Acute Pancreatitis

Acute Pancreatitis

1. Clinical Manifestations

   • abdominal pain
     • usually left upper quadrant
   • back pain
   • nausea
   • vomiting
   • low-grade fever
   • leukocytosis
   • hypotension
   • tachycardia
   • jaundice
   • Grey Turner's spots or sign
   • Cullen's sign

2. Goals

   • relief of pain
   • prevention or alleviation of shock
   • reduction of pancreatic secretions
   • correction of fluid and electrolyte imbalances
   • prevention or treatment of infections
   • removal of the precipitating cause, if possible

3. Nursing Diagnosis & Interventions

   • acute pain r/t distention of pancreas, peritoneal irritation, obstruction of biliary tract, and ineffective pain and comfort measures
     • administer medications
     • provide nonpharmacological pain management
       • quiet environment
       • comfort measures (e.g., back rub, change of position, use of heat or cold compresses)
       • use of relaxation exercises (e.g., focused breathing, visualization, guided imagery)
       • diversional or distraction activities (e.g., television, radio, socialization with others, etc.
   • deficient fluid volume r/t nausea, vomiting, restricted oral intake, and fluid shift into the retroperitoneal space
     • monitor I&O
     • assess skin and oral mucous membranes
     • offer a variety of fluids and water-rich foods
   • Imbalanced nutrition: less than body requirements r/t anorexia, dietary restrictions, nausea, loss of nutrients from vomiting, and impaired digestion
     • auscultate bowel sounds
     • provide diet modifications (e.g., several small meals and snacks daily
     • high-calorie, nutrient-rich dietary supplements, such as meal-replacement shake
     • assist with oral care
   • Ineffective health management r/t lack of knowledge of preventive measures, diet restrictions, alcohol intake restriction, and follow-up care
     • educate on diagnosis, medication management and lifestyle changes
     • referral to dietician

4. Drug Therapy

   • morphine
     • relief of pain
   • antispasmodics (e.g. dicyclomine [Bentyl])
     • decreased vagal stimulation, motility, pancreatic outflow, decreased volume and concentration of bicarbonate and enzyme secretion
   • carbonic anhydrase inhibitor (acetazolamide)
     • decreased volume and bicarbonate concentration of pancreatic secretion
   • proton pump inhibitors (e.g., omeprazone [Prilosec])
     • decreased HCl acid secretion (HCl acid stimulates pancreatic activity)

5. Risk Factors

   • gallbladder disease
   • chronic alcohol intake
   • hypertriglyceridemia (serum levels over 1000 mg/dL
   • trauma
     • postoperative
     • postprocedure of endoscopic retrograde cholangiopancreatography (ERCP)
   • viral infections
     • mumps
     • coxsackievirus B
     • HIV
   • penetrating duodenal ulcer
   • cysts
   • abscesses
   • cystic fibrosis
   • Kaposi sarcoma
   • certain drugs (corticosteroids, thiazide diuretics, oral contraceptives, sulfonamides, NSAIDs)
   • metabolic disorders (hyperparathyroidism, renal failure)
   • vascular diseases

6. Diagnostics

   • Labs
     • elevated serum amylase
     • elevated serum lipase
     • elevated urinary amylase
     • elevated blood glucose
     • decreased calcium
     • elevated serum triglycerides
   • abdominal ultrasound
   • x-ray
   • contrast-enhanced CT scan
   • ERCP
   • magnetic resonance cholangiopancreatography (MRCP)
   • angiography
   • EUS

7. acute inflammation of the pancreas