PANCREATITIS

Diverticulum, Diverculitis, Deverticulosis

Dulnuan, April
Flores, Fiona Jane
Gallevo, Princess Ann
Ganggangan,
Drixel L.
Jaravata, Shaila
Jubilo, Christine
Julian, Aerika
Laureta, Diana Jane
Matabye, Smelita
Magah-ngo, Joann
ETIOLOGIC
AGENT  ALCOHOL ABUSE

BACTERIAL INFECTION

Medications

Gallstones
 SIGNS AND SYMPTOMS
•Acute pancreatitis symptoms •Chronic pancreatitis symptoms
 Pain that starts slowly or suddenly in the upper  Pain in the upper abdomen or no pain at all
abdomen
 Pain that may spread to the back
 Pain that may spread to the back
 Mild or severe pain
 Pain that may become worse after eating

 Pain that may last for several days  Diarrhea

 Fever  Nausea
 Nausea  Weight loss
 Vomiting  Vomiting
 Swollen or tender abdomen
 Fast heart rate
 ASSESSMENT AND DIAGNOSIS
Serum amylase and lipase levels
WBC count Alkaline phosphatase
X-ray studies. Serum calcium
Ultrasound Potassium
Blood studies Serum glucose
CT scan Urinalysis
Ultrasound of abdomen Stool
Abdominal x-rasy
 POST OP
COMPLICATION
PANCREATIC FISTULA

o Characterized by leakage of
pancreatic fluids as a result
of disruption of pancreatic
ducts.
 PATHOPHYSIOLOGY
[Acute ]
Premature activation of
Pancreas Autodigestion
pancreatic enzymes

Injures the acinar cell Impairs the secretion Damages the

of zymogen granules duct epithelium

pancreatic edema

Delays enzymatic secretion

hemorrhage

necrosis Acute pancreatitis

CHRONIC

Long term alcohol

Smoking
consumption

Direct toxic effect on

the cells of the
pancreas Hypersecretion of
Pancreatic secretions
protein

Low in protein

Protein plugs and

Pancreatic ducts
calculi

High/ very low fat

 NURSING MANAGEMENT
The client should avoid oral intake to inhibit
pancreatic stimulation and secretion of pancreatic
enzymes.
Maintain fluid and electrolyte balance.
Promote adequate nutrition.
Promote adequate nutrition.
Teach the client coughing and deep-breathing
techniques.
Continuation….

Provide measures to rest the colon during an acute exacerbation, which results when
food or bacteria in the diverticula cause inflammation.
Help restore the client’s normal bowel elimination pattern by administering one or
more of the following:
• Bulk laxatives
• Stimulant laxatives
Help prevent constipation.
Teach the client about nursing care.
•Administer medications, which may include antibiotics, opioid analgesics, and
antispasmodics.
•Provide return to normal bowel elimination patterns as symptoms subside.
Slowly increase oral intake until the client is drinking six to eight glasses of water daily.
MEDICAL MANAGEMENT
 Relieve pain, IV morphine is used
 Parenteral nutrition is administered to
the debilitated patient
 Intravenous fluid therapy
 Nasogastric tube insertion as prescribed
 Oral intake is withheld to inhibit
pancreatic stimulation and secretion of
pancreatic enzymes.
 Administer fat-soluble vitamins as
prescribed
 Administer antacid
 Administer histamine H2 receptor as
prescribed
 Administer anticholinergics as prescribed
 Administer antibiotics
 Administer calcium supplement and vitamin
D as prescribed
 Instruct the client on the importance of
avoiding alcohol
 Instruct the client on the importance of
follow up check ups
 Instruct the client to notify the physician if
acute abdominal pain, jaundice, clay-colored
stools or dark urine develops.
 POSSIBLE DIAGNOSIS
•Diagnosing acute pancreatitis

•For acute pancreatitis, your provider may order a blood test that measures the levels of two digestive enzymes (amylase and
lipase) produced by the pancreas. High levels of these enzymes indicate acute pancreatitis. An ultrasound or computed
tomography (CT scan) provides images of your pancreas, gall bladder and bile duct that can show abnormalities.

•Diagnosing chronic pancreatitis

•Secretin pancreatic function test: This test checks for your pancreas’s response to a hormone (secretin) released by the small
intestine. Secretin usually triggers the pancreas to release a digestive juice. A medical professional passes a tube from your throat,
through your stomach, into the upper part of the small intestine to insert secretin and measure the response.
•Oral glucose tolerance test: You may need this test if your provider suspects that pancreatitis has damaged your insulin-producing
pancreas cells. It measures how your body handles sugar with a blood test before and after you drink a sugary liquid.
•Stool test: Your provider may order a stool test using a sample of your stool to see if your body is having difficulty breaking
down fat.
•Endoscopic ultrasound (endosonography): An internal (endoscopic) ultrasound takes clearer pictures of your pancreas and
connecting ducts (tubes). A healthcare professional inserts a thin tube with a tiny ultrasound attachment into your throat, through
your stomach and into your small intestine. The endoscopic ultrasound takes detailed pictures of your internal organs including
pancreas, part of liver, gall bladder and bile duct.
•ERCP (endoscopic retrograde cholangiopancreatography): A tube with a tiny camera is passed from your throat to your stomach
and into your small intestine up to the area called the ampulla, where the pancreas and bile duct opens. Dye is injected into the
pancreas duct and /or bile duct. The test lets your provider see inside the pancreas and bile duct. Anything blocking the pancreas
or bile duct, such as a gallstone or pancreas stone, may be removed.
 NURSING CARE PLAN 1
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIO RATIONALE INTERVENTIO
Subjective: Activity After 6 hours of nursing 1.Have the N
patient 1. Helps in increasing N of nursing
After 6 hours
interventions the patient perform the activity the tolerance for the interventions the patient
“agkakapsot intolerance related will participate willingly more slowly, in a longer activity. able to participate
nak ,haanak nga to fatigue in necessary/desired time with more rest or willingly in
komportable” as activities. pauses, or with necessary/desired
verbalized by the assistance if necessary. activities.
-demonstrate a decrease
patient. in physiological signs of 2. Gradually increase 2. Gradual progression -demonstrate a decrease
intolerance :pulse, activity with active of the activity prevents in physiological signs of
Objective: respiration and blood range-of-motion overexertion. intolerance :pulse,
pressure remain within exercises in bed, respiration and blood
-pallor increasing to sitting and
client’s normal range. pressure remain within
-weakness then standing
client’s normal range.
- Fatigue 3. Refrain from 3. Patient with limited
-dizziness performing nonessential activity tolerance need
activities or procedures to prioritize important
task first.
Vital sign:
BP: 160/80mmhg
PR: 120 bpm
RR: 28 bpm
 Continuation…

ASSESSMENT DIAGNOSIS PLANNING INTERVENTI RATIONALE INTERVENTI

      ONbedside
4. Provide
commode as
4.Use of   ON
commode
indicated. requires less energy
expenditure than using a
bedpan or ambulating to
the bathroom.

5. Encourage physical 5. Helps promote a sense

activity consistent with of autonomy while being
the patient’s energy realistic about
levels. capabilities.
 NURSING CARE PLAN 2
Assessment Nursing Diagnosis Outcome Intervention Rationale Evaluation
Subjective: Acute Pain related to After 6 hours of prescribed pain ▪︎To alleviate the symptoms
▪︎Administer After 6 hours of
medications (meperidine of acute abdominal pain.
"Ah....ang sakit ng obstruction of nursing nursing
tiyan ko"as pancreatic ducts interventions the ▪︎Assess the patient’s vital ▪︎To monitor effectiveness of interventions the
signs and characteristics of medical treatment for the patient will
verbalized by the secondary to acute patient will pain at least 30 minutes relief of abdominal pain.
demonstrate
after administration of The time of monitoring of
patient pancreatitis as demonstrate medication. vital signs may depend on relief of pain as
evidenced by pain relief of pain as the peak time of the drug evidenced by a
administered.
Objective: score of 10 out of 10 evidenced by a pain score of 0
▪︎Appeared restless pain score of 0 out of 10, stable
▪︎Elevate the head of the ▪︎To increase the oxygen level
▪︎Displayed out of 10, stable bed if the patient is short by allowing optimal lung
vital signs, and
grimace face and vital signs, and of breath. expansion. absence of
guarding sign on absence of restlessness.
▪︎Maintain bedrest during ▪︎Decreases metabolic rate
the abdomen. restlessness. acute attack. Provide quiet, and GI stimulation and
restful environment. secretions, thereby reducing
▪︎VS: PR-115bpm, pancreatic activity.
BP-
140/80, RR-26 ▪︎Promote position of ▪︎Reduces abdominal
comfort on one side with pressure and tension,
knees flexed, sitting up and providing some measure of
leaning forward. comfort and pain relief.
Continuation…
   
▪︎Provide  

alternative ▪︎Promotes
comfort relaxation
measures and enables
(back rub),
encourage patient to
relaxation refocus
techniques attention;
(guided may enhance
imagery, coping.
visualization),
quiet
diversional
activities (TV,
radio).
 NURSING CARE PLAN 3
Assessment Nursing Diagnosis Outcome Intervention Rationale Evaluation
▪︎To assist in creating an
Subjective: -The Hyperthermia Within 4 hours ▪︎Assess the patient’s accurate diagnosis
and monitor effectiveness of
Within 4 hours of nursing
vital signs at least every interventions, the patient will
patient secondary to infective
complains of chills of nursing 4 hours.
medical treatment, particularly
the antibiotics and
have a stabilized temperature
within the normal range.
process of interventions, feverreducing drugs.
pancreatitis as ▪︎Remove excessive
Objective: the patient will clothing, blankets and ▪︎To regulate the temperature of
▪︎Temperature of evidenced by linens. Adjust the room
the environment and make it

temperature of 38.5
have a stabilized temperature.
more comfortable for the
38.5°c patient.
▪︎Rapid breathing, degrees Celsius, rapid temperature
profuse sweating breathing, profuse within the ▪︎Adminisister the
sweating, and chill normal range. prescribed antibiotic
▪︎-Antibiotic to treat bacterial
infection (pancreatitis), which
and anti-pyretic is the underlying
medications.

      cause of the patient’s  

hyperthermia. -Fever-reducing
medication to stimulate the
hypothalamus and normalize
the body temperature.

▪︎Offer a tepid sponge bath. ▪︎To facilitate the body in cooling

down and to provide comfort.
PROGNOSIS
•Acute pancreatitis usually improves independently of
when dietary changes are made. Patient outcomes are
often very positive and people usually make a full
recovery. Alcohol intake should be eliminated, even in
cases where alcohol was not the cause of the condition.
Smoking should also be stopped, as it acts as a stressor to
the body’s defense mechanisms against inflammation. In
cases where gallstones are identified as the cause, the
gallbladder is surgically removed to prevent any further
episodes.
• Acute pancreatitis usually improves
independently of when dietary changes are made.
Patient outcomes are often very positive and
people usually make a full recovery. Alcohol
intake should be eliminated, even in cases where
alcohol was not the cause of the condition.
Smoking should also be stopped, as it acts as a
stressor to the body’s defense mechanisms
against inflammation. In cases where gallstones
are identified as the cause, the gallbladder is
surgically removed to prevent any further
episodes.
Ranson’s prognostic signs can be used to predict a patient’s prognosis. Of these,
some of the signs that can be identified at the time of hospital admission include the
following:

•Age over 55 years

•A plasma glucose level higher than 200 mg/dL
•A serum lactate dehydrogenase (LDH) level higher than 350 IU/L
•An aspartate aminotransferase level higher than 250 UL
•A white blood cell (WBC) counts higher than 16,000/μL
Six additional signs can be established within two days of hospital admission to assist in determining a patient's prognosis, of which
include:
 

•A decrease in hematocrit of more than 10%

•An increase in blood urea nitrogen (BUN) of more than 5 mg/dL
•A serum calcium level less than 8 mg/dL
•A partial pressure of oxygen in arterial blood of less than 60 mmHg
•A base deficit of less than 4 mEq/L
•An estimated fluid sequestration of more than 6 L
• Mortality due to acute pancreatitis is increased as the number of present
prognostic signs increases. The mortality rate is less than 5% among those
with less than three signs, whereas it can increase to up to 20% among those
with three signs or more
THANK
YOU.