Nursing Care Plan (NCP) for Pancreatitis

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Outline

Pathophysiology

Self-digestion of the pancreas by its own proteolytic enzymes (trypsin) causes acute inflammation of the pancreas. Enzymes within the pancreas may be prematurely activated by obstruction of gallstones in the bile duct. The enzymes then reflux back into the pancreatic duct causing inflammation, erosion and necrosis. There is an elevated risk of mortality due to hypovolemic shock, hypotension or multiple organ dysfunction. Acute pancreatitis is a sudden inflammation that only lasts a short time. Chronic pancreatitis is long-lasting and usually occurs after an acute episode.

Etiology

Acute: In the US, 80%-90% of acute pancreatitis cases are the result of gallstones followed by alcohol intake. Other etiology includes infections, hypercalcemia, hypertriglyceridemia, trauma, pancreatic cancer, autoimmune disease and certain medications.

Chronic: Long-term alcohol use is the major contributor to chronic pancreatitis, in addition to gallstones, hereditary disorders, cystic fibrosis and hypertriglyceridemia

Desired Outcome

The desired outcome of pancreatitis is the absence of obstruction, inflammation or infection of the pancreas and bile duct. Patient will be free from pain and vomiting.

Pancreatitis Nursing Care Plan

Subjective Data:

  • Abdominal pain – mid-epigastric pain that radiates to the back
  • Anorexia
  • Nausea / vomiting

Objective Data:

  • Vomiting
  • Fever
  • Dry mucous membranes
  • Rigid abdomen
  • Tachycardia
  • Hypotension
  • Bruising in the flank and around the umbilicus
  • Elevated serum lipase/amylase levels

Nursing Interventions and Rationales

  • Assess and monitor vitals

 

  • Temperature – fever is a sign of infection and stress response
  • Hypotension (decreased blood pressure) with tachycardia (elevated heart rate): a sign of hypovolemia and can lead to shock

 

  • Assess and manage pain

 

  • Administer medications as ordered: opioid or non-opioid medications for pain
  • Positioning:  place in semi-Fowler’s to decrease pressure on abdomen and diaphragm

 

  • Monitor labs

 

  • Serum lipase – may stay elevated for up to 12 days
  • Serum amylase – usually returns to normal within a few days of treatment
  • CRP – 24-48 hours after presentation – higher levels may indicate possible organ failure
  • WBC – >12,000/uL (leukocytosis) may = inflammation or infection
  • Hematocrit – >47% may indicate more severe disease
  • Serum glucose – monitor for hyperglycemia due to lack of insulin secretion

 

  • Administer Medications as ordered

 

  • Cimetidine (Tagamet) – often given to decrease secretion of hydrochloric acid
  • Antibiotics – as necessary for primary infection
  • Insulin – as necessary for significant hyperglycemia

 

  • Nutrition Monitoring and Education

 

  • Maintain NPO status during acute phase of illness
  • Provide clear liquid diet for a few days once inflammation is under control
  • Parnteral nutrition – in severe cases  may be given to inhibit stimulation of pancreatic enzymes and to decrease metabolic stress

 

  • Assess fluid/electrolyte balance

 

Monitor

  • Skin turgor- tenting is a sign of moderate to severe dehydration
  • Mucous membranes- lips and mouth should be moist and shiny
  • I & O monitor for retention or excess output of fluid

Administer

  • Aggressive IV hydration is recommended within the first 12-24 hours of onset, unless contraindicated (cardiac or renal comorbidities)

 

  • Encourage lifestyle changes

 

Counsel patient on healthy lifestyle choices to include:

  • Stop smoking
  • Cessation of drinking alcohol
  • Healthy diet and exercise to maintain appropriate weight.
  • Lower fat intake to improve hypertriglyceridemia
  • Optimal hydration – pancreatitis can cause dehydration, encourage patient to drink more water throughout the day

 

Writing a Nursing Care Plan (NCP) for Pancreatitis

A Nursing Care Plan (NCP) for Pancreatitis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey guys, in this care plan, we will discuss pancreatitis. In this care plan on pancreatitis, we will cover the desired outcome, the subjective and objective data along with the nursing interventions and rationales. 

 

Our medical diagnosis is pancreatitis. Pancreatitis is when the pancreas is literally digested by its own proteolytic enzymes, which is going to cause inflammation of the pancreas. The enzymes may be prematurely activated by the obstruction of gallstones in the bile duct. Acute pancreatitis is usually caused by gallstones, alcohol intake, hypercalcemia medications, cancer, hypertriglyceridemia, or an autoimmune disease. Chronic pancreatitis may occur after recurrences of acute pancreatitis. Maybe the patient continues to drink alcohol over and over. They’re going to keep getting pancreatitis until it becomes chronic. Our desired outcome is the absence of obstruction, inflammation, or infection of the pancreas in the bowel duct. The patient will be free from pain and vomiting. 

 

Let’s take a look at our pancreatitis care plan. The subjective data of our patient may include abdominal pain. It may be midepigastric and it could radiate to the back. I sometimes have patients that have so much abdominal pain, and then I’ve even had some that have pancreatitis and they don’t experience any, so it just kind of depends. The patient might be experiencing anorexia from not wanting to eat because it causes more pain when the pancreas makes those insights. The patient might have nausea, especially after eating because of those digestive enzymes secreted by the already inflamed pancreas. 

 

Now let’s look at our objective data. The patient might experience some vomiting, especially after eating because of those digestive enzymes secreted by the pancreas. They might have a fever from inflammation or infection brewing. You may see that they have some dry mucous membranes, especially if they’re dehydrated, and their abdomen may become rigid from that peritoneal irritation by the excessive enzyme secretion into the abdominal cavity. Look out for hypotension. The patient might have that because of the hydration, their lipase and amylase levels are probably going to be elevated because that’s something that’s secreted by the pancreas normally. So, when it’s inflamed, it’s going to excrete more than usual. 

 

Now, let’s look at our nursing interventions and the rationales for each. So as the nurse, you’re going to assess your patient and monitor their vital signs. Look for signs of hypovolemia and infection in your patient. Look for elevated temperature because fever is a sign of infection and distress response. Look for hypotension and tachycardia because those are signs of hypovolemia or not getting enough fluid, and that can lead to shock. You want to assess and manage your patient’s pain. Remember, this can be very painful. Administer pain medications as ordered by the doctor and try to work with positioning them to help relieve the abdominal pain. You may want to put them in a semi-Fowler’s position to decrease the pressure of the abdomen. Monitor your patient’s lab values. You want to look at the lipase amylase and even glucose levels, remember, that insulin secreted by the pancreas. The lipase level could be elevated for up to 12 days after, but the amylase actually returns to normal within a few days. 

 

Our next nursing intervention is to administer medications as ordered by the doctor. You might want to give medications that will help to address that stomach acid and the hyperglycemia if they have it, then of course, pain medicine. Our next nursing intervention for pancreatitis is nutritional monitoring and education. You know, a lot of times patients want to keep eating, but you have to explain to them, listen, you have to rest your pancreas, allow it to rest. Just don’t eat or drink anything. We’ll advance the diet as tolerated and ordered by the doctor when you’re not experiencing pain anymore. Parenteral nutrition might have to be given, and in really severe cases, to inhibit the stimulation of pancreatic enzymes and decrease the metabolic stress. 

 

Our next nursing intervention is to assess the fluid and electrolyte balance. This is important because they might not be eating and drinking as much, right? Ensure hydration per IV fluids when they’re NPO, check their mucous membranes, make sure they’re nice and moist. Keep an eye on their eyes and nose. You might have to give aggressive IV hydration as ordered by the doctor. Our last nursing intervention is to encourage lifestyle changes. You want to try to help them avoid the recurrence of this pancreatitis. The doctor will talk to them about what they think caused this. Maybe it was excessive alcohol intake, maybe it was a certain drug that they’re taking, so, just encourage them to stop. Whatever was causing that, encourage them to eat a healthy diet. That’s always an important hydration exercise to maintain an appropriate weight. Also discuss a low-fat diet because this is going to help them to improve any hypertriglyceridemia that’s. 

 

We love you guys. Now, go out and be your best self today and as always, happy nursing!

 

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