Pancreatitis

Pancreatitis  Inflammation of pancreas.  Acute or chronic.  Acute:  Digestion of the organ by enzymes it produces, particularly trypsin.  Indications:  Severe abdominal pain.  Pain often radiates to back.  Nausea and vomiting.  Fever.  Jaundice.  Confusion.  Hyperglycemia.  Chronic:  Obstruction of pancreatic ducts.  Destruction of secreting cells.  Frequently related to alcohol consumption.  Indications:  Those for acute.  Weight loss.  Diabetes mellitus.  Steatorrhea.  Surgery if pain does not respond to medical management.  Nursing interventions:  Keep NPO to rest pancreas and stop production of enzymes.  Establish and monitor nasogastric tube with suction.  Maintain fluid and electrolyte balance.  Place in semi-Fowler position or, especially for pain relief, keep knees flexed when sitting in bed or lying on side with pillow pressed to abdomen.  Monitor for:  Infection.  Shock.  Hyperglycemia.  Administer parenteral nutrition.  Administer medications such as:  Antacids.  Analgesics.  Anticholinergics.  For chronic pancreatitis, give medications for treatment of exocrine insufficiency. Nursing Focus & Concepts Pancreatitis Definition:  Inflammation of pancreas.  Results in premature activation of digestive enzymes.  Either acute or chronic. Concepts:  Digestion.

 Pancreatitis. Assessment:  Acute pancreatitis:  Sudden, severe epigastric and/or abdominal pain.  Tachypnea.  Tachycardia.  Basilar crackles.  Hypotension.  Abdominal distention.  Decreased bowel sounds.  Nausea.  Vomiting.  Fatigue.  Chronic pancreatitis:  Similar in presentation to acute.  Weight loss.  Constipation.  Mild jaundice.  Early and correct assessment of subjective and objective data is key to client survival and return to health. Diagnosis:  Acute pain from distention and inflammation of pancreas.  Deficit in fluid volume due to nausea, vomiting and NPO status. Planning:  Plan for:  Relief of pain.  Bowel rest.  Return to normal fluid balance.  Reducing or eliminating complications.  Preventing future attacks.  Prepare to administer:  IV opioids.  Antiemetics.  IV fluids.  Parenteral nutrition depending on length of inflammation.  Nothing by mouth (NPO).  Monitor for:  Fluid shifts.  Hypovolemia.  Respiratory distress. Implementation:  Administer:  IV opioids.  Antiemetics.  IV fluids as prescribed.  Monitor:  Respiratory rate.  Constipation.

 Diuretics.  Estrogen.  NSAIDs.  Infection. Signs and Symptoms:  Severe abdominal pain.  Acute symptoms:  Nausea.  Vomiting.  Jaundice.  Decreased or absent bowel sounds.  Shock due to hemorrhage.  Chronic symptoms:  Weight loss.  Constipation.  Diabetes mellitus.  Steatorrhea (fatty stool). Diagnostic Testing:  Observation of signs and symptoms.  Elevated:  Serum amylase.  Serum lipase.  Sedimentation rate.  Leukocytosis - may be first indication.  Chronic may not see rise in lab values.  Imaging studies may determine:  Calcifications.  Ductal dilatation.  Pancreatic enlargement. Treatment:  Fluid and electrolyte imbalances - fluid replacement.  Antibiotics for infections.  NPO and NG suction for bowel rest.  IV pain relief.  Chronic pancreatitis:  Pancreatic enzyme replacement.  Low fat diet.  Pain relief.  Surgical removal of gallstones or diversion of bile.  Decreased alcohol intake. Complications:  Acute may become chronic.  Loss of pancreatic cells can be life threatening.  Local pseudocysts and abscesses.  Systemic complications:  Pulmonary effusion.  Acute respiratory distress syndrome (ARDS).

 Hypotension.  Hypocalcemia.  Diabetes mellitus.  Respiratory failure.  Kidney failure.  Abdominal compartment syndrome.  Hypovolemic shock. Expected Outcomes:  Clients with acute pancreatitis can regain pancreatic function with early identification.  Addressing pain and fluid balance are essential for positive outcome.  Client will resume a diet with no reports of abdominal pain and nausea.  Clients with chronic pancreatitis will improve by decreasing alcohol consumption and following medication regimens.