Acute Pancreatitis Nursing Care Plan Notes

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

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

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)

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

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.

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

Assess fluid and electrolyte status (e.g. skin turgor, mucous membranes, intake and output); and provide replacement therapy as indicated.

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.

Place the client in semi-Fowler’s position to decrease pressure on the diaphragm.
Teach the client coughing and deep-breathing techniques.