CHOLECYSTECTOMY

BY: Krizzia Marika A. Bendiola

surgical removal of the gallbladder, an organ located just under the liver on the upper right quadrant of the abdomen

A Gallbladder is.
small pear-shaped organ which lies on the underside of the liver is connected by ducts (or tubes) with the liver and with the upper portion of the small intestine (duodenum).

The Reasons.. gallbladder contains gallstones (cholelithiasis) is inflamed

infected (cholecystitis) is cancerous

Types of Cholecystectomy

OPEN

 4- to 6-inch incision in the right upper portion of the abdomen liver is lifted out of the way and the gallbladder is carefully removed

Laparoscopic Method

 instead of making one large incision, the surgeon makes four one incision is made right under the navel (umbilicus) and a laparoscope is inserted the laparoscope is a miniature telescope attached to a camera, and through its lens the surgeon can see the interior of the abdomen

 Instruments are inserted through the other incisions The gallbladder is cut free and pulled through one of the incisions. Before removing it, the surgeon sometimes shrinks the gallbladder by suctioning out the bile. Incisions are sutured or stapled closed takes 30 to 60 minutes

Nursing Responsibilities

Before
Obtain informed consent. The role of the nurse is to witness the signing of the informed consent. It is the nurses responsibility to reinforce what is learned by the patient Reinforced to client and family the surgical procedure to be done, how long it will take, possible complications and preventive measures Health teachings done regarding proper hygiene necessary for pre-operative preparations like taking a bath and cleansing of perineal area

 Instruct that walking and limited movement are generally encouraged postoperatively, but strenuous activity should be avoided. Inform the patient of signs and symptoms that needs to be reported to the physician immediately fever and/or chills redness, swelling, or bleeding or other drainage from the incision site(s) increased pain around the incision site(s) abdominal pain, cramping, or swelling pain behind the breastbone

 NPO post midnight to allow time for stomach to empty and decrease aspiration Pre op medication to be given Operative records complete

During
Assist patient to OR theater Remove prosthesis, jewelries, nail polish etc. Valuables taken Assist patient in transferring to OR table Attachment of life- supportive devices and indwelling catheter Induction of anesthesia assist patient in c-shape position skin preparation on posterior surface using betadine paint assist in the induction of anesthesia

 Patient prepared for initial intraoperative cholangiogram Skin preparation done on operative site Medical and surgical handwashing done by nurse Gowning and gloving by nurse Setting up of complete pack and instrument set Initial counting of instruments, needles, ATR, operating sponges, visceral packs

Skin Preparation

After Removal of attached assistive and operative devices Patient is undraped Aftercare to be done in the OR theater Patient transferred to post anesthetic care unit

 Patient for NPO Monitor vital signs for 15 min. for 2 hours then 30 min. for 2 hrs ; q hourly thereafter Monitor pain score q hourly Administer post-op medications Monitor intake and output q hourly Refer accordingly

THANK YOU AND GOD BLESS!