Pancreatitis

Introduction:

Pancreatitis is an inflammation of the pancreas which causes destructive cellular
changes. It may be an acute or a chronic process. Acute pancreatitis involves auto-
digestion of the pancreas by pancreatic enzymes and development of fibrosis. Blood
glucose control may be affected by the changes to the pancreas. Chronic pancreatitis
results from recurrent episodes of exacerbation, leading to fibrosis and a decrease in
pancreatic function. Presence of gallstones blocking a pancreatic duct, chronic use
of alcohol, post-abdominal trauma or surgery, or elevated cholesterol are associated
with an increased risk of pancreatitis.

PROGNOSIS

Acute pancreatitis may be life-threatening. Pleural effusion may develop as a com-
plication of acute pancreatitis; older patients have a greater risk of also developing
pneumonia. Disseminated intravascular coagulation is another complication that
may occur, affecting the body’s ability to clot due to depleted clotting factors in
the development of small thrombi.

SIGNS AND SYMPTOMS

• Epigastric pain due to inflammation and stretching of pancreatic duct
• Boring abdominal pain may radiate to back or left shoulder in acute pan-
creatitis
• Gnawing continuous abdominal pain with acute exacerbations in chronic
pancreatitis
• Patient in knee-chest position for comfort—reduces tension on abdomen
• Nausea and vomiting
• Bluish-gray discoloration of periumbilical area and abdomen (Cullen’s sign)
• Bluish-gray discoloration of flank areas (Turner’s sign)
• Ascites
• Weight loss
• Blood glucose elevation
• Fatigue

TREATMENT

• NPO during acute stage to reduce release of pancreatic enzymes.
• Intravenous fluids for hydration.
• Total parenteral nutrition.
• Administer vitamin supplementation.
• Pain management with narcotics during acute stage.
• Avoid morphine that may increase pain due to spasm of the sphincter of Oddi
at the opening to the small intestine from the common bile duct.
• Intravenous, patient-controlled analgesia or transdermal delivery preferable
to intramuscular.
• Acute:
• NG tube connected to suction if vomiting.
• Surgical intervention for abscess or pseudocyst.
• Chronic:
• Blood glucose control with insulin.
• Administer pancreatic enzymes with meals.
• Surgical intervention for pain control, abscess.

NURSING DIAGNOSES

• Acute pain
• Imbalanced nutrition: less than what body requires

NURSING INTERVENTION

• Assess vital signs for elevated temperature, elevated pulse, and changes in
blood pressure.
• Assess pain level.
• Monitor intake and output.
• Assess abdomen for bowel sounds, tenderness, masses, ascites.
• Monitor fingerstick blood glucose.
• Assess lung sounds for bilateral equality.
• Frequent oral care for NPO patients.
• Teach patient about home care:
• Avoid alcohol and caffeine.
• Bland, low-fat, high-protein, high-calorie, small, frequent meals.
• Use of blood glucose meter.
• Medication management, schedule, side effects.
• Plan rest periods until strength returns.