
http:// www.nlm.nih.gov/medlineplus/ency/article/000273.htm
Smeltzer, Suzanne C.et al!
 
 
#  
$
 
 . 11th
edition. Volume 2. Philadelphia. Wolters Kluwer. Lippincott Williams and Wilkins. 2008.
p1354.
Braunwald, Eugene MD, et al

 # 
  

 . 15th Edition. United
States of America. McGraw-Hill Companies Inc. 2001. p1750.
Creager, Joan G. 
   
& &&. Dubuque, Iowa. Wim. C. Brown Publishing.
2003. p712.
Black, J. and Hawks, J. $
 
  USA: Saunders Elsevier, Inc. © 2009. pp.
1125-1128.
Linton, A. 
   
$
 
 USA: Saunders Elsevier, Inc. © 2007. pp
819-821.
Burke, K. and LeMone, P. $
 
 
      
New Jersey:
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Denino, V. and Madara, B.  &&Philippines: Jones and Bartlett Publishers, Inc.
© 2008. pp. 452-454.
Huether, S. and McCance, K. ' 
    &&USA: Mosby, Inc. © 2004. pp.
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Handford, A. and Nowak, T.  &&     
 


  New york: McGraw-Hill Companies, Inc. © 2004. pp. 388-390.
Buenaventura, E. Ñ
 
 Manila, Philippines: Philippine Journalists, Inc. © 2006.
pp. 14-15.
Barnes, H. Ñ
 
 Manila, Philippines: Philippine Journalists, Inc. © 2006. pp. 20.

Webliography:


http://proquest.umi.com/pqdweb?did=1828809441&sid=1&Fmt=3&clientld=63315&
RQT=309&VName=PQD
Microsoft Encarta: 2009
www.wrongdiagnosis.com/gallstones/stats-country.htm

c