Nursing Diagnosis

5 most common diagnosis for gallstone

• Acute pain related to surgical procedure  as evidenced by gallstone 
• Risk for imbalance nutrient relate to inability to eat very well
• Risk for fluid deficit related to vomiting and diarrhea
• Ineffective self-health management related to lack of postoperative management 
• knowledge deficits related to information misinterpretation as evidenced by incorrect follow of instruction.

Actual or potential diagnosis	Nursing intervention	outcome
Acute pain related to surgery as evidenced by gallstone removal	Observation and documentation of pain location, severity (0–10 scale), duration of pain and character of pain (steady, intermittent, colicky).	To be able to identify the best treatment appropriate for patient.
	Record response to medication and other treatment. Monitor side effects of medication.	Understanding more about the patient reaction to medication. To ensure pain is properly managed. To prevent complication and reduce pain.
	Promote bed rest and comfortable position.	Patient assumes position that care is comfortable.

Reference 

Nurselabs (2013). 4 Cholecystitis (Cholelithiasis) Nursing Care Plans. Retrieved from http://nurseslabs.com/4-cholecystitis-cholelithiasis-nursing-care-plans/ 

Nursing care for gallstone

Nursing Interventions	Rationale
Monitor for signs and symptoms of increased or continued nausea or vomiting, abdominal cramps, weakness, twitching, irregular heart rate, paresthesia, hypoactive or absent bowel sounds, depressed respirations.	Prolonged vomiting, gastric aspiration, and restricted oral intake can lead to deficits in sodium, potassium, and chloride.
Eliminate noxious sights or smells from environment.	Reduces stimulation of vomiting center.
Perform frequent oral hygiene with alcohol-free mouthwash; apply lubricants.	Decreases dryness of oral mucous membranes; reduces risk of oral bleeding.
Keep patient NPO as necessary.	Decreases GI secretions and motility.
Promote bedrest, allowing patient to assume position of comfort.	Bedrest in low-Fowler’s position reduces intra-abdominal pressure; however, patient will naturally assume least painful position.
Note response to medication, and report to physician if pain is not being relieved.	Severe pain not relieved by routine measures may indicate developing complications or need for further intervention.
Ambulate and increase activity as tolerated.	Helpful in expulsion of flatus, reduction of abdominal distension. Contributes to overall recovery and sense of well-being and decreases possibility of secondary problems related to immobility (pneumonia, thrombophlebitis).
Consult with dietitian or nutritional support team as indicated.	Useful in establishing individual nutritional needs and most appropriate route.
Advance diet as tolerated, usually low-fat, and high-fiber. Restrict gas-producing foods (onions, cabbage, popcorn) and foods or fluids high in fats (butter, fried foods, nuts).	Meets nutritional requirements while minimizing stimulation of the gallbladder.
Monitor laboratory studies: BUN, prealbumin, albumin, total protein, transferrin levels.	Provides information about nutritional deficits or effectiveness of therapy.
Explain reasons for test procedures and preparations as needed.	Information can decrease anxiety, thereby reducing sympathetic stimulation.
Review disease process and prognosis. Discuss hospitalization and prospective treatment as indicated. Encourage questions, expression of concern.	Provides knowledge base from which patient can make informed choices. Effective communication and support at this time can diminish anxiety and promote healing.

Work Cited 

Image: https://s-media-cache-ak0.pinimg.com/236x/e0/5d/41/e05d417cbf7e56a690f67353bacc80cb.jpg
Image: http://cmapspublic3.ihmc.us/rid=1259597328252_629506399_32843/Cholecystitis.cmap?rid=1259597328252_629506399_32843&partName=htmljpeg
Nursing intervention and Rational from Nurseslabs 4 Cholecystitis (Cholelithiasis) nursing Care Plans http://nurseslabs.com/4-cholecystitis-cholelithiasis-nursing-care-plans/

Treatment of Gallstones

Gallstones that are symptomatic requires treatments.

• Surgery: surgical removal of the gall bladder is usually the first line of treatment because the providers feels that it is safe and has limited side effects. The only side effects know with cholecystectomy (surgical removal of the gallbladder) is diarrhea. The diarrhea occurs after consumption of foods that contains fat. The diarrhea resolves with time because liver adjust to digesting fats. 
•  Nutritional Therapy: In some cases the patient might want conservative nutrition therapy. which is avoiding foods that contains fats that could trigger the gallstones symptoms. Most physicians don’t usually recommend conservative treatment because is not very effective and people can feel deprived when told that they cannot consume fatty foods at all. Nutrition therapy can also be used post-surgery by advising patient to limit their fat intake in order to avoid diarrhea. The only side effects is difficulty adhering to the diet restrictions.
•  Bile Catheter: Transhepatic bile catheter is sometimes inserted into the patient gallbladder to collect the bile. The catheter is used for biliary obstruction and hepatic dysfunction secondary to jaundice. This is for patient that has obstruction to the liver causing jaundice (yellow of skin). The only side effects to this is having an artificial object in the gallbladder that could lead to plague build up. 
• Drug therapy: Drug is recommended only patient who cannot undergo surgery and other treatment therapy. Drug is usually the last resort because it takes months or years to work. The side effects of the medication is nausea, vomiting, diarrhea or constipation, and skin rash. During an acute pain of gallstones patients are give analgesic, Morphine, NSAIDs (Ibuprofen, Advil, and ketrolac) for pain management. Anticholinergics such as atropine and other antispasmodics are used to relax the smooth muscle and reduce ductal tone. The major side effects of this medication are constipation and nausea. 

               Work Cited

        Lewis Dirksen and Heitkemper Bucher Medical Surgical Nursing 9th edition page 1038 to 1039

Signs and symptoms of gallstones

Gallstones signs and symptoms vary from the type and kind of stone in the gall bladder. Some people might have symptoms but other might have stones without symptoms. For those that have symptoms the most common symptom is abdominal pain at the upper right quadrants that radiates to the back. The pain is usually severe and sudden without unknown cause. The sudden and severe start of the abdominal pain is why most of gallstones are diagnosed at the emergency department. The pain is so severe that people who experience the pain thinks they are having a heart attack that is why they end up at the emergency room. More women than men have gallstones that is why sometimes heart attack women heart attack are misdiagnosed or not diagnosed early. Gallstones pain worsens after eating a meal, particularly fatty or greasy foods like that of a heart attack.

Some of the other signs and symptoms of gallstones are:

• Pain that feels dull, sharp, or crampy
• Pain that increases when you breathe in deeply
• Chest pain
• Heartburn, indigestion, and excessive gas
• A feeling of fullness in the abdomen
• Vomiting, nausea, fever
• Shaking with chills
• Tenderness in the abdomen, particularly the right upper quadrant
• Jaundice (yellowing of the skin and eyes)
• Stools of an unusual color (often lighter, like clay)

Whenever you notice any usual pain that last longer than usual is good to sick medical attention because it can be gallstones or something more serious. 

The above table shows the signs and symptoms of gallstone and the percentage of how common they are.

Work cited

Every day health gall bladder www.everydayhealth.com/gallbladder/symptoms/
image 1: http://imaging.cmpmedica.com/cancernetwork/journals/oncology/images/o9501at1.gif
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Diagnosis of Gallstones

Gallstones can be symptomatic meaning there is symptoms that will make the providers suspect a gallstones but sometimes it can be asymptomatic meaning that there is no symptoms that will suggest gallstones. In the case of asymptomatic, the person might have gallstones for years without know that they have it. Asymptomatic gallstones are risk because the stone can leave the gallbladder and go into the bile duct causing blockage and other complications. Some of the complications can lead to liver damage.

There is different ways gallstone can be diagnosed irrespective of it is symptomatic or asymptomatic. Gallstone are diagnosed using the following diagnoses.

Imaging tests used to diagnose gallbladder problems include:

Ultrasound: is a painless procedure in which a machine with a transducer that uses a high frequency wave to on the abdomen to check for any stones in the gallbladder.  The ultrasound can diagnose the type of stone, size and location of the stone. Some clinician use only ultrasound to diagnose but if for some reason the ultrasound did not show much then further diagnoses are used.

Computed tomography (CT) scan: This test is used to check for complicated gallstones like acute pancreatitis in an emergency situation. CT scan involves taking different x-ray of the abdomen to determine the site, location and organs that could be affected.

Magnetic resonance imaging (MRI): this type of scan is carried out to see if there is gallstone in the bile duct.

Endoscopic retrograde cholangiopancreatography (ERCP): this procedure is carried out to find out more information about the gallbladder. This procedure is done with X-ray to see if there is any blockage in the liver, bile ducts, intestines and gallbladder. If blockage is detected the gallbladder is removed using endoscope.

In most cases of symptomatic gallstones the only diagnostic image done is the ultrasound. The ultrasound helps the clinician to determine what further testing or procedures is necessary based on the situation. In some cases, laboratory values like liver enzymes test can be high due to blockage in the liver and white blood cells can also be high due to inflammation of the liver and other organs. 

Work Cited

image:https://encrypted-tbn1.gstatic.com/images?q=tbn:ANd9GcS4pfjczYpFOpEINsVAqMTAuNAeFs2asiPhiu55NCOqATiJ3uJR
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image: https://encrypted-tbn3.gstatic.com/images?q=tbn:ANd9GcTgHccVi6yJ4VlRFFtKgYWHkipJqDnbyXZkrVuoR-jDYsomQLQ_
Image: https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcQIvJgYS-jSgJRd1Y0GnxXm5Cdo8y33eS_czJVlNzD0t5Zm2lS_bA

NHS: choices your health, your choicehttp://www.nhs.uk/Conditions/Gallstones/Pages/Diagnosis.aspx

Etiology/Pathophysiology of Gallstone

Pathophysiology Of Gallstones

Most of the times, gallstones develop from imbalance in the chemical composition of bile inside the gallbladder. This bile is liquid produced by the liver during digestion.  The cause of the imbalance has not yet been identified. The most common form of gallstone is cholesterol gall stone which occurs about four in five gallstone cases. Bilirubin gallstone which is as a result of high bilirubin in the blood is about one in every five gallstone cases. The chemical imbalance leads to the formation of crystals in the form of bile in the gallbladder. These crystals after several years form gallstones. This stones can be as small as a sand grain or large as a pebble.

This picture give a clear overview of gallstones. Gallstone can be fat, calcium (Ca+ ) bilirubin, carbonate, and phosphate, which get transferred from the liver through the biliary duct into the gall bladder.

Etiology of Gallstones

Overweight or obese people with a body mass index (BMI) of 25 or above

Increased aged, 40 years or older

People with liver problems, digestive disorders, Crohn’s disease and irritable bowel syndrome (IBS) and sickle cell disease

Family history of gallstones

Rapid weight loss from either dieting or weight-loss surgery such as gastric banding

Medications such as ceftriaxone, which is an antibiotic used for the treatment pneumonia, meningitis and gonorrhea, oral contraceptive, hormone therapy used for osteoporosis, breast cancer and menopause treatment.
Women with children or child bearing age.

Work Cited

image:http://www.zuniv.net/physiology/book/images/23-6.jpg
image 2: http://old.netterimages.com/images/vpv/000/000/005/5785-0550x0475.jpg
http://www.nhs.uk/Conditions/Gallstones/Pages/Causes.aspx

Epidemiology Of Gallstone

image source: rural and remote article 

The most common type of gallstone is the cholesterol gallstone. This type of stone is formed from fat deposit in the gall bladder. The above picture give the pathway of how gallstone is formed. From the top you can see the factors that contribute to gallstone formation. Gallstone are formed from dietary factor; consummation of food high in fat, obesity, dyslipidemia (imbalance in fat), environmental factor, age (above twenty), genetic factor and gender more in female. All these are factor that contribute to the development of gallstone.  Development of fat will lead to secretion of too much cholesterol in the liver. If the problem is not treated it will lead to the liver secreting bile, which will be distributed to the rest of the body. The bile moves to the gall bladder as biliary sludge and that forms cholesterol gallstones.

Gallstone is a very common disease that can occur at any age. Rapid weight loss and obesity puts one at greater risk of developing gallstone, but that does not mean it can’t happen to anyone. There has not been any clear indication of what causes gallstone. The above are just things that might increase the risk of one developing gallstone. Despite your age, gender, body mass and genetic predisposition gallstone can happen.

The above chart shows the relationship between body weight and the chances of having gallstone. For those whose body mass index (BMI) is less than 24 the chances are less and as one increases in weight the likelihood of getting gallstone increases. The best thing is to keep body weight less than 24 but rapid weight loss is not a good idea either. Ideally losing one pound a week is good and healthy than losing three to five pounds a week. The best thing is to Eat Smart and Stay Healthy. 

Work cited

image1: http://www.rrh.org.au/publishedarticles/article2186_16.gif

image2: http://www.ualberta.ca/~loewen/Medicine/GIM%20Residents%20Core%20Reading/GALLSTONES,%20PANCREATITIS,%20PANC%20CA/Epidem%20Risk%20Factors%20Gallstones_files/bmi_symp.gif

image 3: http://www.ultracleanseguide.com/images/Statistics_on_Gallstones.png Stinton, L. M., & Shaffer, E. A. (2012). Epidemiology of Gallbladder Disease: Cholelithiasis and Cancer. Gut and Liver, 6(2), 172–187. doi:10.5009/gnl.2012.6.2.172