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Pancreatitis- Nursing management, assessment, diagnosis, interventions

NURSING MANAGEMENT

Nursing Assessment

  • Obtain history of gallbladder disease, alcohol use, or precipitating factors.
  • Assess GI distress, including nausea and vomiting, and diarrhea.
  • Assess characteristics and level of abdominal pain.
  • Assess nutritional and fluid status.
  • Assess respiratory rate and pattern and breadth sounds.
  • Assess for steatorrhoea and malabsorption.
  • Assess for signs and symptoms of diabetes mellitus.
  • Assess current level of alcohol intake and motivation and resources available to abstain from drinking such as Alcoholics Anonymous.

Nursing diagnosis

  • Acute Pain related to disease process
  • Chronic Pain related to chronic and unrelenting insult to pancreas
  • Deficient Fluid Volume related to vomiting, self-restricted intake, fever, and fluid shifts
  • Ineffective Breathing Pattern related to severe pain and pulmonary complications
  • Imbalanced Nutrition: Less Than Body Requirements related to fear of eating, malabsorption, and glucose intolerance
  • Impaired skin integrity related to poor nutritional status, bed rest, and multiple drains and surgical wound
  • Anxiety related to surgical intervention

Nursing Interventions

Controlling of Acute Pain

  • Assess and record the character, location, frequency, and duration of pain.
  • Determine precipitating and alleviating factors of the patient’s pain.
  • Explore the effect of pain on the patient’s lifestyle and eating habits.
  • Administer opioid analgesics as ordered to control pain.
  • Assist patient to a comfortable position.
  • Maintain NPO status to decrease pancreatic enzyme secretion.
  • Maintain patency of NG suction to remove gastric secretions and to relieve abdominal distention, if indicated.
  • Provide frequent oral hygiene and care.
  • Administer antacids or H2-receptor antagonists as prescribed.
  • Report increase in severity of pain, which may indicate hemorrhage of the pancreas, rupture of a pseudocyst, or inadequate dosage of the analgesic.
  • Administer or teach self-administration of analgesics (opioids) as ordered to control pain.
  • Use nonpharmacologic methods to promote relaxation, such as distraction, imagery, and progressive muscle relaxation.
  • Assess response to pain control measures, and refer to chronic pain management clinic, if indicated.

Restoring Adequate Fluid Balance

  • Monitor and record vital signs, skin color, and temperature.
  • Monitor intake and output and weigh daily.
  • Evaluate laboratory data for hemoglobin, hematocrit, albumin, calcium, potassium, sodium, and magnesium levels and administer replacements as prescribed.
  • Observe and measure abdominal girth if pancreatic ascites is suspected.
  • Report trends in falling blood pressure or urine output or rising pulse, because this may indicate hypovolemia and shock or renal failure.

Improving Respiratory Function

  • Assess respiratory rate and rhythm, effort, oxygen saturation, and breath sounds frequently.
  • Position in upright or semi-Fowler’s position to enhance diaphragmatic excursion.
  • Administer oxygen supplementation as prescribed to maintain adequate oxygen levels.
  • Report signs of respiratory distress immediately.
  • Instruct patient in coughing and deep breathing to improve respiratory function.

Improving Nutritional Status

  • Assess nutritional status, history of weight loss, and dietary habits, including alcohol intake.
  • Administer pancreatic enzyme replacement with meals, as prescribed.
  • Administer antacids or H2-receptor antagonists to prevent neutralization of enzyme supplements, as indicated.
  • Monitor intake and output and daily weight.
  • Assess for GI discomfort with meals and character of stools.
  • Monitor blood glucose levels and teach balanced, low concentrated carbohydrate diet and insulin therapy as indicated.
  • Identify foods that aggravate symptoms and teach low-fat diet.

Improving skin integrity

  • Carefully assesses the wound, drainage sites, and skin for signs of infection, inflammation, and breakdown.
  • Wound care as prescribed and takes precautions to protect intact skin from contact with drainage.
  • Consult with an enterostomal therapist is often helpful in identifying appropriate skin care devices and protocols.
  • Change the patient’s position every 2 hours; use of specialty beds may be indicated to prevent skin breakdown.
  • Provide skin care and back care.

Relieving Anxiety About Surgical Intervention

  • Describe planned surgical intervention and the expected results.
    • Decreased pain.
    • Ability to eat better and improve general condition.
  • Prepare patient for adverse effects and complications of surgery.
    • Total pancreatectomy will cause permanent diabetes mellitus, dependence on insulin, severe malabsorption, and the need for lifelong pancreatic enzyme replacement.
    • Malnutrition and debility increase patient’s risk for poor healing and complications of surgery.
  • Assist patient to prepare for surgery by encouraging abstinence of alcohol and intake of nutritional and vitamin supplements.
  • Encourage patient to enlist help of support network and strengthen appropriate coping mechanisms.
  • After surgery, provide meticulous care to prevent infection, promote wound healing, and prevent routine complications of surgery.

Evaluation: Expected Outcomes

  • Verbalizes reduced pain level
  • Blood pressure stable; urine output adequate
  • Respirations unlabored; breath sounds clear
  • Verbalizes reduced pain level
  • Weight stabilized or weight gain noted
  • Verbalizes understanding of effects of surgical procedure

CONCLUSION

Patients with chronic pancreatitis should eat a low-fat diet, abstain from alcohol, and avoid abdominal trauma to prevent acute attacks and further damage. Those with high triglyceride levels should lose weight, exercise, and avoid medications, such as thiazide diuretics and beta-blockers, that increase triglyceride levels. Research reports suggest that oxidative stress may contribute to the development of pancreatitis, and that antioxidant supplementation may be of some benefit, health care providers may begin recommending antioxidant nutrients to their patients with pancreatitis.

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