B.

Treatment
1. Intravenous Therapy
This involves infusion of fluids directly into the vein. Intravenous therapy allows medicine to

reach heart quickly as well as circulate through the body extremely fast. Uses include for

dehydrated and severely malnourished clients which IV fluids can quickly deliver electrolytes,

nutrients and water into the body. Blood and plasma can also be transfused through

intravenously in cases of severe blood loss and low blood count.

a. D5LRS 1L at 100cc/hour

D5LR is a hypertonic solution which contains 130 mEq/L of sodium, 109

mEq/L of chloride, 4 mEq/L of potassium, 3 mEq/L of calcium, 28 mEq/L of

lactate and 50 grams of dextrose. Hypertonic solution have effective

osmolarity greater than the body fluids. This pulls the fluid into vascular by

osmosis resulting in an increase vascular volume and rises intravascular

pressure.

Purpose: This was given to the client to supply needed nutrients, electrolytes and

calories that is needed to meet daily requirements since the client was placed on

NPO.

Date ordered: 10/05, 10/09, 10/10

Ordered by: Dr. G, Dr. S

b. Plain LR 1L for 6 hours x 2 cycles

Plain LR 1L for 8 hours

Plain LR is an isotonic solution that contains 130 mEqs/L of sodium, 109

mEqs/L of chloride, 28 mEqs/L of lactate, 4 mEqs/L of potassium and 3

mEqs/L of calcium.
 This type of solution is infused to replace fluid losses, usually extracellular

losses, and to expand the intravascular volume. Most isotonic solutions do not

provide calories or free water.

Based on the current evidence from pancreatitis specific, as well as

general critical care studies, balanced crystalloid solutions such as Ringers´

Lactate should be used for fluid resuscitation in acute pancreatitis patients

(Beyer, 2016).

Purpose: This was given to the client as form of fluid resuscitation. Fluid choice

remains unclear but client will benefit more in giving Plain LR than Normal Saline

(both isotonic) as it reduces the risk of hyperchloremic acidosis which is associated

with impaired renal function (Lipinski, et.al., 2015).

Date ordered: 10/06 – 10/08

Ordered by: Dr. G, Dr. S

Nursing Responsibilities Rationale

1. Verify the doctor’s order. To determine what
specific type of solution
to be infused including
the desired hours to be
infused.
2. Prepare all the materials needed To save time and energy.
in the initiation of IV line.
3. Check IV bottles for cloudiness, This may inflict risk to
expiration date and integrity of the client since this is no
IV bottles. longer sterile.
4. Inform the client and watchers This will gain full
about the purpose of the cooperation of the client.
procedure.
5. Select the best vein to puncture The gauge of the IV
and use the appropriate IV cannula used should be
cannula. based on the size of the
 vein to be punctured for
easier insertion.
6. After initiation, properly label Identification of the
the IV fluid and IV tubing solution, initiation and
following institutional policy. time to be consumed help
monitor the infusion.
7. Regulate the IV fluid properly This will prevent
and never speed up the flow rate circulatory overload.
when the volume has fallen
behind.
8. Instruct client not to manipulate This will help in
the roller clamp of the IV tubing. maintaining the
appropriate infusion rate.
9. Change IV tubing and IV This will prevent IV
cannula every 3 days, as needed complications.
or following institutional policy.
10. Discard all used items including To avoid injury.
sharps following cross
contamination policy.
11. Document the procedure For legal purposes.
including patient’s response.

2. Diet Therapy

NPO (Nil per os)

This is a medical instruction to withhold food and fluids from a person for various reason.

Purpose: This was done to the client to rest his GI tract especially pancreas, so as not to release

and accumulate any digestive enzyme. Also, it was done as preparation for CT scan.

Date ordered: 10/05/2020

Ordered by: Dr. G

Nursing Responsibilities Rationale

 1. Check the doctor’s order. To ensure that the client is really for

NPO.
2. Tag diet list in HOMIS. This will notify the dietary section.
3. Explain the purpose of the diet This will gain full cooperation.

plan to the client.

4. Instruct watcher to remove or This will prevent stimulation client’s

hide all foods on the bedside appetite.

table.
5. Advise to dip of wet cotton balls To relieve thirst and dry mouth.

in the oral mucosa.

Soft Diet

The soft diet serves as a transition from liquids to a regular diet for individuals

who are recovering from surgery or a long illness. It can help to ease difficulty in

chewing and/or swallowing due to dental problems or extreme weakness, and it is

sometimes recommended to relieve mild intestinal or stomach discomfort.

Purpose: This was done to the client to as a transitional diet treatment from NPO so

as not to overwhelm his GI tract.

Date ordered: 10/10/2020

Ordered by: Dr. S

Nursing Responsibilities Rationale

1. Check the doctor’s order. To ensure that the client is really for

soft diet.
2. Update diet list in HOMIS. This will notify the dietary section.
3. Explain the purpose of the diet This will gain full cooperation.

plan to the client.

4. Give some possible additional This will help client to choose food
 food to be taken aside from the appropriate to diet treatment.

food from dietary.

5. Advise to eat in small frequent So as not to overwhelm the GI tract

feeding. after long periods of NPO.

3. CBG Monitoring

Blood glucose monitoring is a way of testing the concentration of glucose in the blood.

Particularly important in diabetes management, a blood glucose test is typically performed by

piercing the skin (typically, on the finger) to draw blood, then applying the blood to a chemically

active disposable test-strip.

Purpose: This was done to the client to monitor the possibility of hyper or hypoglycemia episode.

Date ordered: 10/06/2020

Ordered by: Dr. S

Nursing Responsibilities Rationale

1. Check the doctor’s order. To ensure that the client is for CBG

monitoring.
2. Inform client that he will be on This will ease anxiety and gain full

CBG monitoring. Explain that he cooperation from the client.

will be pricked in the fingers and

will be withdrawn blood 4 times

a day. (TID and HS).

3. Follow institutional policy on Following institutional policy will

proper way of performing CBG make procedure easier and shorter

and do after care. duration.

4. Inform attending physician This will warrant attending physician
 regarding abnormal results. to give or modify existing treatment.
5. Document the procedure For legal purposes.

including patient’s response.

A. Drug Study
1. Meperidine

Date ordered: 10/05/2020

Generic Name: Meperidine

Brand Name: NA (not given due to unavailability of stock)

Classification: Opiod analgesic

Dosage, Route, Frequency: 50 mg TIV every 8hours PRN for pain

Mechanism of Action: Depresses pain impulse transmission at the spinal cord level

by interacting with opiod receptors.

Desired Effect: This was ordered to the client for relief of abdominal pain.

Nursing Responsibilities Rationale

1. Follow institutional policy on To prevent medication error.

medication administration.
2. Assess type, location and Pain medication should be given

character of pain. before the pain becomes extreme.

3. Raise side rails up and locked. The drug can cause drowsiness and

to prevent fall.
4. Advise client to change position The drug can cause orthostatic

slowly. hypotension.
5. Advise use of diversionary To divert attention of focusing on

tactics like listening to music or pain felt.

watching funny youtube videos

or play games using android or

tablet phones.
6. Provision of comfort like well- This will help in lessening the

ventilated, well-lit and well-kept aggravation of pain felt.

 room.
7. Evaluate therapeutic response of Unrelieved pain will prompt further

the client. referral to attending physician and

modification of present treatment.

2. Tramadol

Date ordered: 10/06/2020

Generic Name: Tramadol

Brand Name: Tramal

Classification: Analgesic - Miscellaneous

Dosage, Route, Frequency: 50 mg TIV every 8hours RTC for pain

Mechanism of Action: Not completely understood, binds to opiod receptors, inhibits

reuptake of norepinephrine, serotonin; does not cause histamine release or affect

heart rate.

Desired Effect: This drug was given to the client to relieve abdominal pain in lieu of

meperidine.

Nursing Responsibilities Rationale

1. Follow institutional policy on To prevent medication error.

medication administration.
2. Assess type, location and Pain medication should be given

character of pain. before the pain becomes extreme.

3. Monitor I and O. Decreasing output may indicate

urinary retention.
4. Advise use of diversionary To divert attention of focusing on

tactics like listening to music or pain felt.

watching funny youtube videos

 or play games on android phone

or tablet.
5. Provision of comfort like well- This will help in lessening the

ventilated, well-lit and well-kept aggravation of pain felt.

room.
6. Evaluate therapeutic response of Unrelieved pain will prompt further

the client. referral to attending physician.

3. Metoclopramide

Date ordered: 10/05/2020

Generic Name: Metoclopramide

Brand Name: Mets

Classification: Cholinergic, anti-emetic

Dosage, Route, Frequency: 10mg TIV every 8hours PRN for vomiting

Mechanism of Action: Enhances response to acetylcholine of tissue in upper GI

tract, which causes contraction of gastric muscle, relaxes pyloric, duodenal

segments and increases peristalsis without stimulating secretions, blocks

dopamine in chemoreceptor trigger zone of CNS.

Desired Effect: This drug was given to the client to relieve/ prevent vomiting.

Nursing Responsibilities Rationale

1. Follow institutional policy on To prevent medication error.

medication administration.
2. Raise side rails up and locked. The drug can cause drowsiness and

to prevent fall.
3. Monitor for extrapyramidal This is adverse of the drugs and
 symptoms (spasm, continuous standby diphenhydramine should be

muscle contraction and readily available.

restlessness jerky movements

and others)
4. Evaluate therapeutic response of Unrelieved symptoms will prompt

the client. further referral to attending physician

and warrants modification of existing

treatment.
4. Omeprazole

Date ordered: 10/05/2020

Generic Name: Omeprazole

Brand Name: Hyperzole

Classification: antiulcer, proton pump inhibitor

Dosage, Route, Frequency: 40 mg TIV now then OD

Mechanism of Action: Suppresses gastric secretion by inhibiting

hydrogen/potassium ATPase enzyme system in gastric parietal cell; characterized

as gastric acid pump inhibitor since it blocks final step of acid production.

Desired Effect: This drug was given to the client to prevent secretion of gastric

acid since client was on NPO. Also, it depletes/ prevents the production of other

pancreatic enzymes.

Nursing Responsibilities Rationale

1. Follow institutional policy on To prevent medication error.

medication administration.
2. Administer the drug slowly. To prevent phlebitis.
3. Raise side rails up and locked. The drug can cause drowsiness and

to prevent fall.
 4. Instruct client to report severe This will prompt further referral to

diarrhea. attending physician and warrants

modification of existing treatment.

L. Nursing Care Plan

Nursing Diagnosis 1

Acute pain related to inflammatory process secondary to the disease process as manifested

by irritability, guarding behavior, grimacing face, tachycardia (115 bpm), tachypnea (28

bpm), pain upon direct palpation on epigastric area with pain scale of 9/10 and

verbalization of “nasakit toy banda na rusok ko nga kumamang toy likod, ken mas sumakit

nu agkuti ak aglalo nu bumangonak”

Nursing Inference

In acute pancreatitis, the damage in the pancreatic cells can bring about pain sensation due

to the sensory neurons present in the organ. The damage in the pancreatic tissue initiates

the inflammatory response that can also bring about pain due to release of chemical

mediators and presence of inflammation and edema to the site. Hence, acute pain.

Nursing Goal

After 30 minutes-1 hour of rendering intervention, the client will be able to relieve from

pain as manifested by absence of irritability, guarding behavior, grimacing face, pulse rate

and respiratory rate within normal values (60-100) and (12-20) respectively, absence or

decrease pain felt on the epigastric area (3-4/10 pain scale) and verbalization of “haan nga
nasakit toy banda na rusok ko nga kumamang toy likod, ken haan nga sumakit nu agkuti ak

aglalo nu bumangonak”

Nursing Intervention

1. Encourage verbalization of This can reduce anxiety, thus

feelings of pain. promotion of comfort.

2. Provision of comfort measure Therapeutic touch can ease pain and

such as touch and repositioning. anxiety.

3. Provide quiet, cool and calm Client may experience exaggerated

environment. pain or decrease pain tolerance if

environmental factors are present that

stresses the client.

4. Encourage deep breathing Deep breathing relaxes abdominal

exercises. muscles.
5. Encourage client to listen to slow Music therapy is one of the best non-

paced and soothing type of pharmacological intervention to relieve

music. pain. It also distracts the client in

sensing the pain.

6. Provision of entertainment like This will divert client in sensing pain.

youtube videos and cellular

games.
7. Administer pain medication PRN To relieve pain.

(Tramadol) as ordered.
8. Monitor vital signs every 4 hours Feeling of pain may affect vital signs.

or as needed. Any alteration will prompt necessary

referral to attending physician.

Nursing Evaluation
After 1 hour of rendering intervention, the client was able to relieve from pain as

manifested by absence of irritability, guarding behavior, grimacing face, pulse rate within

60-100 bpm and respiratory rate within 12-20bpm, decrease epigastric pain felt with 4/10

on pain scale and verbalization of “haan unay nasakit toy banda na rusok ko nga

kumamang toy likod, ken haan nga sumakit nu agkuti ak aglalo nu bumangonak”

Nursing Diagnosis 2

Non-compliance (causes and treatment of pancreatitis) related to the lack of information

and attitude towards prevention as manifested by incorrect task performance (eating meals

despite NPO treatment) and verbalization of nagin-inomak latta ngamin idi uray maiparit

ngem sagga bassit met lang”

Nursing Inference

Knowledge plays an influential and significant part of a patient’s life and recovery. It may

include any of the three domains: cognitive domain (intellectual activities, problem-

solving, and others); affective domain (feelings, attitudes, belief); and psychomotor domain

(physical skills or procedures). Lack of in depth information regarding the cause of the

disease and its treatment can be a reason of incorrect task performance. However, attitude

can also play an important role in the implementation of that knowledge. Lack of in depth

information and attitude on carrying out right tasks hence, non-compliance.

Nursing Goal

After 3-4 days of rendering intervention, the client will be able to gain in depth knowledge

and information of the disease as manifested by correct task performance (NPO as part of

treatment) and verbalization of “haanak to umininom ti arak’n”

Nursing Intervention

1. Identify the learner: patient and Learning can will not only for the

watcher and or significant other. patient but for significant others. As

such, significant other can warn or look

after if the patient will do incorrect task

performance.
2. Assess motivation in learning. Learning entails effort and energy. The

patient must see the need and the

purpose of learning.
3. Assess barriers to learning. The patient brings a unique personality

to the learning situation, established

social interaction patterns, cultural

norms and values, and environmental

influences.
4. Provide physical comfort to the Ensuring physical comfort allows the

client. patient to concentrate on what is being

discussed or demonstrated
5. Provide calm and peaceful This will facilitate concentration and

environment that is conducive for patient will be more focused.

learning.
6. Determine priority of learning This is to know what needs to be
 needs within the overall care discussed especially if the patient

plan. already has a background about the

situation. Knowing what to prioritize

will help prevent wasting valuable

time.
7. Allow the patient to open up Patient learn best when teaching builds

about previous experience and on previous knowledge and experience.

health teaching. Also, they might have beliefs and

practices that must be considered.

8. Ask or note existing Patient might have beliefs and

misconceptions and cultural practices that must be considered.

influences regarding the disease.

9. Explore reactions and feelings Imposing change is very difficult and

about changes. changing lifestyle ca be hard to the

patient. Exploration will assist the

nurse on how the client respond to the

information given and possibly how

successful the client may be with the

expected change.
10. Pace the instruction and keep Learning requires energy, so shorter

sessions short. but concise, well-paced sessions reduce

fatigue and allow the patient to absorb

information more completely.

11. Encourage patient to ask Questions facilitate open

question. communication between patient and

health care professionals and allow

 verification of understanding of given

information.

Plan of Nursing Evaluation

After 4 days of rendering intervention, the client was able to gain in depth knowledge and

information regarding the disease as manifested by correct task performance (NPO as part

of treatment) and verbalization of “haanak to umininom ti arak’n”

Nursing Diagnosis 3

Risk for fluid volume deficient related to vasodilation, third-space fluid transudation and

ascites formation.

Nursing Inference

In acute pancreatitis, the damage to the pancreatic tissue initiates inflammatory response.

In turn, the body will release chemical mediators that causes vasodilation, third-fluid

transudation happens in acute pancreatitis due to the release of pancreatic enzymes in to

the bloodstream which may cause a damage hence, fluids transudate from intravascular to

extravascular space and into peritoneal cavity. On the other hand, vomiting may lead to

substantial amount of fluid loss from the GIT due to the activation of vomiting center in

the brin secondary to the perception of pain, hence, risk for fluid volume deficit.

Nursing Goal

After 4-5 days of rendering nursing intervention, the client will be less risk of developing

fluid volume deficiency.

Nursing Intervention

1. Monitor vital signs. Change in vital signs especially blood

 pressure and cardiac rate can be a

warning for fluid volume deficiency

and impending shock.

2. Strictly monitor I and O This can be an indicator of fluid

accurately and calculate 24-hour replacement need and effectivity of

fluid balance. fluid replacement therapy.

3. Examine and note client for poor This can be further indicator of volume

skin turgor, dry skin and oral deficiency and dehydration.

mucosa.
4. Administer fluid replacement as Fluid replacement therapy is one

indicated. (IV fluid replacement mainstay treatment for pancreatitis.

therapy). Regulate IV fluids as This will prevent dehydration.

desired.
5. Monitor laboratory results Hematocrit is one indicative of

especially hematocrit. dehydration and can be a parameter for

effectivity of fluid replacement.

6. Maintain client on NPO. This will not further aggravate

vomiting. Food may induce vomiting at

this time.

Nursing Evaluation

After 5 days of rendering nursing intervention, the client did not manifest any fluid volume

deficiency.

Nursing Diagnosis 4

Risk for infection related to pancreatic tissue destruction.

Nursing inference

In acute pancreatitis, the main culprit is the pancreatic tissue destruction. This can be a

good medium for bacterial growth and infection. Hence, risk for further infection.

Nursing Goal

After 5-6 days of rendering intervention, the client will be less risk of developing infection.

Nursing Intervention

1. Monitor vital signs. Observe for Cholestatic jaundice and decreased

fever and respiratory distress in pulmonary function may be first sign

conjunction with jaundice. of sepsis involving Gram-negative

organisms.
2. Increased abdominal pain, This may suggest peritonitis.

rigidity and rebound tenderness,

diminished and absent bowel

sounds.
3. Increased abdominal pain and Abscesses can occur 2 weeks or more

tenderness, recurrent fever after the onset of and should be

(higher than 101°F), suspected whenever patient is

leukocytosis, hypotension, deteriorating despite supportive

tachycardia, and chills. measures.

4. Administer antibiotic therapy as Broad-spectrum antibiotics are

necessary. generally recommended for sepsis.

5. Prepare for surgical intervention Abscesses may be surgically drained

as necessary. with resection of necrotic tissue.

Pseudocysts may be drained because of

the risk and incidence of infection and

 rupture.
6. Encourage to eat foods rich in This will promote tissue healing and

CHON and vitamins C such as faster recovery and boost immune

green leafy vegetables and citrus system.

fruits.

Nursing Evaluation

After 6 days of rendering nursing intervention, the client was able to be free from infection.

General Evaluation

IM, a 29-year old male and resident of Brgy. Tabug Batac City. He was admitted at

MMMH and MC last October 05, 2020 due to sharp epigastric pain that radiates from left

upper quadrant to the back with a pain scale of 9/10 accompanied by nausea and vomiting

few hours prior to admission. He was admitted by Dr. G with an admitting diagnosis of

Acute Pancreatis. Laboratory and diagnostic examination were done to confirm the

diagnosis. Serum lipase was done which revealed significant elevation from normal. CT

scan of the abdomen was also done which confirmed the diagnosis of acute pancreatitis. He

was also subjected for Xray to see the extent of the disease and ECG for differential

diagnosis. Serum electrolytes, kidney and liver profile yielded normal results. Hydration

was done with D5LR and Plain LR since mainstay treatment of the disease was hydration.

He was also put into NPO to further rest his GI tract so as not to release and accumulate

digestive enzymes. He wwas given pain medication of Tramadol 50 mg IV RTC every 8

hours for pain in lieu of meperedine which was not available. Omeprazole 40 mg IV OD

was also given suppress and deplete release of digestive enzymes. CBG monitoring was

also done to monitor the progression of the disease.

 After 6 days of aggressive medical and nursing intervention, the client was able to

recuperate from his condition and was advised not to drink alcoholic beverages again. He

was also advised for follow up check up on October 20, 2020 at OPD Internal Medicine

with take home medication of Multivitamins 1 tablet once a day.

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