Medical Surgical Nursing

Nursing Process for the Patient Undergoing Surgery for Gallbladder Disease

Nursing Process for the Patient Undergoing Surgery for Gallbladder Disease

Assessment
The patient who is to undergo surgical treatment of gallbladder disease is often
admitted to the hospital or same-day surgery unit on the morning of surgery.
Preadmission testing is often completed a week or longer before admission. At that
time, the nurse instructs the patient about the need to avoid smoking, to enhance
pulmonary recovery postoperatively and to avoid respiratory complications. It also is
important to instruct the patient to avoid the use of aspirin and other agents (over-the-
counter medications and herbal remedies) that can alter coagulation and other
biochemical processes.
Assessment should focus on the patient's respiratory status. If a traditional surgical
approach is planned, the high abdominal incision required during surgery may
interfere with full respiratory excursion. The nurse notes a history of smoking,
previous respiratory problems, shallow respirations, a persistent or ineffective cough,
and the presence of adventitious breath sounds. Nutritional status is evaluated through
a dietary history and a general examination performed at the time of preadmission
testing. The nurse also reviews previously obtained laboratory results to obtain
information about the patient's nutritional status.
Diagnosis
Nursing Diagnoses
Based on all the assessment data, the major postoperative nursing diagnoses for the
patient undergoing surgery for gallbladder disease may include the following:

 Acute pain and discomfort related to surgical incision

 Impaired gas exchange related to the high abdominal surgical incision (if

traditional surgical cholecystectomy was performed)

 Impaired skin integrity related to altered biliary drainage after surgical

intervention (if a T-tube was inserted because of retained stones in the

common bile duct or another drainage device was employed)

 Imbalanced nutrition, less than body requirements, related to inadequate bile

secretion

 Deficient knowledge about self-care activities related to incision care, dietary

modifications (if needed), medications, and reportable signs or symptoms (eg,

fever, bleeding, vomiting)

Collaborative Problems/Potential Complications
Based on assessment data, potential complications may include the following:

 Bleeding

 Gastrointestinal symptoms (may be related to biliary leak or injury to the

bowel)

Planning and Goals
The goals for the patient include relief of pain, adequate ventilation, intact skin and
improved biliary drainage, optimal nutritional intake, absence of complications, and