Pancreatitis – Pathophysiology, Podcast, and Nursing Care Plan

Pancreas

Pancreatitis

Pancreatitis is defined as inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the start of the small intestine called the duodenum.  The pancreas has two functions:

  1. Release the hormones glucagon and insulin into the body via the blood stream. Glucagan and insulin are utilized for blood glucose metabolism and regulating how the body uses and stores food or nutrients for energy.
  2. Secrets digestive enzymes into the small intestine to help the digestion of fat, carbohydrates, and proteins.

Pancreatitis can be acute (sudden) and last for days,  or chronic pancreatitis, which does not heal and tends to get worse over time.

Normally during digestion, the pancreas releases inactivated pancreatic enzymes which move through ducts in the pancreas and then travel to the duodenum (small intestine). Once in the small intestine, the enzymes activate and assist with digestion.

Damage to the pancreas occurs when the digestive enzymes that are usually released by the pancreas are activated inside the pancreas instead of the small intestine and begin to attack the pancreas. This attack inside the pancreas irritates the cells and causes inflammation.

When acute pancreatitis occurs over and over again, this damage can lead to chronic pancreatitis from the scar tissue that is formed. Once the pancreas is compromised by repeated damage, digestion problems and diabetes can occur.

Pancreatitis

 Sign and Symptoms

Depending on the type and severity of the pancreatitis, sign and symptoms will vary.

Acute Pancreatitis

  • Abdominal pain that worsens after eating
  • Upper quadrant abdominal pain with radiation to the back
  • Nausea and vomiting
  • Tenderness to abdomen with touch
  • Cullen’s Sign: bruising around umbilicus (1-2 days to appear)
  • Grey Turner’s Sign: Bruising on the flanks (1-2 days to appear)

Cullen's sign

Chronic Pancreatitis

  • Weight loss
  • Steatorrhea: foul, oily stools
  • Upper abdominal pain

 

 

Causes

Some of the causes of pancreatitis include:

  • Gallstones (most common)
  • Alcoholism
  • Smoking
  • Infection
  • Abdominal injury
  • Pancreatic cancer
  • Abdominal surgery
  • Some medications
  • Cystic fibrosis
  • ERCP – Endoscopic retrograde cholangiopancreatography (used to treat gallstones)
  • Family history of pancreatitis
  • High triglyceride levels

 Complications

Serious complications from pancreatitis can include:

  • Infections: In acute pancreatitis, the pancreas is susceptible to bacteria that can cause infections. Surgery may be needed to remove damaged tissue.
  • Pseudocyst: This is debris and fluid that can collect in pockets of the pancreas. If this cyst-like pocket ruptures, infection and bleeding can result.
  • Diabetes: Due to damage of the insulin producing cells.
  • Renal failure
  • Respiratory problems
  • Malnutrition: Due to damage of the digestive enzymes.
  • Pancreatic Cancer

Diagnosis

The following is a list of some tests used to diagnose pancreatitis:

  • Blood work: especially amylase and lipase, which may at least 3x the normal values.
  • CT scan: to look for gallstones and inflammation.
  • Abdominal Ultrasound: to look for gallstones and inflammation.
  • Endoscopic Ultrasound: to visualize any blockages in the bile or pancreatic duct.
  • MRI: to visualize any abnormalities in pancreas, ducts, and gallbladder.

 Treatment

Initial treatment may include hospitalization to stabilize the condition. Other treatments may include:

  •  NPO: nothing by mouth to allow the pancreas to rest.
  • Pain medications: to control the pain that can be severe.
  • IV fluids: to maintain hydration.

To treat the underlying cause of pancreatitis:

  • ERCP: to diagnose and repair issues with bile ducts.
  • Surgery of pancreas: to remove bad tissue and fluid from the pancreas.
  • Cholecystectomy: gallbladder removal may be needed if gallstones are problem in onset of pancreatitis.
  • Treat alcohol dependence: Since drinking alcohol can cause pancreatitis, sometimes within a few hours after drinking. Abstaining from drinking alcohol is important.

Other treatments include:

  • Enzyme supplements: to assist breaking down food into usable nutrients for the body.
  • Dietary changes: recommend low-fat, high nutrient meals.

 

 

 Nursing Care Plan

Nursing Diagnosis

1. Acute pain related to inflammatory process of the pancreas as evidenced by patient rates pain at 8/10 on pain scale and states abdominal cramping and tenderness in abdomen.

Desired outcomes:

Patient will report a decrease in pain from 8 to 0 on the pain scale by discharge.

InterventionsRationals
InterventionsRationals
Assess level of pain using appropriate pain scale. Assess pain 30 minutes before and after pain medication is given.Using an appropriate age pain rating scale will help the healthcare providers monitor the level of pain and adjust pain medications as needed.
Administer pain medications as prescribed and indicated.Analgesics are helpful in relieving pain and helping in the recovery process.
Have patient maintain limited bedrest and activityThis will help to minimize pancreatic secretions and pain.
Incorporate nonpharmacologic measures to assist with control of pain.Ideally, the use of comfort measures will distract the patient from pain and may increase the effectiveness of pharmacological measures.

2. Risk for Infection related to possible tissue damage from necrosis from the release of pancreatic enzymes.

Desired outcomes:

By discharge, the patient will remain free signs and symptoms of infection.

InterventionsRationals
InterventionsRationals
Assess vital signs including temperature every 4 hours and as needed. Report any abnormal findings to the healthcare provider.Fever is often one of the first signs of infection.
Assess mental status and level of consciousnesses every 4-6 hours.Mental status changes, confusion, or any deterioration from baseline can signify infection.
Report and note any abnormal laboratory values (i.e. elevated WBC count) to the healthcare provider.Certain abnormal laboratory results could be an indicator of infection.

Other possible nursing diagnosis:

Risk for imbalanced fluid volume

Impaired gas exchange

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

 

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Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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