{
  "name": "Cholecystitis & Cholelithiasis",
  "slug": "cholecystitis",
  "url": "https://nursingplex.com/care-plans/cholecystitis",
  "category": "Gastrointestinal",
  "summary": "Gallbladder inflammation/stones; pain control, low-fat diet and surgical preparation.",
  "nursing_diagnoses": [
    "Acute pain",
    "Imbalanced nutrition",
    "Risk for deficient fluid volume"
  ],
  "overview": [
    "Cholecystitis is inflammation of the gallbladder, most often caused by a stone obstructing the cystic duct (cholelithiasis). Bile stasis irritates the wall, bacteria proliferate, and the gallbladder becomes distended, edematous and potentially gangrenous.",
    "The classic presentation is severe right upper quadrant pain radiating to the right shoulder or scapula, often after a fatty meal, with nausea, vomiting, fever and a positive Murphy's sign. Stones lodged in the common bile duct add jaundice, dark urine and clay-colored stools, and can trigger pancreatitis.",
    "Nursing care controls pain, keeps the gut at rest during the acute phase, monitors for perforation and biliary obstruction, and prepares most patients for laparoscopic cholecystectomy."
  ],
  "key_facts": [
    {
      "label": "Murphy's sign",
      "text": "Inspiratory arrest during deep palpation of the right upper quadrant."
    },
    {
      "label": "Risk profile",
      "text": "Traditionally described as female, forty, fertile, fat and fair, though anyone can be affected."
    },
    {
      "label": "Obstruction picture",
      "text": "Jaundice, pruritus, dark urine and clay stools with elevated bilirubin and alkaline phosphatase."
    },
    {
      "label": "Diet",
      "text": "Low-fat meals reduce gallbladder contraction and pain between attacks."
    }
  ],
  "nursing_priorities": [
    "Relieve biliary colic pain.",
    "Rest the gastrointestinal tract and maintain hydration.",
    "Monitor for complications: perforation, sepsis, pancreatitis, obstruction.",
    "Prepare for surgical or endoscopic intervention.",
    "Teach dietary management and postoperative expectations."
  ],
  "assessment": {
    "subjective": [
      "Reports of severe right upper quadrant pain radiating to the shoulder",
      "Complaints of nausea, vomiting and fatty-food intolerance",
      "Reports of itching, dark urine or pale stools",
      "Reports of fever or chills"
    ],
    "objective": [
      "Right upper quadrant tenderness, guarding and positive Murphy's sign",
      "Fever, tachycardia, leukocytosis",
      "Jaundice, scleral icterus, elevated bilirubin, ALP, ALT and amylase/lipase",
      "Ultrasound showing stones, wall thickening or pericholecystic fluid",
      "Vomiting, decreased bowel sounds, abdominal distention"
    ],
    "related_factors": [
      "Gallstone obstruction of the cystic or common bile duct",
      "Bile stasis, obesity, rapid weight loss, pregnancy",
      "High-fat diet and sedentary lifestyle",
      "Bacterial infection of stagnant bile",
      "Prolonged fasting or total parenteral nutrition"
    ]
  },
  "goals": [
    "The client will report pain reduced to an acceptable level.",
    "The client will maintain hydration and electrolyte balance.",
    "The client will remain free from perforation, sepsis and pancreatitis.",
    "The client will describe a low-fat diet and postoperative care plan."
  ],
  "interventions": [
    {
      "title": "Pain and comfort",
      "points": [
        "Administer prescribed analgesia promptly and reassess; give antispasmodics as ordered.",
        "Position in semi-Fowler or side-lying with knees flexed.",
        "Provide antiemetics and oral care during vomiting.",
        "Avoid fatty foods entirely during an acute attack."
      ]
    },
    {
      "title": "Rest the gut and hydrate",
      "points": [
        "Maintain NPO status with IV fluids during severe attacks; insert NG tube if vomiting persists.",
        "Monitor intake, output and electrolytes.",
        "Administer antibiotics as ordered and monitor temperature trends.",
        "Advance to clear liquids then a low-fat diet as symptoms settle."
      ]
    },
    {
      "title": "Monitor and prepare",
      "points": [
        "Assess for rigid abdomen, rebound tenderness or sudden pain relief followed by shock — signs of perforation.",
        "Track bilirubin, liver enzymes and lipase for duct obstruction and pancreatitis.",
        "Prepare the patient for ERCP or cholecystectomy including preoperative teaching.",
        "Observe stool and urine color for changes indicating obstruction."
      ]
    }
  ],
  "patient_teaching": [
    "Explain which foods commonly trigger attacks and how to build low-fat meals.",
    "Advise gradual weight loss rather than crash dieting.",
    "Report fever, jaundice, severe unrelenting pain or persistent vomiting.",
    "Review what to expect from laparoscopic surgery and recovery timelines."
  ]
}