A cholecystectomy is the surgical removal of the gallbladder, typically to relieve pain, treat severe infections and stop recurring gall stones. A surgeon can do the procedure laparoscopically through small incisions in the abdomen or through a larger incision under the rib cage. Open gallbladder surgeries require a two- to six-day hospital stay, according to Medline Plus. Laparoscopic procedures may allow patients to go home the same day as the procedure. By making nursing diagnoses before and after gallbladder removal, a nurse can develop a care plan for the patient.
Some patients find it easier to relax if they know what to expect during and after the surgery. For such a person, a possible nursing diagnosis is “deficient knowledge related to surgical procedure as manifested by patient stating he is concerned about recovery.” Take the time to answer questions and provide information about pain control after the procedure. If the patient is going home the same day as the surgery, educate caretakers about possible post-operative risks.
Every surgery carries risks such as excessive bleeding, infection at the site of the incision, blood clots due to lack of leg movement and pneumonia related to anesthesia and lack of movement. Additional risks of a cholecystectomy include injury or blockage of the bile duct, bile leakage and kidney problems. The surgeon may order tests to determine liver functioning and may request monitoring of the patient's urine output.
Possible priority diagnoses for risk factors include “risk for impaired liver functioning related to gallbladder removal surgery.” Be alert for signs of jaundice, including yellowing of the skin and eyes. Report any changes to the doctor immediately. A ”risk for infection” diagnosis would require monitoring of vital signs and temperature as well as regular evaluation of the incisions. Patients who have difficulty breathing after anesthesia may be diagnosed with “risk for aspiration.” Assess the patient's gag reflex and ability to swallow, and monitor lung sounds through a stethoscope.
Pain is very subjective, and nurses must rely solely on the patient's verbal and nonverbal cues to determine the level of discomfort. The patient may state that she has pain, or she may grimace or wince when moving. A possible diagnosis may be “acute pain related to gallbladder removal surgery as manifested by the patient verbalizing pain.” Interventions include instructing the patient to place a pillow against her abdomen when coughing or moving, monitoring the effectiveness of pain medication and encouraging distractions such as television or music.
Cholecystectomy can leave scarring, which means patients may suffer from or be at risk for situational low self-esteem or disturbed body image. Open procedures may leave a more pronounced scar than a laparoscopic procedure. Tell the patient what to expect in the scar healing process.The scar will heal during a period of four to six weeks and will become less pronounced in the following year, according to the American College of Surgeons.