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