What is the nursing care for a post cholecystectomy patient?

Answer 1

Besides standard wound care, the biggest problem with post gall-bladder surgery is that it hurts to breath. Anything you can do to get the patient to take deep breaths is good.

Left to themselves, respiratory problems are routine.

Answer 2

Post-operative care for the patient who has had an open cholecystectomy, as with those who have had any major surgery, involves monitoring of blood pressure, pulse, respiration and temperature.

Answer 3

Aftercare is similar to any patient having undergone surgery. Pain in the right shoulder may be relieved by lying on the left side with right knee and thigh drawn up to the chest, walking also helps.

Answer 4

Monitoring of the patient's vital signs (and hence, the patient's general condition); including temperature to detect any fever which could develop due to an infection.

Administration of IV fluids (plus intake and output charting to obtain an overview of the patient's hydration status). Ensure that post op urine is passed.

Administer medication prescribed (always check the 5 R's i.e. the right patient, drug, dose, route and frequency). Pain assessment and management. Ensure patient is as pain-free as possible; administer medication prescribed (usually on a PRN basis i.e. on the patient's request). Change of dressing 24 hours after. Do not touch it before 24 hrs (PLUS change only if soiled). Cover with a dry dressing such a Mepore. Care of any abdominal drains (Intake and output) / any NG tube for drainage purposes.

Watch out for any signs of complications; both in general and those specific to cholecystectomy. In general, for example: DVT, atelactasis, fluid and electrolyte imbalance, fever..

Specific to lap chole for example: Injury to the common bile duct / cystic duct, damage to adjacent organs such as the pancreas / liver and peritonitis.

The patient can usually start taking sips of water the evening of the operation day, so make sure to provide fluid (only sips). The nurse can perform oral hygiene to the patient (including application of lib balm to prevent cracking and bleeding of lips). Mouth care is important because the patient will have been starved for quite some time and so as to avoid any feeling of an excessively dry mouth.

Then remove any drains when suggested by the doctor, check whether the patient needs any further appointments (follow up or for removal of sutures; usually sutures are dissolved by the body).

Education to the patient &/ relatives: especially about diet. Suggest a fat free diet especially during the first 4-6 weeks post-op. This is because the gall bladder is no longer available to store bile and hence, if a fatty meal is consumed, the supply of bile will be far less than the demand for it.

Instruct the patient to remove dressing completely and take a normal shower after approximately 5 days post-op.