Pancreatitis is a disease caused by many different factors, and the symptoms are often vague. This post will discuss how to recognize pancreatitis and the nursing diagnosis for the care of this condition.
Pancreatitis is an inflammation of the pancreas that may or may not cause pain or other noticeable symptoms. The most common symptom associated with this condition is abdominal pain, but in some cases, there may also be nausea and vomiting (NANDA-I 2012). It’s important to remember that acute pancreatitis can occur suddenly due to gallstones blocking bile ducts leading from the liver; however, it can also develop gradually over time due to alcohol abuse, obesity, diabetes mellitus type 2, and hyperlipidemia (NANDA-I 2012).
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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
The pancreas is a gland that produces enzymes to digest food and hormones such as insulin, glucagon, somatostatin, and pancreatic polypeptide.
The pancreas has two parts – the head, which secretes digestive enzymes into the small intestine, and the tail, where bile ducts from the liver lead the pancreatic enzymes to do their job.
The pancreas also produces insulin, a hormone that regulates the level of glucose in the blood and other fluids within cells. Insulin is secreted from beta-cells located at the head of the pancreas, which is sensitive to changes in levels of sugar such as high or low concentrations (NANDA-I 2012).
The pancreas is a part of the endocrine system and exocrine system, which produces both hormones and enzymes.
Pancreatitis is a condition in which the pancreas becomes inflamed. The pancreas is located behind the stomach and produces digestive enzymes that are essential for digestion. Pancreatitis can be acute (lasting less than six weeks) or chronic (continuing over six weeks).
Acute pancreatitis usually occurs after gallstones block one of the ducts leading from the liver to the pancreas, causing bile to back up.
Chronic pancreatitis may be caused by alcoholism, diabetes mellitus, cystic fibrosis, or an idiopathic condition.
Symptoms include acute pain in the upper middle abdomen radiating to the back; nausea and vomiting; jaundice; fever; dark urine; and bright feces.
Pancreatitis can be either acute or chronic. Acute pancreatitis usually occurs after gallstones block one of the ducts leading from the liver to the pancreas, causing bile to back up.
Chronic pancreatitis may occur as an idiopathic condition or secondary to several different factors, including alcoholism, diabetes mellitus, and cystic fibrosis.
Causes for acute pancreatitis include gallstones blocking ducts leading from the liver to the pancreas, blockage of bile in these ducts, and alcohol abuse.
Acute pancreatitis can be caused by gallstones that obstruct one or more ducts between the liver and the pancreas (pancreaticobiliary tract), such as when a gallstone obstructs a bile duct.
Biliary pancreatitis can be caused by obstruction of the sphincter at the junction between the common bile duct and pancreas or blockage of one of four major branches that supply pancreatic tissue with digestive enzymes (ampulla of Vater).
In about one-third of cases, the cause is unknown.
Acute pancreatitis can also be caused by the consumption of alcohol or certain drugs (e.g., acetaminophen). Alcohol causes inflammation in the pancreas when it enters through the damaged lining and leaks into its tissue; this leakage produces a toxic chemical reaction that kills off cells within the pancreas.
Drugs, such as acetaminophen (Tylenol), can cause acute pancreatitis by damaging the cells that produce digestive enzymes within the pancreas.
In rare cases, chest trauma or a hard blow to the abdomen may be causative factors in an episode of acute pancreatitis.
Symptoms of acute pancreatitis include pain in the upper middle abdomen radiating to the back, nausea and vomiting, jaundice (yellowing of the skin), fever, dark urine, and bright feces.
Acute pancreatitis can cause pain that is often severe enough to be mistaken for appendicitis or gallstones.
This pain is typically located in the upper-middle region of the abdomen but sometimes radiates to the back.
Physical examination may be conducted to assess for signs and symptoms of pancreatitis.
How Physical Examination is performed
-Physical assessment includes looking at the abdomen, including listening with a stethoscope.
-Auscultation: listening to the abdomen with a stethoscope.
-Palpations: feeling for lumps, masses, or abnormalities beneath the skin by pressing down on various body areas.
-Percussion: tapping lightly over an area and then assessing its sound as it echoes off underlying tissue or bone; used to identify localized abnormalities beneath the surface.
-During this exam, nurses will also assess jaundice (yellowing of the skin), fever, dark urine, and bright feces.
A physical examination will identify localized tenderness or rigidity in the right upper abdomen, fever, or chills.
Patients may also be experiencing nausea and vomiting (which is indicative of acute pancreatitis).
They will more than likely have elevated blood pressure or heart rate when they are in pain.
The enzyme amylase breaks down complex carbohydrates into simple sugars, broken down into glucose by lipases in the pancreas. The ratio between these two enzymes can be measured to assess the severity of inflammation in patients with acute pancreatitis.
A more accurate result can be obtained by measuring amylase and lipase in blood taken after four hours, as this is the point when both enzymes have reached their peak levels. However, it should also be noted that a normal ratio does not rule out pancreatitis, as the ratio of less than one for amylase or two for lipase could be due to other conditions that are not related to pancreatitis.
This test can help make the diagnosis of pancreas inflammation. It measures two enzymes: amylase and lipase.
-After fasting for 12 hours, the patient drinks a solution of water and juice containing a small amount of radioactive glucose.
-The person is then given an intravenous injection to clear any remaining pancreatic fluid before having blood drawn hourly for three hours.
-A more accurate result can be obtained by measuring amylase and lipase in the blood taken at four hours.
-The amylase/lipase ratio is calculated by dividing the lipase concentration (in mU/L) by that of amylase (mU/dL).
-A normal result for a patient with acute pancreatitis will be less than one; patients taking corticosteroids may have a ratio of less than two.
Special procedures: a procedure may be performed to examine internal organs or structures, such as an x-ray of the abdomen or Endoscopy (inserting a tube with a camera into the mouth and throat).
-X-rays are taken of the abdomen to see any fluid or gas in the abdominal cavity.
-Patient needs to drink lots of fluids on the day prior so that they can be X-rayed with their bowel relatively full and free-flowing.
-If there is a large amount of fluid present in the abdominal cavity, this can indicate that the pancreas has ruptured.
-X-rays will show if other organs have been injured by pancreatitis or inflammation.
This test may be ordered to identify the severity of damage and whether there is bleeding into organs.
-If a CT scan or MRI is prescribed, the patient will lie in a machine that takes pictures of the organs and bones.
-A contrast dye may be injected into major arteries to improve diagnosis.
-If there is a CT scan or MRI, it will show if the pancreas and other organs have been damaged by inflammation.
-It can also show whether any spleen, liver, or kidneys have ruptured due to pancreatitis.
Endoscopy is a special procedure to examine the interior of a hollow organ such as the intestine, stomach, or esophagus.
Endoscopy involves inserting an instrument with a light and camera, called an endoscope, into the mouth and throat to examine parts of the digestive tract.
The patient will need general anesthesia (sedation) or local anesthesia during this procedure if they are conscious and feeling pain.
-Endoscopy may show whether there is any bleeding or ulcers in the stomach.
-It can also determine if gallstones obstruct bile from flowing out of the liver and into the intestines.
A biopsy may be done as well, in which a small sample is taken for examination under a microscope.
How Biopsy is done:
-A small sample of the pancreas can be taken during an endoscopy, CT scan, or MRI.
-Lab analysis will show whether there are any signs that pancreatitis has caused permanent damage to the organ and how much inflammation was present at the time of Biopsy.
If a result suggests cancer, surgery will be needed to remove the tumor or cells for further examination and diagnosis.
Acute pancreatitis may be diagnosed by taking the history of a patient.
– If the patient has had pain in the upper abdomen for more than 12 hours.
-If the patient has a fever with vomiting and diarrhea, this is considered septicemia from peritonitis (infection of the abdominal cavity).
-In cases with known causes (e.g., alcohol abuse), the diagnosis is made on a history of alcohol abuse and other factors.
Causes of chronic pancreatitis include biliary duct stones, diet (e.g., high fat), trauma to the pancreas, and alcohol abuse.
-Stones may block bile from flowing into the intestines, which can cause pancreatitis symptoms due to obstruction inflow of bile out of the liver.
-High-fat diets have been linked to chronic inflammation that can result in chronic pancreatitis.
-Trauma is usually caused by blunt force to the abdomen and can seriously injure the pancreas and cause other injuries to organs such as the stomach, liver, or spleen.
-Alcohol abuse may contribute to chronic pancreatitis due to alcohol’s effect on gut motility (controlling muscles in intestines to allow food to move through).
Diagnoses for chronic cancer involve assessing the patient’s current condition, a treatment plan for pancreatic cancer, and prognosis. If there are symptoms of septicemia (e.g., fever), then other organs may rupture due to inflammation if it is not treated immediately. The long-term effects of chronic pancreatitis include weight loss, malnutrition, dehydration, and electrolyte imbalances that require nursing interventions.
Use appropriate pain relief medications if the nursing care plan includes increased discomfort for pancreatitis or chronic pancreatitis that is not being adequately managed with other interventions.
Monitoring nutrition and fluid intake to prevent dehydration can lead to further complications such as abdominal cramps and pain.
Use appropriate position changes to help prevent any skin breakdown due to the pancreas becoming enlarged and not functioning properly.
The nursing care plan should include interventions that promote sobriety, assess risk factors such as pancreatitis or chronic pancreatitis from alcohol abuse, provide education on dealing with addiction healthily, and monitor nutrition and fluid intake.
The intervention should include teaching the patient how to avoid alcohol use to not lead to any other health problems such as pancreatitis or chronic pancreatitis, which may lead to pancreatic cancer.
A nursing care plan will be provided if acute pancreatitis is confirmed based on the patient’s history and signs/symptoms.
If chronic pancreatitis is confirmed based on the patient’s history, the patient will be advised to follow a low-fat diet and avoid alcohol.
In cases of biliary obstruction with acute pancreatitis or chronic inflammation without an identifiable cause, medical management may include medications for pain relief (e.g., morphine).
Treatment: a long course of antibiotics and pancreatic enzyme replacement are the main treatment for acute pancreatitis.
-Pancreatic enzymes will be given to reduce pain and inflammation in the pancreas, improve absorption of nutrients and prevent complications such as strictured (narrowed) bowel syndrome or loss of gall bladder.
Pain management is an important nursing care plan for pancreatitis. The affected person should be informed about the pain as it can help with coping and provide a sense of relief to know what’s going on (i.e., “I’m in pain because my pancreas is inflamed and not functioning”). The nursing care plan should include:
-Pain medications (e.g., acetaminophen, aspirin)
-Acetaminophen with codeine or other narcotic medicine for increased relief from the pain
-A positioning that eases breathing if it’s difficult or painful
A diet high in protein and carbohydrates, with little fat or fiber, creates less stress on the pancreas. Nutritional supplements may be needed if there are problems absorbing food due to pancreatitis. Fluids should also be increased because dehydration can occur since fluids help provide digestive enzymes for digestion and regulate blood sugar.
-Patients with pancreatitis require rest and activity to promote comfort
The mental health nursing care plan includes listening, teaching coping techniques, processing thoughts or feelings related to the diagnosis, and providing information on pancreatitis or available resources (e.g., support groups). The nursing care plan should also include many of these activities for chronic pain management.
-Restoration of skin integrity is a nursing care plan that should be included with any activity or positioning to help prevent pressure ulcers, which can occur due to the pancreas becoming inflamed and not functioning properly. The nursing care plan may also include monitoring signs of infection from chronic pancreatitis (e.g., fever, vomiting).
-Prevention of weight loss is a nursing care plan since the patient will possibly not eat as much or maintain their usual diet for a short period.
-If there are symptoms of septicemia, a risk would be that other organs may rupture due to inflammation if it is not treated immediately.
-If chronic pancreatitis is caused by biliary obstruction because of gallstones, stone removal may be recommended.
-In cases related to alcohol abuse, the patient will need nursing interventions for detoxification and education on how to deal with addiction in a healthy way to not lead to any other health problems such as pancreatitis.
-Fluid volume maintenance (e.g., oral fluids, IV fluid)
-Chronic pain management
-Restoration of mental health
-Restoration of skin integrity
-Prevention of weight loss
Treatment for pancreatitis includes intravenous (IV) fluids, medications to decrease stomach acid such as H2 blockers or proton pump inhibitors, pain medication, nutrition support if the patient cannot eat on their own, and antibiotics if there are signs of infection. Nurses document and monitor the progress of patients diagnosed with pancreatitis to provide timely interventions and prevent complications.
The treatment of pancreatic cancer includes surgery, chemotherapy, and radiation. Surgery is the most common type of intervention for this disease because it can remove any tumors in the pancreas or nearby organs that have not spread beyond that area. Chemotherapy and radiation are used to help slow the progression of cancer in other areas.
Pancreatitis is an easy diagnosis because the patient will have abdominal pain, vomiting, and other evidence of pancreatic involvement. Anytime that a person has these symptoms, there should be suspicion for acute or chronic pancreatitis. Imaging techniques can help confirm, such as ultrasound to view the pancreas through the skin (trans-abdominal ultrasonography) or by inserting a thin tube (nasogastric intubation) through the nose and throat to view the inside the stomach.
The most interesting part about pancreatitis is that in some cases where it’s hard for patients to know if they have it because people often don’t experience pancreas-related symptoms. This is more common in people who have chronic pancreatitis because they may not experience the same type of pain if there are other problems (e.g., biliary obstruction) that lead to these issues instead.
In some cases where it’s hard for patients to know if they have pancreas-related symptoms, such as when they have chronic pancreatitis, and people may not experience the same type of pain. This is more common in patients with other problems that lead to these symptoms, such as biliary obstruction.