Our Lady of Fatima University Antipolo Campus College of Nursing

CHOLECYSTECTOMY

In partial fulfilment of requirement for: Related Learning Experience

Submitted by: Magdaraog, May Ann Ortego BSN 3Y1-6 Group 363B

I.

Introduction

Cholecystectomy is a surgical removal of the gall

bladder, a small pear-shaped organ located just under the liver on the upper right quadrant of the abdomen. It is indicated for the patients having cholelithiasis and cholecystitis. According to Steven P. Shikiar M.D., Cholecystectomy is perhaps the most common procedure performed by a general surgeon possibly second only to herniorrhaphy.

Today, the standard treatment for symptomatic

gallstones is Laparoscopic Cholecystectomy, which is the performance of Cholecystectomy through small (1/4 - ) incisions, aided by a special camera called a Laparoscope, which is designed to be introduced into the abdomen. The major advantage of this procedure as compared to the open procedure is in short post-operative recovery and rapid return to full function. Cholecystitis is associated with very low mortality. However, cholecystectomy in the presence of acute cholecystitis doubles perioperative mortality and increases morbidity, particularly from bleeding, sepsis, and duct injury.

As nurses they must be aware of the risk factors and potential complications of
the surgical procedure for these will make the surgical team alert of any possible emergency situation that will occur during the procedure or while the patient is in his post-surgical state. Morbidity and mortality rate produce its significance as they indicate the need to emphasize primary prevention regarding modification of lifestyle of the given population sample. Health education as a part of the nurses role is vital in health particularly in the preventive aspect of the said disease in case the ailment is present and clinically proven, at least suspected complications will be discussed to the client and further prophylaxis will be reinforced. One of the foremost aims of the procedure is to return the client to its optimal level of functioning and for him to do his activities of daily living normally as he lived before he experienced the disease.

II. Pathophysiology
Cholecystitis and Cholelithiasis Non-modifiable Factors - Age- young adult up to middle- aged - Gender- more prevalent on women - Race- prevalent among African American
Modifiable Factors - Prolonged TPN feeding - Smoking - Abdominal aneurysm - fad diet - Diabetes Mellitus - trauma - bacterial infxn (E. coli, S. Fecalis

A. Cholelithiasis

Cholelithiasis or gallstones in lay term is the accumulation of metabolic

salts on the gall bladder. Gall stones may occur anywhere in the gall bladder, formation of these metabolic salts usually obstruct the release of stored bile on the gall bladder thus promoting stasis of the bile which alters the metabolism of fats for systemic use and then eventually increases the viscosity of bile which will then go several chemical processes promoting the calcification of the bile and its components.

Cholelithiasis is common among young adults and middle aged women and
among African Americans due to their lifestyle. A condition which may alter the blood flow such as Diabetes mellitus, abdominal aneurysm, prolonged TPN feeding, and atherosclerosis precipitates the occurrence of the disease condition. Lifestyle especially smoking may also precipitate the occurrence of the disease condition.

Client with cholelithiasis usually complain RUQ pain which radiates to

the back, chest and the shoulder this is particularly because of the accompanied inflammation of the gall bladder and the irritation of the phrenic nerve. Clients also reports frequent belching and passing out of flatus this due to an increased abdominal pressure related to indigestion of fats with this client may also report nausea and vomiting. The client may also experience a low grade fever related to the inflammatory process.

B. Cholecystitis

Cholecystitis is the inflammation of the gall bladder brought about by gall

stones or infection of the gall bladder. There are two types of cholecystitis the: 1. Acalculous Cholecystitis- described as the inflammation of the gall bladder in the absence of gallstones. 2. Calculous Cholecystitis- described as the inflammation of the gall bladder due to deposition of gallstones on the gall bladder impeding the release of the bile.

Acalculous cholecystitis usually may develop among clients who have

been on trauma such as burn, major surgeries and the like which may precipitate release of chemical mediators which may promote inflammatory process and a decrease in the perfusion of the gall bladder which may slow the activity of the gall bladder resulting into the stasis of the bile which will then promote inflammation of the gall bladder. Bacterial infections such as E.coli may also promote release chemical mediators which will then lead to the inflammation of the gall bladder.

On the other hand, Calculous cholecystitis is brought about by

cholelithiasis. Sign and symptoms are the same with cholelithiasis. Difference is pain is more severe and constant.

III. Required instruments, devices, supplies, equipment, and facilities. Basic Set Mosquito Kelly curves Allis Babcock Needle holder Tissue forcep Thumb forcep Army navy Kidney basin Towel clips Straight clamp Mixter

Laparotomy Set Deaver- A retractor is a surgical instrument that separates the edges of a surgical incision or wound, and holds back underlying organs and tissues, so that body parts under the incision may be accessed. They are available in many shapes, sizes, and styles.

Malleable- A retractor that can be changed in size and shape by curving because it consist of metal that can be easily bent and curved.

Richardson retractor- A retractor is a surgical instrument that separates the edges of a surgical incision or wound, and holds back underlying organs and tissues, so that body parts under the incision may be accessed. They are available in many shapes, sizes, and styles.

Mayo-Hegar needle holder- are surgical instruments, similar to a hemostat, used to hold a suturing needle for suturing tissue during surgical procedures. They lock to hold the needle in a manner which allows the operator to maneuver the needle through the various tissues.

Foester sponge forceps- are used simply to hold a 4 x 4 gauze (sponge) that will be used to mop up fluids inside the body cavity. They are also called Ring Forceps. Some have serrated jaws and some do not.

Straight Kocher clamp- A heavy, straight haemostat with interlocking teeth on the tip.

Mixter Adson hemostat forceps- A hemostat is commonly used in both surgery and emergency medicine to control bleeding, especially from a torn blood vessel, until the bleeding can be repaired by sutures or other surgical techniques. The process of halting bleeding is called hemostasis. Babcock- Forceps with loop blades which are also semicircular in Sagittal cross-section. Designed to hold a short length of intestine Without compressing it.

Allis- Forceps with inward-curving toothed blades and a ratcheted handle. Designed for grasping fascia and tendons.

Curved Crile- Standard type of hemostats with box joint, ratchet catch, long blades with cross ridging on the blade face.

Mosquito Clamp- A small hemostatic forceps.

Straight Kelly- A clamp is a fastening device to hold or secure objects tightly together to prevent movement or separation through the application of inward pressure. A hemostat without teeth, introduced for gynecologic surgery. Curve Mayo and Straight Mayo Scissors- Heavy-duty surgical sissors with narrowed but blunt pointed blades, which may be straight or curved. These scissors are used to cut and trim braces and splints as they begin to harden. They have curved blades, which can cut to the right or the left. The stainless steel scissors are available in right-hand or left-hand versions.

Metzenbaum- are used to cut tissues during surgical procedures.

No. 3 and 4 knife handles- A scalpel is a very sharp knife used for surgery, anatomical dissection, and various arts and crafts. Scalpels may be disposable or re-usable. Re-usable scalpels can have attached, resharpenable blades or, more commonly, non-attached, replaceable blades. Disposable scalpels usually have a plastic handle with an extensible blade (like a utility knife) and are used once, then the entire instrument discarded

Adson forceps with teeth and Russian- This forcep is designed for grasping skin during oculoplastic surgery. The tips have teeth set at right angle to each other.

Smooth tissue Forceps with and without teeth- Forceps are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task.

Thumb forceps- This allows one to quickly and easily grasp small objects or tissue to move and release it or to grasp and hold tissue with easily variable pressure. Thumb forceps are used to hold tissue in place when applying sutures, to gently move tissues out of the way during exploratory surgery and to move dressings or draping without using the hands or fingers.

SUPLLIES: Basin set Blades no. 1 and no. 15 Hemoclips Dissectors T- Tube (when cholecystectomy is done) EQUIPMENTS Suction Electrosurgical unit FACILITIES:

EMERGENCY ANESTHESIOLOGIST
Surgical Light Surgical Light

S U R G E O N

SCRUB

P A T I E N T

A S S I S S T A N T

SUTURE

SUCTION BACK TABLE CIRCULATING