Pancreatitis Nursing Diagnosis Care Plan

Pancreatitis Nursing Diagnosis Care Plan Pathophysiology and NCLEX review

Pancreatitis is defined as inflammation of the pancreas. It has been described as auto digestion of the pancreas.  The pancreas is a large gland behind the stomach and close to the start of the small intestine called the duodenum.   It is important to remember that the pancreas is basically two glands that reside in one organ. It is both an endocrine and exocrine gland. The pancreas has two functions:

Endocrine and Exocrine Functions

The first function is that the exocrine cells release enzymes via Acinar cells into the pancreatic duct which then drains into the duodenum. These enzymes assist with food digestion of fats, carbohydrates, and proteins.

  • Acinar cells include the following enzymes:
  • Lipase: breaks down fats.
  • Amylase: breaks down carbohydrates and starches into sugars.
  • protease: breaks down proteins into amino acids.

The second function is the pancreas functions as an endocrine gland. Inside the pancreas, there are small island of cells names the islets of Langerhans. These cells release hormones such as glucagon and insulin into the blood stream. Glucagon and insulin are utilized for blood glucose metabolism and regulating how the body uses and stores food or nutrients for energy.

Pancreatitis can be acute (sudden) and last for days,  or chronic pancreatitis, which does not resolve 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. This causes irreversible damage to the pancreas.

Pancreatitis
Acute Pancreatitis

 Sign and Symptoms

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

Acute Pancreatitis

  • Abdominal pain that worsens after eating
  • Upper quadrant abdominal pain with radiation to the back
  • Nausea and vomiting
  • Blood glucose issues
  • 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

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

Causes

Some of the causes of pancreatitis include:

  • Gallstones (most common)
  • Alcoholism – most patients have a history of long term alcohol use / abuse or biliary tract disease.
  • Smoking
  • Infection, in some cases Pancreatitis has been associated with the mumps virus.
  • Abdominal injury
  • Pancreatic cancer
  • Abdominal surgery
  • Some medications, such as oral contraceptives and corticosteroids
  • Cystic fibrosis – -In patients with CF, there is a dysfunction of a protein called CFTR.  The absence of this protein causes think mucus and blockage in the pancreatic ducts.  This blockage causes a drop in the amount of digestive enzymes the pancreas puts out
  • 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.

InterventionsRationales
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 bed rest and activityThis will help to minimize pancreatic secretions and pain.
Incorporate non pharmacologic 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.

InterventionsRationales
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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3 comments

  1. Hello! My name is Jen, I am a PA in the Emergency Department. I came across your diagram of Cullen’s sign and Grey Turner sign, which is a great tool to help remember which is which! The way the information is presented however almost makes it sound like this is a common finding of acute pancreatitis when you say (appears in 1-2 days). This is NOT a common finding in acute pancreatitis, however it is absolutely imperative to know and recognize these signs ESPECIALLY in the emergency department as they mean your patient is deteriorating. If you see these signs in the setting of acute pancreatitis it means he patient has probably progressed to necrotizing pancreatitis and is bleeding into the retroperitoneum which is linked to a high mortality rate. (Also look for these signs in the setting of blunt force trauma) There is a ton of fantastic information in this article, I hope in the future there is more emphasis placed on Cullen’s sign and Grey Turner sign clinically because, though not common, they are imperative to recognize and understand. I attached a link to the New England Journal of Medicine below for more complete info!

    https://www.nejm.org/doi/full/10.1056/NEJMicm1504339

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