Mrs Lopez is a 45year-old Hispanic woman who has been suffering from severe abdominal pain.
In the past 2 weeks, she has experienced increasing intensity and abdominal pain.
There is no history of abdominal problems in her family.
Mrs Lopez stated that she has nausea, vomiting and pain radiating from her right shoulder. She also experiences sweating and chills.
When she was asked about her life, she stated that her diet consisted of regular take-out with an intolerance for fatty foods and little exercise.
Mrs Lopez is experiencing mild abdominal pain.
She is febrile at 38.2 Celsius. Her blood pressure reads 126/72mmHg. Mrs Lopez also has a regular pulse and respiration rate of 22 breathes/min. While breathing room air, her oxygen saturation is 97%.
Mrs Lopez wants to be admitted to the surgical unit for observation, medication control and surgery.
Mrs Lopez feels anxious and guilty about her current lifestyle.
Mrs Lopez will need to have a laparoscopic procedure for cholecystectomy.1.
Health Promotion and Risk Factors. Which factors are modifiable?
Mrs Lopez seeks assistance about her modifiable factors.
Outline the way you would approach Mrs Lopez about these and what referrals and health information you would provide.2.
Pathophysiology. Describe in your own words (just like you would explain it to a loved one) the pathophysiology that causes acute cholecystitis.3.
Homeostatic Mechanisms. This is a nursing assessment that will outline the homeostatic factors that Mrs Lopez experiences.
*Referred shoulder pain*nausea and vomiting*fever4.
Nursing Care Outline the nursing treatment required for Mrs Lopez, focusing on her initial presenting symptoms.5.
Activities of Daily Living. Consider the 12 (12) activities of everyday living outlined within the Roper Logan & Tierney Model of Nursing. Specifically, discuss which of the activities of Mrs Lopez’s daily life may be influenced/alternated post-operatively.
The registered nurse could help the patient to manage these activities.
Answer to Question: NMIH202 Developing Nursing Practice 1
Gall bladder, an organ located under the liver, stores bile.
Gall bladder disorder called acute cholecystitis.
If bile juice becomes trapped in the gall bladder, this condition can occur.
This can lead to gall bladder inflammation and pain (Barie, Eachempati (2015)
It can get severe, and it is often necessary to seek medical attention.
Acute Cholecysitis is a Risk Factor
A risk component is any property or trademark that may increase the possibility of harming someone or causing them to become malady.
Gallstones, which are most commonly associated with severe cholecystitis, are by far the most well-known. (Barie and Eachempati 2015).
Gallstones can lead to bile in the gallbladder.
Another reason for intense cholecystitis is a serious condition or tumor.
These are however rare.
This condition is considered to be incessant if cholecystitis attacks continue or are prolonged.
Gallstones develop more often in females that in males.
Intensive cholecystitis may also be more likely in these women.
Both in males as well as females, risk factors are based on age.
Individuals with Scandinavian, Native American or Hispanic heritage are at increased risk (Sippey et. al. 2015).
There are two types available for risk variables. They can be modifiable (or non-modifiable) elements.
Modifiable components can be altered and traded. However, non-modifiable component’s cannot have any extension for change.
Because of intense cholelithiasis (Treinen and al. 2014).
Gallstones can be advanced by hereditary weakness. This is why family ponders indicate a recurrence rate very close to 5 times that of the average gallstone. There is also a high risk of gallstones developing in relatives.
Experts conducted a review on more than 43,000 twins suffering from gallstones. The majority of cases had vesicular symptomatic and hereditary issues. Only 13% of cases had natural effects.
The gallstones phenomenon is an example of the perplexing interaction between hereditary qualities and the environment, especially the quality of the eating habits.
The risk of developing LV is also a factor.
The likelihood of gallstones recurring increases with age, particularly after 40.
Mrs. Lopez has the ability to change her diet, from eating take-out fatty foods, to a normal balanced home-made diet. Her diet must have the right balance of nutrients, fatty acids and carbohydrates.
Mrs. Lopez should exercise regularly, such as jogging and aerobics, to help dissolve excess fat.
Due to acute cholecystitis she needs good sleep.Pathophysiology Of Cholecystitis:
Cholecystitis can be aggravation of your gallbladder. It is caused most often by a disincentive of cystic pipes by gallstones that have emerged from your gallbladder (cholelithiasis).
Edematous, or first-stage, cholecystitis (2-4 day): The gallbladder contains interstitial fluid that has widened vessels.
The gallbladder divide is oedematous.
Histologically speaking, the gallbladder tissue is in place. There is oedema within the sublayer (Haas, et. al. 2016).
Second stage of Necrotizing Cholecystitis (3-5 day): The gallbladder contains oedematous, varying levels of discharge, and corruption.
The blood stream becomes obstructed when the gallbladder divide is raised to its maximum weight. There is histological confirmation that there is vascular obstruction and thrombosis.
There are several types of scattered mold, but it is usually not as severe as the thickness of the gallbladder divider.
Third stage, suppurative, cholecystitis (7-10 Days): The gallbladder separator has white plaquelets, with regions that are putrefaction or suppuration.
At this stage, aggravation dynamic repair is evident.
The developed gallbladder contracts and the divider thickens due to sinewy extension.
The intra-wall abscesses can be found and cover the entire thickness.
The stage of the pericholecystic is also available (de Mestral, et al. 2014).
Chronic cholecystitis (chronic cholecystitis) is an autoimmune condition that occurs following the abrupt event of cholecystitis. It’s characterized by mucosal destruction and fibrosis.
Chronic cholecystitis can also be caused when there is an inexorable aggravation due to large gallstones.
Also, there is an extreme cholecystitis.
There are four main types of intensecholecystitis.
This can lead to bile leakage into the gallbladder-divider.
Histocytes consume the bile. This results in granulomas composed of frothy mytocytes.
Most patients have side effects from intense cholecystitis at the underlying stage.
(3) Emphysematous and chronic cholecystitis. This is when air builds up in the gallbladder wall due to contamination with gas framing anaerobes (including Clostridium perfringens).
This form is more likely to develop into sepsis and then gangrenous, as it is common in diabetic patients.
(4) Torsion of gallbladder.
The gallbladder may be subject to torsions due to intrinsic, external, and other physical reasons.
An intrinsic variable can be a glide gallbladder. It is extremely portable because the gallbladder as well as cystic pipes are connected with the liver through a melded tendency (Eachempati, et al. 2014).
Some of the gained elements are splanchnoptosis (decrepit humpback), scoliosis, weight reduction, and splanchnoptosis.
Torsion of the gallbladder may be caused by sudden changes, including intraperitoneal and body weight changes, sudden changes in body positions, a pendulum-like shift in the position or anteflexion, hyperperistalsis at the gallbladder, poop, stomach injury, and other physical elements.
Homeostasis, which is the body system mechanism that establishes a state equilibrium between different interdependent elements as a result of metabolic and physiological process can be described as “homeostasis”.
There are many instances of homeostasis within the human body. These include thermoregulation, pH maintenance and salinity, water level and pressure.
The purpose of homeostasis in the human body is to protect the body’s internal mechanisms from external influences.
However, there are some clinical symptoms that are related to homeostasis. For example, in this case study, the significant effect of homeostasis is on the symptoms the patient has.
The various ionic channel types that regulate pain sensations in our bodies are important. In particular, K+ channels play a key role in neuronal excitation.
Inflammation is the first line response of the human body to any cellular abnormality. Any inflammation alters K+ channel function in the nerve system associated with the pain pathway.
Chronic pain can be associated with abnormalities in the somatosensory pathway of the body. Abnormal K+ concentrations in the can hyperexcite the neurones, causing unbearable pain sensation.
Homeostatic mechanisms are responsible for maintaining balance in the body. They also control the action potential firing in neurons to preserve functionality (Stinton, Shaffer 2012).
Homeostatic regulation allows a neurone, when it receives a large input, to decrease its excitability.
This regulation mechanism targets intrinsic excitability to stabilize the neural network. It regulates the K+ channel flux and influx.
When homeostatic regulation fails in monitoring K+ influx within the cell, the neuronal tissues hyperexcite and pain sensation is created.
Insulin influx by the body can impact the K+ concentrations. In this case, the patient’s diet has caused insulin mediated K+ overflow and interfered in homeostatic regulation. 2012).Nausea And Vomiting:
Another physiological function that is controlled by homeostatic regulation are the blood sugar levels in the body.
The blood glucose levels are monitored by the pancreas through a specific glucose receptor. An antagonistic action between hormones, insulin or glucagon is produced by the alpha- and beta cells of the islets.
The insulin function is to convert glucose from bloodstream into metabolic or physiological functions such respiration. While glucagon helps prevent hyperglycaemia, it stimulates glycogenolysis which causes the body to stop utilizing excess glucose. 2012).
An oily diet can affect the homeostatic equilibrium and cause hyperglycaemia.
As symptoms, low glucose concentrations can cause nausea or vomiting.Fever:
The homeostatic regulation of the human body’s temperature is the most important. The hypothalamus is the thermoregulatory centre. This regulates the temperature to ensure that the body functions at its best. 2012).
Multiple signals can be sent to the body by thermoregulatory sensors that adjust the body’s temperature.
When there is a cellular malfunction, the body sends an electrical stimulus to its regulatory centre at the hypothalamus. This then in turn sends signals through the skin to the receptors and generates heat. 2011).
Nursing Care Plan
The case study involves a patient with acute cholelithiasis. This is an inflammation in the gall bladder that leads to gall stones. (Smeltzer et. al. 2010).Symptoms:
These are some of her symptoms
Moderate abdominal discomfort
Blood pressure at 126/72
22 Breaths per Minute Respiratory Rate97% oxygen saturation.Diagnostic Needs:
The following are her diagnostic requirements
Abdominal Xrays are used to diagnose gallstones and determine the reason for the pain.
The presence of gallstones can be detected by biliary ultrasonography
Oral cholecystography detects general function and appearance in the gall bladder.Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography to differentiate the gall bladder issue with the patient (Smeltzer et al. 2010).
Priorities for Patient Care
The patient is experiencing high fever and moderate abdominal discomfort.
The patient is in need of immediate care.
Forcing pain management at its best
The patient’s resting place
Maintaining fluid, electrolyte and other balances in the patient.
Include details about the severity and extent of her condition.
Discuss the treatment plans with her
Tell her all about the cholecystectomy she will need.
Halabi et.al. 2014).
In the case of any patient, the nursing intervention must be focused on the patients’ care priorities.
Mrs. Lopez needs nursing interventions that minimize her anxiety and pain.
Before and after administering pain medication, pain assessment should be done.
In order to manage pain, it’s also important to alter the patient’s posture so that they are in a low Fowler’s pose (Halabi and al.
2014). Nursing is responsible for administering intravenous fluids.
A nurse should also incorporate non-pharmocological pain relief techniques.
A nurse should also be able to evaluate vital signs, such as temperature, blood pressure, and rest time in every hour (Lirici 2010).
The last steps of the nursing plans should include preparing the patient to undergo surgery and recording her vitals. They also need to address post-surgery pain management, administration of analgesia, assessment of the patient’s mental and cognitive stability, and preparation of discharge goals (Lirici, Califano 2010, Califano, 2010).
What are the goals for discharge?
The patient’s discharge goals should include pain relief.
Before the patient is discharged, she should feel relief from pain.
All medical complications must be eliminated and the patient must fully understand the health promotion program (Warttig Ward & Rogers 2014).
Activities for daily living
Lifestyle choices are a major factor in health. Better living comes with some sacrifices.
A strict, healthy daily schedule can speed up recovery (Warttig Ward and Rogers 2014.
Health care professionals agree that a daily life plan is necessary for patients who have special needs. This will help speed up recovery and promote healthy living.
There are many comprehensive nursing models that help in the formulation of such specific regimens. Roper Logan Tierney model is one example (Patton 2013).
This model is composed of 12 units that provide activities of living to encourage independence and empowerment. It also serves as a catalyst for faster recovery (Dunnion, Griffin 2010).
These activities have been designed with the goal of achieving independence in areas that are difficult to reach.
It encourages participation and engagement of patients in activities. This allows them to have control over their recovery and reduces restrictions caused by their medical conditions.
It increases the mental stress and encourages optimism among patients about their health and recovery (Cutcliffe McKenna and Hyrkas, 2010).
A patient who has had to undergo critical surgery may find it helpful to receive instructions on daily living.
Mrs Lopez, the patient in this example, was suffering with cholethiasis. In order to recover, she needed laparoscopic surgery for cholecystectomy.
Her lifestyle was poor and she ate takeout every day. It is important that she makes changes to ensure a healthy lifestyle.
These are some of the basic daily activities she can engage in.
The patient needs to be in a safe environment where there is no risk of injury to her incision area.
She should ensure that her children are away from her, and that her activities don’t threaten the opening of her wounds (Elsherif und Noble 2011).
The patient must have a way to contact the assigned registered nurses at any time.
She must follow a strict diet plan that incorporates more fibre and eliminates sugary and oily food items.
Liquid diet should be observed in the initial days. A registered nurse must inform the patient in detail about the patient’s dietary plan.
Also, she must adhere to the rules regarding bathing. She should not wash the incisions. The dressing should be changed regularly.
Alligood 2014 – The patient must be accompanied by a registered nurse who will set up regular check-ups.
If the patient experiences high fever, the registered nurse should inform her about the best ways to maintain it.
The registered nurse assigned should converse with the patient about her progress, and any difficulties she may have in following these regulations (Elsherif-Nicholson 2011).Conclusion:
This lifestyle is all about running, chase, and taking all the time one has to spend on themselves.
She made poor life choices and was negligent about the consequences. This has had a profound impact on her health.
However, Mrs Lopez isn’t the only one making wrong decisions.
It is a common problem for the majority of the tech-savvy generations of today.
However, this generation may find it beneficial to consider the new age frameworks for healthy living.References:Alligood, M.R., 2014.
The work of nursing theorists. Elsevier Health Sciences.Barie, P.S.
Barie (P.S.) and Eachempati (S.R.), 2015.
Cholecystitis acalculous acute. In Acute Cholecystitis (pp. 187-196).
Springer International Publishing.Brown, L.M., Rogers, S.J., Cello, J.P., Brasel, K.J.
The cost-effective treatment of patients suffering from symptomatic or common bile stone disease and symptomatic Cholelithiasis.
Journal of the American College of Surgeons. 226(6). pp.1049-1060.
Cutcliffe J.R. McKenna H. & Hyrkas K. 2010.
Nursing models: How they can be applied to practice.
de Mestral C. Rotstein O.D. Laupacis A. Hoch J.S. Zagorski B. Alali A.S. Nathens A.B.
Comparative operative results of delayed and early cholecystectomy to acute cholecystitis.
Annals Of Surgery, 259(1). pp.10-15.Dunnion, M.E.
Emergency department care planning. International emergency nursing, 18(2), pp.67-75.Eachempati, S.R.
Reed, L. eds., 2015.
Springer International Publishing.
Eachempati S.R.. Cocanour C.S. Dultz L.A. Phatak U.R. Albarado R. Todd S.R.
Acute Cholecystitis in the Sick Patient.
Current problems in surgical, 51(11), P.441-466.
Elsherif M. and Noble H. 2011.
Management of COPD using Roper–Logan–Tierney.
British Journal of Nursing. 20(1). p. 29.
Haas I., Lahat E., Griton Y., Shmulevsky P., Shichman S., Elad G., Kammar C., Yaslovich O., Kendror S., Ben-Ari A. & Paran H. (2016)
Prospective study: Percutaneous aspiration to the gall bladder in the treatment of acute Cholecystitis. Surgical endoscopy, 30(5), pp.1948-1951.Halabi, W.J., Kang, C.Y., Ketana, N., Lafaro, K.J., Nguyen, V.Q., Stamos, M.J., Imagawa, D.K.
The national trends and outcomes of gallstone ileus surgery.
Annals Of Surgery, 259(2). P. 329-335.
Koller T., Kollerova J. Hlavaty T., Huorka M., and Payer J., 2012.
Cholelithiasis, markers of nonalcoholic liver disease, and metabolic risk factors in patients with metabolic risk factors.
Scandinavian journal, 47(2), pages 197-203.Lirici, M.M.
Califano A., 2010.
An alternative approach to complicated cholecystectomies for managing complex gallstones
Minimally Invasive Therapy & Allied Technologies 19, pp.304-315.
Othman M.O. Stone E. Hashimi M. Parasher G. 2012
The recurrent symptoms of cholelithiasis, and its complications during pregnancy, can be caused by conservative treatment. This leads to more emergency department visits. Gastrointestinal endoscopy, 76(3), pp.564-569.Patton, D., 2013.
Strategic direction or operational confusion: The level of service users’ involvement in Irish acute unit care.
Journal of mental and psychiatric Nursing, 20(5), pp.387-395.Sippey, M., Grzybowski, M., Manwaring, M.L., Kasten, K.R., Chapman, W.H., Pofahl, W.E., Pories, W.J.
Acute cholecystitis. Risk factors that could lead to open surgery.
Journal of Surgical Research 199(2) pp.357-361.Smeltzer, S.C.C., Bare, B.G., Hinkle, J.L.
Cheever K.H. eds., 2010.
Brunner & Suddarth’s textbook of medical and surgical nursing (Vol. 1). Lippincott Williams & Wilkins.Stinton, L.M.
Shaffer E.A., 2012
Epidemiology in gallbladder disease: Cholelithiasis or cancer.
Gut Liver (6(2)), pp.172-187.Treinen, C., Lomelin, D., Krause, C., Goede, M. and Oleynikov, D., 2015.
Acute acalculous and cholecystitis of the critically ill: Risk factors and surgical options.
Langenbeck’s Archives of Surgery, 400(4): pp.421-427.
Ward, S. Warttig, and Rogers G.
NICE guidance summarizes the diagnosis and treatment of gallstone disease.
BMJ (British Medical Journal) Online, 349.