NCP Cholecystitis with cholelithiasis



Severe acute attacks may require brief hospitalization on a medical unit. This plan of care deals with the acutely ill, hospitalized patient.



Fluid and electrolyte imbalances, see Nursing Plan CD-ROM

Psychosocial aspects of care

Total nutritional support: parenteral/enteral feeding

Patient Assessment Database


May report: Fatigue

May exhibit: Restlessness


May exhibit: Tachycardia, diaphoresis, lightheadedness


May report: Change in color of urine and stools

May exhibit: Abdominal distension

Palpable mass in right upper quadrant (RUQ)

Dark, concentrated urine

Clay-colored stool, steatorrhea


May report: Anorexia, nausea/vomiting

Intolerance of fatty and “gas-forming” foods; recurrent regurgitation, heartburn, indigestion, flatulence, bloating (dyspepsia)

Belching (eructation)

May exhibit: Obesity; recent weight loss

Normal to hypoactive bowel sounds


May report: Severe epigastric and right upper abdominal pain, may radiate to mid-back, right shoulder/scapula, or to front of chest Midepigastric colicky pain associated with eating, especially after meals rich in fats

Pain severe/ongoing, starting suddenly, sometimes at night, and usually peaking in 30 min, often increases with movement

Recurring episodes of similar pain

May exhibit: Rebound tenderness, muscle guarding, or abdominal rigidity when RUQ is palpated; positive Murphy’s sign


May exhibit: Increased respiratory rate

Splinted respiration marked by short, shallow breathing


May exhibit: Low-grade fever; high-grade fever and chills (septic complications)

Jaundice, with dry, itching skin (pruritus)

Bleeding tendencies (vitamin K deficiency)


May report: Familial tendency for gallstones

Recent pregnancy/delivery; history of diabetes mellitus (DM), IBD, blood dyscrasias

Discharge plan

DRG projected mean length of inpatient stay: 4.3 days

May require support with dietary changes/weight reduction

Refer to section at end of plan for postdischarge considerations.






Cholecystograms (for chronic cholecystitis): Reveals stones in the biliary system. Note: Contraindicated in acute cholecystitis because patient is too ill to take the dye by mouth.





CBC: Moderate leukocytosis (acute).

Serum bilirubin and amylase: Elevated.




1. Relieve pain and promote rest.

2. Maintain fluid and electrolyte balance.

3. Prevent complications.



1. Pain relieved.

2. Homeostasis achieved.

3. Complications prevented/minimized.

4. Disease process, prognosis, and therapeutic regimen understood.

5. Plan in place to meet needs after discharge