Nursing Management of Acute Pancreatitis: Comprehensive Care Plan

1. Nursing Process Acute Pancreatitis

2. Assessment • History focussed on abdominal pain and discomfort, alcohol consumption • Gallstone colic • Anyother gastrointestinal problems • Respiratorystatus • Emotional and psychological status of the patient and his relativesl

3. Nursing diagnoses • Include pain related to inflammation, oedema, distentionof the pancreas, and peritoneal irritation • Ineffective breathingpattern related to severe pain pulmonary infiltrates, pleural effusion, and atelectasis • Altered nutrtionalstatus • Impaired skinintegrity related to poor nutritional status, bed rest, and multiple drains and surgical wound

4. Collaberative problems / potential complications • Fluid and electrolyte disturbances • Necrosis of the pancreas • Shock and multiple organ dysfuntion • Planning and goals: • Reliefofpain and discomfort • Improved respiratory function, improved nutritional statusmaintenance of skin integrity • Absence of complications

5. Nursing interventions • Relieving pain and discomfort – Meperidine • Oral feeding withheld • Parenteral fluids • Electrolytes • Fluid balance • Nasogastric suction • Relieve abdominal distention • Oral hygiene • Relieve dryness of the mouth • Bed rest • If there is no pain relief suspect haemorrhage in the pancreas

6. Improving breath pattern • Semi-Fowler’s position • Frequent changes of postion to prevent atelectasis and pooling of respiratory secretions • Pulmonary assessment and monitoring of pulse oximetry or arterial blood gases • Patient is instructed in techniques of coughing and deep breathing to improve respiratory function and ecouraged and assisted to cough and deep breathe every 2 hours

7. Improving nutritional status • TPN • After acute syptoms subside, oral feedings are reintroduced gradually • Between acute attacks, the patient receives a diet high in carbohydrates and low in fat and proteins . Heavy meals are avoided, as are alcoholic beverages

8. Improving skin integrity • Skin breakdown likely • Pressure sores – guarded against • Drainage sites – protected • Use of special beds

9. Monitoring and managing potential complications • Abdominal girth assessed, skin turgor monitored • Be ready to combat circulatory collapse • Low levels of serum calcium and magnesium levels may occur and require prompt treatment. • Watch for early signs of neurologic dysfunction • cardiovascular, renal, and respiratory dysfunction • Keep the patient’s family informed and they must be allowed to spend some time with the patient.

10. Promoting home and community-based care • Repeat and reinforce the instructions given to the patient while he was acutely ill. • Instruct the family to recognize any complication or adverse situation and report promptly to the physician.

11. Continuing care • Referral for home care is often indicated • This enables the nurse to assess the patient’s physical and psychological status and compliance with the therapeutic regimen. • Assess the home situation • Reinforce instructions about fluid and nutrition intake and avoidance of alcohol • Refer to alcoholics anonymous if needed