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I. INRODUCTION

A. Overview of the case

Cholecystitis is inflammation of the gall bladder. It is commonly due to impaction

or sticking of a gallstone within the neck of the gall bladder that leads to inspissation of

bile, bile stasis, and infection by gut organisms. Cholecystitis may be a cause of right

upper quadrant pain. The pain may actually manifest in the right flank or scapular region

at first. Acute cholecystitis classically presents with acute pain in the right upper quadrant

of the abdomen, nausea or vomiting, and fever. On physical examination, the patient may

have Murphy's sign, spasm of the diaphragm (due to the intense pain) when the region of

the gallbladder is palpated by the examiner. There may be a previous history of gallstone

attacks.

Laboratory values may be notable for an elevated alkaline phosphatase, possibly

an elevated bilirubin and possibly an elevation of the WBC count. CRP (C-reactive

protein) is often elevated. The degree of elevation of these laboratory values may depend

on the degree of inflammation of the gallbladder. Patients with acute cholecystitis are

much more likely to manifest abnormal laboratory values, while in chronic cholecystitis

the laboratory values are frequently normal.

In severe cases, the gall bladder can rupture and form an abscess or it may lead to

a life-threatening infection of the liver called ascending cholangitis. In other cases, it may

lead to a stable inflammatory state termed chronic cholecystitis. Cholecystectomy is the

surgical removal of the inflammed gall bladder. Despite the development of non-surgical

techniques, it is the most common method for treating symptomatic gallstones, although

there are other reasons for having this surgery done. Each year more than 500,000

Americans have gallbladder surgery. The conventional method of removing the gall

bladder was through a six inches incision in the right upper abdomen wich is the standard

procedure or the open cholecystectomy it is an older more invasive procedure, but now

with the advances in surgery we have the additional laparoscopic method where the

surgery can be carried out through 3 or 4 tiny key-holes incisions called laparoscopic

cholecystectomy.

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B. Objectives of the study:

The objectives of this study are intended to identify health problems encountered

by my patient and further understand the extent of the case. As a student nurse,

this would serve as a tool and preparation for my training from what I have

learned in classroom discussions and be able to apply these in real clinical area

such as this case.

This case study focuses to accomplish the following objectives:

a. To establish rapport from the client and also to his significant other

b. To determine the content on the nursing assessment, diagnosis, planning,

implementation, and evaluation for this specific disease condition

c. To know the underlying causes and health history on the clients medical

diagnosis upon admission

d. To search the medical management as being ordered based upon the clients

diagnostic and laboratory results

e. To compare & contrast the ideal and actual nursing care management for this

specific disease condition: and

f. To evaluate the effectiveness of the interventions and detect any progress of

the clients condition.

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The purpose of the study is to understand thoroughly the clients disease

condition, the factors involving the processes and the causes of the disease

condition, which is cholecystitis.

In general, this study aims to develop the skills and learning of the students

through performing actual procedures, wherein students are exposed and able

to learn the genuine hospital setting in every case that they encounter.

Enhancing ones understanding and competence is important to impart the best

possible care to the client.

C. Scope and limitation:

The scope of the study includes the overall gathered data during the two

days assessment as manifested by the patient and its complaints. It deals with

some factors observed within the time span given by our clinical instructor. After

assessing the patient’s condition an interview followed. To the extant, there was

some nursing and medical management done depending on the patients needs

during his confinement in the hospital and some health history was asked for the

completion of the study.

The limitations depends upon the time and duration of my care given to

the patient and the sources of the data coming from significant others. The

study was completed all together by interaction with the patient and actual

hands-on exposure learned during our return demonstration and lecture class

during our two days hospital duty.

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II. Health History

A. PATIENT’S PROFILE

Name: CPL. Armando Ubaob

Sex: male

Status: married

Birth date: May 28, 1976

Age: 34 y/o

Weight: 60 lbs.

Religion: roman Catholic

Nationality: Filipino

Address: Damulog, Bukidnon

Allergy: no known food and drug allergy

Informant: Mrs. Ruth Ubaob (wife)

Date of admission: December 28, 2009

Chief complaint: pain at right upper quadrant

Vital signs:

Temperature: 37.8˚ C

Pulse rate: 74 bpm

Respiratory rate: 22 cpm

BP: 100/70 mmHg

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Diagnosis: Colecystitis

Attending Physician: Dr. Borungawan

B. Family and personal health history

According to Mr. Ubaob the familial disease he knows that they have in their

family was the hypertension that is on his father’s side. His father died because of

heart attack and her mother died because of natural cause.

C. History of present illness

This is the first time Mr. Ubaob admitted to the hospital. He also added that he

had an asthma when he was 7yrs.old that last when he was 21yrs.old, his asthma

just stopped when he start drinking alcohol beverages as he said.

As for his present illness, he was admitted in to this hospital because of

cholecystitis, he was admitted last December 28,2009. He was been diagnosed

with cholecystisis prior to admission due to severe epigastric pain and weight loss

and was advised to removed his gallbladder. He just not have his cholecestectomy

done immediately due to financial problem.

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III. DEVELOPMENTAL TASK

Erik Erickson’s Eight Stages of Human Development

Each stage is characterized by a different conflict that must be resolved by

the individual. When the environment makes new demands on people, the

conflicts arise. 'The person is faced with a choice between two ways of coping

with each crisis, an adaptive or maladaptive way. Only when each crisis is

resolved, which involves a change in the personality, does the person have

sufficient strength to deal with the next stages of development. If a person is

unable to resolve a conflict at a particular stage, they will confront and struggle

with it later in life.

Mr. Armando Ubaob 34 years old he is on the middle adulthood stage

wherein the basic conflict is generativity vs, stagnation, the important event in this

stage is parenting in which Mr. Ubaob Had met because he is a father. In this

stage, each adult must find some way to satisfy and support the next generation.

Sigmund Freud’s Stages of Development

Freud's theory has three main parts, the stages of development, the

structure of the personality, and his description of mental life. He advanced a

theory of personality development that centered on the effects of the sexual

pleasure drive on the individual psyche. At particular points in the developmental

process, he claimed, a single body part is particularly sensitive to sexual, erotic

stimulation. These erogenous zones are the mouth, the anus, and the genital

region. The child's libido centers on behavior affecting the primary erogenous

zone of his age; he cannot focus on the primary erogenous zone of the next stage

without resolving the developmental conflict of the immediate one.

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IV. MEDICAL MANAGEMENT

A. Medical orders and rationale

Doctors order rationale

December 28, 2009

Please admit under the service of

Dr. Borungawan

Secure consent to care

TPR every 4 hours

DAT

Start IVF D5LR @ 30gtts/min

Medications:

Nalbuphine (Nubain)

Ketorolac (Toradol)

Ranitidine (Zantac)

For medical management of the

patient’s condition

For legal purposes

To obtain baseline data and note for

any abnormalities in vital signs

Proper diet avoid worsening of the

patient’s condition

To replace the fluids lost from

insensible sources and decreased

oral intake

Pain reliever

Anti-inflammatory

reducing stomach acid production

cephalosporin antibiotic

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Cefuroxime (Ceftin)

B. DRUG STUDY

Nalbuphine (Nubain)

USES: This medication is a narcotic pain reliever. It is used to treat moderate to

severe pain and to boost the effects of anesthesia

HOW TO USE: This medication is given by injection under the skin or into a

vein or muscle by a health care professional. How much and how often you use

this is based on your condition and response. Use this medication exactly as

directed by your doctor. Do not increase your dose, use it more frequently or use

it for a longer period of time than prescribed because this drug can be habit-

forming. Also, if used for an extended period, do not suddenly stop using this

drug without your doctor's approval. Over time, this drug may not work as well.

Consult your doctor if this medication isn't relieving the pain sufficiently.

SIDE EFFECTS: Drowsiness, dizziness, sweating, headache, nausea,

restlessness, itching, vomiting, dry mouth or constipation may occur. If these

effects persist or worsen, contact your doctor or pharmacist promptly. Tell your

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doctor immediately if any of these unlikely but serious side effects occur:

depression, confusion, mood changes, hallucinations, trouble breathing, blurred

vision, seizures. A serious allergic reaction to this drug is unlikely, but seek

immediate medical attention if it occurs. Symptoms of a serious allergic reaction

include: rash, itching, swelling, severe dizziness, trouble breathing. If you notice

other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Before taking nalbuphine, tell your doctor or pharmacist if

you are allergic to it; or if you have any other allergies. Tell your doctor if you

have: heart problems, liver problems, kidney problems, lung diseases, brain

disorders, a history of drug dependence, drug allergies. Limit use of alcohol while

using this medication. Use caution driving or performing task requiring alertness

as this medication may cause drowsiness or dizziness. This drug should be used

with caution in elderly persons. Use of nalbuphine in children under 18 years of

age is not recommended. Tell your doctor if you are pregnant before using this

medication. Nalbuphine is not recommended for prolonged use or in high doses at

the end of pregnancy. It is not known is nalbuphine is excreted into breast milk.

Consult your doctor before breast-feeding.

STORAGE: Store this at room temperature between 59 and 86 degrees F (15 to

30 degrees C), away from heat, light and moisture. Do not store in the bathroom.

Keep out of the reach of children

Ketorolac (Toradol)

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MECHANISM OF ACTION: The primary mechanism of action responsible for

Ketorolac's anti-inflammatory/antipyretic/analgesic effects is the inhibition of

prostaglandin synthesis by competitive blocking of the the enzyme

cyclooxygenase (COX). Like most NSAIDs, Ketorolac is a non-selective

cyclooxygenase inhibitor.

INDICATION: Ketorolac is indicated for short-term management of pain (up to

five days).

CONTRAINDICATION: Contraindicated against patients with a previously

demonstrated hypersensitivity to ketorolac, and against patients with the complete

or partial syndrome of nasal polyps, angioedema, bronchospastic reactivity or

other allergic manifestations to aspirin or other non-steroidal anti-inflammatory

drugs (due to possibility of severe anaphylaxis). As with all NSAIDs, ketorolac

should be avoided in patients with renal dysfunction. (Prostaglandins are needed

to dilate the afferent arteriole; NSAIDs effectively reverse this.) The patients at

highest risk, especially in the elderly, are those with fluid imbalances or with

compromised renal function (e.g., heart failure, diuretic use, cirrhosis,

dehydration, and renal insufficiency).

CAUTION: Ketorolac is not recommended for pre-operative analgesia or co-

administration with anesthesia because it inhibits platelet aggregation. OT is not

recommended for obstetric analgesia because it has not been adequately tested for

obstetrical administration and has demonstrable fetal toxicity in laboratory

animals.Ketorolac has been co-administered with meperidine and morphine

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without apparent adverse effects.IT is not recommended for long-term chronic

pain patients

Ranitidine (Zantac)

DRUG CLASS AND MECHANISM: Histamine is a natural chemical that

stimulates the stomach cells to produce acid. Ranitidine belongs to a class of

medications, called H2-blockers,that block the action of histamine on stomach

cells, thus reducing stomach acid production.

PREPARATIONS: Tablets (150 mg, 300 mg), Capsules (150 mg, 300 mg);

Syrup (15 mg/ml)

STORAGE: Should be stored at room temperature in a tightly closed container.

PRESCRIBED FOR: Ranitidine blocks the action of histamine on stomach cells,

and reduces stomach acid production. Ranitidine is useful in promoting healing of

stomach and duodenal ulcers, and in reducing ulcer pain. Ranitidine has been

effective in preventing ulcer recurrence when given in low doses for prolonged

periods of time. In doses higher than that used in ulcer treatment, ranitidine has

been helpful in treating heartburn and in healing ulcer and inflammation of the

esophagus resulting from acid reflux (reflux esophagitis).

DOSING: May be taken with or without food. Since ranitidine is excreted by the

kidney and metabolized by the liver, dosages of ranitidine need to be lowered in

patients with significantly abnormal liver or kidney function.

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DRUG INTERACTIONS: Antacids may decrease the absorption of ranitidine.

Safety of ranitidine in children has not been established. Ranitidine is not habit

forming. Ranitidine can interfere with the metabolism of alcohol. Patients taking

ranitidine who drink alcohol may have elevated blood alcohol levels.

SIDE EFFECTS: Minor side effects include constipation, diarrhea, fatigue,

headache, insomnia, muscle pain, nausea, and vomiting. Major side effects are

rare; they include: agitation, anemia, confusion, depression, easy bruising or

bleeding, hallucinations, hair loss, irregular heartbeat, rash, visual changes, and

yellowing of the skin or eyes.

Cefuroxime (Ceftin)

DRUG CLASS AND MECHANISM: Cefuroxime is a semisynthetic

cephalosporin antibiotic, chemically similar to penicillin. It is effective against a

wide variety of bacteria organisms, such as Staphylococcus aureus, Streptococcus

pneumoniae, Haemophilus influenzae, E. coli, N. gonorrhoeae, and many others.

PREPARATIONS: Tablets: 125 mg, 250 mg, 500 mg. Suspension: 125 mg per 5

ml teaspoon.

STORAGE: Tablets should be stored at room temperature in a tightly closed

container. The oral suspension should be stored in the refrigerator in a tightly

closed container.

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PRESCRIBED FOR: Cefuroxime is effective against susceptible bacterias

causing infections of the middle ear, tonsillitis, throat infections, laryngitis,

bronchitis, and pneumonia. It is also used in treating urinary tract infections, skin

infections, and gonorrhea. Additionally, it is useful in treating acute bacterial

bronchitis in patients with chronic obstructive pulmonary disease (COPD).

DOSING: Should be taken with food.

DRUG INTERACTIONS: Cefuroxime should be avoided by patients with a

known allergy to cephalosporin type antibiotics. Since cefuroxime is chemically

related to penicillin, an occasional patient can have an allergic reaction

(sometimes even anaphylaxis) to both medications. Treatment with cefuroxime

and other antibiotics can alter the normal bacteria flora of the colon and permit

overgrowth of C. difficile, bacteria responsible for pseudomembranous colitis.

Patients who develop pseudomembranous colitis as a result of antibiotics

treatment can experience diarrhea, abdominal pain, fever, and sometimes even

shock. Probenecid may increase the blood levels of cefuroxime. Cefuroxime can

be used by children. It is not habit forming.

SIDE EFFECTS: Cefuroxime is generally well tolerated and side effects are

usually transient. Reported side effects include diarrhea, nausea, vomiting,

abdominal pain, headache, rash, hives, vaginitis, headache, and mouth ulcers.

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LABORATORY RESULTS

Ultrasound Report

Liver is normal in size & shows hemogenous echotexture Gall bladder is distended with thickened wall measuring 0.63cm

Right Kidney Left Kidney

Length 8.8cm 8.4cm

Cortex 1.1cm 1.1cm

Both kidneys are normal in size and show smooth outlines. Urinary bladder is slightly distended with non-thickened walls

Impression:- Thickened GB wall may be due to adenomyomatosis with sludge.

Cannot totally rule out chronic cholecystitis.

Complete Blood Count 04-13-‘07

Blood Chemistry 04-11-‘07

Normal Values

Normal Values

Clotting Time 3’37” Venous: 5-15 minCapillary: 3-15 min

Bleeding Time 3’06” Capillary: 3-5 min

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Fasting Blood Sugar 80.3 70-105 mg/dL

Creatinine 0.3 0.4-1.4 mg/dL

Alkaline PO4 83 U/L 100-290 U/L

Serology

HbAsg Non-Reactive

V. ANATOMY & PHYSIOLOGY

Anatomy of the gall bladder

The gall bladder is a small pear shaped organ (sac) for the storage of bile. It is

located on the underside of the liver in the right side of the upper abdomen. The main

purpose of the gall bladder is to store and concentrate bile. Bile is manufactured in the

liver and secreted through the hepatic duct partly into the gall bladder via the cystic duct

and partly into the small intestine (duodenum) via the common bile duct. The

concentrated bile stored in the gall bladder is released through the common bile duct into

the duodenum whenever fatty foods are eaten. One of the functions of bile is to aid the

digestion of fatty foods.

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Gallstones are crystallized bile formed in the gallbladder because of the excessive

level of cholesterol in the bile. These stones can travel and block the flow of bile

resulting in pain in the right upper abdomen. It is also possible for a small stone to lodge

in the opening of the common bile duct into the duodenum. This is a more serious

condition where the stone can also block the flow of the pancreatic juice from the

pancreatic duct that joins the common bile duct. This may result in pancreatitis

(inflammation of the pancreas). Gallbladder problems are very common and if they cause

pain, medical attention is usually needed.

PATHOPHYSIOLOGY

Predisposing Factors Precipitating Factors

· Overweight. · Escherichia coli

· High blood cholesterol level · Alcohol abuse

· Family history of gallbladder disease · Severe illness

· People who eat fatty foods · Tumor in the gall bladder

Obstruction of the cystic duct

A gallstone usually causes the obstruction (calculous cholecystitis)

Inflammation may be sterile or bacterial

Obstruction may be acalculous or caused by sludge

Gallbladder distention, gallbladder wall edema, ischemia, and necrosis

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Inflammatory mediators, specifically prostaglandins are released

Increased gallbladder inflammation

Chronic Cholecystitis

VI. Nursing Assessment (System Review and Nursing

Assessment)

A. Physical assessmentName CPL. Armando UbaobBP: 100/70 mmHg T: 37.8˚ C PR: 74 bpm RR: 22cpm Weight: 60lbs

EENT:[ ] Impaired vision [ ] blind[ ] pain redden [ ] drainage[ ] gums [ ] hard of hearing [ ] deaf[ ] burning [ ] edema [ ] lesion teeth[ ] assess eyes ears nose[ ] throat for abnormality [ ] no problem RESP:[ ] Asymmetric [ ] tachypnea [ ] barrel chest[ ] apnea [ ] rales [ ] cough [ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanotic[ ] assess resp. rate, rhythm, pulse blood [ ] breath sounds, comfort [ ] no problemCARDIOVASCULAR:[ ] arrhythmia [ ] tachycardia [ ]numbness [ ] diminished pulses [ ] edema [ ] fatigue [ ] irregular [ ] bradycardia [ ] mur mur[ ] tingling [ ] absent pulses [ ] painAssess heart sounds, rate rhythm, pulse, bloodPressure, circ., fluid retention, comfort [ ] no problemGASTROINTESTINAL TRACT:[ ] obese [ ] distention [ ] mass[ ] dysphagia [ ] rigidity [ ] pain[ ] assess abdomen, bowel habits, swallowing[ ] bowel sounds, comfort [ ] no problemGENITO – URINARY AND GYNE[ ] pain [ ] urine [ ] color [ ] vaginal bleeding[ ] hematuria [ ] discharge [ ] nocturia[ ] assess urine frequency, control, color, odor, comfort[ ] gyne bleeding [ ] discharge [ ] no problemNEURO:[ ] paralysis [ ] stuporous [ ] unsteady [ ] seizure[ ] lethargic [ ] comatose [ ] vertigo [ ] tremors

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[ ] confused [ ] vision [ ] grip[ ] assess motor, function, sensation, LOC, strength[ ] grip, gait, coordination, speech [ ] no problemMUSCULOSKELETAL and SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechiae[ ] hot [ ] drainage [ ] prosthesis [ ] swelling[ ] lesion [ ] poor turgor [ ] cool [ ] flushed[ ] atrophy [ ] pain [ ] ecchymosis [ ] diaphoretic moist[ ] assess mobility, motion gait, alignment, joint functionSkin colo , texture, turgur,integrity ( ) no problem

NURSING ASSESSMENT IISUBJECTIVE OBJECTIVE

Communication:[ ] hearing loss Comments: “wala man ko’y [ ] visual changes problema sa pandungog ug [ ] denied sa akong panlantaw” as Verbalized by the patient.

[ ] glasses [ ] languages[ ] contact lens [ ] hearing aid R LPupil Size: 4mm [ ] speech difficultiesReaction: Pupils Equally Round Reactive to Light and Accommodation.

Oxygenation:[ ] dyspnea Comments: “wala man pud [x ]smoking history ko gi ubo karon” as ver-[ ] cough balized by the patient.[ ] denied

Resp. [X] regular [ ] irregularDescribe: Symmetrical Breathing

R : Right symmetrical to the left lung L : Left symmetrical to the right lung

Circulation:[ ] chest pain Comments: “wala man nag-[ ] leg pain sakit akong dughan” as .[ ] numbness of verbalized by the pts.extremities [ ] denied

Heart Rhythm [ x ] regular [ ] irregularAnkle Edema : None

Pulse Car. Rad. DP Fem*R + + + +L + + + +Comments: pulses are palpable in all areas*If applicable

Nutrition:Diet: Diet As Tolerated[ ] N [ ] V Comments: “mayo man koCharacter mokaon sad’ as verbalized[ ] recent change in .by the patient weight, appetite [ ] swallowing Difficulty -[ ] denied

[ ] dentures [X] none

Full Partial with PatientUpper [ ] [ ] [ ]

Lower [ ] [ ] [ ]

Elimination:Usual bowel pattern [ x ] urinary frequency 1 x a day 3-7x [ ] urgency[ ] constipation [x] dysuriaremedy [x] hematuria

Comments: The Bowel Sounds: patient has Normoactive bowel Normoactive bowel soundssounds occuring Abdominal Distentionevery 5-10 seconds Present [ ] yes [ ] no Urine* (color,

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No constipation [ ] incontinence [ ] polyuria –Date of Last BM [ ] foly in place 01/15/10 [ ] denied[ ] diarrhea characterNone

consistency, odor) the patient is not in foley bag catheter. *if they are in place? Not in foley catheter

MGT. OF HEALTH ILLNESS:[ ] alcohol [ ] denied(amount, frequency)__________________________________________________________________ [ ] SBE Last Pap Smear N/ALMP: N/A

Briefly describe the pt.’s ability to follow treatments (diet, meds, etc.) for chronic health problems (if present).Patient has proper compliance of medications and on therapeutic regimen as supervised by her family members.

SUBJECTIVESKIN INTEGRITY:[ ] dry Comments: “.ok raman raman[ ] itching ” as verbalized by .[ ] other the patient.[ ] denied

OBJECTIVE[ ] dry [ ] cold [ ] pale[ ] flushed [X] warm [ ] moist [ ] cyanotic*rashes, ulcers, decubitus (describe size, location, drainage) None

ACTIVITY/ SAFETY:[ ] convulsion Comments.”wala man ko nag[ ] dizziness lisod ug lihok ug maka lakaw[ ] limited motion sab ko” as verbalized by the of joints patient.Limitation in Ability to [ ] ambulate[ ] bathe self[ ] other[ ] denied

[ ] LOC and orientation: client is oriented to time and place

Gait: [ ] walker [ ] cane [ ] other

[ x ] steady [ ] unsteady ______[ ] sensory and motor losses in faceor extremities None[ ] ROM limitations: inability to ambulate by self and has limited motions due to its muscle weakness.

COMFORT/SLEEP/AWAKE:[ ] pain Comments: “mayo naman (location, frequen- akong pag tulog” as cy, remedies) verbalized by the patient”[ ] nocturia .[ ] sleep difficulties [ ] denied

[ ] facial grimace[ ] guarding[ ] other signs of pain: the patient is restless.

[ ] siderail release form signed (60+ years)

COPING:Occupation: Corporal

Observed non-verbal behavior: The patient appears to be fair and good.

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Members of Household:NoneMost Supportive Person: None

The person and his phone number that can be reached any time: ruth ubaob

SPECIAL PATIENT INFORMATION (USE LEAD PENCIL) 60lbs Daily Weight N/A PT/OT . 100/70mmhg BP q Shift N/A Irradiation N/A Neuro vs N/A Urine Test . N/A CVP/SG Reading N/A 24°urine collection

Date ordered

Diagnostic/Laboratory exams

Date done

Date ordered

I.V. fluids/blood

Date done

12/30/0901/12/1001/17/10

COMPLETE BLOOD COUNT

UrinalysisFecalysis

12/30/1001/12/1001/12/1001/17/10

12-28-09 D5LR

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B. ACTUAL NURSING MANAGEMENT (SOAPIE)

S SUBJECTIVE: “ Sakit akong tiyan diri dapit sa akong kilid ” as verbalized by the patient.

O - Facial grimace - Guarding - Restlessness

A Alteration in comfort pain related to inflammation and distortion of the tissue

P After 8hrs of nursing interventions the patient pain will be relieved or controlled

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I Assess pain noting location, characteristics and intensity. (0-10 scale).

-bed rest in low fowlers position

-encourage use of relaxation technique

-use soft cotton linens

E Goal fully met, patients abdominal pain was relieved and controlled.

VIII. EVALUATION AND COMPLICATIONS

Since cholecystisis is the inflammation which is usually accompanied by the

gallstones may block the way of toxic substance that really needs to go out but due to this

blockage this toxic substance are not then being expelled are just being stored in the

bladder for a period of time. This then causes inflammation of the gallbladder. The

treatment usually done is the cholecystectomy.

In order to lower risk of having this kind of condition each of every one of us must be

conscious on our diet. We should try to avoid foods in which in rich of salts and fats,

especially those foods contain many seasonings. We should be conscious on our health if

we want to live longer and also to avoid those lives threatening disease which not shorten

our lives but causes us some financial problem.

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. BIBLIOGRAPHY

Bare & Smeltzer, Medical-Surgical Nursing 10 th edition Volume 2

Phillips, Berr y & Kohn’s Operating Room Technique 10 th edition

Doenges et. al., Nurses Pocket Guide 10th edition

http://www.medicinenet.com/nalbuphi ne

http://www.laparoscopic-surgeon.co.uk/cholecystectomy.htm

ne-_injection/article.htm

http://www.medicinenet.com/cefuroxime/article.htm

http://www.medicinenet.com/cholecystectomy/article.htm

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