Adults with small frames also present problems in gall bladder accessibility and hence the need for conventional open cholecystectomy. Mostly this procedure is performed through laparoscopic incisions using a laser (Tacchino, Greco, & Matera, 2010; Tian et al., 2009). Most patients, however, prefer the conventional open cholecystectomy due to its acute symptomatology and avoidance of future stone presence recurrence.
Care setting
The care setting for after cholecystectomy operation is normally planned on a short-term basis. However, when complications arise including emphysema, gangrene, or perforation, in-patient stay may be appropriately indicated. Among the concern areas on admission include cholecystitis with cholelithiasis, pancreatitis, peritonitis, psychological care perspective, and possible surgical intervention (Tajima & Katagiri, 2009). Discharge planning is also necessary whereby several concerns are dressed including possible assistance with wounds and other homemaker tasks.
The nursing priorities will however include;
Discharge goals
Nursing care will focus on achieving specific goals t the time of discharging the patient. These will include;
Nursing Diagnosis
Various diagnoses are evaluated to establish the best possible approach in the patient’s treatment for the mentioned condition (Lukovich, Vanca, & Gero, 2009). Possible diagnoses for this case are discussed below and justification provided.
Nursing Diagnosis 1: Pain, Acute
Pain is related to biologically injuring agents like obstruction in the duct, inflammations, and tissue ischemia/neurosis. It is evidenced by patient reporting of pain, biliary colic, facial pain mask, as well as autonomic responses like change in blood pressure and pulse (Joris et al., 2007). The desired outcomes in pain management include patient reports of pain relief and demonstration of relaxation position as evidenced by patient’s activities.
Actions/Interventions
Managing pain takes either an independent or collaborative form. Independent pain management begins with observing and documenting the location of the pain. Pain is ranked based on the severity on a scale of 0-10 (Joris et al., 2007). The character of pain is also documented, for instance, if it is steady, intermittent, or colicky. After administration of pain killers, the patient is observed for responses and a report generated on the same. Additionally, the patient is encouraged to have bed rest and assume a comfortable position (Joris et al., 2007). The temperature of the environment is also regulated.
Rationale
Assessment and ranking of pain help in differentiation of the causes of pain and hence avail relevant information on progressions of disease, possible complication, and effectiveness of other measures of intervention put in place. Severe pain, for instance, indicates the development of further complications (Joris et al., 2007). Bed rest in low-Fowler’s position decreases intra-abdominal pressure. However, a patient is always let to assume the position with the least pain. Control the environmental conditions helps in the reduction of itchiness and skin dryness. Further, it limits dermal discomfort experienced by the patient.
Other than these independent pain management measures, collaborative measures include maintenance of status and insertion/maintenance of NG suction. Additionally, pain management drugs are administered as indicated. Such drugs include Anticholinergics like atropine and propantheline (Pro-Banthı-one) as well as sedatives like Phenobarbital. Narcotics are also administered including meperidine hydrochloride (Demerol) and morphine sulfate. Other drugs include Smooth muscle relaxants, for instance, papaverine (Pavabid) and amyl nitrite. Antibiotics are also administered.
Rationale
While anti-biotic are meant to eliminate infections and hence inflammation, most of the mentioned drugs are meant to directly relieve the patient from pain.
Nursing Diagnosis 2: Breathing pattern
This is often associated with pain, muscular impairment, reduced levels of
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