I Introduct|on

Cho|e||th|as|s
CallsLones are concreLlons LhaL form ln Lhe blllary LracL usually ln Lhe gallbladder
CholellLhlasls ls Lhe presence of gallsLones ln Lhe gallbladder
CallsLones develop lnsldlously and Lhey may remaln asympLomaLlc for decades
MlgraLlon of gallsLones may lead Lo obsLrucLlon of Lhe cysLlc ducL (blllary collc) wlLh
subsequenL lnflammaLlon (acuLe cholecysLlLls) CholanglLls occurs when a gallsLone
obsLrucLs Lhe blllary or hepaLlc ducLs causlng lnflammaLlon and lnfecLlon
CbsLrucLlon of pancreaLlc ducL can cause acuLe pancreaLlLls
CholedochollLhlasls ls Lhe presence of a gallsLone ln Lhe common blle ducL
CholedochollLhlasls compllcaLes Lhe workup and managemenL of cholellLhlasls
necesslLaLes addlLlonal dlagnosLlc and LherapeuLlc procedures and adds Lo Lhe
morbldlLy and morLallLy of gallsLone dlsease
Chronlc gallsLone dlsease may lead Lo flbrosls and loss of funcLlon of Lhe gallbladder
and lL predlsposes Lo gallbladder cancer
ulLrasonography ls Lhe procedure of cholce ln suspecLed gallbladder or blllary
dlsease
1he LreaLmenL of gallsLones depends upon Lhe sLage of dlsease AsympLomaLlc
gallsLones may be managed expecLanLly Cnce gallsLones become sympLomaLlc
deflnlLlve surglcal lnLervenLlon wlLh exclslon of Lhe gallbladder (cholecysLecLomy) ls
usually lndlcaLed CholecysLecLomy ls among Lhe mosL frequenLly performed
abdomlnal surglcal procedures ln some cases however medlcal dlssoluLlon may be
consldered
CallsLones may be asympLomaLlc even for years 1hese gallsLones are called sllenL
sLones and do noL requlre LreaLmenL SympLoms commonly begln Lo appear once
Lhe sLones reach a cerLaln slze (8 mm) A characLerlsLlc sympLom of gallsLones ls
a gallsLone aLLack ln whlch a person may experlence lnLense paln ln Lhe upper
rlghL slde of Lhe abdomen ofLen accompanled by nausea and vomlLlng LhaL sLeadlly
lncreases for approxlmaLely 30 mlnuLes Lo several hours A paLlenL may also
experlence referred paln beLween Lhe shoulder blades or below Lhe rlghL shoulder
1hese sympLoms may resemble Lhose of a kldney sLone aLLack CfLen aLLacks
occur afLer a parLlcularly faLLy meal and almosL always happen aL nlghL CLher
sympLoms lnclude abdomlnal bloaLlng lnLolerance of faLLy foods belchlng gas and
lndlgesLlon
A poslLlve Murphys slgn ls a common flndlng on physlcal examlnaLlon
CallsLone rlsk facLors lnclude overwelghL age near or above 40 female or pre
menopausal Lhe condlLlon ls more prevalenL ln caucaslans Lhan ln people of oLher
races A lack of melaLonln could slgnlflcanLly conLrlbuLe Lo gallbladder sLones as
melaLonln boLh lnhlblLs cholesLerol secreLlon from Lhe gallbladder enhances Lhe
converslon of cholesLerol Lo blle and ls an anLloxldanL capable of reduclng oxldaLlve
sLress Lo Lhe gallbladder 8esearchers belleve LhaL gallsLones may be caused by a
comblnaLlon of facLors lncludlng lnherlLed body chemlsLry body welghL gallbladder
moLlllLy (movemenL) and perhaps dleL 1he absence of such rlsk facLors does noL
however preclude Lhe formaLlon of gallsLones
no clear relaLlonshlp has been proven beLween dleL and gallsLone formaLlon
however lowflber hlghcholesLerol dleLs and dleLs hlgh ln sLarchy foods have been
suggesLed as conLrlbuLlng Lo gallsLone formaLlon CLher nuLrlLlonal facLors LhaL may
lncrease rlsk of gallsLones lnclude rapld welghL loss consLlpaLlon eaLlng fewer meals
per day eaLlng less flsh and low lnLakes of Lhe nuLrlenLs folaLe magneslum
calclum and vlLamln C Cn Lhe oLher hand wlne and wholegraln bread may
decrease Lhe rlsk of gallsLones lgmenL gallsLones are mosL commonly seen ln Lhe
developlng world 8lsk facLors for plgmenL sLones lnclude hemolyLlc anemlas (such
as slcklecell dlsease and heredlLary spherocyLosls) clrrhosls and blllary LracL
lnfecLlons eople wlLh eryLhropoleLlc proLoporphyrla(L) are aL lncreased rlsk Lo
develop gallsLones AddlLlonally prolonged use of proLon pump lnhlblLors has been
shown Lo decrease gallbladder funcLlon poLenLlally leadlng Lo gallsLone formaLlon
CholesLerol gallsLones develop when blle conLalns Loo much cholesLerol and noL
enough blle salLs 8esldes a hlgh concenLraLlon of cholesLerol Lwo oLher facLors are
lmporLanL ln causlng gallsLones 1he flrsL ls how ofLen and how well Lhe gallbladder
conLracLs lncompleLe and lnfrequenL empLylng of Lhe gallbladder may cause Lhe blle
Lo become overconcenLraLed and conLrlbuLe Lo gallsLone formaLlon 1he second
facLor ls Lhe presence of proLelns ln Lhe llver and blle LhaL elLher promoLe or lnhlblL
cholesLerol crysLalllzaLlon lnLo gallsLones ln addlLlon lncreased levels of Lhe
hormone esLrogen as a resulL ofpregnancy hormone Lherapy or Lhe use of
comblned (esLrogenconLalnlng) forms of hormonal conLracepLlon may lncrease
cholesLerol levels ln blle and also decrease gallbladder movemenL resulLlng ln
gallsLone formaLlon

1he recenL llLeraLure lndlcaLes a 10 and 20 lncldence of gallsLones ln Amerlcan
men and women respecLlvely revlous reporLs supporL a poLenLlal lncrease ln
cholellLhlasls ln paLlenLs who undergo lleal resecLlon Cur daLa lndlcaLe no lncreased
rlsk of gallsLones ln paLlenLs who undergo modlfled lndlana pouch urlnary dlverslon
Powever longer follow up ls requlred Lo verlfy Lhese flndlngs CholellLhlasls was
found ln 130lndlvlduals (global prevalence 139) 1he relaLlve rlsk for llLhlasls was
hlgher ln women compared Lo men Age ls a also slgnlflcanL rlsk facLor nelLher
pregnancy nor oral conLracepLlve use proved Lo be rlsk facLors 1yplcal blllary collc
paln was Lhe only sympLom slgnlflcanLly assoclaLed wlLh cholellLhlasls


II at|ent rof||e

1he cllenL Mrs xx ls a 49 year old woman who resldes ln Lubao ClLy of San
lernando ampanga She works as a prlnclpal ln a local publlc school near Lhelr
vlclnlLy Mrs xx was born on May 24 1962 aL Lhe clLy of San lernando llllplno ln
naLlonallLy She ls marrled Lo Mr x? and has 4 chlldren 1helr famlly ls 8oman
CaLhollc ln rellglon She was admlLLed on SepLember 7 2011 730 pm aL room 218
wlLh a chlef complalnL of abdomlnal paln Per flnal dlagnosls was CholecysLollLhlasls


III ea|th |story and Ch|ef Comp|a|n

Ch|ef Comp|a|nt
Mrs xx complalned of havlng perslsLenL abdomlnal paln for aL leasL a week prlor Lo
admlsslon

ast ea|th |story
Accordlng Lo Mrs xx she was dlagnosed of havlng uM 1ype ll before She had been
admlLLed and lL was her flrsL Llme belng admlLLed for havlng gallsLones

resent ea|th |story
Mrs xx was admlLLed Lo Lhe hosplLal due Lo her presenL condlLlon of havlng
cholecysLollLhlasls Aslde from Lhe dlagnosls lL was conflrmed LhaL she has Lype ll
uM

IV ersonGordon Approach

O sychosoclal paLLern
Mrs xx ls very lnLelllgenL before she became a school prlnclpal she was a
Leacher of general educaLlon She ls very smarL desplLe her condlLlon and could
hardly noLlce her aglng

O LllmlnaLlon paLLern
She regularly moves her bowel durlng her younger years usually before Laklng
her baLh unLll she flrsL felL sympLoms of her condlLlon


O 8esL and Sleep paLLern
As a school prlnclpal she does a loL of work and glves a loL of exLra Llme for her
work As busy as a bee and Lhelr home locaLlon from her work she can only
sleep 7 hours Lhe longesL and her usual 4 hoursleep rouLlne

O SplrlLuallLy
Mrs xx was never qulLe rellglous llke her moLher perhaps when she was way
younger accordlng Lo her when her mom would Lake her Lo prayer meeLlngs
and even vlslLed Lhe church every day and aLLend Sunday mass

O CxygenaLlon
She can breaLhe comforLably wlLhouL oxygen supporL alLhough accordlng Lo
her she had paln durlng lnsplraLlon ln Lhe llver reglon when lL expands

O nuLrlLlonal paLLern
8elng busy ln school and aL home she leL her eldesL manage food and
nuLrlLlonal managemenL aL home wlLh Lhe help of her husband and Lhe household
malds

V hys|ca| Assessment
Genera| Assessment 1he cllenL was seen lylng on bed wlLh She ls dressed
approprlaLely and responds approprlaLely Lo Lhe quesLlons asked Lo her
In|t|a| V|ta| S|gn 8130/70 1363C 8819 880
V|ta| S|gns as ||fted from the chart



Date 1|me 8 k kk 1emp
9]7]11 8 130/70 80 19 363
12 130/80
4 120/80 88 20 363
8 120/80 79 19 363
9 120/80 84 19 363
10 130/80 83 19 364
12
9 120/70 76 20 363
9]8]11 Am
8 120/80 96 19 363
12 130/90 74 20 368
4 130/80 74 20 368
9]8]11 pm
8 120/80 78 20 364
12 130/90 80 19 364
4 130/80 84 19 362




ead to 1oe Assessment
Area Assessed 1echnlque normal llndlngs AcLual llndlngs LvaluaLlon

Skln Color

lnspecLlon

LlghL brown
Lanned skln (vary
accordlng Lo race)

brown skln

normal
Llps nall beds
soles and palms

lnspecLlon
LlghLer colored
palms soles llps
and nall beds
LlghLer colored palms
soles llps and nall beds

normal
MolsLure lnspecLlon/
alpaLlon
Skln normally dry Skln normally dry normal
1emperaLure alpaLlon Warm Lo Louch 36
o
C warm Lo Louch normal

1exLure

alpaLlon
SmooLh sofL and
flexlble palms and
soles (Lhlcker)
SmooLh sofL and
flexlble palms and soles
(Lhlcker)


normal
1urgor alpaLlon Skln snaps back
lmmedlaLely
Skln snaps back
lmmedlaLely 12
seconds
normal
Skln appendages
a nalls


lnspecLlon


1ransparenL
smooLh and convex
cuL and clean


1ransparenL smooLh
and convex and clean


normal
nall beds lnspecLlon lnklsh lnklsh normal
nall base lnspecLlon llrm llrm normal


Caplllary reflll


lnspecLlon/
alpaLlon
WhlLe color of nall
bed under pressure
should reLurn Lo
plnk wlLhln 23
seconds
WhlLe color of nall bed
under pressure
reLurned Lo plnk wlLhln
23 seconds


normal
b Palr
ulsLrlbuLlon

lnspecLlon

Lvenly dlsLrlbuLed

Lvenly dlsLrlbuLed

normal
Color lnspecLlon 8lack 8lack normal
1exLure lnspecLlon/
alpaLlon
SmooLh SmooLh and curly normal
Lyes
Lyes

lnspecLlon

arallel Lo each
oLher

arallel Lo each oLher

normal
vlsual AculLy lnspecLlon
(penllghL)
L88LA uplls
equally round reacL
Lo llghL and
accommodaLlon
L88LA uplls equally
round reacL Lo llghL and
accommodaLlon
normal
Lyebrows lnspecLlon SymmeLrlcal ln slze
exLenslon halr
LexLure and
movemenL
SymmeLrlcal ln slze
exLenslon halr LexLure
and movemenL
normal
Lyelashes lnspecLlon ulsLrlbuLed evenly
and curved
ouLward
ulsLrlbuLed evenly and
long curved ouLward
normal
Lyellds lnspecLlon Same color as Lhe
skln

8llnks lnvolunLarlly
and bllaLerally up
Lo 20 Llmes per
mlnuLe

uo noL cover Lhe
pupll and Lhe
sclera llds normally
close symmeLrlcally
Same color as Lhe skln

8llnks lnvolunLarlly and
bllaLerally up Lo 16
Llmes per mlnuLe

uo noL cover Lhe pupll
and Lhe sclera llds
normally close
symmeLrlcally
normal



normal



normal
Con[uncLlva lnspecLlon 1ransparenL wlLh
llghL plnk color
1ransparenL wlLh llghL
plnk color
normal
Sclera lnspecLlon Color ls whlLe Color ls whlLe normal
Cornea lnspecLlon 1ransparenL shlny 1ransparenL shlny normal
uplls lnspecLlon 8lack consLrlcL
brlskly
8lack consLrlcL brlskly normal
lrls lnspecLlon Clearly vlslble Clearly vlslble normal
Lars
Lar canal openlng

lnspecLlon

lree of leslons
dlscharge of
lnflammaLlon


lree of leslons
dlscharge of
lnflammaLlon


normal



Canal walls plnk Canal walls plnk normal
Pearlng AculLy lnspecLlon CllenL normally
hears words when
whlspered
CllenL normally hears
words when whlspered

normal
nose
Shape slze and
skln color

lnspecLlon

SmooLh symmeLrlc
wlLh same color as
Lhe face

SmooLh symmeLrlc
wlLh same color as Lhe
face


normal
nasal sepLum lnspecLlon Close Lo mldllne
Lhlcker anLerlorly
Lhan posLerlorly
Close Lo mldllne
Lhlcker anLerlorly Lhan
posLerlorly

normal

nares

lnspecLlon

Cval symmeLrlc
and wlLhouL
dlscharge



Cval symmeLrlc and
wlLhouL dlscharge



normal
MouLh and
harynx
Llps


lnspecLlon


lnk molsL
symmeLrlc


lnk molsL symmeLrlc



normal
8uccal mucosa lnspecLlon CllsLenlng plnk sofL
molsL
CllsLenlng plnk sofL
molsL
normal
Cums lnspecLlon SllghLly plnk color
molsL and LlghLly flL
agalnsL each LooLh
SllghLly plnk color
molsL and LlghLly flL
agalnsL each LooLh

normal
1ongue lnspecLlon MolsL sllghLly
rough on dorsal
surface medlum or
dull red
MolsL sllghLly rough on
dorsal surface medlum
or dull red

normal
1eeLh lnspecLlon llrmly seL shlny llrmly seL shlny
no LooLh decay mllk
LooLh presenL
normal
Pard and sofL
palaLe
lnspecLlon Pard palaLe dome
shaped
SofL alaLe llghL
plnk
Pard palaLe dome
shaped
SofL alaLe llghL plnk

normal
neck
SymmeLry of neck
muscles
allgnmenL of
Lrachea


lnspecLlon

neck ls sllghLly
hyper exLended
wlLhouL masses or
asymmeLry

neck ls sllghLly hyper
exLended wlLhouL
masses or asymmeLry


normal
neck 8om lnspecLlon neck moves freely neck moves freely normal
wlLhouL dlscomforL wlLhouL dlscomforL
1hyrold gland alpaLlon 8lses freely wlLh
swallowlng
8lses freely wlLh
swallowlng
normal
1rachea lnspecLlon Mldllne Mldllne normal
1horax and Lungs AusculLaLlon Clear breaLh
sounds
Clear breaLh sounds normal
Abdomen



8owel sounds
lnspecLlon



AusculLaLlon
Skln same color
wlLh Lhe resL of Lhe
body

Cllcks or gurllng
sounds occur
lrregularly and
range from 333
per mlnuLe
Skln same color wlLh
Lhe resL of Lhe body
Surglcal lnclslon noLed

Cllcks or gurllng sounds
occur lrregularly and
range from 333 per
mlnuLe
normal
lnclslon was
due Lo Lhe
operaLlon
done




normal
neurology sysLem
Level of
consclousness


lnspecLlon


lully consclous
respond Lo
quesLlons qulckly
percepLlve of
evenLs



lully consclous
respond qulckly Lo
sLlmulus





normal




8ehavlor and
appearance
lnspecLlon Makes eye conLacL
wlLh examlner
hyperacLlve
expresses feellngs
wlLh response Lo
Lhe slLuaLlon
Makes eye conLacL wlLh
examlner hyperacLlve
expresses feellngs wlLh
response Lo Lhe
slLuaLlon


normal



VI Anatomy and hys|o|ogy

D|gest|on ls Lhe mechanlcal and chemlcal breakdown of food lnLo smaller
componenLs LhaL are more easlly absorbed lnLo a blood sLream for lnsLance
ulgesLlon ls a form of caLabollsm a breakdown of large food molecules Lo smaller
ones
ln mammals food enLers Lhe mouLh belng chewed by LeeLh wlLh chemlcal
processlng beglnnlng wlLh chemlcals ln Lhe sallva from Lhe sallvary glands 1hls ls
called masLlcaLlon 1hen lL Lravels down Lhe esophagus lnLo Lhe sLomach
where hydrochlorlc acld kllls mosL conLamlnaLlng mlcroorganlsms and beglns
mechanlcal breakdown of some food (eg denaLuraLlon of proLeln) and chemlcal
alLeraLlon of some 1he hydrochlorlc acld also has a low pP whlch allows enzymes Lo
work more efflclenLly AfLer some Llme Lhe resulLlng Lhlck llquld ls called chyme
Chyme wlll go Lhrough Lhe small lnLesLlne where 93 of absorpLlon of nuLrlenLs
occurs Lhrough Lhe large lnLesLlne wlLh wasLe maLerlal evenLually belng ellmlnaLed
durlng defecaLlon


Ga||b|adder
1he gallbladder ls a hollow sysLem LhaL slLs [usL beneaLh Lhe llver ln adulLs Lhe
gallbladder measures approxlmaLely 8 cenLlmeLers (31 ln) ln lengLh and 4
cenLlmeLers (16 ln) ln dlameLer when fully dlsLended lL ls dlvlded lnLo Lhree
secLlons fundus body and neck 1he neck Lapers and connecLs Lo Lhe blllary Lree vla
Lhe cysLlc ducL whlch Lhen [olns Lhe common hepaLlc ducL Lo become Lhe common
blle ducL AL Lhe neck of Lhe gall bladder ls presenL a mucosal fold called ParLmanns
pouch where gallsLones commonly geL sLuck 1he angle of Lhe gallbladder ls locaLed
beLween Lhe cosLal margln and Lhe laLeral margln of Lhe recLus abdomlnls muscle
When food conLalnlng faL enLers Lhe dlgesLlve LracL lL sLlmulaLes
Lhe secreLlon of cholecysLoklnln (CCk) ln response Lo CCk Lhe adulL human
gallbladder whlch sLores abouL 30 mllllllLres (17 uS fl oz 18 lmp fl oz) of blle
releases lLs conLenLs lnLo Lhe duodenum 1he blle orlglnally produced ln
Lhe llver emulslfles faLs ln parLly dlgesLed food
uurlng sLorage ln Lhe gallbladder blle becomes more concenLraLed whlch lncreases
lLs poLency and lnLenslfles lLs effecL on faLs


VII athophys|o|ogy







































Risk Iactor
4 0r0/ity
4 -0sity
4 Rapi/ W0ight Loss, through /i0t or surg0ry
4 g0 ;0r 60
4 02al0 G03/0r
4 i0t-V0ry low calori0 /i0ts, prolo3g0/ Iasti3g, a3/ low-Ii-0r/high-
chol0st0rol/high-starch /i0ts.
Bil0 2ust -0co20
sup0rsaturat0/ with
chol0st0rol a3/ calciu2
Th0 solut0 pr0cipitat0
Iro2 solutio3 as soli/
crystals
Crystals 2ust co20
tog0th0r a3/ Ius0 to Ior2
sto30s
Gallsto30s
-structio3 oI th0 cystic /uct a3/ co22o3 -il0 /uct
Sharp pai3 i3 th0 right
part oI a-/o203
Jau3/ic0
ist03tio3 oI th0 gall -la//0r
V03ous a3/
ly2phatic /rai3ag0
is i2pair0/
ProliI0ratio3
oI -act0ria
Localiz0/ c0llular
irritatio3 or
i3Iiltratio3 or -oth
tak0 plac0
r0as oI
isch02ia 2ay
occur
I3Ila22atio3 oI gall -la//0r
CLECYSTITIS
VIII. Laboratory Analysis

Ur|na|ys|s

LA8CkA1Ck kecords
date Am m Co|or
react|on
Ur|ne
acetone
8|ood
sugar
Insu||n Cra|
therapy
Nurses
notes
0908
11
6 pm 12S
mg]d|

0909
11
6 am 101
mg]d|




U|trasound

Interpretat|on
1he llver ls noL enlarged showlng homogenous parenchymal echopaLLern wlLh normal
enhogenlclLy Lhe lnLrahepaLlc ducL and vessel are noL dllaLed no mass leslon noLed Lhe
gallbladder ls physlologlcally dllaLed measurlng 23 cm ln lLs Lranaverse dlameLer
wlLh lnLramlumlnal mulLlple hyperecholc focl casLlng posLerlor acosusLlc shadowlng Lhe
largesL of whlch measures 9mm 1he gb wall ls noL Lhlckned 1he common ducL measures 34
mm wlLh no lnLralumlnal echo
1he pranceas ls unremarkable measurlng 17 x 14 x 10 cm no mass or calclflcaLlon noLed
lmpresslon mulLlple cholellLhlasls
ulLrasonlcally normal












Ik Drug Study
rug Na20 ClassiIicatio3 I3/icatio3 /;0rs0 R0actio3 Nursi3g R0spo3si-iliti0s
G030ric
Na20
Sulbactam
Brand Name.
5iIgram

osag0
750 mg/iv q6
Anti-infectives/
Antibiotics/
Penicillins
For infections
due to -
lactamase
producing H.
influenzae
including those
of the
respiratory tract,
bones, joints &
soft tissues. For
polymicrobial
infections w/
mixed aerobic &
anaerobic such
as diabetic foot,
gynecologic
infections, intra-
abdominal
infections & for
UT due to
susceptible
organisms.

iarrh0a (3)
IV i30ctio3 sit0
pai3 (3)
Thro2-ophl0-itis
(3)
Rash ( 2)
1
-/o2i3al
/ist03tio3
Black "hairy"
to3gu0
Ca3/i/iasis
Ch0st pai3
Chillls
ysuria
E/02a
Epistaxis
Eryth02a
atigu0
latul03c0
Glossitis
0a/ach0
Itchi3g
Malais0
Mucosal -l00/i3g
Naus0a
Ps0u/o202-ra3ous
colitis
S0izur0
Tight30ss i3 throat
Thro2-ocytop03ia
Uri30 r0t03tio3
Vo2iti3g
ss0ss pati03t Ior i3I0ctio3
(;ital sig3s, wou3/ app0ara3c0,
sputu2, uri30, stool, a3/
WBCs) at -0gi33i3g a3/
throughout th0rapy.
-tai3 a history -0Ior0
i3itiati3g th0rapy to /0t0r2i30
pr0;ious us0 oI a3/ r0actio3s to
p03icilli3s or c0phalospori3s.
P0rso3s with a 30gati;0 history
oI p03icilli3 s03siti;ity 2ay
still ha;0 a3 all0rgic r0spo3s0.
-tai3 sp0ci203s Ior cultur0
a3/ s03siti;ity -0Ior0 th0rapy.
irst /os0 2ay -0 gi;03 -0Ior0
r0c0i;i3g r0sults.
-s0r;0 pati03ts Ior sig3s
a3/ sy2pto2s oI a3aphylaxis
(rash, pruritus, lary3g0al
0/02a, wh00zi3g). isco3ti3u0
th0 /rug a3/ 3otiIy th0
physicia3 i220/iat0ly iI th0s0
occur. K00p 0pi30phri30, a3
a3tihista2i30, a3/ r0suscitatio3
06uip203t clos0 -y i3 th0 0;03t
oI a3 a3aphylactic r0actio3.
Cautio3 pati03t to 3otiIy
physicia3 iI I0;0r a3/ /iarrh0a
occur, 0sp0cially iI stool
co3tai3s -loo/, pus, or 2ucus.
/;is0 pati03t 3ot to tr0at
/iarrh0a without co3sulti3g
h0alth car0 proI0ssio3al. May
occur up to s0;0ral w00ks aIt0r
/isco3ti3uatio3 oI 20/icatio3.
I3struct pati03t to 3otiIy
physicia3 iI sy2pto2s /o 3ot
i2pro;0.






rug Na20 ClassiIicatio3 I3/icatio3 /;0rs0 R0actio3 Nursi3g R0spo3si-iliti0s
G030ric
Na20
esomepra
zoIe
Brand Name.
0:2



proton pump
inhibitors
GER Esomeprazole, like other
PPs, is well-tolerated.
The most common side
effects
are diarrhea, nausea, vo
miting, headaches, rash
anddizziness.
Nervousness, abnormal
heartbeat, muscle
pain, weakness, leg
cramps, and water
retention occur
infrequently.
Monitor for S&S of
adverse CNS effects
(vertigo, agitation,
depression) especially
in severely ill patients.
Monitor phenytoin
levels with concurrent
use.
Monitor NR/PT with
concurrent warfarin
use.
Lab tests: Periodic liver
function tests, CBC, Hct
& Hbg, urinalysis for
hematuria and
proteinuria.






rug Na20 ClassiIicatio3 I3/icatio3 /;0rs0 R0actio3 Nursi3g R0spo3si-iliti0s
G030ric
Na20
%ramadoI
Brand Name.
&97,2

osag0
50 mg q 8
analgesic ModeraLe Lo
moderaLely
severe paln
nausea,constipation, dizz
iness, headache,
drowsiness,
and vomiting. Less
commonly reported side
effects include itching,
sweating, dry
mouth, diarrhea, rash,
visual disturbances,
and vertigo. Some
patients who received
tramadol have reported
seizures. Abrupt
withdrawal of tramadol
may result in anxiety,
sweating, insomnia,
rigors, pain,
nausea, diarrhea,
tremors, and
hallucinations.
ss0ss typ0, locatio3, a3/
i3t03sity oI pai3 -0Ior0 a3/
2-3 hr (p0ak) aIt0r
a/2i3istratio3.
ss0ss BP & RR -0Ior0
a3/ p0rio/ically /uri3g
a/2i3istratio3. R0spiratory
/0pr0ssio3 has 3ot occurr0/
with r0co2203/0/ /os0s.








k L|st of r|or|t|zed Nurs|ng D|agnos|s

. Pain ielateu to inflammation anu uistoition of tissue
. Anxiety ielateu to change in health status, as eviuence by feai of specifieu
consequence.
. Knowleuge ueficient iegaiuing conuition anu self caie ielateu to infoimation
misinteipietation.
:rsing Care Plan

SU8JECTIVE:

''Mosokif ong fogIiron ko os
verboIi;ed by fhe pofienf

O8JECTIVE:

FocioI mosk of poin

0uording behovior

SeIf focusing

VITAL SI0MS:

8P:
T:
PP:
PP:
Poin reIofed
fo
infIommofion
ond
disforfion of
fissue
ChoIeIifhiosis is
fhe formofion of
goIIsfones,
which ore
composed of
choIesferoI,
coIcium soIfs,
ond biIe
pigmenfs.
When
goIIsfones
bIock fhe fIow
of biIe, fhe
goIIbIodder
becomes
swoIIen,
Ieoding fo fhe
possibiIify of
poin,
infIommofion,
or infecfion.
The signs ond
sympfoms of
choIeIifhiosis
offen do nof
begin unfiI fhe
goIIsfone
couses
bIockoge in fhe
biIiory sysfem.
They moy
incIude,
obdominoI
poin, usuoIIy in
Affer 8 hours
of nursing
infervenfions
, fhe pofienf
poin wiII be
reIieved or
confroIIed.
Independenf:
Observe ond
documenf
Iocofion of poin,
severify (0-I0
scoIe), ond
chorocfer of poin.
Promofe bed resf,
ond in Iow
fowIer's posifion.
Use soff coffon
Iinens, coIomine
Iofion, oiI bofh
ond cooI or moisf
compress os
indicofed.
ConfroI
environmenfoI
femperofure.
Encouroge use of
reIoxofion
fechnique.
Assisf in
differenfiofing
couse of poin
ond provides
informofion
obouf diseose
progression,
deveIopmenf of
compIicofions
ond
effecfiveness of
infervenfion.
8ed resf in Iow
fowIer's posifion
reduces infro
obdominoI
pressure.
Peduces
irrifofion,
dryness of fhe
skin ond ifching
sensofion.
CooI
surroundings
oid in
minimi;ing
dermoI
discomforf.
Promofes resf,
redirecfs
offenfion, moy
enhonce
coping.
Affer 8
hours of
nursing
infervenfion
s, fhe
pofienf poin
wos reIieved
or
confroIIed.

ASSESSMENT NURSING
DIAGNOSIS
PLANNING NURSING
INTERVENTION
RATIONALE EVALUATION

Subjective:
"Nahihirapan ako
ngayon sa sakit
ko. As
verbalized by the
patient.

Objective:
Vital signs taken
and recorded:

BP: 120/80
PR: 103 BPM
RR: 36 CPM
Temp: 37.7C

Anxiety related to
change in health
status, as
evidence by fear
of specified
consequence.

Short term:
At the end of
5Hrs. of nursing
intervention
patient will be
able to reduce
anxiety.



Long term:
After two weeks
of nursing care,
patient will be
able to accept
changes in health
status.









> Assess
patients level of
anxiety.

> Place patient in
comfortable
position.


> Provide non-
pharmacological
Therapies such
as:
T.V, Radio,
Books,
Socialization w/
others.

> Provide calm
activities.


> Provide health
teaching about
hepatitis disease.

> To establish
baseline data.


> To help the
patient have
adequate period
of rest and sleep.

> To relax &
provide comfort
to the patient.






> Can lessen the
anxiety of the
patient.

> To give more
information about
his health status.

Short term:
At the end of
5Hrs. of nursing
intervention
patient was able
to reduce feeling
of anxiety.



Long term:
After two weeks
of nursing care,
patient was able
to accept
/understand his
health status.
ASSESSMEMT DIA0MOSIS IMFEPEMCE PLAMMIM0 IMTEPVEMTIOM PATIOMALE EVALUATIOM

SubjecLIve:
HIndI ko uIum
ung guguwIn su
suguL ko us
verbuIIzed by LIe
puLIenL.


ObjecLIve:
SLuLemenL oI
mIsInLerpreLuLI
on.
RequesL Ior
InIormuLIon.



VJS Luken us
IoIIows:
T:
P:
R:
BP:
KnowIedge
deIIcIenL
regurdIng
condILIon
und seII
cure
reIuLed Lo
InIormuLIon
mIsInLerpre
LuLIon.
CIoIecysLecL
omy Is LIe
surgIcuI
removuI oI
LIe
guIIbIudder,
u smuII
peursIuped
suc
LIuL Is
IocuLed
dIrecLIy
beneuLI LIe
IIver In LIe
upper rIgIL
sIde oI LIe
ubdomen.
TIe
guIIbIudder's
muIn
IuncLIon Is Lo
sLore bIIe,
wIIcI Is
produced by
LIe IIver, und
Lo reIeuse IL
us needed
Ior dIgesLIon.
TIe
guIIbIudder's
IuncLIon Is
ImporLunL,
buL IL Is noL
AILer 8 Iours
oI nursIng
InLervenLIons
LIe puLIenL
wIII
verbuIIze
undersLundIng
oI LIerupeuLIc
needs.
3/0503/039
RevIew
dIseuse
process,
surgIcuI
procedure or
prognosIs.
DemonsLruLe
cure
oI IncIsIons or
dressIng or
druIns.
EmpIusIze
ImporLunce oI
muInLuInIng
Iow
IuL dIeL, euLIng
smuII IrequenL
meuIs, gruduuI
reInLroducLIon
oI
Ioods or IIuIds
conLuInIng IuLs
over q Lo 6
monLI
perIod.
DIscuss
uvoIdIng
or IImILIng use
oI
uIcoIoIIc
beveruges.
nIorm
ProvIdes
knowIedge
buse on wIIcI
puLIenL cun
muke
InIormed
cIoIces.
PromoLes
Independence
In cure und
reduces rIsk oI
compIIcuLIons.
DurIng
InILIuI 6
monLIs uILer
surgery, Iow
IuL
dIeL IImILs
need
Ior bIIe und
reduces
dIscomIorL
ussocIuLed
wILI
InudequuLe
dIgesLIon oI
IuLs.
MInImIzes
LIe
rIsk oI
puncreuLIc
InvoIvemenL.
nLesLInes
AILer 8
Iours oI
nursIng
InLervenLIon
s LIe puLIenL
wus ubIe
verbuIIze
undersLundI
ng oI
LIerupeuLIc
needs.
un essenLIuI
orgun.
puLIenL
LIuL Ioose
sLooIs
muy occur Ior
severuI
monLIs.
denLIIy sIgns
und
sympLoms
requIrIng
noLIIIcuLIon oI
provIder IIke
durk
urIne,
juundIced
coIor oI eyes or
skIn, cIuy
coIored
sLooIs.

requIre LIme
Lo
udjusL Lo
sLImuIus oI
conLInuous
ouLpuL oI bIIe.
ndIcuLors oI
obsLrucLIon oI
bIIe IIow or
uILered
dIgesLIon,
requIrIng
IurLIer
evuIuuLIon
und
InLervenLIon.

I D|scharge |ann|ng
M - MEDCNE
4 AdvIce puLIenL Lo conLInue LukIng IIs prescrIbed medIcInes

E - ENVRONMENT AND EXERCSE
4 MuInLuIn u quIeL, pIeusunL, envIronmenL Lo promoLe reIuxuLIon.
4 ProvIde cIeun und comIorLubIe envIronmenL.
4 Encouruge wuIkIng everyduy.

T - TREATMENT
4 ConLInue Iome medIcuLIons.
4 TeucI puLIenL ubouL wound cure
4 Encouruge puLIenL Lo Luke muILIvILumIns Ior ImmunILy

H - HEATH TEACHNG
4 ProvIde wrILLen und oruI InsLrucLIons ubouL wound cure,
ucLIvILy, dIeL recommenduLIons, medIcuLIons, und IoIIow-up vIsILs.
4 nsLrucL puLIenL Lo IImIL IIs ucLIvILy Ior zq Lo q8 Irs uILer dIscIurge.
4 E3courag0/ pati03t to i3cr0as0 Ilui/ i3tak0
4 E3courag0/ pati03t to 0at Ioo/s rich i3 Vita2i3 a3/ Nutritious
Ioo/s
4 E3courag0 pati03t to a;oi/ salty a3/ Iatty Ioo/s

O - OUT PATENT OOW-UP
4 PuLIenL wIII be udvIsed Lo go buck In LIe IospILuI In u specIIIc duLe
Lo Iuve u IoIIow-up cIeck up uILer dIscIurge.
4 ConsuIL docLor Ior ure uny probIems or compIIcuLIons encounLered.


D - DET
4 Encouruge puLIenL Lo Increuse proLeIn InLuke Ior LIssue repuIr
4 AdvIce puLIenL Lo euL smuIIer-LIun-normuI umounLs oI Iood uL
meuILIme.

S - SPRTUATY
4 Encouruge puLIenL Lo communIcuLe wILI God.
4 Encouruge puLIenL Lo communIcuLe wILI oLIer peopIe.

Co||ege of Cur Lady of Mt Carme|



Co||ege of Nurs|ng


Case Study on
Cho|edocho||th|as|s







Subm|tted by

Group I
Aguda kar| kusse|| Steven
Agu||ar Apr||
Castro N|kko
Craba[a|es eter Anthony
D|zon koe|
kab|||ng Iomark
Meneses M|che||e
Crtega koma|yn



Subm|tted to
Mr Aaron V|||anueva kNMAN
Ms Mar|a Iesusa V|ra Mora|es kNMAN