Cholelithiasis

Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile

Clinical Manifestation: Epigastric distress, such as fullness, abdominal distention, and vague pain in the right upper quadrant of the abdomen, may occur. This distress may follow a meal rich in fried or fatty foods. Biliary colic with excruciating upper right abdominal pain that radiates to the back or right shoulder, is usually associated with nausea and vomiting, and is noticeable several hours after a heavy meal. Jaundice Dark Urine Color Putty or grey feces

Nursing Responsibilities: Cholescystectomy Preoperative Instruct the patient about the need to avoid smoking to enhance pulmonary recovery postoperatively and to avoid respiratory complications. Instruct the patient to avoid the use of aspirin and other agents (over-the-counter medications and herbal remedies) that can alter coagulation and other biochemical processes. Assessment should focus on the patients respiratory status. If a traditional surgical approach is planned, the high abdominal incision required during surgery may interfere with full respiratory excursion. The note history of smoking, previous respiratory problems, shallow respirations, a persistent or ineffective cough, and the presence of adventitious breath sounds. Nutritional status is evaluated through a dietary history and general examination performed at the time of preadmission testing. The nurse also reviews previously obtained laboratory results to obtain information about the patients nutritional status.

Postoperative
Place the patient in the low Fowlers position. Intravenous fluids may be given as ordered Nasogastric suction (a nasogastric tube was probably inserted immediately before surgery for a nonlaparoscopic procedure) may be instituted to relieve abdominal distention as Ordered. Water and other fluids are given in about 24 hours Soft diet is started when bowel sounds return. Tell patient to avoid turning and moving, to splint the affected site, and to take shallow breaths to prevent pain Reminds patients to take deep breaths and cough every hour to expand the lungs fully and prevent atelectasis. Fasten tubing to the dressings or to the patients gown, with enough leeway for the patient to move without dislodging or kinking it. Because jaundice may result, the nurse should be particularly observant of the color of the sclerae. The nurse should also note and report right upper quadrant abdominalpain, nausea and vomiting, bile drainage around any drainage tube, clay-colored stools, and a change in vital signs.

Closely monitor vital signs and inspects the surgical incisions and drains, if in place, for evidence of bleeding. Periodically assess the patient for increased tenderness and rigidity of the abdomen. Assess the patient for loss of appetite, vomiting, pain, distention of the abdomen, and temperature elevation. These may indicate infection or disruption of the gastrointestinal tract and should be reported to the surgeon promptly. Encourage the patient to eat a diet low in fats and high in carbohydrates and proteins immediately after surgery.

Appendicitis