PATHOPHYSIOLOGY Non modifiable factors: -Age (40 years old and above) -Gender/sex (female) -Genetic predisposition -Estrogen

levels -Ethnicity (Native American & Hispanics) Modifiable factors: -Obesity -Rapid weight loss and diet -Lack of physical activity -Long-term total parenteral nutrition -Oral contraceptives -Pregnancy

Genetic & Demography

Change in Bile Composition

Decreased contractility of bile flow Bile Stasis

Increased intraluminal Pressure

Contraction of substances present in bile Precipitation of bile substances Bile substance will increase in size Stones migrate to gall bladder Obstruction of the flow in bile

Stimulates smooth muscle contraction

Increase tension to duodenum

RUQ abdominal Pain Radiating pain to lower back

Impaired Hepatic uptake of bilirubin

Collection of soluble

No bile reaches the GIT bilirubin in the urine

Cholesterol salts In the skin Jaundice

Escape of bilirubin to GUT

No bile in small intestine for fat Digestion Emulsification of fats

Decrease bile in the duodenum Sterobilin Clay-colored stool

Presence of Bile in the urine

Nausea/ Vomiting Obstructed cystic duct Bile duct obstructed already Gall bladder becomes distended

Dark yellow urine

RUQ pain

ASSESSMENT Subjective: Patient verbalized ang sakit sakit ng tyan ko! Dito o! Objective: Facial Grimace Pain scale 10/10 BP 130/80 Guarding behavior

DIAGNOSIS Acute pain related to inflammation of the gallbladder as evidenced by verbal reports of pain.

PLANNING

INTERVENTION

RATIONALE For baseline data

EVALUATION Short term: Goal partially met Long term: Goal not met due to patients continous uncooperation to his course of treatment.

Short-term: Independent: After 30 minutes of Observe and document nursing location, severity and intervention, the character of pain. patient will have a Promote bed rest, decrease in pain allowing patient to scale from 10 to assume position of 6/10. comfort. Long-term: After 8 hours of nursing intervention, the patient will show no facial grimace and a pain scale from 6/10 to 0/10

Control environmental temperature. Encourage use of relaxation techniques, e.g., guided imagery, visualization, deepbreathing exercises. Provide diversional activities. Make time to listen to and maintain frequent contact with patient.

Bed rest in low-Fowlers position reduces intraabdominal pressure; however, patient will naturally assume least painful position. Cool surroundings aid in minimizing dermal discomfort. Promotes rest, redirects attention, may enhance coping.

Helpful in alleviating anxiety and refocusing attention, which can relieve pain. Relief of pain facilitates cooperation with other therapeutic interventions. To have an immediate course of action to the patient.

Dependent: Administer analgesics/pain medication as prescribed by the physician. Follow up-results of laboratory and diagnostic examinations to the

physician. Assist in the surgical procedure (cholecystectomy) to the patient and monitor his vital signs.

Collaborative: Encourage relative to help the patient to divert his attention by means of talking to him or placing him into his desired position.

To promote comfort