Post-Operative Nursing Diagnoses for Cholelithiasis (Post-Cholecystectomy)

1. Acute Pain

• Assess pain using a numeric scale (0-10) every 2-4 hours
• Administer analgesics as prescribed (NSAIDs, opioids) and evaluate effectiveness
• Encourage splinting of the incision site with a pillow when coughing or moving
• Position patient in semi-Fowler's to reduce abdominal tension
• Apply ice packs to incision sites to reduce swelling and pain
• Monitor for adverse effects of opioids (respiratory depression, sedation)

2. Ineffective Breathing Pattern

• Assess respiratory rate, depth, and oxygen saturation continuously
• Auscultate breath sounds for atelectasis or congestion (absent/diminished sounds)
• Encourage incentive spirometry use every 1-2 hours while awake
• Assist patient with turning, coughing, and deep breathing exercises
• Elevate head of bed 30-45 degrees to facilitate diaphragm descent

3. Risk for Infection

• Perform strict aseptic wound care with each dressing change
• Monitor incision site for signs of infection: redness, warmth, swelling, purulent drainage, dehiscence
• Monitor vital signs for fever (>38.5°C), elevated WBC, tachycardia
• Maintain patency and sterility of T-tube and drainage system (if present)
• Monitor bile drainage: amount, color, consistency (should be golden yellow/green)
• Administer prescribed prophylactic antibiotics

4. Risk for Deficient Fluid Volume

• Monitor intake and output strictly (urine output >0.5 mL/kg/hr is the target)
• Assess for signs of dehydration: tachycardia, hypotension, poor skin turgor
• Administer IV fluids as prescribed to maintain hemodynamic stability
• Monitor electrolytes and hemoglobin/hematocrit
• Advance oral fluids and diet as tolerated once bowel function returns

5. Imbalanced Nutrition: Less Than Body Requirements

• Introduce clear liquids first, then progress to low-fat soft diet as tolerated
• Encourage small, frequent meals rather than large ones
• Educate patient to avoid high-fat foods for 4-6 months post-surgery (bile is now continuously secreted vs. stored)
• Monitor for bloating, loose stools (common for several months as intestines adjust)
• Consult dietitian for meal planning guidance
• Administer antiemetics (ondansetron) as prescribed for nausea

6. Impaired Physical Mobility / Activity Intolerance

• Encourage early ambulation (within 6-8 hours post-op for laparoscopic; day 1-2 for open)
• Assist with positioning and transfers to prevent falls
• Educate on activity restrictions: no heavy lifting (>5 kg) for 4-6 weeks (open), 1-2 weeks (laparoscopic)
• Encourage progressive activity increase each day

7. Deficient Knowledge

• Teach wound care: how to clean incision, signs of infection to report
• Instruct on low-fat diet and gradual reintroduction of fats over 4-6 months
• Advise to report danger signs: jaundice, dark urine, clay-colored stools, fever, chills, severe abdominal pain (may indicate bile duct obstruction or retained stones)
• Educate on medication use (bile salt replacements if prescribed, laxatives for opioid-induced constipation)
• Advise that loose stools may persist for several months post-operatively

8. Risk for Constipation

• Monitor bowel sounds and bowel movements
• Encourage early ambulation to promote peristalsis
• Ensure adequate fluid intake
• Administer prescribed stool softeners or laxatives if on opioid therapy
• Advance diet progressively to include fiber-rich foods

9. Anxiety / Fear

• Provide clear, consistent information about recovery expectations
• Allow patient to verbalize concerns; validate feelings
• Include family/support persons in discharge teaching
• Explain all procedures before performing them

Special Considerations: T-Tube Care (Open Cholecystectomy)

• Keep tube patent and monitor drainage (300-500 mL/day is normal initially)
• Gradually clamp as ordered before removal
• Position drainage bag below incision level
• Teach patient T-tube care at home if discharged with it

Priority Nursing Diagnoses (Post-Op Day 1)

Nursing Diagnosis for Diarrhea

NANDA Update Note: NANDA International has recently relabeled "Diarrhea" to "Impaired Fecal Continence" in newer editions. Many clinical settings and nursing programs still use the term "Diarrhea" - both labels refer to the same condition. This guide uses both for clarity.

Definition

PRIMARY NANDA Nursing Diagnosis

Diarrhea (Impaired Fecal Continence)

• Gastrointestinal infections (bacterial, viral, parasitic)
• Irritable bowel syndrome (IBS) / inflammatory bowel disease (IBD)
• Malabsorption syndromes (lactose intolerance, celiac disease)
• Antibiotic therapy (C. difficile-associated diarrhea)
• Tube feeding / enteral nutrition
• Stress and anxiety
• Dietary indiscretion (contaminated food, high fiber, caffeine)
• Cancer or cancer treatment (chemotherapy/radiation)
• Medications (laxatives, antacids containing magnesium)
• Post-GI surgery changes

• At least 3 loose/watery stools per day
• Urgency to defecate
• Abdominal cramping and pain
• Hyperactive bowel sounds
• Increased frequency of defecation
• Loose or liquid stool consistency

• Patient re-establishes and maintains a normal bowel pattern within 24 hours of interventions
• Patient consumes 1,500-2,000 mL of clear fluids daily to maintain hydration
• Patient verbalizes understanding of causes and treatment rationale within 8 hours

Nursing Assessment

Nursing Interventions

Fluid & Electrolyte Management

• Encourage oral fluid intake of 1,500-2,000 mL/day of clear liquids (water, electrolyte solutions, broth, clear juices)
• Administer IV fluids and electrolyte replacements as ordered for severe dehydration
• Monitor and document intake and output strictly
• Weigh patient daily at the same time on the same scale
• Administer oral rehydration solution (ORS) - contains Na, K, glucose for optimal intestinal absorption

Dietary Management

• Advance to a BRAT diet (Bananas, Rice, Applesauce, Toast) or bland, easy-to-digest foods
• Avoid foods that worsen diarrhea: milk products (if lactose intolerant), high-insoluble-fiber foods, caffeine (coffee, tea, dark sodas, chocolate), fatty/greasy foods
• Encourage small, frequent meals rather than large ones
• Reintroduce regular diet gradually as stools normalize

Skin Care (Perianal)

• Clean perianal area gently with mild soap and water after each stool
• Pat dry (do not rub) and apply barrier cream or moisture-barrier ointment (zinc oxide, petrolatum)
• Use soft, moist wipes rather than dry toilet paper
• Assess perianal skin at each stool episode for breakdown, redness, or excoriation

Infection Control

• Implement contact precautions if infectious etiology is suspected (C. difficile, norovirus)
• Obtain stool culture/sensitivity, ova and parasite examination as ordered
• Perform strict hand hygiene before and after patient contact
• Dispose of soiled linens per facility infectious waste policy

Pharmacologic Interventions

• Administer antidiarrheal agents as prescribed (loperamide, bismuth subsalicylate)
• Administer antibiotics as ordered for confirmed bacterial or C. difficile infection
• Note: Antidiarrheals are contraindicated in infectious/bloody diarrhea - withhold and notify provider
• Administer probiotics as ordered to restore normal gut flora (especially post-antibiotic diarrhea)

Patient Education

• Teach hand hygiene as primary prevention for infectious diarrhea
• Educate on safe food handling and preparation practices
• Instruct on dietary modifications and fluid intake targets
• Advise when to seek medical attention: blood in stool, fever >38.5°C, diarrhea lasting >48-72 hours, signs of severe dehydration
• Educate on proper medication use, including avoidance of OTC antidiarrheals if stool is bloody

Associated / Secondary Nursing Diagnoses

1. Deficient Fluid Volume

2. Imbalanced Nutrition: Less Than Body Requirements

3. Acute Pain

4. Impaired Skin Integrity

5. Risk for Electrolyte Imbalance

6. Anxiety / Situational Low Self-Esteem

7. Deficient Knowledge

8. Risk for Impaired Tissue Integrity (Oral Mucosa)

Priority Nursing Diagnoses (Ranked)

Sample Nursing Care Plan Statements