Nursing Care Plan: Laparoscopic Cholecystectomy Patient Case Study

This report presents a nursing care plan for an 80-year-old patient, Mr. Chan Wu, undergoing laparoscopic cholecystectomy with intraoperative cholangiogram and common duct examination due to gallstones. The plan includes organization of patient data, a description of the surgical procedures, identification of potential intraoperative and postoperative complications, nursing diagnoses, expected outcomes, and nursing interventions. The interventions focus on managing symptoms like pain, nausea, and fever, as well as monitoring for complications such as bile leakage and infection. The evaluation concludes that the surgery was successful in removing the stones, but the patient's age may affect the healing process. The plan emphasizes a holistic approach to patient care, covering pre-operative to post-operative stages, and includes references to support the nursing interventions and diagnostic tests.

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Nursing care plan
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2/1/2019

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Organization of data:
The name of the patient is Chan Wu. His care plan includes laparoscopic
cholecystectomy in addition to an intraoperative cholangiogram and further a mutual duct
examination. He has been detected with several gallstones in the gallbladder and has a large
stone in the common duct which was not capable of removal through endoscopic retrograde
cholangiopan creatography (ERCP). Mr. Chan is an old man aged 80 years and the history of his
surgeries includes total hip replacements, a right shoulder joint replacement, and a kyphoplasty.
He also complains about pessimistic and extreme pruritus in the allotment area. The thing which
came in my notice is that he has quite a few open abrasions on his arms due to scratching. The
history about his medical surgeries also tells that he took bilateral left knee arthroplasty.
 Laparoscopic cholecystectomy: in this surgical procedure the doctors tend to remove
the gallbladder due to infection in gallbladder or production of gallstones that was not
dissolved by the medications provided. This procedure involves numerous tiny cuts.
Doctors use this method of surgery for the removal of the gallbladder as the structure of
laparoscope is a narrow in shape and it is in a form of a tube and further this tube is
attached to a camera that helps in inserting the tube through one incision. By this process,
the doctor can easily locate the gallbladder on the screen and then operate it by viewing it
through the help of the camera. This process is commonly practiced when the gallbladder
have stones ( Kim, & et.al, 2009).
Bile juice secretion occurs from the liver which is stored in the gallbladder. The food we eat
every day is digested with the help of the fluid which is called bile juice. When gallstones are
produced in the digestive system they block the path of bile juice produced from the
pancreas. The blockage occurs due to gallstone which makes a patient nauseous, the patient
may vomits, bloating occurs, pain in the abdomen, shoulder, back, or chest may be caused.
These stones also block the ducts which help in transportation of the bile from the
gallbladder to intestine. Gallbladder can be severely infected by gallstones (Simmons, 2010).
 Intraoperative cholangiogram: in this practice, doctors take X-ray of the ducts that
produce bile which helps the doctor’s analyses the image and then use the image during
the surgery. This procedure is not like ordinary X-ray procedure which produces an

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image of the internal material, this is a different type X-ray in which the doctor can watch
a live video of the bile ducts and then precedes the surgery. Laparoscopic surgery method
is used by the doctors with the assistance of intraoperative cholangiogram for the removal
of gallbladder stones (Tarek T. Amin & Abdulrahman S. Al-Mulhim, 2011).
The risk factors that can be faced by Mr. Wu are:
Intraoperative complication risks:
 Bleeding from tissues, abdominal wall or ligaments of the liver
 Injuries may cause in the common bile duct path
 Spilled gallstones
 Lesions of the omentum
Postoperative complications risk:
 Bile leakage
 Infection in the surgical wound
 Incisional hernia
 Hematoma of the abdominal wall
 Lost gallstones
Nursing plan:
Diagnoses:
Test to examine by generating images of the patient’s gallbladder: As Mr. Wu has
several gallstones and a big stone in the common bile duct this procedure and tests can be used in
removal of stones by the process of ultrasound and a computerized tomography (CT) in the
abdominal area. This process will be useful as a nurse to analyze the size and reactions of the
gallstones while treating the patient with any particular medication as well as I can analyze the
problem if any occur in Mr. Wu’s body. (NRSNG, 2019).
Test to check the patient’s bile ducts for gallstones: In this test Mr. Wu will be using a
different type of dye which will highlight the ducts from where the bile is produced and it can be
visualized on the screen. This will be helpful to me as a nurse to know about the problem which

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has been created by the gallstone. This test can also include a HIDA (herpatobiliary
iminodiacetic acid) scan, ERCP (endoscopic retrograde cholangiopan creatography) or MRI
(magnetic resonance imaging). Gallstones discovered while ERCP test can be easily removed.
To test the blood to check for any kind of complication: this diagnosis is used on Mr.
Wu to check if he is infected with pancreatitis, jaundice or any other problems due to gallstones.
This diagnosis will be helpful to me as a nurse to know about patient’s infection in body and
causes of irritation.
Expected outcomes:
From all the above diagnosis, the outcome expected in Mr. Wu’s case is that he may face
difficulties in the process of Laparoscopic cholecystectomy surgery ( Radunovic, & et.al, 2016).
Mr. Wu may heal slowly due to his age, as in this age the growth rate of tissues is slow.
Nursing interventions:
Mr. Wu faces the problem of gallstones inside the gallbladder and he complains about
appetite loss, pain in stomach and at times he feels nauseated. He also deals with fever
frequently, vomits usually, clay-colored stool and abnormal labs. Therefore, in case of Mr. Wu
the nursing intervention used for him is cholecystitis nursing care plan. This intervention works
through examining the patient’s status in the gastrointestinal. This also includes, observing for
distended stomach, paying attention to the frequent burps of Mr. Wu and examining inflexibility
of abdominal and perceptible gallbladder and annotate the sensitivity of the gallbladder ( Frances
, & et.al, 2014).
Mr. Wu goes through immense pain caused by the gallstones so I assess by offering
anesthesia. I administer the medications that are prescribed to him, after or during surgery
procedures ( Thomas, & et.al, 2015).
I monitor diagnostic tests prescribed that are MRI, X-ray, ultrasound and CT. Mr. Wu
may go through dysfunction of liver and at during this, AST/ALT is intervened. Raise of
bilirubin is the indication of obstruction in the common bile duct. CT or MRI can produce
comprehensive evaluation to achieve positive results (Workman & Ignatavicius, 2016).

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Evaluation:
The conclusion of the surgery is the same as per the predictable outcome. Mr. Wu had
gone through the nursing intervention and surgery, and got removed the stones. Due to his age he
is consuming more time to heal his cuts.
References:
Frances , M., Doenges, M., & Murr, A. (2014). Nursing Care Plans: Guidelines for
Individualizing Client Care Across the life span. USA: F.A Davis Company.
Kim, H., Park, Y. L., Yoo, C., & Son, B. (2009). Outcome of laparoscopic cholecystectomy is
not influenced by chronological age in the elderly. World J Gastroenterol, 15(6), 722–
726.
Radunovic, M., Vukovic, M., Radunovic, L., Bulajic, M., Magdelinic, M., & Popovic, N. (2016).
Complications of Laparoscopic Cholecystectomy: Our Experience from a Retrospective
Analysis. Open Access Maced J Med Science, 4(4), 641–646.
Thomas, D., Porter, B., Winland-Brown, J., & M Dunphy, L. (2015). Primary Care: Art and
Science of Advanced Practice Nursing. USA: F.A. Davis.
Workman, M., & Ignatavicius, D. (2016). Medical-Surgical Nursing - E-Book: Patient-Centered
Collaborative Care . Missouri: Elsevier Health Sciences.
NRSNG. (2019). Nursing Care Plan for Cholecystitis. Retrieved february 1, 2019, from
NRSNG: https://www.nrsng.com/care-plan/cholecystitis/
Simmons, S. (2010). PATIENT EDUCATION: Gallstones. Nursing2019, 40(11), 37.
Tarek T. Amin, & Abdulrahman S. Al-Mulhim. (2011). Outcome of Laparoscopic
Cholecystectomy at a Secondary Level of Care in Saudi Arabia. Saudi J Gastroenterol,
17(1), 47–52.