Acute Pancreatitis Nursing Care Plan Notes
Definition
- inflammation of the pancreas, ranging from mild edema to extensive hemorrhage, resulting from various insults to the pancreas.
- defined by a discrete episode of abdominal pain and serum enzymes elevations
- function and structure usually return to normal after an acute attack
Risk Factors
- Alcoholism
- Cholecystitis
- Surgery involving or near the pancreas
- Viral hepatitis, mumps, peptic ulcer disease, periarteritis
- Hyperlipidemia,hypercalcemia, anorexia nervosa, shock with ischemia
- Trauma to the pancreas
- Medications
Pathophysiology and Etiology
- excessive alcohol consumption
- biliary tract disease such as cholelithiasis, acute and chronic cholecystitis
- mortality is high because of shock, anoxia, hypotension or multiple organ dysfunction
- autodigestion of all or part of the pancreas is involved
Assessment/Clinical Manifestations/Signs and Symptoms
- abdominal pain, usually constant, midepigastric or periumbilical, radiating to the back or flank
- nausea and vomiting
- fever
- involuntary abdominal guarding, epigastric tenderness
- dry mucous membranes, hypotension, cold clammy skin, cyanosis or tenderness, tachycardia and mild to moderate dehydration
- shock with respiratory distress and acute renal failure
- purplish discoloration of the flanks (Turner’s sign) or of the periumbilical area (Cullen’s sign)
Diagnostic Evaluation
- serum amylase, lipase, glucose, bilirubin, alkaline phosphatase, lactate dehydrogenase, AST, ALT, potassium and cholesterol may be elevated
- Serum albumin, calcium, sodium, magnesium and potassium may be low due to dehydration
- Abdominal x-ray to detect an ileus or isolated loop of small bowel overlying pancreas
- CT scan is the most definitive study
- Chest x-ray for detection of pulmonary complications
Medical Management
During the acute phase, management is symptomatic and directed toward preventing or treating complications.
- Oral intake is withheld to inhibit pancreatic stimulation and secretion of pancreatic enzymes.
- Parenteral nutrition is administered to the debilitated patient.
- Nasogastric suction is used to relieve nausea and vomiting, decrease painful abdominal distention and paralytic ileus and remove hydrochloric acid so that it does not stimulate the pancreas.
- Cimetidine (Tagamet) is given to decrease hydrochloric acid secretion.
- Adequate pain medication is administered; morphine and morphine derivatives are avoided because they cause spasm of the sphincter of Oddi.
- Correction of fluid, blood loss, and low albumin levels is necessary.
- Antibiotics are administered if infection is present.
- Insulin is necessary if significant hyperglycemia occurs.
- Aggressive respiratory care is provided for pulmonary infiltrates, effusion and atelactasis.
- Biliary drainage (drains and stents) results in decreased pain and increased weight gain.
- Surgical intervention may be performed for diagnosis, drainage, resection or debridement.
Complications
- Pancreatic ascites, abscess or pseudocyst
- Pulmonary infiltrates, pleural effusion, acute respiratory distress syndrome
- Hemorrhage with hypovolemic shock
- Acute renal failure
- Sepsis and multi-oran dysfunction syndrome
Nursing Diagnosis
- Pain and discomfort related to edema, distention of the pancreas, and peritoneal irritation
- Imbalanced nutrition: less than body requirements related to inadequacy dietary intake, impaired absorption, reduced food intake, and increased metabolic demands.
- Activity intolerance related to fatigue
- Ineffective breathing pattern related to severe pain, pulmonary infiltrates, pleural effusion and atelactasis
- Impaired skin integrity resulting from poor nutritional status, bed rest, surgical wound
- Fear in response to the diagnosis of pancreatitis
- Ineffective coping related to the diagnosis of pancreatitis
Nursing Management
The client should avoid oral intake to inhibit pancreatic stimulation and secretion of pancreatic enzymes.
- Total parenteral nutrition is administered to assist with metabolic stress.
Maintain fluid and electrolyte balance.
- Assess fluid and electrolyte status (e.g. skin turgor, mucous membranes, intake and output); and provide replacement therapy as indicated.
Promote adequate nutrition.
- Assess nutritional status; monitor glucose levels; monitor IV therapy, provide a high-carbohydrate, low-protein, low-fat diet when tolerate; and instruct the client to avoid spicy foods.
Maintain optimal respiratory status.
- Place the client in semi-Fowler’s position to decrease pressure on the diaphragm.
- Teach the client coughing and deep-breathing techniques.