Cronica Fay G.

De Leon
BSN 3-Y2-20

CASE STUDY
Acute Pancreatitis

Patient Profile
● V.A. is a 55-year-old man admitted to the hospital with acute pancreatitis.

Subjective Data
● Has severe abdominal pain in the LUQ radiating to the back
● States that he is nauseated and has been vomiting

Objective Data
Physical Examination
● Vital signs: Temp 101°F (38.3°C), HR 114 bpm, RR 26, BP 92/58
● Jaundice noted in sclera
Laboratory Tests
● Serum amylase: 400 U/L (6.67 mkat/L)
● Serum lipase: 600 U/L
● Urinary amylase: 3800 U/day
● WBC count: 20,000/μL
● Blood glucose: 180 mg/dL (10 mmol/L)
● Serum calcium: 7 mg/dL (1.7 mmol/L)

Collaborative Care
● NPO status
● NG tube to low, intermittent suction
● IV therapy with lactated Ringer's solution
● Morphine PCA
● Pantoprazole (Protonix) IV

1. Explain the pathophysiology of acute pancreatitis.

Acute pancreatitis is characterized by inflammation of the pancreas, which can
lead to autodigestion of pancreatic tissue. The key events include:
a. Enzyme Activation: Digestive enzymes (such as amylase and lipase) become
activated within the pancreas instead of the small intestine.
 b. Autodigestion: Activated enzymes cause damage to pancreatic cells, leading to
inflammation and edema.
c. Inflammatory Response: The inflammation triggers an inflammatory response,
leading to systemic manifestations.
d. Vascular Changes: Blood vessel damage can result in hemorrhage, necrosis, and,
in severe cases, organ failure.

2. What are the most common causes of acute pancreatitis?

● Gallstones: Blocking the pancreatic duct.
● Alcohol Consumption: Chronic alcohol abuse.
● Trauma: Injury to the pancreas.
● Infections: Viral or bacterial infections.

3. How are the results of V.A.'s laboratory values relate to the pathophysiology of acute
pancreatitis?
● Elevated Amylase and Lipase: Released from damaged pancreatic cells.
● High Urinary Amylase: Release of digestive enzymes like amylase into the
bloodstream.
● Increased WBC Count: Indicative of inflammation or infection.
● Elevated Blood Glucose: Insulin release impaired due to pancreatic
inflammation.
● Hypocalcemia: Calcium binds to necrotic fatty acids, forming insoluble salts,
leading to decreased serum calcium levels.

4. What causes hypocalcemia in acute pancreatitis? How does the nurse assess
hypocalcemia?
Calcium binds to necrotic fatty acids in the form of insoluble salts. Assessment
includes observing for signs of tetany, Chvostek's sign (facial muscle spasm), and
Trousseau's sign (carpal spasm).

5. Describe the characteristics of the pain that occurs in acute pancreatitis.

● Location: Severe abdominal pain in the LUQ, radiating to the back.
● Quality: Continuous, severe, and unrelenting.
● Aggravating Factors: Eating or drinking.

6. What complications can occur with acute pancreatitis?

● Pancreatic Necrosis: Tissue death in the pancreas.
 ● Systemic Inflammatory Response Syndrome (SIRS): Widespread inflammation
affecting distant organs.
● Abscess Formation: Collection of pus in the pancreas.

7. Why is V.A. NPO? What is the purpose of the NG tube?

● NPO (Nothing by Mouth): To rest the pancreas, decrease enzyme secretion, and
prevent stimulation of pancreatic activity.
● NG Tube: Reduces gastric secretion and decompresses the stomach, minimizing
pancreatic stimulation.

8. Identify the purpose of each medication prescribed for this patient.

● Morphine PCA: Manages severe pain.
● Pantoprazole (Protonix) IV: Reduces gastric acid secretion, preventing further
pancreatic stimulation.

9. Priority Decision: Based on the assessment data presented, what is the priority nursing
diagnosis? Are there any collaborative problems?
● Priority Nursing Diagnosis: Acute Pain related to pancreatic inflammation and
abdominal distension.
● Collaborative Problems: Potential for sepsis due to pancreatic necrosis, potential
for fluid and electrolyte imbalance.