{
  "name": "Cholecystectomy",
  "slug": "cholecystectomy",
  "url": "https://nursingplex.com/care-plans/cholecystectomy",
  "category": "Surgery & Perioperative",
  "summary": "Gallbladder removal recovery: drain care, shoulder gas pain, fat-modified diet teaching.",
  "nursing_diagnoses": [
    "Acute pain",
    "Ineffective breathing pattern",
    "Imbalanced nutrition"
  ],
  "overview": [
    "Cholecystectomy is removal of the gallbladder, most often laparoscopically, for symptomatic gallstones, acute or chronic cholecystitis, biliary dyskinesia or gallstone pancreatitis. Open cholecystectomy is reserved for complicated disease or conversion during surgery.",
    "The laparoscopic approach means shorter stays and less pain but introduces carbon-dioxide insufflation, which causes referred shoulder pain, and a small risk of bile-duct injury or bile leak. Open procedures use a right subcostal incision, which is painful with breathing and predisposes to atelectasis.",
    "Nursing care emphasizes pain control that permits deep breathing, monitoring for bile leak and bleeding, early ambulation, and dietary transition as the body adapts to continuous rather than stored bile delivery."
  ],
  "key_facts": [
    {
      "label": "Shoulder pain",
      "text": "Referred right-shoulder pain after laparoscopy comes from residual CO2 and is relieved by ambulation and position change."
    },
    {
      "label": "T-tube",
      "text": "If a T-tube is placed after common-duct exploration, expect 300–500 mL bile in the first 24 hours, decreasing thereafter."
    },
    {
      "label": "Warning signs",
      "text": "Fever, jaundice, clay-colored stools, dark urine or increasing abdominal pain suggest bile-duct obstruction or leak."
    },
    {
      "label": "Diet",
      "text": "Low-fat meals in the early weeks; most people return to a normal diet as the ducts adapt."
    }
  ],
  "nursing_priorities": [
    "Control pain enough to allow deep breathing and ambulation.",
    "Monitor for bleeding, bile leak and duct injury.",
    "Prevent atelectasis and pneumonia, especially after open surgery.",
    "Maintain nutrition with a graded low-fat diet.",
    "Provide incision and drain care teaching."
  ],
  "assessment": {
    "subjective": [
      "Reports of right upper quadrant or shoulder pain",
      "Complaints of nausea, bloating or fatty-food intolerance",
      "Reports of pruritus or dark urine preoperatively"
    ],
    "objective": [
      "Vital signs and trends suggesting bleeding or infection",
      "Incision or port sites for redness, drainage or dehiscence",
      "T-tube or drain output color, volume and consistency",
      "Jaundice, clay-colored stools or dark urine",
      "Bowel sounds, abdominal distention and breath sounds"
    ],
    "related_factors": [
      "Surgical incision and tissue manipulation",
      "Residual carbon-dioxide insufflation",
      "Bile duct manipulation or obstruction",
      "Reduced ventilation from subcostal incision pain"
    ]
  },
  "goals": [
    "The client will report pain at or below the agreed level with movement.",
    "The client will maintain clear lung sounds and adequate oxygen saturation.",
    "The client will tolerate a low-fat diet without nausea.",
    "The client will remain free from infection and bile leak."
  ],
  "interventions": [
    {
      "title": "Pain and respiratory care",
      "points": [
        "Give analgesia on schedule early on and before ambulation or spirometry.",
        "Teach pillow splinting for coughing and deep breathing.",
        "Encourage incentive spirometry hourly while awake and semi-Fowler positioning.",
        "Ambulate early to relieve CO2 shoulder pain and prevent VTE."
      ]
    },
    {
      "title": "Monitor for complications",
      "points": [
        "Assess incisions and drains each shift; report bile-stained dressings.",
        "Record T-tube output and keep the bag below the incision level; never clamp without an order.",
        "Watch for fever, tachycardia, rigid abdomen or jaundice.",
        "Monitor liver enzymes and bilirubin if ordered."
      ]
    },
    {
      "title": "Nutrition and activity",
      "points": [
        "Advance from clear liquids to a low-fat diet as tolerated.",
        "Offer small frequent meals and note any diarrhea, which is common early.",
        "Encourage fluids and gradual increase in activity, avoiding heavy lifting for several weeks."
      ]
    }
  ],
  "patient_teaching": [
    "Keep incisions clean and dry; shower once permitted and pat dry.",
    "Eat smaller low-fat meals initially and add fats back gradually.",
    "Report fever above 38 °C, yellowing skin, severe pain or persistent vomiting.",
    "Avoid lifting more than 10 pounds for the period specified by the surgeon."
  ]
}