NURSING CARE PLAN

CHRONIC PANCREATITIS

GOMEZ, ETHEIL JOY F.

BSN 3-A RLE GROUP 3

ADELA S. ALDEA RN, MAN

CI INCHARGE
 Cues Nursing Rationale Goal/ Outcome Criteria Nursing Interventions Rationale Evaluation
Diagnosis

1. Subjective Pain related to In pancreatitis, Goal: 1. Independent Independent

Patient reported inflammatory enzymes that Patient will be relieved
epigastric pain process of the normally are from pain & discomfort Assessment Assessment
radiating to her pancreas as released into the within appropriate time  Assess level of pain using  Pain is a subjective
back. evidenced by digestive tract frame appropriate pain scale. experience and must
pain scale of begin to damage Assess pain 30 minutes be described by
2. Objective 8/20 and the pancreas Outcome Criteria: before and after pain patient. Using an
Facial grimace verbalization of itself. The gland  Reports relief of pain, medication is given. appropriate age pain
pain in the becomes swollen discomfort, and rating scale will help
abdomen. and inflamed. abdominal cramping. in monitoring the level
More enzymes  Verbalize non- of pain and adjust pain
are released into pharmacological medication as needed.
the surrounding methods that provide
tissues and relief  Incorporate non-  Ideally, the use of
bloodstream. As  Rests comfortably and pharmacologic measures to comfort measures will
a result, sleeps for increasing assist with control of pain. distract the patient
digestion slows periods from pain and may
down and increase the
becomes painful. effectiveness of
pharmacological
measures.

 Promote and assist patient  Reduces abdominal

to assume position of pressure and tension,
comfort on one side with providing some
knees flexed, sitting up and measure of comfort
leaning forward and turn and pain relief. Note:
and reposition every 2 Supine position often
hours. increases pain.
Frequent turning
relieves pressure.

Health Teaching
Health teaching  Promotes active rather
Provide for individualized than passive, role and
physical therapy or exercise enhances sense of
program that can be continued control.
by the client after discharge.
2. Dependent
2. Dependent  Anticholinergic
 Administer anticholinergic medications reduce
medication as prescribed gastric and pancreatic
and indicated. secretion

 Limits and reduces

 Withhold food and fluid as release of pancreatic
indicated. enzymes and resultant
pain.

 Morphine, fentanyl,
 Administer morphine, and hydromorphone
fentanyl or hydromorphone act by depressing the
frequently, as prescribed, to central nervous
achieve level of pain system and thereby
acceptable to patient based increasing the
on patient’s level of pain patient’s threshold.
and discomfort.
3. Collaborative
3. Collaborative
 Surgical exploration
 Prepare for surgical may be required in
intervention if indicated. presence of
intractable pain and
complications
involving the biliary
tract, such as
pancreatic abscess or
pseudocyst.
 Cues Nursing Diagnosis Rationale Goal/ Outcome Criteria Nursing Interventions Rationale

1. Subjective Imbalanced Nutrition: Patient with chronic Goal: 1. Independent 1. Independent

Less Than Body pancreatitis often lose Improve patient’s
Requirements related to weight, even when nutritional status Assessment Assessment
impaired pancreatic their appetite and  Assess abdomen, noting  Gastric distention and intestinal
2. Objective secretions as evidenced eating habits are Outcome Criteria: presence and character of atony are frequently present,
Malnutrished by weight loss normal. The weight  Demonstrate bowel sounds, abdominal resulting in reduced and absent
Vomiting loss occurs because progressive weight gain distension, and reports of bowel sounds. Return of bowel
the body does not toward goal with nausea. sounds and relief of symptoms
secrete enough normalization of signal readiness for
pancreatic enzymes laboratory values. discontinuation of gastric
to digest food, so  Experience no signs of aspiration (NG tube).
nutrients are not malnutrition.
absorbed normally.  Demonstrate behaviors,  Maintain NPO status and  Prevents stimulation and release
Poor digestion leads lifestyle changes to gastric suctioning in acute of pancreatic enzymes (secretin),
to malnutrition due to regain and/or maintain phase. released when chyme and HCl
excretion of fat in the appropriate weight. enter the duodenum.
stool.
 Assist patient in selecting  Previous dietary habits may be
food and fluids that meet unsatisfactory in meeting current
nutritional needs and needs for tissue regeneration and
restrictions when diet is healing. Use of gastric stimulants
resumed. (caffeine, alcohol, cigarettes, gas-
producing foods), or ingestion of
large meals may result in
excessive stimulation of the
pancreas and recurrence of
symptoms.

 Observe color, consistency  steatorrhea may develop from

and amount of stools. Note incomplete digestion of fats.
frothy consistency and foul
odor.

 Note signs of increased  May warn of developing

 thirst and urination or hyperglycemia associated with
changes in mentation and increased release of glucagon
visual acuity (damage to [beta] cells) or
decreased release of insulin
(damage to [beta] cells).

Health teaching Health Teaching

 Educate patient of the  This would improve patients

importance of lifestyle quality of life
changes

2. Dependent 2. Dependent
Administer medications as
indicated:
 Vitamins: A,D,E,K;  Replacement required because fat
metabolism is altered, reducing
absorption and storage of fat-
soluble vitamins.

 Replacement enzymes:  Used in chronic pancreatitis to

pancreatin (Dizymes), correct deficiencies to promote
pancrelipase (Viokase, digestion and absorption of
Cotazym) nutrients.

 Provide insulin as  Corrects persistent

appropriate. hyperglycemia caused by injury
to cells and increased release of
glucocorticoids. Insulin therapy is
usually short-term unless
permanent damage to pancreas
occurs.

3. Collaborative 3. Collaborative
  Provide medium-chain  MCTs are elements of enteral
triglycerides (MCTs) feedings (NG or J-tube) that
(MCT, Portagen) provide supplemental calories
and nutrients that do not require
pancreatic enzymes for digestion
and absorption.
 Indicator of insulin needs because
 Monitor serum glucose. hyperglycemia is frequently
present, although not usually in
levels high enough to produce
ketoacidosis.

 Test urine for sugar and  Early detection of inadequate

acetone. glucose utilization may prevent
development of ketoacidosis.

Cues Nursing Diagnosis Rationale Goal/ Outcome Criteria Nursing Interventions Rationale
3. Subjective Ineffective breathing Acute pancreatitis Goal: 4. Independent 1. Independent
Verbalization of pattern related to can cause chemical Improve patient’s
difficulty of splinting from severe changes in your body respiratory function Assessment Assessment
breathing pain as evidenced by that affect your lung  Assess respiratory status  Acute pancreatitis produces
adventitious sound function, causing the Outcome Criteria: (rate, pattern, breath retroperitoneal edema, elevation
level of oxygen in  Demonstrate normal sounds), pulse oximetry, of the diaphragm, pleural
4. Objective your blood to fall to respiratory rate and and ABG. effusion, and inadequate lung
Temp-38˚c dangerously low pattern and full lung ventilation. Intra-abdominal
RR-20 levels. expansion. infection and labored breathing
 Show normal breath increase the body’s metabolic
sound and absence of demands, which further decreases
adventitious sounds pulmonary reserve and leads to
 Exhibit no signs or respiratory failure.
symptoms of  . Maintain in semi-fowler’s  Decreases pressure on the
respiratory infection or position. diaphragm and allows greater
impairment. lung expansion.

 Assist patient to turn and  Changing position frequently

change position every 2 assists aeration and drainage of all
hours. lobes of the lungs.

Health teaching Health Teaching

 Instruct and encourage  Taking deep breaths and

patient to take a deep coughing will clear the airways
breaths and to cough every and reduce atelectasis.
hour.

5. Dependent 2. Dependent
Reduce the excessive
metabolism of the body:
 Administer antibiotics as  Pancreatitis produces a severe
prescribed. peritoneal and retroperitoneal
 Place patient in an air reaction that causes fever,
conditioned room or tachycardia and accelerated
well-ventilated room respirations. Placing the patient in
 Administer nasal oxygen an air conditioned room and
as required for hypoxia supporting the patient with
 Use hypothermia if oxygen therapy decreases the
necessary workload of the respiratory
system and tissue utilization of
oxygen. Reduction of fever and
pulse rate decreases the metabolic
demands of the body.

6. Collaborative 3. Collaborative
 Collaborate with the  It helps promotes patient’s to be
respiratory therapist free from discomfort.
when necessary