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Pancreatitis Short Patho

Pancreatitis Short Patho

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Published by: E on May 14, 2009
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Elisabeth FandrichSeptember 30, 2008Pancreatitis (526 R,S)
Pancreatitis is the inflammation of the pancreas. Necrosis of the pancreatic tissues may occur.There are two sub-categories of pancreatitis, acute and chronic. 526 R,S has pancreatitis withassociated gallbladder complications requiring a cholecystectomy after the pancreatitis hassubsided.Acute pancreatitis can be a life-threatening condition. It presents with a great deal of pain in theepigastric region. This pain may radiate to the back or left shoulder. In chronic pancreatitis, this pain may be described as a more continuous, gnawing pain. The patient will commonly presentin a “fetal” position, have nausea/vomiting, a bluish-gray discoloration of the umbilical area and/or flank areas, grossly distended abdomen, blood glucose elevation and fatigue.Avoiding alcohol and cigarette smoking are some lifestyle changes that can be made by the patient to reduce the risk of future episodes. 526 R,S was very receptive to the idea of smokingcessation, and information as well as encouragement were provided to him.Common labs ordered are Serum Amylase (normal: 50-180 u/dl, pancreatitis: >180 u/dl), serumcalcium (normal: 8.6-10.3 mg/dl, pancreatitis: <8.6 mg/dl), CT (pancreatic enlargement,inflammation, fluid collection), Serum Lipase (normal: 31-186 u/l, pancreatitis: >186 u/l), Serumglucose (normal: 74-105 mg/dl, pancreatitis: >105 mg/dl). Pertinent lab values for this patientare as follows (on admission, most recent): RBC 4.39↓, 3.92↓; Hgb 14.8↓, 13.5↓; Hct 42.9,38.2↓; Na 133↓, 135; K 3.3↓, 3.9; Ca 8.1↓, 8.4↓; Albumin 2.6↓, 2.2↓; ALT 8↓, 7↓; Stool occult blood NEG; MCH 33.8↑, 34.4↑; Total Bilirubin 0.7, 0.5; Amylase 51; Globulin 4.3↑, 4.4↑.These lab values indicate that the pancreatitis is resolving, and that the patient has an unspecifiedmacrocytic anemia. I saw no indication in the patient’s chart that this was of concern, but it is afinding that I would monitor.Treatment for pancreatitis includes abstaining from oral intake (NPO), IV fluids, TPN, painmanagement (no morphine as it can cause spasm of the common bile duct), PCA painmanagement, NG tube for bowel decompression and nausea/vomiting, blood glucose control(insulin), pancreatic enzymes with food, surgical intervention (abscess or pseudocyst). 526 R,Swas treated for pain via PCA, a NG tube was in place before I was assigned to him, surgicalintervention was taken in the form of a Jackson-Pratt drain placed to drain bile from thegallbladder. Follow-up at the patient’s local hospital is indicated for a cholecystectomy.Pain is usually the primary nursing problem with this condition. The primary nursing problemfor this patient at the time I cared for him was impaired gas exchange. The patient haddeveloped atelectasis during his stay in the hospital. Although his pancreatitis was resolvingwell, his gas exchange was impaired. This condition was being treated with Xopenex, arespiratory bronchodilator, deep breathing and coughing exercises, incentive spirometry and oral

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