Elisabeth Fandrich

September 30, 2008

Pancreatitis (526 R,S)

Pancreatitis is the inflammation of the pancreas. Necrosis of the pancreatic tissues may occur.
There are two sub-categories of pancreatitis, acute and chronic. 526 R,S has pancreatitis with
associated gallbladder complications requiring a cholecystectomy after the pancreatitis has
subsided.

Acute pancreatitis can be a life-threatening condition. It presents with a great deal of pain in the
epigastric region. This pain may radiate to the back or left shoulder. In chronic pancreatitis, this
pain may be described as a more continuous, gnawing pain. The patient will commonly present
in a “fetal” position, have nausea/vomiting, a bluish-gray discoloration of the umbilical area and/
or flank areas, grossly distended abdomen, blood glucose elevation and fatigue.

Avoiding alcohol and cigarette smoking are some lifestyle changes that can be made by the
patient to reduce the risk of future episodes. 526 R,S was very receptive to the idea of smoking
cessation, and information as well as encouragement were provided to him.

Common labs ordered are Serum Amylase (normal: 50-180 u/dl, pancreatitis: >180 u/dl), serum
calcium (normal: 8.6-10.3 mg/dl, pancreatitis: <8.6 mg/dl), CT (pancreatic enlargement,
inflammation, fluid collection), Serum Lipase (normal: 31-186 u/l, pancreatitis: >186 u/l), Serum
glucose (normal: 74-105 mg/dl, pancreatitis: >105 mg/dl). Pertinent lab values for this patient
are as follows (on admission, most recent): RBC 4.39↓, 3.92↓; Hgb 14.8↓, 13.5↓; Hct 42.9,
38.2↓; Na 133↓, 135; K 3.3↓, 3.9; Ca 8.1↓, 8.4↓; Albumin 2.6↓, 2.2↓; ALT 8↓, 7↓; Stool occult
blood NEG; MCH 33.8↑, 34.4↑; Total Bilirubin 0.7, 0.5; Amylase 51; Globulin 4.3↑, 4.4↑.
These lab values indicate that the pancreatitis is resolving, and that the patient has an unspecified
macrocytic anemia. I saw no indication in the patient’s chart that this was of concern, but it is a
finding that I would monitor.

Treatment for pancreatitis includes abstaining from oral intake (NPO), IV fluids, TPN, pain
management (no morphine as it can cause spasm of the common bile duct), PCA pain
management, NG tube for bowel decompression and nausea/vomiting, blood glucose control
(insulin), pancreatic enzymes with food, surgical intervention (abscess or pseudocyst). 526 R,S
was treated for pain via PCA, a NG tube was in place before I was assigned to him, surgical
intervention was taken in the form of a Jackson-Pratt drain placed to drain bile from the
gallbladder. Follow-up at the patient’s local hospital is indicated for a cholecystectomy.

Pain is usually the primary nursing problem with this condition. The primary nursing problem
for this patient at the time I cared for him was impaired gas exchange. The patient had
developed atelectasis during his stay in the hospital. Although his pancreatitis was resolving
well, his gas exchange was impaired. This condition was being treated with Xopenex, a
respiratory bronchodilator, deep breathing and coughing exercises, incentive spirometry and oral

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Elisabeth Fandrich

September 30, 2008

Pancreatitis (526 R,S)

fluids. The patient was receiving O2 via nasal canula at 4L. At this rate, his SaO2 was 90%, it
dropped however, to 85% on room air. The patient was to be discharged to home with the JP
drain in place, and O2.

References:

Diseases and Disorders: A Nursing Therapeutics Manual

Marilyn Sawyer Sommors

Susan A. Johnson

Theresa A. Beery

Medical-Surgical nursing DeMystified

Mary DiGiulio, RN, MSN, APRN, BC

Donna Jackson, RN, MSN, APRN, BC

Jim Keogh