NURSING CARE STUDY OF A PATIENT WITH ACUTE PANCREATITIS

BY

NAME: …………………………………………….

MATRIC NUMBER: ……………………………...

INDEX NO: ……………………………………….

DEPARTMENT OF NURSING SCIENCES

FACULTY OF HEALTH SCIENCES
ABIA STATE UNIVERSITY, UTURU

NOVEMBER, 2022

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 NURSING CARE STUDY OF PATIENT WITH ACUTE PANCREATITIS

BY

NAME: …………………………………………….

MATRIC NUMBER: ……………………………...

INDEX NO: ……………………………………….

DEPARTMENT OF NURSING SCIENCES

FACULTY OF HEALTH SCIENCES
ABIA STATE UNIVERSITY, UTURU

IN PARTAIL FULFILMENT OF THE REQUIREMENTS OF NURSING AND MIDWIFERY

COUNCIL OF NIGERIA FOR THE AWARD OF ‘‘REGISTERED NURSE” CERTIFICATE

NOVEMBER, 2022.

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 APPROVAL/ CERTIFICATION PAGE

This is to certify that the client care by ………………………………………………… with

index number …………………………………………………………………..has been examined
and approved for the award of Registered Nurse Certificate.

…………………...... ………………………..
Date

…………………...... ………………………..
Dr. Mrs. Emonye O. P Date

…………………...... ………………………..
External Examiner Date

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 ACKNOWLEDGEMENT

I must sincerely acknowledge God Almighty for his infinite grace and mercy to complete this
case study. I am particularly grateful to my supervisor …………………………. for her guidance
and corrections throughout the course of this work.
A big thank you to all my colleagues which in one way or another contributed to the success of
this work.
God bless you all.

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 Table of Content
Cover Page i
Title Page ii
Approval/Certification iii
Acknowledgment iv
Introduction 1
Patient’s Bio Data 1
Disease History 2

Anatomy and Physiology of the Pancreas 3

Comprehensive Literature Review 4
Incidence 4
Causes 4
Pathophysiology 5
Clinical Manifestations 5
Diagnostic Investigation 6

Application of the Nursing Process 7

Nursing History 7
Nursing Management 8
Nursing Diagnoses 9
Nursing Care Plan 10
Pharmacological Review of Drugs Used 12
Progress and Discharge Summary 14
Conclusion 14
Implication of the Study 14
Importance of the Study 15
Inferences Drawn from the Study 15
Suggestions 15
Recommendations ` 15
References 16

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Aims and Objectives
1. To determine the incidence of acute pancreatitis among Nigerians
2. To determine the causes of acute pancreatitis
3. To assess the level of knowledge of acute pancreatitis among patients.

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 INTRODUCTION

Acute pancreatitis is inflammation of the pancreas. The pancreas is a gland that sits just
behind the stomach. It has two roles: 1) To secrete digestive juices into the small bowel to digest
food and neutralize gastric acid secretion and 2) to release insulin to regulate the glucose levels
in the blood. There are three types of pancreatic cells: 1) acinar cells, which produce pancreatic
digestive enzymes; 2) ductal cells lining pancreatic ducts, which secrete a watery fluid to carry
the digestive enzymes into the intestine; and 3) endocrine cells present in the islets of
Langerhans, which secrete insulin and other hormones. Because acinar and ductal cells secrete
into a duct this portion is called the exocrine pancreas. Pancreatic digestive enzymes are made as
inactive precursors and carried to the small bowel where there are additional enzymatic
processes that convert the inactive digestive enzymes to actives ones that digest our food. When
pancreatic enzymes are prematurely activated in the pancreas, they attack the pancreas itself
instead of digesting food and cause pancreatitis.

There are many causes of acute pancreatitis. The most common causes include gallstones,
alcohol abuse induced acute pancreatitis and drug induced acute pancreatitis which accounts for
3 to 5% of all cases. However despite all known causes, more than one third of cases of acute
pancreatitis are idiopathic, meaning that the underlying etiology is unknown.

Acute pancreatitis can be stratified into various severities. Approximately 85% of the
cases are mild (also called acute interstitial pancreatitis, AIP), which indicates an uneventful
course. In approximately 15% of cases, patient can develop severe pancreatitis with tissue
damage (also called acute necrotizing pancreatitis (ANP), in which he or she will have a
complicated recovery with systemic complications. There is a risk of death associated with ANP
(Aghani, 2014).

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Patients Bio Data

Name of patient: Mr. M. O

Address: 21 Azikiwe, Umuahia

Age: 48 years

Sex: Male

Religion: Christianity

Next of Kin: Mrs. F. O

Address of Next of Kin: 21 Azikiwe, Umuahia

Family Composition

Mr. M. O is from a family of 4 children, 3 males and 1 female, all alive. He is the 3rd child of his
parents. All are alive.

Socio-Economic Status

Mr. M. O is a 48 year old minister. He is married with 1 child; a boy. His wife is late. He is a
minister at the Dominion City Church of Nigeria.

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 DISEASE HISTORY

Mr. M. O reported to the hospital on 3rd March, 2022. He presents with a history of a sudden
onset of acute upper central abdominal pain radiating to his back, which began shortly after his
morning meal 1 week ago. He reported to have vomited several times, without relief of his pain.

Surgical history shows he had Appendectomy 25 years ago. His medical history show he was
diagnosed with Hypertension 5 years ago.

Treatment Taken So Far: Mr. M.O reported to have taken ibuprofen on the onset of the pain.
He also stated that he had been taking Atenolol (30mg),) for his hypertension.

Clients Belief: Mr. M. O stated that his father had Cholecystectomy 13 years ago.

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 ANATOMY AND PHYSIOLOGY OF THE PANCREAS

The pancreas is an elongated, tapered organ located across the back of the belly, behind
the stomach. The right side of the organ—called the head—is the widest part of the organ and
lies in the curve of the duodenum, the first division of the small intestine. The tapered left side
extends slightly upward—called the body of the pancreas—and ends near the spleen—called the
tail.

The pancreas is made up of 2 types of glandular cells:

1. Exocrine. The exocrine gland secretes digestive enzymes. These enzymes are secreted
into a network of ducts that join the main pancreatic duct. This runs the length of the
pancreas. It makes up 85% of the pancreas.
2. Endocrine. The endocrine gland, which consists of the islets of Langerhans, secretes
hormones into the bloodstream.

Functions of the Pancreas

The pancreas has digestive and hormonal functions:

The enzymes secreted by the exocrine gland in the pancreas help break down carbohydrates, fats,
proteins, and acids in the duodenum. These enzymes travel down the pancreatic duct into the bile
duct in an inactive form. When they enter the duodenum, they are activated. The exocrine tissue
also secretes bicarbonate to neutralize stomach acid in the duodenum. This is the first section of
the small intestine.

Hormones Secreted by the Pancreas

The main hormones secreted by the endocrine gland in the pancreas are insulin and glucagon,
which regulate the level of glucose in the blood, and somatostatin, which prevents the release of
insulin and glucagon.

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 COMPREHENSIVE LITERATURE OF ACUTE PANCREATITIS

Definition: Pancreatitis is the sudden inflammation of the pancreas characterized by a discrete

episode of abdominal pain and serum enzymes elevations. (Belleza, 2020).

Incidence: Worldwide, the incidence of acute pancreatitis is between 4.9 and 73.4 cases per
100,000. There is an increasing incidence of acute pancreatitis in the United States. The risk of
acute pancreatitis increases with age. Both men and women are at risk for pancreatitis; however
gender difference is determined by the cause of acute pancreatitis. For example, acute
pancreatitis due to alcohol is more likely in men than in women, which reflects more use of
alcohol in men. In contrast, acute pancreatitis due to gallstones is more common in women.
More than 60% of the cases of acute pancreatitis occur in adults. However, acute pancreatitis in
children and adolescents has become more recognized.

In Nigeria, the prevalence of acute pancreatitis has been found to be rising among alcoholics.

Predisposing Factors

i. Gallstones
ii. Alcoholism
iii. Medications
iv. High triglyceride levels in the blood (hypertriglyceridemia)
v. High calcium levels in the blood (hypercalcemia), which may be caused by an overactive
parathyroid gland (hyperparathyroidism)
vi. Pancreatic cancer
vii. Abdominal surgery
viii. Cystic fibrosis
ix. Infection
x. Injury to the abdomen
xi. Obesity
xii. Trauma (NPA, 2015)

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Pathophysiology

Regardless of the cause, an early event in pathogenesis of acute pancreatitis is intra-

acinar activation of pancreatic enzymes leading to the autodigestive injury of the gland itself.

The enzymes can damage tissue and activate the inflammatory process, producing cytokines
and causing inflammation and edema. This causes irritation and pressure on the nerve endings
resulting to pain and tenderness in the upper left quadrant. This process causes tissue necrosis
which results in hemorrhage into the retroperitoneal tissue.

Formation of pancreatic abscess and pseudocyst raises the diaphragm to cause shallow
breathing. (Belleza, 2020)

Clinical Manifestations

i. Abdominal pain in the left upper quadrant,

ii. Abdominal guarding
iii. Fever
iv. Nausea
v. Vomiting
vi. Jaundice
vii. Cyanosis
viii. Cold and clammy skin
ix. Tachycardia (NPA, 2015)

Diagnostic Investigations

i. Serum markers (amylase, lipase); > 3 times the upper limit of normal
ii. CT- scan
iii. Chest X-ray for detection of pulmonary complications
iv. Abdominal ultrasound
v. Complete blood count

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Complications

1. Pancreatitis ascites, abscess or pseudocyst

2. Pulmonary infiltrates, pleural effusion, acute respiratory distress syndrome
3. Hemorrhage with hypovolemic shock
4. Acute renal failure
5. Sepsis

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 APPLICATION OF THE NURSING PROCESS

Nursing History

Mr. M.O reported to the hospital on 3rd March, 2022. He presents with a history of a sudden
onset of acute upper central abdominal pain radiating to his back, which began shortly after his
morning meal 1 week ago. He reported to have vomited several times, without relief of his pain.

On palpation, the abdomen felt tender to touch in the mid-epigastruim

Vital signs on admission read;

 Temperature – 37.70C,
 Pulse - 95,
 Respiration - 24,
 SpO2 - 91%,
 BP- 110/70mmHg, and were duly recorded.

Further assessment during hospitalization showed; increased serum amylase and lipase. Imaging
studies showed inflamed and edematous pancreas.

He was assessed by the doctor and was diagnosed with acute pancreatitis.

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 Nursing Management

Assessment

i. Assess sources of fluid and electrolyte loss

ii. Assessment of abdomen for ascites.

Positioning

i. Maintains the patient in a semi-Fowler’s position to improve respiratory status

ii. Encourages frequent position changes.
iii. Instruct patient to obtain adequate rest

Observation

i. Assessment of fluid and electrolyte status ( e.g. skin tugor, mucous membranes, intake
and output)
ii. Monitor vital signs frequently
iii. Monitor patients weight daily

Nutrition

i. Assess nutritional status

ii. Monitor glucose levels
iii. Monitor IV therapy
iv. Avoid oral intake to inhibit pancreatic stimulations and secretion of pancreatic enzyme
v. Parenteral nutrition is administered to assist with metabolic stress
vi. Provide a high carbohydrate, low protein, low fat diet when tolerated and instruct patient
to avoid spicy foods.

Drugs

i. Administer analgesics e.g. morphine to relieve pain and improve comfort

ii. Administer other prescribed medications such as histamine receptor antagonists and
proton pump inhibitors.

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iii. Maintain nasogastric tube suctioning to relieve nausea and vomiting, decrease painful
abdominal distension, and remove hydrochloric acid.

Nursing Diagnoses

1. Acute Pain related to inflammation of the retroperitoneal nerve plexus evidenced by

patient’s verbalization.
2. Ineffective breathing pattern related to splinting from severe pain, pulmonary infiltrates,
pleural effusion, and atelectasis.
3. Imbalanced nutrition: less than body requirement related to loss of digestive enzymes
and insulin evidenced by weight loss.
4. Risk for Deficient Fluid Volume related to excessive loss of fluid evidenced by excessive
vomiting
5. Risk for infection related to nutritional deficiencies.

6.

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 Nursing Care Plan

S/N Nursing Diagnoses Nursing Objectives Nursing Scientific Rationale Evaluation

Intervention
1. Acute Pain related to Mr. M.O will Assess patients vital Assessment is a Mr. M.O
inflammation to the verbalize reduced signs and pain level priority which allows verbalized
retroperitoneal nerve pain within 24 hours to get the baseline reduced pain
plexus evidenced by of nursing data. within 24 hours
patients intervention of nursing
verbalization. Maintain bed rest Decreases metabolic intervention
during acute attack. rate and GI
Provide quiet, restful stimulation and
environment. secretions, thereby
reducing pancreatic
activity.

Promote position of Reduces abdominal

comfort on one side pressure and tension,
with knees flexed, providing some
sitting up and leaning measure of comfort
forward. and pain relief.

Provide diversional Promotes relaxation

activities and enables patient to
refocus attention;
may enhance coping.

Administer analgesics Analgesics help to

in timely manner relieve pain and
(smaller, more prevents its

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 frequent doses). complication

2. Deficient Fluid Mr. M.O will Measure I&O To indicate Mr. M.O
Volume related to maintain adequate including vomiting, replacement needs maintained
excessive loss of blood and electrolyte gastric and effectiveness of adequate blood
fluid evidenced by throughout the period aspirate, diarrhea. therapy. and electrolyte
excessive vomiting of hospitalization Calculate 24-hr fluid throughout the
balance. period of
hospitalization
Monitor vital signs Cardiac changes and
dysrhythmias may
reflect hypovolemia
or electrolyte
imbalance,
commonly
hypokalemia and
hypocalcemia

Administer fluid Fluid replacement

replacement as used to promote
indicated (saline mobilization of fluid
solutions, albumin, back into vascular
blood, blood space
products, dextran).

3. Imbalanced nutrition: Miss O.M will Provide nasogastric NG tube helps to Miss O.M
less than body demonstrate adequate tube feeding deliver nutritional demonstrated
requirement related nutritional intake by requirement when adequate
to loss of digestive eating 50% of her patient is unable to nutritional intake
enzymes meal every day by eating 50% of

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and insulin evidenced throughout the period feed her meal every
by weight loss. of hospitalization day throughout
Monitor bowel Helps to determine the period of
sounds, abdominal readiness for hospitalization
distension and reports discontinued gastric
of nausea tube feeding

Assist patient in Previous dietary

selecting food and habits may be
fluids that meet unsatisfactory in
nutritional needs and meeting current
restrictions needs for tissue
regeneration and
healing.

Provide frequent oral Decreases vomiting

hygiene stimulus and
inflammation and
irritation of dry
mucous membranes
associated with
dehydration and
mouth breathing
when NG is in place

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 Pharmacological Review of Drugs Used

Aspirin

Ceftriaxone

Name Group Dosage Route Indications Side effects Contraindications Nursing

of Responsibili
drug ty
Aspiri Non steroidal, 300- Orally, Rheumatoid Peptic ulcer, Peptic Ulcer, Should not
n Anti- 900mg Supposito arthritis, Nausea, Asthmatics, Anaemia, be
inflammatory 3x daily rily Minor aches vomiting, Thrombocytopenia administered
, and pains, Tinnitus, Children under 16yrs, to peptic
Antirheumati fever, Cold, Confusion, Gout ulcer
c, Soft tissue Vertigo, patients.
Antiplatelet inflammatio metabolic Should not
Analgesics n, acidosis bee
Antipyretic Osteoarthriti administered
s, to children
below 12
years
Should not
be
administered
in the latter
stages of
pregnancy.
Ceftria Antibiotic 1-2g Intramusc Infectious Diarrhea, History of Use with
xone daily ular, fever, Abdominal hypersensitivity to caution if
Intraveno Gonococcal Pains, penicillins patient
us infections, Mouth hypersensiti

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Meningitis, soreness, ve to
UTIs Body penicillin.
rashes, Client
Pruritus, should take
Hypersensiti full course
vity of drug to
maintain
therapeutic
blood levels.
Instruct not
to drink
alcohol to
avert
abdominal
pain, nausea,
vomiting,
hypotension,
tachycardia
and
sweating.

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Progress and Discharge Summary

Patient presented with a history of a sudden onset of acute upper central abdominal pain
radiating to his back and persistent vomiting. She was seen by the doctor and was diagnosed with
acute pancreatitis Patient was successfully managed without compromise. He was reviewed by
the doctor and was discharged.

Conclusion

Patient was admitted and received good nursing and medical management which aided in
subsiding the symptoms. Patient was fully recovered and was discharged.

Implication of the Study

Pancreatitis is the sudden inflammation of the pancreas characterized by a discrete episode of

abdominal pain and serum enzymes elevations. Patient with this illness find it difficult to process
food as a result of pancreatic insufficiency and tissue damage. In conclusion, this study helps the
nurse to;

i. To identify the signs and symptoms of acute pancreatitis so as to treat it early and prevent
complications.
ii. Relief of pain and discomfort.
iii. Improvement in nutritional status.
iv. Improvement in respiratory function.
v. Improvement in fluid and electrolyte status.
vi. To provide adequate information about the condition to the patient.
vii. To prevent infections.

Importance of the Study

i. To gain knowledge on the nursing and medical care of a patient with acute pancreatitis
ii. To have a detailed knowledge of the nursing process
iii. To improve skill and professionalism
iv. To gain more clinical experience.

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Inferences Drawn From the Study

This client case study has broadened my knowledge and has made it more interesting to be in the
nursing profession.

Suggestions

i. Health education should be given to the individuals.

ii. Medical checkups should be advised in order to manage illnesses at the early stage

Recommendations

i. Health Education
ii. Frequent Medical Checkup
iii. Hospitalization

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REFERENCES

Maisonneuve & Sullivan (2013), The changing character of acute pancreatitis:

epidemiology, etiology, and prognosis.

Jain V & Pitchumoni C.S (2009), Gastro-intestinal side effects of prescription

medications in the older adult.

Elham Afghani (2014), Introduction to Pancreatic Disease: Acute Pancreatitis,

Division of Gastroenterology, Cedars-Sinai Medical Center.

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APPENDIX

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