Nursing Management: Acute Pancreatitis

Nursing Management: Acute Pancreatitis

• Nursing Assessment
  • Subjective Data
    • Important Health Information
      • Past health history:
        • Biliary tract disease, alcohol use, abdominal trauma, duodenal ulcers, infection, metabolic disorders
      • Medications:
        • Thiazides
        • Nonsteroidal anti-inflammatory drugs
      • Surgery or other treatments:
        • Surgical procedures on the pancreas, stomach, duodenum, or biliary tract.
        • Endoscopic retrograde cholangiopancreatography (ERCP)
    • Functional Health Patterns
      • Health perception–health management:
        • Chronic alcohol use, fatigue
      • Nutritional-metabolic:
        • Nausea and vomiting, anorexia
      • Activity-exercise:
        • Dyspnea
      • Cognitive-perceptual:
        • Severe midepigastric or left upper quadrant pain that may radiate to the back, aggravated by food and alcohol intake and unrelieved by vomiting
  • Objective Data
    • General
      • Restlessness, anxiety, low-grade fever
    • Integumentary
      • Flushing, diaphoresis, discoloration of abdomen and flanks, cyanosis, jaundice. Decreased skin turgor, dry mucous membranes
    • Respiratory
      • Tachypnea, basilar crackles
    • Cardiovascular
      • Tachycardia, hypotension
    • Gastrointestinal
      • Abdominal distention, tenderness, and muscle guarding. Diminished bowel sounds
    • Possible Diagnostic Findings
      • Increased serum amylase and lipase
      • Leukocytosis
      • Hyperglycemia
      • Hypocalcemia
      • Abnormal ultrasound and CT scans of pancreas
      • Abnormal ERCP or MRCP
• Nursing Diagnoses
  • Acute pain related to distention of pancreas, peritoneal irritation, obstruction of biliary tract, and ineffective pain and comfort measures
  • Deficient fluid volume related to nausea, vomiting, restricted oral intake, and fluid shift into the retroperitoneal space
  • Imbalanced nutrition: less than body requirements related to anorexia, dietary restrictions, nausea, loss of nutrients from vomiting, and impaired digestion
  • Ineffective health management related to lack of knowledge of preventive measures, diet restrictions, alcohol intake restriction, and follow-up care
• Nursing Planning
  • The overall goals are that the patient with acute pancreatitis will have
    • Relief of pain
    • Normal fluid and electrolyte balance
    • Minimal to no complications
    • No recurrent attacks