A. Definition
Cholecystitis is inflammation of the gallbladder is an acute inflammatory gallbladder wall with upper right abdominal pain, tenderness and heatbody. Are two classifications namely acute and chronic ( Brooker , 2001).
Acute cholecystitis is inflammation of the gallbladder wall, usually is the result of the presence of gallstones in the cystic duct, which issudden attack causing tremendous pain.
Chronic cholecystitis is a chronic inflammation of the gallbladder wall, which is characterized by recurrent attacks of abdominal pain and severe sharp.
Cholesistektomy is the surgical removal of the gall bladder (usually forrelief of gallstone pain).
B. Etiology
Approximately 95 % of patients with acute gallbladder inflammation, have gallstones. Sometimes a bacterial infection causes inflammation. Acute cholecystitis without stones is a serious illness and tendarise after the occurrence of :
-injury
-surgery
-burn
-sepsis ( infection that spreads throughout the body
-severe diseases ( especially people who receive food throughinfusion in the long term ).
Before secsara suddenly felt a tremendous pain in the abdomenabove, patients usually do not show signs of gallbladder disease. Chronic cholecystitis caused by recurrent attacks of acute cholecystitis, that causes thickening of the gallbladder wall and shrinkageempedu. On bladder finally gallbladder bile is not able to accommodate. The disease is more common in women and increase the number of eventsat the age above 40 years. Risk factor is a history of chronic cholecystitisprevious acute cholecystitis.
C. Pathophysiology
The gall bladder has a function as a place to store bile andconcentrate the bile fluid in it by way of absorbing water andelectrolyte. Bile is a liquid produced by the cell electrolyteliver. In normal individuals, bile flows into the gallbladder at the time of Oddi valve closed. In the gallbladder, bile is concentrated by absorb water. Degrees shown by the increase in concentration solids. Stasis of bile in the gallbladder may lead to progressive supersaturation and precipitation changes in the chemical composition of these elements. Metabolic changes caused by changes in the composition of bile, stasisbile, can cause infection of the gallbladder.
D. Symptom
The onset of symptoms can be triggered by eating fatty foods.
Symptoms can include :
- Early signs of inflammation of the gallbladder is usually a pain in the right abdomen top.
- Pain is intensified when the patient breathe deeply and often spread to right shoulder
- Usually there is nausea and vomiting
- Abdominal tenderness
- In a few hours , the abdominal muscles become stiff right hand .
- At first, mild fever, which is the longer tends to rise .
- The attack reduced pain within 2-3 days and then disappear within 1 week .
- Chronic digestive disorders
- Abdominal pain is not clear ( vague )
- Belching .
E. Complication
High fever, chills, increased leukocyte count and cessation of movement intestine ( ileus ) may indicate the occurrence of abscesses, gangrene or perforation of the bladder bile. Attack with jaundice ( jaundice ) or backflow of bile into in the liver showed that the bile duct was blocked partially by stone bile or by inflammation. If blood tests show elevated levels of the enzyme amylase, may there has been inflammation of the pancreas ( pancreatitis ) caused by blockage bile duct stones in the pancreas ( pancreatic duct ).
F. Investigations
- CT scan of the abdomen
- Oral Kolesistogram
- Abdominal ultrasound .
- Blood tests ( looking for elevated white blood cells)
G. Medical Management
- The usual treatment is surgery .
- Cholecystectomy surgery can be done through the abdomen or throughlaparoscopy .
- Patients who have a high surgical risk due to other medical conditions, recommended for low-fat diet and lose weight.
- Can be given antacids and anticholinergic drugs.
H. Nursing Management
-Assessment Assessment is the first step in the process and basic nursing thorough ( Boedihartono , 1994).
Post operative patient assessment ( Doenges , 1999) are included:
1 ) . Circulation Symptoms : a history of heart problems, GJK, pulmonary edema, vascular disease peripheral or vascular stasis ( increased risk of formation thrombus ).
2 ) . ego integrity Symptoms : feelings of anxiety , fear , anger , apathy ; stress factor multiple , such as financial , relationship , lifestyle .Mark : can not break , increasing tension / sensitive excitatory ;sympathetic stimulation .
3 ) . Food / fluid Symptoms : pancreatic insufficiency / DM , ( predisposition to hypoglycemia /ketoacidosis ), malnutrition ( including obesity ) ; mucous membranedry ( restriction intake / preoperative fasting period
4 ) . breathing Symptoms : infection , chronic conditions / cough , smoking .
5 ) . security Symptoms : allergic / sensitive to medications , foods , plasters , and solutions ; Immune deficiency ( risk of systemic infection and delay shealing ) ; emergence of cancer / latest cancer therapies ; History family of malignant hyperthermia reaction / anesthesia ; Historyhepatic disease ( effect of detoxification of drugs and canchange coagulation ) ; history of blood transfusion / transfusion reactions .Signs : infection exhausting process ; fever.
6 ) . Counseling / Learning Symptoms : anticoagulation , steroids , antibiotics , antihypertensives ,cardiotonic glokosid , antidisritmia , bronchodilator , diuretic ,decongestants , analgesics , anti-inflammatory , anticonvulsant or tranquilizers and also the-counter medicines or drugs recreational. Alcohol use ( risk of kidney damage ,affecting coagulation and anesthesia options , and also potential for postoperative withdrawal ) .
I. Nursing Diagnoses
that appear in patients post Operative include :
1. Breathing pattern , ineffective related to neuromuscular , imbalanceperceptual / cognitive , increased lung expansion , tracheobronchial obstruction .
2. Changes in thought processes associated with chemical changes such as the use of pharmaceutical drugs , hypoxia ; limited therapeutic environment for example excessive sensory stimuli ; physiological stress.
3. Fluid volume deficiency , associated with a high risk of restrictions oral fluid intake , loss of body fluids is not normal , blood vessel integrity expenditures .4 . Acute pain associated with disorders of the skin , tissue and integrittas muscle , trauma muskuloskletal , appearance and hose lines ( Doenges , 1999) .
J. Intervention and Implementation
Intervention is planning nursing actions that will be implemented to tackle the problem in accordance with the nursing diagnoses ( Boedihartono ,1994). Implementation is the realization of the plan of management and nursing have been prepared at the planning stage ( Effendi , 1995). Nursing interventions in post- operative patients ( Doenges , 1999) include :
- DP 1 :Goals : establish a normal breathing pattern / effective and free of cyanosis or other signs of hypoxia. Expected outcomes : no change in the frequency and depth of breathing .
- Maintain patient's airway by tilting the head , jaw hyperextension ,oral pharyngeal airflow
R : prevent airway obstruction .
- Auscultation of breath sounds . Listen to the presence / absence of breath sounds .
R : lack of breath sounds is an indication of obstruction by mucus orthe tongue and can be addressed by changing the position or suction .
- Observation of the frequency and depth of breathing , use of auxiliary musclesbreathing , chest expansion , retraction or nostril breathing ,skin color , and the air flow
R : is done to ensure that the effectiveness of respiratory effortsegerra can be done to fix it
- Place the patient in the appropriate position , depending on the power of breathingand type of surgery
R : elevation head and tilted position will prevent the occurrence of aaspirasivomiting , the correct position will encourage ventilation on lung lobe sectionsdown and reduce pressure on the diaphragm
- motion exercises as soon as possible in patients with reactive and continuein the postoperative period
R : active ventilation opening in the alveoli , issued secretion ,increase oxygen transport , dispose of anesthetic gases ; cough assistissued secretion of the respiratory system
- Perform suctioning if necessary
R : airway obstruction may occur due to the presence of blood or mucus inthroat or trachea
- Collaboration , giving oxygen as needed
R : is done to improve or maximize the uptake of oxygenwill be bound by the hemoglobin in the place of anesthetic gases and encourageterssebut gas expenses substances through inhalation
- DP 2 :Goals : increasing the level of awareness. Outcomes: the patient is able to recognize one's limitations and seek sourcesassistance as needed.
- Orient the patient continuously back after being out of the influenceanesthesia ; stated that the operation had been completed
R : because patients have increased awareness , support and guarantee it willhelp eliminate anxiety
- Talk in patients with jelaas and normal voice without yelling , consciousfull of what was said
R : can not be determined when the patient fully conscious , but sensoryhearing is the first time the ability to recover
- Evaluation of sensation / movement of the extremities and the corresponding trachea
R : return of function after spinal nerve block or localdepends on the type or amount of drug used and the duration of the procedureperformed
- Use the pads on the edge of the bed, do binding if necessary
R : provide security for the patient during the emergency phase , preventinginjury to the head and extremities when patients take the fight forperiod of disorientation
- Test the infusion , endotracheal tube , catheter , when installed and make surekepatenannya
R : in patients who experienced disorientation may occur damthe infusion flow system and other expenses , regardless , or kinked
- Maintain a calm and comfortable environment
R : external stimulus may cause abrasion psychic when it occursdissociative anesthetic drugs that have been given
- DP 3 :Objectives : adequate fluid balance .Criteria results : no no signs of dehydration ( stable vital signs ,good pulse quality , normal skin turgor , mucous membranesmoist and corresponding expenditures urine )
- Measure and record income and expenditure . Review the operation of intra records .
R : Accurate documentation will help in identifying expenditureliquid / replacement requirements and the choices that affectintervention .
- Assess urinary spending , especially for the type of surgical procedure performed .
R : may be a decrease or elimination of the procedures setelahaor genitourinary system and adjacent structures indicatemalfunction or obstruction of the urinary system .
- Monitor vital signs .
R : hypotension , tachycardia , increased breathing indicates lacklack of fluids .
- Place the patient in the appropriate position , depending on the power of breathingand type of surgery .
R : elevation head and tilted position will prevent the occurrence of aaspirasivomiting , the correct position will encourage ventilation on lung lobe sectionsdown and reduce pressure on the diaphragm.
- Check pads , appliance drain at regular intervals . Assess the wound for theswelling .
R : excessive bleeding can refer to hypovolemia / hemorrhage .
- Monitor the temperature of the skin , palpation of peripheral pulses .
R : skin cold / damp , weak pulse indicates a decreaseperipheral circulation and extra fluid needed for replacement .
- Collaboration , give parenteral fluids , blood products and plasma expanders oras directed . Increase speed IV if large is .
R : replace fluid losses have been documented . Record timepenggangtian circulation volume potential for the reduction of complications ,such imbalances
Intervention
- Evaluation regular seccara pain , note the characteristics , location andintensiitas ( 0-10 ) .
R : provide information about the need / effectiveness of the intervention .
- Note the emergence of anxiety / fear and connect with the environment and preparationfor the procedure .
R : consider the things that are unknown and / or inadequate preparationapendikstomi eg emergency ) can worsen the patient's perception would tastesick .
- Assess vital signs , note tachycardia , hypertension and increasedbreathing , even if the patient denied any pain .
R : can indicate acute pain and discomfort .
- Provide information on the nature of discomfort , as needed .
R : understand the cause of discomfort , provide emotional security .
- Do repositioning as directed , such as semi - Fowler ; skewed .
R : may reduce pain and improve circulation . Position semi -Fowler can reduce abdominal muscle tension and muscle pungguungarthritis , while reducing pressure dorsal oblique .
- Observation of analgesic effect .
R : respiration may be decreased in the administration of narcotics , and may causesynergistic effects with anesthetic agents .
- Collaboration , IV administration of analgesics as needed .
R : IV analgesic with pain by immediately reach the center , raisesbusting drug is more effective in small doses .
R : Accurate documentation will help in identifying expenditureliquid / replacement requirements and the choices that affectintervention .
- Assess urinary spending , especially for the type of surgical procedure performed .
R : may be a decrease or elimination of the procedures setelahaor genitourinary system and adjacent structures indicatemalfunction or obstruction of the urinary system .
- Monitor vital signs .
R : hypotension , tachycardia , increased breathing indicates lacklack of fluids .
- Place the patient in the appropriate position , depending on the power of breathingand type of surgery .
R : elevation head and tilted position will prevent the occurrence of aaspirasivomiting , the correct position will encourage ventilation on lung lobe sectionsdown and reduce pressure on the diaphragm.
- Check pads , appliance drain at regular intervals . Assess the wound for theswelling .
R : excessive bleeding can refer to hypovolemia / hemorrhage .
- Monitor the temperature of the skin , palpation of peripheral pulses .
R : skin cold / damp , weak pulse indicates a decreaseperipheral circulation and extra fluid needed for replacement .
- Collaboration , give parenteral fluids , blood products and plasma expanders oras directed . Increase speed IV if large is .
R : replace fluid losses have been documented . Record timepenggangtian circulation volume potential for the reduction of complications ,such imbalances
- DP 4 :Purpose: The patient said that the pain has been controlled or missing .Outcomes: the patient seemed to relax , to rest / sleep and domovement which means the corresponding tolerance .
Intervention
- Evaluation regular seccara pain , note the characteristics , location andintensiitas ( 0-10 ) .
R : provide information about the need / effectiveness of the intervention .
- Note the emergence of anxiety / fear and connect with the environment and preparationfor the procedure .
R : consider the things that are unknown and / or inadequate preparationapendikstomi eg emergency ) can worsen the patient's perception would tastesick .
- Assess vital signs , note tachycardia , hypertension and increasedbreathing , even if the patient denied any pain .
R : can indicate acute pain and discomfort .
- Provide information on the nature of discomfort , as needed .
R : understand the cause of discomfort , provide emotional security .
- Do repositioning as directed , such as semi - Fowler ; skewed .
R : may reduce pain and improve circulation . Position semi -Fowler can reduce abdominal muscle tension and muscle pungguungarthritis , while reducing pressure dorsal oblique .
- Observation of analgesic effect .
R : respiration may be decreased in the administration of narcotics , and may causesynergistic effects with anesthetic agents .
- Collaboration , IV administration of analgesics as needed .
R : IV analgesic with pain by immediately reach the center , raisesbusting drug is more effective in small doses .
J. Evaluation Evaluation is the stage at which the level of success of the nursing process in achievement of nursing assessed and the need to modify the destination or a nursing intervention defined ( Brooker , 2001)
Evaluation of the expected post- operative patients included :
1 . Establish a normal breathing pattern / effective and free of cyanosis or other signs of hypoxia .
2 . Increase the level of awareness .
3 . Adequate body fluid balance .
4 . The patient said that the pain has been controlled or missing .
REFERENCES
Brooker, Christine. 2001. Kamus Saku Keperawatan. Jakarta : EGC.
http://arifs45.multiply.com/journal/item/8
http://kamus.landak.com/cari/cholecystectomy
http://www.mamashealth.com/stomach/cholecy.asp
http://www.medicastore.com/index.php?mod=penyakit&id=607
http://www.medicastore.com/index.php?mod=penyakit&id=608
Sloane, Ethel. 2004. Anatomi dan Fisiologi Untuk Pemula, Edisi I. Jakarta : EGC.
Syaifudin, H, B.Ac, Drs. 1997. Anatomi Fisiologi Untuk Siswa Perawat, Edisi 2.
Jakarta: EGC.
Evaluation of the expected post- operative patients included :
1 . Establish a normal breathing pattern / effective and free of cyanosis or other signs of hypoxia .
2 . Increase the level of awareness .
3 . Adequate body fluid balance .
4 . The patient said that the pain has been controlled or missing .
REFERENCES
Brooker, Christine. 2001. Kamus Saku Keperawatan. Jakarta : EGC.
http://arifs45.multiply.com/journal/item/8
http://kamus.landak.com/cari/cholecystectomy
http://www.mamashealth.com/stomach/cholecy.asp
http://www.medicastore.com/index.php?mod=penyakit&id=607
http://www.medicastore.com/index.php?mod=penyakit&id=608
Sloane, Ethel. 2004. Anatomi dan Fisiologi Untuk Pemula, Edisi I. Jakarta : EGC.
Syaifudin, H, B.Ac, Drs. 1997. Anatomi Fisiologi Untuk Siswa Perawat, Edisi 2.
Jakarta: EGC.
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4 komentar:
Hi,
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wow. that is a very good and extensive overview of this health condition
Nice post. Well what can I say is that these is an interesting and very informative topic on abdominal health
Thank you for the deep knowledge about cholecistitys and functioning its worth to read it . For the best treatment of cholecystectomy visit best Gall Bladder Hospital in Ludhiana .
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