Acute cholecystitis is an inflammatory condition of the gallbladder, commonly triggered by gallstone obstruction in the cystic duct. This condition causes persistent right upper quadrant abdominal pain, fever, leukocytosis, and gastrointestinal symptoms. For nursing students and healthcare professionals in the United States, understanding the patient’s clinical data, interpreting assessment findings, and developing an evidence-based nursing care plan is essential.
Definition
Acute cholecystitis refers to the acute inflammation of the gallbladder, usually caused by gallstone obstruction. The blockage leads to bile accumulation, gallbladder distention, ischemia, and bacterial overgrowth. Patients often present with persistent right upper quadrant pain, fever, nausea, vomiting, and a positive Murphy’s sign.
Etiology (Causes)
- Gallstones (Cholelithiasis) – the most common cause; stones obstruct the cystic duct, leading to inflammation.
- Tumors – may block bile drainage and cause bile stasis.
- Bile duct scarring or kinking – obstructs bile flow.
- Infections – viral infections, including in immunocompromised patients, may cause gallbladder inflammation.
- Decreased gallbladder perfusion – occurs in critically ill patients, leading to acalculous cholecystitis.
Symptoms
- Right upper quadrant pain
- Fever and chills
- Leukocytosis
- Nausea and vomiting
- Abdominal tenderness
- Positive Murphy’s sign
- Fat intolerance (symptoms worsen after high-fat meals)
Case Example
A 60-year-old woman presents with right upper abdominal pain, tenderness on palpation, and fever for 3 days. Pain scale is 5/10, persistent, and worsens with activity. She also reports nausea and vomiting, decreased appetite, and inability to eat more than a quarter portion of a meal. Ultrasound shows pericholecystic fluid and thickened gallbladder wall. Laboratory results indicate leukocytosis and elevated CRP. Vital signs: BP 130/90 mmHg, Pulse 95 bpm, Temperature 39°C, Respiratory rate 24/min.
Clinical Data Analysis
| Data |
Interpretation |
| RUQ pain, Murphy sign(+) |
Indicates gallbladder inflammation |
| Fever 39°C, leukocytosis, ↑CRP |
Suggest infection or inflammation |
| Nausea, vomiting, inability to eat |
Risk for dehydration and nutritional imbalance |
| Bad skin turgor |
Signs of fluid volume deficit |
Priority Nursing Diagnoses
- Acute Pain related to biological injury agents
- Hyperthermia related to infectious process
- Risk for Fluid Volume Deficit related to active fluid loss
- Imbalanced Nutrition: Less Than Body Requirements related to inadequate food intake
Nursing Outcomes (NOC) and Nursing Interventions (NIC)
1. Nursing Diagnosis: Acute Pain
NOC (Expected Outcomes)
- Pain Level
- Comfort Status
- Symptom Control
NIC (Interventions)
- Pain Management
- Analgesic Administration
- Positioning
Intervention Table with Rationale
| Intervention |
Rationale |
| Assess pain level using numerical scale every 2–4 hours |
Provides baseline data and helps evaluate response to treatment |
| Place patient in a semi-Fowler position |
Decreases abdominal muscle tension and enhances comfort |
| Administer prescribed analgesics (e.g., NSAIDs or opioids) |
Reduces pain by controlling inflammation and gallbladder spasms |
| Encourage relaxation techniques (deep breathing) |
Helps reduce muscle tension and improve pain tolerance |
2. Nursing Diagnosis: Hyperthermia
NOC
- Thermoregulation
- Infection Status
NIC
- Fever Treatment
- Infection Control
Intervention Table with Rationale
| Intervention |
Rationale |
| Monitor temperature every 4 hours |
Detects fever progression and treatment effectiveness |
| Administer antipyretics (e.g., acetaminophen) |
Reduces elevated body temperature |
| Encourage fluid intake if tolerated |
Prevents dehydration due to fever |
| Apply tepid sponge bath if temperature >38.5°C |
Enhances heat loss via conduction and evaporation |
3. Nursing Diagnosis: Risk for Fluid Volume Deficit
NOC
NIC
- Fluid Management
- Oral/IV Hydration
Intervention Table with Rationale
| Intervention |
Rationale |
| Monitor intake and output |
Early detection of dehydration and kidney perfusion problems |
| Assess skin turgor, mucous membranes |
Helps evaluate hydration status |
| Administer IV fluids as prescribed |
Maintains intravascular volume and prevents complications |
| Monitor electrolytes (Na, K, Cl) |
Vomiting may cause electrolyte imbalances |
4. Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements
NOC
- Nutritional Status
- Appetite
- Energy Level
NIC
- Nutritional Support
- Nausea Management
Intervention Table with Rationale
| Intervention |
Rationale |
| Assess food intake pattern and weight |
Identifies degree of nutritional deficit |
| Provide small, frequent, low-fat meals |
Reduces gallbladder workload and prevents nausea |
| Administer antiemetics as prescribed |
Controls nausea and helps improve oral intake |
| Collaborate with dietitian |
Ensures individualized nutrition planning |
Conclusion
Acute cholecystitis requires prompt assessment and structured nursing interventions to prevent complications such as sepsis and gallbladder rupture. By analyzing clinical data, identifying nursing diagnoses, implementing appropriate NOC–NIC interventions, and evaluating outcomes, nurses can significantly improve patient recovery. This comprehensive care plan can be used by nursing students and professionals as a reference for managing patients with acute cholecystitis.
References
- Harrison’s Principles of Internal Medicine, 17th Edition, McGraw-Hill, 2008.
- Mayo Clinic. Cholecystitis – Symptoms and Causes.
- Medical News Today. Cholecystitis Overview.
