Acute Pancreatitis Nursing Care Plan & Management

 Acute Pancreatitis Nursing Care Plan & Management

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.

Institute measures to prevent complications of immobility, such as impaired skin integrity, constipation, and deep vein thrombosis.

Monitor for complications, which may include fluid and electrolyte disturbances, pancreatic necrosis, shock, and multiple organ failure.

Administer prescribed medications, which may include opioid or nonopioid analgesics, histamine receptor antagonists, and proton-pump inhibitors.

Maintain patent nasogastric suctioning to relieve nausea and vomiting, decrease painful abdominal distention, and remove hydrochloric acid.