ECOLOGIC MODEL

(WHEEL)

Obesity

Contraceptive Pill Declined good cholesterol Levels

Increased Age(.60 years old)Rapid Weight Loss

Sex (Female)

Total Parenteral Nutrition

CHOLEDOCHOLITHIASIS

I. Hypothesis

“The host factors of the patient have a significant effect on the client’s predisposition to develop

choledocholithisis rather than the environmental factors.” Specifically age, decreased LDL level, prolong IV feeding,

hormonal factors, rapid weight loss, obesity and sex are the main predisposing factors that made the client to have

choledocholithiasis.

II. Predisposing Factors

Host

Age – Gallstones occur in nearly 25% of women in the U.S. by age 60, and as many as 50% by age 75.

(Medical – Surgical nursing 7th edition by smeltzer and bare)

Declined “good” cholesterol levels – Gallstone formation is associated with low levels of "good" HDL

cholesterol and high triglyceride levels. Some evidence suggests that high levels of triglycerides may impair

the emptying actions of the gallbladder. Unfortunately, some fibrates (drugs used to correct these

conditions) actually increase the risk for gallstones by increasing the amount of cholesterol secreted into the

bile. These medications include gemfibrozil (Lopid) and fenofibrate (Tricor). Other cholesterol-lowering drugs

do not have this effect. (Medical – Surgical nursing 7th edition by smeltzer and bare).

Total Parenteral Nutrition - Prolonged intravenous feeding reduces the flow of bile and increases the

risk for gallstones. Up to 40% of patients on home intravenous nutrition develop gallstones, and the risk may

be higher in patients on total intravenous nutrition. It is suspected that the cause is lack of stimulation in the

gut, because patients who also take some food by mouth have less risk of developing gallstones. However,

treatment for gallstones in this population is associated with a low risk of complications. (Medical-Surgical

Nursing 10th ed., Black and Hawks).

Contraceptive pill - Several large studies have shown that the use of hormone replacement therapy

(HRT) doubles or triples the risk for gallstones, hospitalization for gallbladder disease, or gallbladder

surgery. Estrogen raises triglycerides, a fatty acid that increases the risk for cholesterol stones. How the

hormones are delivered may make a difference, however. Women who use a patch or gel form of HRT face

less risk than those who take a pill. HRT may also be a less-than-attractive option for women because

studies have shown it has negative effects on the heart and increases the risk for breast cancer. (Medical –

Surgical nursing 7th edition by smeltzer and bare);

Rapid Weight Loss – Rapid weight loss or cycling (dieting and then putting weight back on) further

increases cholesterol production in the liver, which results in supersaturation and an increased risk for

gallstones. (Medical-Surgical Nursing 10th ed., Black and Hawks)

Obesity - Being overweight is a significant risk factor for gallstones. In such cases, the liver over-produces

cholesterol, which is delivered into the bile and causes it to become supersaturated. (Medical – Surgical

nursing 7th edition by smeltzer and bare).

Sex- Women are much more likely than men to develop gallstones. In general, women are probably at

increased risk because estrogen stimulates the liver to remove more cholesterol from blood and divert it into

the bile. Pregnancy increases the risk for gallstones, and pregnant women with stones are more likely to

have symptoms than nonpregnant women. Surgery should be delayed until after delivery if possible. In fact,

gallstones may disappear after delivery. If surgery is necessary, laparoscopy is the safest approach.

(Medical – Surgical nursing 7th edition by smeltzer and bare).

III- Ecologic Model

IV. Analysis

The wheel model is a form of ecologic model designed to de-emphasize the agent factor of the ecologic

triad. Specifically, our problem focuses on the multiple factors that predispose the client to develop

choledocholithiasis which are mainly due to host factors based on the assessment.

IV. Interventions / recommendations

As nurses, it is our primary goal is to alleviate the signs and symptoms feel by our client related to

his / her current condition. Our interventions for the condition of the patient are:

Provide comfort measures such as touch therapy, repositioning, and use of heat / cold compress.

Teach client deep breathing exercise to alleviate pain.

Give pain reliever if prescribed by the physician.

Tell patient to move from side to side or avoid too much sedentary lifestyle for it enhances intestinal mobility.

Administer stool softeners or laxatives as prescribed by physician to facilitate defecation.

Once the client is discharge , encourage to eat a balanced diet especially those foods that are rich in fiber

and low in cholesterol