NUR 2254 Medical-Surgical Nursing 5

PANCREATITIS & CARE
Nurul Afifah Marzuki (0914856) Nor Hazira Hashim (0919414) Raihan Madihah Ghani (0913956) Nurul Farahin Jamaldin (0912114) Instuctor: Bro Mohd Kamil Che Hasan

OBJECTIVE
At the end of this session, the students will be able to: ‡ Identify the differences between acute pancreatitis and chronic pancreatitis ‡ Know the sign and symptom and the etiology of pancreatitis ‡ Discuss the diagnostic test and medical management for pancreatitis ‡ Plan the nursing process for pancreatitis

INTRODUCTION
‡ Inflammation of the pancreas. It may occur suddenly, in a severe form as in acute pancreatitis, or may continue as a slow, long drawn illness as in chronic pancreatitis (Smolarz,2010). ‡ Pancreas is an organ situated in the upper part of abdomen. ‡ About 6 inches or 15 cm long. ‡ Has a flattened bulbous head that is surrounded by part of the duodenum, a narrow body part lies behind the stomach

http://www.medindia.net/patients/patientinfo/pancreatitisanatomy-and-physiology.htm

http://www.aurorahealthcare.org/yourhealth/healthgate/getcon tent.asp?URLhealthgate=11634.html

REVIEW
‡ Has both exocrine & endocrine function. ‡ Exocrine Function - It secretes an alkaline juice with enzymes (amylase, lipase) which help digest the fat, protein as well as carbohydrates from the food. The alkaline juice helps to neutralize the acid secretions .(1.5 liters/ day). ‡ The enzymes are conveyed to duodenum via pancreatic duct. ‡ Endocrine Function - secretes insulin and glucagon ‡ In pancreatitis, the juices are activated within the pancreatic gland and it begin to digest the pancreas itself causing inflammation, injury and necrosis resulting in an acutely inflammatory process.
(Smolarz, 2010)

TYPE OF PANCREATITIS
‡ There are 2 types of pancreatitis; acute & chronic ‡ Acute- occurs suddenly & usually resolves in a few days with treatment. ‡ If there is severe complication, acute pancreatitis can be life threatening. ‡ Most causes of AP is the presence of gallstones

http://www.top5plus5.com/Gallstone%20Pancreatitis.html

CHRONIC PANCREATITIS
‡ CP- inflammation of pancreas that does not heal or improve (it gets worse overtime, leads to permanent damage). ‡ Just like AP, it occurs when digestive enzymes attack the pancreas & nearby tissue (Kloppel, 2007). ‡ Often develops in people who are between 30-40 yrs.

http://www.nature.com/modpathol/journal/v20/n1s/fig_tab/38 00690f10.html

Acute pancreatitis Etiology & risk factors
‡ Gallstones ‡ Excessive alcohol usage ‡ Hyperlipidemia (high levels of fat in the blood) ‡ Hypercalcemia (high levels of calcium in the blood) ‡ Viral infection (mumps, coxsackie B, mycoplasma pneumonia, and campylobacter) ‡ Traumatic injury ‡ Pancreatic or common bile duct surgical procedures ‡ Medications (especially estrogens, corticosteroids, thiazide diuretics, and azathioprine) ‡ Cholecystitis & cholelithiasis. ‡ Familial cases with no definite mechanisme define. ‡ Pancreatic tumor. ‡ pancreatic ischemia.
(Black & Hawks, 2010)

Sign & Symptoms
‡ Pain in the upper abdomen (can be severe, radiate to the back and may last for several days). ‡ Person look and feel very ill. ‡ Swollen and tender abdomen. ‡ Nausea and vomiting. ‡ Fever. ‡ Rapid pulse.
(Pancreatitis Symptoms, 2011)

Chronic pancreatitis Etiology & Risk factors
‡ Long-term excessive alcohol consumption. ‡ Hypercalcemia - high levels of calcium in the blood ‡ Abnormalities in anatomy which are usually present at birth hereditary disorders of pancreas. ‡ Cystic fibrosis most common inherited disorder. ‡ Hyperlipidemia or hypertriglyceridemia - high blood fats.
(Black & Hawks, 2010)

Sign & Symptoms
‡ Upper abdominal pain (some people have no pain). ‡ Nausea. ‡ Vomiting. ‡ Weight loss. ‡ Diarrhea. ‡ Oily stool.
(Black & Hawks, 2010)

COMPLICATIONS
Pancreatitis can cause serious complications, including: ‡ Breathing problems. Acute pancreatitis can cause chemical changes in body that affect lung function, causing the level of oxygen in blood to fall to dangerously low levels. ‡ Diabetes. Damage to insulin-producing cells in pancreas from chronic pancreatitis. ‡ Infection. Acute pancreatitis can make pancreas vulnerable to bacteria and infection.7

(William, 2010)

‡ Kidney failure. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if the kidney failure is severe and persistent. ‡ Malnutrition. Both acute and chronic pancreatitis can cause pancreas to produce fewer of the enzymes that are needed to break down and process nutrients from the food that we eat. ‡ Pancreatic cancer. Long-standing inflammation in pancreas caused by chronic pancreatitis is a risk factor for developing pancreatic cancer. ‡ Pseudocyst. Acute pancreatitis can cause fluid and debris to collect in cyst-like pockets in the pancreas. A large pseudocyst that ruptures can cause complications such as internal bleeding and infection.

(William, 2010)

Diagnostic Test & Medical Management

Diagnostic Test

(Black & Hawks, 2010)

ERCPP- Endoscopic Retrograde Cholangiopancreatography NPO- Nothing by mouth

‡ ‡

‡ -

-

Reduce the pain Treated with opiod analgesics The drug of choice: Meperidine Maintain volume status, electrolyte balance, and nutritional status Commonly associated with fluid loss resulting from emesis Maintain pancreatic rest Withholding food and liquids by mouth initially because pancreatic secretion may increase inflammation and pain Severe to moderate: nutritionally supported by TPN
(Chen, 2001)

Medical Management (Acute Pancreatitis)

‡ Treat complications - Include pancreatic disorders (e.g., pancreatic abscess, infected necrosis) may warrant surgery, or non-pancreatic disorders (e.g., renal or pulmonary disorders) ‡ Other measures - Antibiotics are not routinely administered but generally reserved for documented infections - Maybe necessary to perform peritoneal dialysis to get rid potentially toxic compounds
(Black & Hawks, 2010)

Medical Management (Chronic Pancreatitis)
‡ Relieve pain - Should begin with non-opiod analgesics and progress to opiod analgesics, if needed - Surgical procedures may be an option ‡ Treat endocrine insufficiency - Exogenous insulin therapy may be necessary because of destruction of islet tissue ‡ Treat exocrine insufficiency - Treated with exogenous pancreatic enzyme therapy (lipase, trypsin, or H2-receptor antagonists)
(Black & Hawks, 2010)

Surgical Management (Chronic Pancreatitis)

(Black & Hawks, 2010)

Nursing Mx (Pre-op)
‡ Pre: - Pre-op assessment (medical history, previous surgery, medication history, allergies etc) - PE - Informed consent - Physical care (bathing, shaving, enema, NBM), and nutritional care (adequate nutrition) - Deep breathing and coughing exercises - Pre medications - Taking vital signs as baseline

(Black & Hawks, 2010)

Nursing Mx (Post-op)
‡ Post: General appearance Vital sign Level of consciousness Emotional status Skin color and temperature Discomfort and pain Nausea and vomiting Type of flow IV fluid / flow rate Dressing site Urinary output
(Black & Hawks, 2010)

NURSING MX ACUTE PANCREATITIS

1) Nursing diagnosis: Acute pain r/t inflammation of the pancreas and surrounding tissue, obstruction of pancreatic ducts, and interruption of the blood supply

Outcomes : The client will domenstrate an absence or a decrease in pain level aeb verbalizing this fact and resting quietly and show fewer expression of pain

(Black & Hawks, 2010)

INTERVENTIONS
1) Administer parenteral opiods (morphine). 2) Promote pancreatic rest -NG suction -NBM -Bed rest 3)Provide comfort measures -Correct positioning -Relaxation technique -Quiet environment

RATIONALES
To quiet the pancreas and to decrease enzyme secretion To decrease gastrin release from the stomach, remove HCL acid, prevent gastric content from entering the duodenum, and decrease distention. Help promote comfort and rest

(Black & Hawks, 2010)

2) Nursing diagnosis: Imbalanced nutrition: Less than body requirements r/t inability to ingest or digest food , nausea and vomiting

Outcomes : The client will maintain adequate nutritional status aeb maintaining normal body weight, keeping blood glucose within normal limits, and showing no evidence of muscle wasting.

(Pancreatitis , n.d.)

INTERVENTIONS
1) Assess client s daily weight

RATIONALES
To establish a baseline data and to monitor the client s progress

2) Administer enteral / To maintain balanced nutrition parenteral ( under aseptic technique) feeding as prescribed. 3) Monitor serum glucose To prevent hypoglycemic shock 4-6 hourly.

(Pancreatitis , n.d.)

3) Nursing diagnosis: Ineffective breathing pattern r/t abdominal distention , pain, or respiratory complications.

Outcomes : The client will maintain an effective breathing patterns aeb respiratory rate within normal limits, relaxed respiratory effort, and clear lungs.

(Black & Hawks, 2010)

INTERVENTIONS
1) Assess client s respiration rate, monitor pulse rate, pulmonary assessment. 2) Put client in SemiFowler or side-lying position

RATIONALES
To establish a baseline data and to monitor the client s progress

To facilitate normal respiration and promote lung expansion

3) Teach coughing & deep Promote relaxation breathing techniques. 4) Teach the client regarding the use of incentive spirometry To promote lung expansion

(Black & Hawks, 2010)

NURSING MX CHRONIC PANCREATITIS

INTERVENTIONS

RATIONALES

1) Monitor client s weight, This measures are effective screening height, and serum premethods to detect clients at risk for albumin and albumin poor nutritional status levels

2) Document any result of To establish a baseline of information the assessment and to monitor the client s progress

(Black & Hawks, 2010)

CONCLUSION
In conclusion, we able to identify the differences between acute pancreatitis and chronic pancreatitis, know the sign and symptom and the etiology of pancreatitis, know the diagnostic test and medical management for pancreatitis and managed the nursing care plan for pancreatitis.

REFERENCES
‡ Allen, J. (2005). Anatomy & Physiology. Retrieved on January 15th, 2011 from http://www.medindia.net/patients/patientinfo/pancreatitis-anatomy-andphysiology.htm Black, J. M. & Hawks, J. H. (2010). Medical- Surgical Nursing (8th Ed.). Singapore: Saunders Elsevier. Burke. K. M., LeMone. P., Mohn-Brown. E. L. (2007). Medical-Surgical Nursing Care (2nd Edition). New Jersey: Pearson Education Inc Chen, Q. P. (2001). Enteral nutrition and acute pancreatitis. Retrieved 7th February 2011 from http://www.wjgnet.com/1007-9327/7/185.pdf Kloppel, G. (2007). Pancreatitis. Retrieved on January 15th, 2011 from http://www.nature.com/modpathol/journal/v20/n1s/fig_tab/3800690f10.html Munoz, A. & Katerndahl D. A. (2000). Diagnosis and Management of Acute Pancreatitis. Retrieved 7th February 2011 from http://www.aafp.org/afp/20000701/164.html ‡ ‡

‡

‡

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‡ Pancreatitis (n.d.). Retrieved 7th February 2011 from http://www.scribd.com/doc/21322360/Pancreatitis ‡ Pancreatitis Symptoms (2011). Retrieved 6th February 2011 from http://www.emedicinehealth.com/pancreatitis/page3_em.htm ‡ Smolarz, B. G. (2010). Healthy Diet. Retrived on January 15th, 2011 from http://www.aurorahealthcare.org/yourhealth/healthgate/getcon tent.asp?URLhealthgate=11634.html September 2010 by ‡ William, R. (2010). Hepatobiliary System. Retrievd on January 15th, 2011 from http://www.mayoclinic.com/health/pancreatitis/DS00371/DSECT ION=complications

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