Acute Pancreatitis

Angeles University Foundation
Angeles City
Case Study
ACUTE PANCREATITIS secondary to
Cholecystolithiasis
Submitted By:
Amansec, Ma. Carmina A.
Bautista, Christopher
Bontogon, James Russel
Submitted To:
Mrs. Abigail A. Buan. R.N.
Date of submission:
September 18, 2007
1
I. INTRODUCTION
In our generation today, fast foods are ubiquitous, junk foods, high caloric foods
and salty foods are the favorites of the majority especially the young generation. People
often neglect the possible complication that can possibly occur with their routine of
eating.
The current complication that often arises today are: diabetes mellitus,
hypertension, and cardiovascular diseases . . . . One of which is pancreatitis or the
inflammation of the pancreas.
Before our duty in every rotation ends, we are obliged to present a case study with
regards to the patient that we have handled. And fortunately we had this case regarding
Acute Pancreatitis resolved Cholecystolithiasis. Our main objective in conducting this
case study is to come across about the causes and other factors that caused the patient to
have this acute pancreatitis. By merely establishing rapport to gain the patient’s trust and
together with the significant others we were able to gather data and information that will
be of help for our case study. The first thing we did is the student nurse- patient
interaction and as well as interacting with the significant others, then reviewing the
patient’s chart.
A. Current trends about the disease condition.
Statistical data:
Extrapolated Population Estimated
Country/Region
Incidence Used
Acute Pancreatitis in North America (Extrapolated Statistics)
USA 86,369 293,655,4051
Canada 9,561 32,507,8742
Mexico 30,870 104,959,5942
Acute Pancreatitis in Caribbean (Extrapolated Statistics)
Puerto Rico 1,146 3,897,9602
Acute Pancreatitis in South America (Extrapolated Statistics)
Brazil 54,147 184,101,1092
Colombia 12,444 42,310,7752
Venezuela 7,358 25,017,3872
Acute Pancreatitis in Northern Europe (Extrapolated Statistics)
Denmark 1,592 5,413,3922
1,533 WARNING!
Finland 5,214,5122
(Details)
2
Sweden 2,643 8,986,4002
Acute Pancreatitis in Western Europe (Extrapolated Statistics)
Britain (United Kingdom) 17,726 60,270,708 for UK2
Belgium 3,043 10,348,2762
France 17,771 60,424,2132
Ireland 1,167 3,969,5582
Netherlands (Holland) 4,799 16,318,1992
United Kingdom 17,726 60,270,7082
Wales 858 2,918,0002
Acute Pancreatitis in Central Europe (Extrapolated Statistics)
Austria 2,404 8,174,7622
Germany 24,242 82,424,6092
Poland 11,360 38,626,3492
Switzerland 2,191 7,450,8672
Acute Pancreatitis in Eastern Europe (Extrapolated Statistics)
Russia 42,345 143,974,0592
Acute Pancreatitis in the Southwestern Europe (Extrapolated Statistics)
Portugal 3,095 10,524,1452
Spain 11,847 40,280,7802
Acute Pancreatitis in the Southern Europe (Extrapolated Statistics)
China 382,014 1,298,847,6242
Hong Kong. 2,016 6,855,1252
Japan 37,450 127,333,0022
Taiwan 6,691 22,749,8382
Acute Pancreatitis in Southeastern Asia (Extrapolated Statistics)
Malaysia 6,918 23,522,4822
Philippines 25,365 86,241,6972
Singapore 1,280 4,353,8932
Thailand 19,078 64,865,5232
Vietnam 24,312 82,662,8002
Acute Pancreatitis in Oceania (Extrapolated Statistics)

Australia 5,856 19,913,1442
New Zealand 1,174 3,993,8172
3
*These statistics are calculated extrapolations of various prevalence or
incidence rates against the populations of a particular country or region. The
statistics used for prevalence/incidence of Acute Pancreatitis are typically based
on US, UK, Canadian or Australian prevalence or incidence statistics, which are
then extrapolated using only the population of the other country. This
extrapolation calculation is automated and does not take into account any genetic,
cultural, environmental, social, and racial or other differences across the various
countries and regions for which the extrapolated Acute Pancreatitis statistics
below refer to.
*The extrapolation does not use data sources or statistics about any
country other than its population. As such, these extrapolations may be highly
inaccurate (especially for developing or third-world countries) and only give a
general indication (or even a meaningless indication) as to the actual prevalence
or incidence of Acute Pancreatitis in that region. These statistics are presented
only in the hope that they may be interesting to some people.
Coffee Can Reduce Risk Of Pancreatitis, Scientists Discover
Article Date: 16 Mar 2006 - 10:00 PDT
Scientists at the University of Liverpool have found how coffee can reduce the risk of
alcohol-induced pancreatitis.
Pancreatitis is a condition in which the pancreas becomes inflamed, causing severe

abdominal pain. It is often triggered by alcohol consumption which causes digestive
enzymes to digest part of the pancreas.
Scientists have known for some time that coffee can reduce the risk of alcoholic
pancreatitis, but have been unable to determine how. Researchers at the University have
now discovered that caffeine can partially close special channels within cells, reducing to
some extent the damaging effects of alcohol products on the pancreas.
Professor Ole Petersen and Professor Robert Sutton, from the University's Physiological
Laboratory and Division of Surgery, have found that cells in the pancreas can be damaged
by products of alcohol and fat formed in the pancreas when oxygen levels in the organ
are low. Under these conditions, excessive amounts of calcium are released from stores
within the cells of the pancreas. Special organelles, called mitochondria, also become
damaged and cannot produce the energiser that normally allows calcium to be pumped
out of the cells. The excess calcium then activates protein breakdown, destroying the cells
in the pancreas.
Professor Petersen explains: "The primary cause of the build up in calcium ion
concentration is movement of calcium ions from a store inside the cells into the cell water
through special channels in the store membrane. We have found that caffeine, present in
4
drinks such as coffee can at least partially close these channels. This explains why coffee
consumption can reduce the risk of alcoholic pancreatitis. The caffeine effect, however, is
weak and excessive coffee intake has its own dangers, so we have to search for better
agents.
"At the moment there is no specific pharmacological treatment for pancreatitis. As a

result of this research however, we can, for the first time, begin to search for specific
chemical agents that target the channels causing the excessive liberation of calcium ions
inside the cells, which is where the problem originates. We are also hoping that these
findings can be used to warn against the dangers of binge drinking. Some of the effects of
the non-oxidative alcohol products on isolated pancreatic cells cannot be reversed,
explaining why excess alcohol intake can be so dangerous."
B. Reasons for choosing such case for presentation.
To find out and apprehend the significance of concerning the family, society and
government in achieving the wellness of the patient is one of the reasons in choosing this
case. Essentially, it is about the outcome of proper nursing care and the provision of
giving consistent information or knowledge concerning the disease. Enriching and
elevating the quality of nursing as a call, career, vocation or a profession is one of the
major errands and the foundation of nursing profession
The reason and enthusiasm of the group in choosing the case for presentation is to
hold close with the information and management of the condition for the group to give
their full and quality service as student- nurse to their patients.
For the group the only way to carry out the different nursing interventions is
obtaining full range of knowledge and the only way to meet it is personal interest by
curiosity.
As well as to have an experience and be familiar in handling, managing and

providing compassionate health services to a patient who has it and provide any
intervention or management indicated based on the specific etiology.
C. Objectives
5
C.1. (Nurse- centered)
o Formulate nursing care plans based on the prioritized health needs of the patient.
o Assist patient and family to participate in patient’s care as circumstances allow.
o Determine the personal and pertinent family history of the patient and relate it to
the present state.
o Gain proper knowledge and understanding about the existing disease condition,
its pathophysiology, sociology, etiology and risk factors involve in its acquisition
and progression.
o Analyze the different laboratory and diagnostic procedure, its indication and their
essential relationship to the disease condition.
C.2. (Patient- centered)

o Describe the disease process, diagnostic procedures, treatment regimen and
nursing care based on her level of understanding.
o Cooperate in the necessary medical and nursing interventions
II. NURSING ASSESSMENT
6
Personal History
Ms. Snowhite 23 years old is the 4th eldest child of Mr. and Mrs. Usher who loves
to ate junk foods 10 times a day and to drink 8 oz of soft drink 3 times a day. She lives at
Juliana, CSFP. She is a Filipina and a roman catholic. She was born on January 05, 1984
at Riverside Ormoc city, Leyte. Ms. Snowhite is a High school Graduate of central school
at Leyte. She and her family is not allowed to sweep, wash clothes and to take a bath
when someone from the family died. Also believes that when a person bite his or her
tongue means that someone remembers you and lizards are bad luck,
Has an unhealthy body that’s why she can’t play in her friends. She only gets
inside of her house watching TV and after that sleeping. At the age of 8 years old, she
started to experience body malaise. She had to use pain reliever like Alaxan. She said that
using alaxan is the best way to have enough energy. But up until she reached the age of
20 body weakness has not already been stopped until the other manifestation occur which
is abdominal pain. Mrs. Beyonce taught that this is only normal. Maybe because she is
supplying her body enough fluid.
Ms. Snowhite easily gets tired that was she can’t engage in recreation together
with her friends. She only gets inside their house watching T.V and after that just takes e
rest then afterwards, sleeps. At the age of 8 years old, she started to experience body
malaise. She had use analgesics like alaxan for his. But up until she reached the age of
20, body weakness hasn’t stopped until other manifestation occurs which is abdominal
pain. Ms. Snowhite thought that is only normal to experience abdominal pain one in a
while.
Upon assessing her together with the Significant others, we also jotted down notes
especially those potential factors that could contribute to her disease. Starting at their
house, originally, they have house in Leyte, but due to unreasonable decision, they
migrated here at pampanga last 2000. Where they resided at Juliana, CSFP near their
relatives and occupied an apartment which has an area of 300 meter square, and
estimating the area, dividing 300 meter square into 9 persons which will result into 33
square meter each. And it is adequate to their family. Their apartment is concrete and
consists of 3 windows, which more than 20% of adequate ventilation. And they do not
have any problem regarding to their electrical and water bills. As mentioned a while ago,
they have some relatives who has been very supportive to their family in terms of
financial crisis.
While their source of lighting is coming from a fluorescent bulb. Their source of
water is coming from NAWASA and they store it on a pitcher. They don’t usually prepare
foods, but they buy cooked foods from outside and they store their food on a plate with
cover. They don’t tend to consult to the near health clinic if illness occurs. But they only
consult to a hospital when illness persist.
7
Past Illness
Mrs. Snowhite had a fever and headache when she was two years old. Mrs. Usher,
her mother, sends her to the health center near their residence. And unfortunately when
they reached the center, the midwife was not around so what they did is self-medicate.
Mr. Usher give her daughter Biogesic for this, If they do not have enough money to avail
medicines during times of sickness they usually take paracetamol such as Biogesic. They
resort in using “herbal medicine”, like Yerba Buena for headache and they usually make
use of the decoction in preparing for this. At the age of eight, she experienced having
measles that lasted for a week. According to Mr. Usher (Mrs. Snowhite’s father), their
physician prescribed antibiotic for her measles, but they can’t recall what specific name
of antibiotics was given.
When she was ten years old, she had mumps, which lasted for a month; they
applied TINA on the mumps. When she was in her 2 nd year high school, she acquired
Chicken fox that lasted for two weeks. According to Mrs. Usher took egg and salt as a
form of healing for the chicken pox. Mr. Usher, reported that Mrs. Snowhite’s uterus was
diagnosed with benign myoma through checkup at Makabali. She said that she can’t
recall. It was treated through taking of the medicines that was prescribed by her physician
but she can’t remember the name of the drugs anymore.
Present Illness
At the age of twenty-three, Ms. Snowhite was diagnosed of acute pancreatitis due
to the gall bladder stone formation. She is experiencing abdominal pain a month prior to
the admission. According to her she just sleeps when she had abdominal pain. She said
that she can still tolerate the pain at this time. Three weeks prior to the admission, Ms.
Snow white experience remittent abdominal pain, which also diminishes upon sleeping?
She feels the same way two weeks prior to admission. Then three days before the
admission she had severe abdominal pain, that was not tolerable by sleeping. She was not
able to stand and was cramping with pain, according to her she screams when this pain
happened. The pain she experience was usually at the epigastric region. That is why her
brother Shriek, decided to send her to the hospital. Their first choice of hospital was at
Makabali but because there is no available bed she was not admitted their, making them
to transfer her to Jose B. Lingad.
8
FAMILY HEALTH-ILLNESS HISTORY
Mother Father
Died @ old Died @ old Died @ old Died @ old age

age age age age
A1 A2 A3 A4 A5 A6 Father
Mother
“Hypertension
”
Sis 1 Bro Bro Snowhite Sis 2 Bro

1 2 Acute Pancreatitis, 3
mumps and benign
uterine myoma
9
Family Health-illness History:
Ms. Snowhite’s family has a few history of pertinent illness. Her grandparents on
both maternal and paternal side have died due to old age. It means that they don’t die on
such illnesses that commonly geriatric would have experienced such as renal impairment
or heart attack. While Mr. Usher (Ms. Snowhite father), has no siblings meaning to say
that he is the only child of his parents. But Mr. Usher is noted to be hypertensive.
On the other hand, Mrs. Usher (Ms. Snowhite mother) is the third sibling on their
family. And she is the only girl among seven children of her parents. But all of them has
have not experienced any serious health-illness. They were all healthy and normal.
When Mr. and Mrs. Usher got marriage, they were blessed with 6 children. Which
are 3 girls and 3 boys in ratio. All of their children are well and in good health except for
Ms. Snowhite which suffering from acute pancreatitits. Aside from her present disease,
she had a past illness such as childhood illness like mumps. And she has been diagnosed
of benign uterine myomas. Until, she has been diagnosed of Acute Pancreatititis
secondary to cholecystolithiasis.
10
A. Physical Examination
General Appearance
The patient has a proportionate body built, characterized by a normal body figure.
The patient has synchronized body movements though an attack of abdominal pain
causes her to twitch at times. She is cooperative and exhibits thought association. She
responds appropriately to every question asked to her at moderate pace and as long as she
can tolerate the pain.
Physical Assessment (August 23, 2007)

T- 36.8*C R- 20bpm
P- 80bpm B/P- 110/80mmHg
August 23,2007
Physical Assessment
The Integument
Skin
[] Has no odor
[] Has a uniform brown to whitish complexion
[] Ha a good skin turgor
[] skin is warm to touch within normal limits
[] Presence of scar in the left lower leg
[] absence of edema
Hair
[] Evenly distributed black hair Extends until below the shoulder
[] Thick and silky
[] Absence of Pediculosis
Nails
[] Long and dirty finger nails and toe nails.
[] Light brown to pink in color
[] Convex curve
[] Good capillary refill (less than 4 seconds)
The Head
Skull
[] Rounded, normocephalic, and symmetrical
[] Smooth and uniform in consistency
[] Absence of nodules or masses
Face
[] Symmetrical facial movements (can smile frown, close eyes, raise eyebrows, wrinkle,
forehead, show teeth, purse lip, and puff cheeks)
Scalp
[] presence of dandruff
11
The eyes and vision
Eyebrow
[] Hair evenly distributed with the skin intact
[] Symmetrically aligned equal movement
Eyelashes
[] Equally distributed
[] Curled slightly outward
Eyelids
[] Skin intact
[] Absence of discharges and discoloration
[] Closes symmetrically
[] 10-15 blink/min
Bulbar Conjunctiva
[] Transparent
[] Capillaries are evident
[] whitish sclera
[] Palpebral Conjunctiva
[] Shiny and smooth
Lacrimal gland, Lacrimal sac,

And Nasolacrimal duct
[] Absence of tenderness
[] Absence of tearing when palpated
[] Cornea
[] Transparent, smooth and shiny details of iris visible
Pupils
[] Equally round and reactive to light accommodation
Visual
[] patient can see objects in the periphery even when looking straight ahead
[] able to read printed words at a distance of 14 inches
Extra ocular Muscles
[] coordinated movements of both eyes
The Ear and Hearing

Auricles
[] same as facial skin
[] symmetrical
[] aligned with the outer canthus of the eye
[] firm and not tender
[] pinna recoils after it is folded
External Ear Canal
[] presence of dry to wet cerumen
[] normal voice tone audible
[] able to hear watch thick on both ears
12
[] able to speak out whispered words
The Nasal Cavity

Nose
[] symmetrical and straight
[] absence of discharges or flaring
[] air moves freely as patient breaths through the nares
The Mouth and Oropharynx
Lips and Buccal Mucosa
[] Pinkish in color but lips
[] able to purse lip
Inner lip and front teeth
[] complete number of teeth
[] smooth and white
[] shiny tooth enamel
[] pinkish moist gums
[] firm texture
Buccal Mucosa and Back teeth

[] no retraction of gums
[] absence of plaque and tartar
[] tongue located in the midline
[] not able to protrude tongue fully
Hard/Soft Palates
[] pink, smooth palate
[] no discharges or flaring
Uvula
[] located midline of soft palate
Oropharynx and tonsils
[] no discharges
[] slightly pink and smooth
[] Gag reflex
The Neck and Lymph nodes

Neck
[] Muscles equal in size and strength
[] head centered
[] can freely move the head
Lymph Nodes
[] not palpable
The Thorax and Lungs

[] full and symmetric chest expansion
[] spine vertically aligned
[] spinal column straight
[] left and right shoulders are of the same height
13
[] absence of abnormal breath sounds\
The Heart
[] symmetric pulse volumes
[] full pulsations thrusting quality
[] cardiac beating remains the same when the patients breaths
The Peripheral Pulses

[] full pulsations
[] limbs not tender
[] skin in the peripheries is uniformly pink in color
[] temperature not excessively warm and cold
[] no edema
The Breast and Axillae

[] round; generally symmetric
[] unequal
[] no discharges
[] both nipples are not inverted and is present
[] no tenderness, masses, or nodules
The Abdomens
[] normal bowel sound
[] no presence of binder
The Bones and Joints

[] no swelling or tenderness
[] no signs of crepitation
[] absence of nodules
[] joints move smoothly
The Extremeties
[] symmetrical in shape, firm, smooth
[] with coordinated muscle movement
[] No tenderness or swelling
[] No deformities noted
Cranial Nerve Assessment
14
Cranial Nerve Assessment Expected Responses
Technique Outcome
Cn1: Olfactory Ask client to The client will be Patient was able to
{sensory} identify different able to identify to identify different
aromas with each different aromas aroma like cologne,
nostril unless such alcohol,
Separately with conditions like cold
eyes close. is present.
Cn2: Optic Ask the client to The client will be Patient was able to
{sensory} read words on a able to read the read the words
piece of paper with words. written on a paper
each eye first then “olfactory”
both eyes.
Cn3: Oculomotor Ask client to look Pupil will constrict Pupils are equally
{motor} straight ahead then upon introduction round and reacted to
approach the pupil of light. light
with a penlight and accommodation
observe for pupil
constriction
Cn4: Trochlear Ask client to hold The client will be Has good
{motor} the head still and able to follow the coordination of eye
follow the penlight movement of the movement and able
as it moves in the penlight. to follow the
six cardinal eye movement of the
movements. penlight
Cn5: Trigeminal Ask the client to The client will be The client was able
{motor} make chewing able to make to elicit chewing
movements, open chewing movements, open
the mouth against movements, open the mouth against
resistance, move the mouth against resistance move jaw
jaw from side to resistance move from side to side
side and open jaw from side to and open mouth
mouth widely. side and open widely.
mouth widely.
Cn6: Abducens Have the client to The client will be The client has a
{motor} hold his head able to follow the good coordination
steady and follow movement of of eye movements,
the penlight penlight and able to follow
direction the movement of
the penlight.
Cn7: Facial{sensory Ask the client to The client will be The client was able
and motor} smile, frown, raise able to smile, to smile, frown,
eyebrow, puff the frown, raise raise eyebrow, puff
cheeks and show eyebrow, puff the the cheeks and
teeth. cheeks and show show teeth.
15
teeth.
Cn8:VestibulocochlearHave the client to The client will able the client was able
/Acoustic repeat the be to hear and to hear and repeat
{sensory} whispered few repeat the words the words
words at the clients whispered to him. whispered to
back. him/her.
Cn9:Glossopharyngeal Ask the client to Client elicits gag The client was able
{sensory and motor} swallow the open reflex to elicits gag reflex.
mouth widely and
say “AH”
Cn10: Vagus Ask the client to The client will be The client cannot
{motor} cough and say it able state name cough effectively
name without hoarseness
of voice.
Cn11: Accessory Ask the client to The client will be The client was able
{motor} elevate shoulders able to elevate the to elevate the
against the shoulders against shoulders against
resistance and turn the resistance and the resistance and
head from side to turn the head from turn the head from
side. side to side. side to side.
Cn12: Hypoglossal Ask the client to The client will be The client was able
{motor} protrude the tongue able to protrude to protrude his/her
this tongue tongue.
A. August 31,2007
Physical Assessment (August 3123, 2007)

T- 36.4*C RR- 23bpm
PR- 78bpm B/P- 120/80mmHg
Skin
[] Has no odor
[] Has a uniform brown to whitish complexion
[] Ha a good skin turgor
[] skin is warm to touch within normal limits
[] Presence of scar in the left lower leg
[] absence of edema
Hair
[] Evenly distributed black hair Extends until below the shoulder
[] Thick and silky
Nails
[] Long and dirty finger nails and toe nails.
[] Light brown to pink in color
[] Convex curve
16
[] Good capillary refill (less than 4 seconds)
The Head
Skull
[] Rounded, normocephalic, and symmetrical
[] Smooth and uniform in consistency
[] Absence of nodules or masses
Face
[] Symmetrical facial movements (can smile frown, close eyes, raise eyebrows, wrinkle,
forehead, show teeth, purse lip, and puff cheeks)
Scalp
[] presence of dandruff
The eyes and vision

Eyebrow
[] Hair evenly distributed with the skin intact
[] Symmetrically aligned equal movement
Eyelashes
[] Equally distributed
[] Curled slightly outward
Eyelids
[] Skin intact
[] Absence of discharges and discoloration
[] Closes symmetrically
[] 10-15 blink/min
Bulbar Conjunctiva
[] Transparent
[] Capillaries are evident
[] whitish sclera
[] Palpebral Conjunctiva
[] Shiny and smooth
Lacrimal gland, Lacrimal sac,

And Nasolacrimal duct
[] Absence of tenderness
[] Absence of tearing when palpated
[] Cornea
[] Transparent, smooth and shiny details of iris visible
Pupils
[] Equally round and reactive to light accommodation
Visual
[] patient can see objects in the periphery even when looking straight ahead
[] able to read printed words at a distance of 14 inches
Extra ocular Muscles
[] coordinated movements of both eyes
17
The Ear and Hearing
Auricles
[] same as facial skin
[] symmetrical
[] aligned with the outer canthus of the eye
[] firm and not tender
[] pinna recoils after it is folded
External Ear Canal
[] presence of dry to wet cerumen
[] normal voice tone audible
[] able to hear watch thick on both ears
[] able to speak out whispered words
The Nasal Cavity

Nose
[] symmetrical and straight
[] absence of discharges or flaring
[] air moves freely as patient breaths through the nares
The Mouth and Oropharynx
Lips and Buccal Mucosa
[] Pinkish in color but lips
[] able to purse lip
Inner lip and front teeth
[] complete number of teeth
[] smooth and white
[] shiny tooth enamel
[] pinkish moist gums
[] firm texture
Buccal Mucosa and Back teeth

[] no retraction of gums
[] absence of plaque and tartar
[] tongue located in the midline
[] not able to protrude tongue fully
Hard/Soft Palates
[] pink, smooth palate
[] no discharges or flaring
Uvula
[] located midline of soft palate
Oropharynx and tonsils
[] no discharges
[] slightly pink and smooth
[] Gag reflex
The Neck and Lymph nodes
18
Neck
[] Muscles equal in size and strength
[] head centered
[] can freely move the head
Lymph Nodes
[] not palpable
The Thorax and Lungs

[] full and symmetric chest expansion
[] spine vertically aligned
[] spinal column straight
[] left and right shoulders are of the same height
[] absence of abnormal breath sounds\
The Heart
[] full pulsations thrusting quality
[] cardiac beating remains the same when the patients breaths
The Peripheral Pulses

[] full pulsations
[] limbs not tender
[] skin in the peripheries is uniformly pink in color
[] temperature not excessively warm and cold
[] no edema
The Breast and Axillae

[] round; generally symmetric
[] unequal
[] no discharges
[] both nipples are not inverted and is present
[] no tenderness, masses, or nodules
The Abdomens
[] normal bowel sound
[] no presence of binder
The Bones and Joints

[] no swelling or tenderness
[] no signs of crepitation
[] absence of nodules
[] joints move smoothly
19
The Extremities
[] symmetrical in shape, firm, smooth
[] with coordinated muscle movement
[] No tenderness or swelling
[] No deformities noted
Cranial Nerve Assessment
Cranial Nerve Assessment Expected Responses

Technique Outcome
Cn1: Olfactory Ask client to The client will be Patient was able to
{sensory} identify different able to identify to identify different
aromas with each different aromas aroma like cologne,
nostril unless such alcohol,
Separately with conditions like cold
eyes close. is present.
Cn2: Optic Ask the client to The client will be Patient was able to
{sensory} read words on a able to read the read the words
piece of paper with words. written on a paper
each eye first then “olfactory”
both eyes.
Cn3: Oculomotor Ask client to look Pupil will constrict Pupils are equally
{motor} straight ahead then upon introduction round and reacted to
approach the pupil of light. light
with a penlight and accommodation
observe for pupil
constriction
Cn4: Trochlear Ask client to hold The client will be Has good
{motor} the head still and able to follow the coordination of eye
follow the penlight movement of the movement and able
as it moves in the penlight. to follow the
six cardinal eye movement of the
movements. penlight
Cn5: Trigeminal Ask the client to The client will be The client was able
{motor} make chewing able to make to elicit chewing
movements, open chewing movements, open
the mouth against movements, open the mouth against
resistance, move the mouth against resistance move jaw
jaw from side to resistance move from side to side
side and open jaw from side to and open mouth
mouth widely. side and open widely.
mouth widely.
Cn6: Abducens Have the client to The client will be The client has a
{motor} hold his head able to follow the good coordination
steady and follow movement of of eye movements,
the penlight penlight and able to follow
20
direction the movement of
the penlight.
Cn7: Facial{sensory Ask the client to The client will be The client was able
and motor} smile, frown, raise able to smile, to smile, frown,
eyebrow, puff the frown, raise raise eyebrow, puff
cheeks and show eyebrow, puff the the cheeks and
teeth. cheeks and show show teeth.
teeth.
Cn8:VestibulocochlearHave the client to The client will able the client was able
/Acoustic repeat the be to hear and to hear and repeat
{sensory} whispered few repeat the words the words
words at the clients whispered to him. whispered to
back. him/her.
Cn9:Glossopharyngeal Ask the client to Client elicits gag The client was able
{sensory and motor} swallow the open reflex to elicits gag reflex.
mouth widely and
say “AH”
Cn10: Vagus Ask the client to The client will be The client cannot
{motor} cough and say it able state name cough effectively
name without hoarseness
of voice.
Cn11: Accessory Ask the client to The client will be The client was able
{motor} elevate shoulders able to elevate the to elevate the
against the shoulders against shoulders against
resistance and turn the resistance and the resistance and
head from side to turn the head from turn the head from
side. side to side. side to side.
Cn12: Hypoglossal Ask the client to The client will be The client was able
{motor} protrude the tongue able to protrude to protrude his/her
this tongue tongue.
F. Diagnostic and Laboratory Procedures
21
Diagnostic/ Date Indications Results Normal Analysis and
Laboratory ordered or Purposes Values Interpretation
Procedures Date of Results
Results
BLOOD DO: This test, -There is a
COUNT 08-18-07 usually 127 g/L normal level of
DR: performed as Hgb, which
Hemoglobin 08-18-07 part of a cbc, means tat there
measure the 115-155g/L is no
DO: grams of alterations in
08-21-07 hemoglobin the blood Hgb
DR: found on a of the patient.
08-21-07 deciliter (100
ml) of whole
blood
-There is a
normal level of
Hematocrit,
BLOOD DO: - Measures 0.38 which means
COUNT 08-18-07 the percentage that there is a
DR: by volume of normal
Hematocrit 08-18-07 packed red 0.38 – 0.48 concentration
blood cells in in the contents
DO: a whole blood of blood that
08-21-07 sample indicates
DR: absence of
08-21-07 - To check the abnormality.
volume of
RBC in the
blood.
-To aid
diagnosis of
abnormal
states of
hydration,
polycythemia,
and anemia.
-There is a
5.9 normal level of
WBC DO: - Part of the WBC, which
08-18-07 CBC is the implies that
DR: WBC reports there is no
08-18-07 the number of presence of
white cells infection.
found in
22
DO: micro 5- 10
08-21-07 liter (cubic x 10 g/l
DR: millimeter of
08-21-07 whole blood
cell)
- - To
determine
infection or
inflammation.
-This indicates
that the patient
Lymphocyte - Are 0.09 has a
DO: important debilitating
08-18-07 humeral and illness or
DR: cell mediated immunodeficie
08-18-07 immunity. It ncy.
compromises 0.20- 0.35
DO: majority of
08-21-07 WBC.
DR:
08-21-07
Neutrophils -Are in first

DO: line defense -.
08-18-07 against
DR: infection. It is - There is an
08-18-07 the primary increase in the
cell to level of
DO: respond 0.45- 0.65 neutrophils
08-21-07 during an 0.76 due to
DR: acute impairment in
08-21-07 inflammatory the immune
response. system or
inflammatory
-Capable of response.
ingesting and
-There is a
normal level of
creatinine,
which means
that the kidney
is functioning
23
Creatinine DO: -To 62.9 well.
08-18-07 evaluate renal 58- 100
DR: function and mmol/L
08-18-07 disorder
- To detect
and monitor
liver and/or
bone disease.
- The test
provides, a
more sensitive
measure of
renal damage
than blood
urea nitrogen
levels
because renal
impairment is
virtually the
only cause of
creatinine
metabolism.
Alkaline DO: - The primary 127.5 - The Alkaline

Phospatase 08-18-07 importance of 64- 306 Phosphatase
DR: measuring IU/L level is within
08-18-07 alkaline normal range,
phosphatase is which means
to check the there is no
possibility of bone or
bone disease liver/kidney
or liver disease
disease. Since present.
the mucosal Pancreatic
cells that line cancer raised
the bile ALP levels and
system of the increase may
liver are the indicate biliary
source of abstraction.
alkaline
phosphatase,
the free flow
of bile
24
through the
liver and
down into the
biliary tract
and
gallbladder
are
responsible
for
maintaining
the proper
level of this
enzyme in the
blood.
BUN (blood
urea DO: - The uric acid 1.81 - The blood
nitrogen): 08-18-07 tests are used 1.7- 8.3 uric acid level
DR: to evaluate the mmol/L is normal,
08-18-07 blood levels which
of uric acid indicates that
for gout and there is no
to assess uric presence or
acid levels in formation of
the urine for kidney stones.
kidney stone -Increased
formation. renal disease,
dehydration,
urinary tract
- Released abstraction and
into blood 34.2 increase
when the liver 10- 40 IU/L CHON
or heart is catabolics.
damaged. -decrease
severe hepatic
- This test is damage,
used to malnutrition,
SGOT DO: evaluate the over hydration
08-18-07 possibility of
DR: coronary
08-18-07 occlusive
heart disease - There is a
or liver normal SGOT
disease. level, which
means that
25
there is no
presence of
any heart
- This test is 31.5 damage or any
used to 0-39 IU/L possibility that
identify liver can lead to
disease and to coronary
distinguish occlusive heart
between the disease or liver
liver and red disease.
SGPT DO: blood cell
08-18-07 hemolysis as
DR: the source of
08-18-07 jaundice. - There is a
normal SGPT
- Measured to level, which
check for means that the
tissue damage liver is
functioning in
its optimum
level.
- This test
measures the 406.5
intracellular 225- 450
enzyme LDH IU/L
which, when
present in the
blood, can
LDH (Lactic support the
dehydrogena DO: detection of
se) 08-18-07 injury or
DR: disease.
08-18-07
- There is a
- To test the normal level of
sugar level 4.73 LDH, which
- Good 3.83- 9.0 means that an
indicative of mmol/L injury or
diabetes disease can be
easily
detected.
RBS DO:
08-18-07
DR:
08-18-07
26
- There is a
normal level of
RBS, which
means that the
sugar levels
are within
normal limits
and not prone
in acquiring
diabetes.
Nursing Responsibilities:
Prior:
 Explain the procedure to the patient’s SO.
 Inform the SO that there are no food or fluid restrictions.
27
 Inform the SO that the test requires blood sample, tell who will do the test and
when.
 Tell that there will be discomfort from the needle that will be inserted and
pressure from the tourniquet.
During:
 Wipe with cotton balls and alcohol the site where insertion is done.
 Tell the client’s SO when the needle will be inserted for them to get prepared.
 Try to get a sample once.
After:
 Apply pressure on the puncture site.
 Send the specimen immediately to the laboratory
Urinalysis DO: 08-23-07 Routine Color: dark Color: dark -Indicates that
urinalysis brown to red yellow the patient lacks
-Routine U/A is serves many water and has a
an important, functions. It can concentrated
commonly be used to urine due to the
used screening screen patients protein in the
test for urinary for kidney and glomerulus’s /
and systematic urinary tract maybe due to
pathologies disease and can the patients diet,
help detect drug and
metabolic or disease.
systemic
disease. Results Transparency: Transparency: -normal
of urine test are turbid turbid
based on the
elements that Sugar: negative Sugar: negative -normal
make up urine.
Even with Albumin: +3 Albumin: -due to the
normal findings, negative protein in the
these elements glomerulus’s
have certain PH: neutral PH: acidic normal increase
characteristics. value indicates
infection.
Specific Specific -normal

gravity: gravity:
1.030 1.005-1.035
Pus cell: Pus cell: -Genitourinary

6-8/HPF 1.2/ HPF tract infection.
28
Prior:
 Explain the procedure to the patient's significant others that these test assess
response to treatment.
 Tell the patient's significant others that specimen will be taken.
During:
 Plan to obtain the specimen when the patient is calm and physically still.
 Instruct the SO to collect urine specimen.
 Collect urine by clean catching.
After:
 If there is a necessary urine collection, instruct SO to collect the urine in every
urisnation and put it in the bedside.
Ultrasound Report:
The liver is not enlarged. Parenchyma is homogenous in echopattern and normal in

echogenecity. Intrahepatic ducts are not dilated. No definite focal hepatic mass seen,
The gallbladder measures 63 x 16 mms. The coomon ducts is 4mms in luminal diameter.
Multiple calcific foci, 3- 9mm size are seen in the gallbladder body and neck. Gallbladder
wall is not thickened.
Impression:
Sonographically right liver cholecystolithiasis.
Please correlate and follow- up.
29
III. ANATOMY AND PHYSIOLOGY
Where is the pancreas located?
The pancreas is located deep in the abdomen, sandwiched between the stomach and the
spine. It lies partially behind the stomach. The other part is nestled in the curve of the
duodenum (small intestine). To visualize the position of the pancreas, try this: Touch the
thumb and "pinkie" finger of your right hand together, keeping the other three fingers
together and straight. Then, place your hand in the center of your belly just below your
lower ribs with your fingers pointing to the left. Your hand will be at the approximate
level of your pancreas.
Because of the pancreas' deep location, tumors are rarely palpable (able to be felt by
pressing on the abdomen.) It also explains why many symptoms of pancreatic cancer
often do not appear until the tumor grows large enough to interfere with the function of
nearby structures such as the stomach, duodenum, liver, or gallbladder.
Fig. 1-1
30
Parts of Pancreas
The pancreas is made up of glandular tissue and a system of ducts. The main duct
is the pancreatic duct, which runs the length of the pancreas. It drains the pancreatic fluid
from the gland and carries it to the duodenum. The main duct is about one-sixteenth of an
inch in diameter and has many small side branches. The pancreatic duct merges with the
bile duct to form the ampulla of Vater (a widening of the duct just before it enters the
duodenum.)
Fig. 1-2
Your doctor will probably refer to different parts of the pancreas when discussing your
situation. The part of the pancreas that a tumor arises in will effect how it is treated. For
descriptive purposes, there are two ways the pancreas is divided into parts: by parts of the
overall shape and by the function of its cells.
Pancreas is the part of the gland that bends backwards and underneath the body of the
pancreas. There are two very important blood vessels, the superior mesenteric artery and
vein cross in front of the uncinate process.
Head is the widest part of the gland. It is found in the right part of abdomen, nestled in
the curve of the duodenum, which forms an impression in the side of the gland. Neck is
the thin section between the head and the body of the gland. Body is the middle part of
gland between the neck and the tail. The superior mesenteric blood vessels run behind
this part of the gland. Tail is the thin tip of gland in the left part of abdomen in close
proximity with the spleen.
Function of the Pancreas
The pancreas can also be thought of as having different functional components,

the endocrine and exocrine parts. Tumors can arise in either part. However, the vast
majority arises in the exocrine (also called non-endocrine) part. Since the parts have
different normal functions, when tumors interfere with these functions, different kinds of
symptoms will occur.
31
Fig. 1-3
Islets of Langerhans.
These are the endocrine (endo= within) cells of the pancreas that produce and
secrete hormones into the bloodstream. The pancreatic hormones, insulin and glucagon
work together to maintain the proper level of sugar in the blood, the sugar glucose is used
by the body for energy.
Acinar cells.
These are the exocrine (exo= outward) cells of the pancreas that produce and
transport chemicals that will exit the body through the digestive system. The chemicals
that the exocrine cells produce are called enzymes. They are secreted in the duodenum
where they assist in the digestion of food.
Fig. 1-4
The pancreas is an integral part of the digestive system. The flow of the digestive
system is often altered during the surgical treatment of pancreatic cancer. Therefore it is
helpful to review the normal flow of food before reading about surgical treatment.
Food is carried from the mouth to the stomach by the esophagus. This tube descends from
the mouth and through an opening in the diaphragm. (The diaphragm is a dome shaped
muscle that separates the lungs and heart from the abdomen and assists in breathing.)
32
Immediately after passing through the diaphragm's opening, the esophagus empties into
the stomach where acids that break down the food are produced. From the stomach, the
food flows directly into the first part of the small intestine, called the duodenum. It is here
in the duodenum that bile and pancreatic fluids enter the digestive system.
What is bile?
Fig. 1-5
(Flow of bile indicated by green arrows.)
Bile is a greenish-yellow fluid that aids in the digestion of fats. After being produced by
cells in the liver, the bile travels down through the bile ducts, which merge with the cystic
duct to form the common bile duct. The cystic duct runs to the gallbladder, a small pouch
nestled underneath the liver. The gallbladder stores extra bile until needed. The common
bile duct actually enters the head of the pancreas and joins the pancreatic duct to form the
ampulla of Vater, which then empties into the duodenum.
What is pancreatic fluid
Instead of carrying bile, the pancreatic duct carries the pancreatic fluid produced by the
acinar cells (exocrine) of the pancreas. The pancreatic duct runs the length of the
pancreas and joins the common bile duct in the head of the pancreas. These ducts join to
form the ampulla of Vater, which then empties into the duodenum.
33
Fig. 1-6
(Flow of pancreatic fluid indicated by dark yellow arrow.)
The food, bile and pancreatic fluid travels through many more feet of continuous intestine
including the rest of the duodenum, jejunum and ileum, which comprise the small
intestine, then through the cecum, large intestine, rectum, and anal canal.
IV. THE PATIENT’S ILLNESS
A. Synthesis of the disease

1. Definition of the disease
The pancreas is located in the midline of the back of the abdomen, closely
associated with the liver, stomach, and duodenum (the first part of the small intestine).
The pancreas is considered a gland. A gland is an organ whose primary function is to
produce chemicals that pass either into the main blood circulation (called an endocrine
function), or pass into another organ (called an exocrine function). The pancreas is
unusual because it has both endocrine and exocrine functions. Its endocrine function
produces three hormones. Two of these hormones, insulin and glucagon, are central to the
processing of sugars in the diet (carbohydrate metabolism or breakdown). The third
hormone produced by the endocrine cells of the pancreas affects gastrointestinal
functioning.
This hormone is called vasoactive intestinal polypeptide (VIP). The pancreas's

exocrine function produces a variety of digestive enzymes (trypsin, chymotrypsin, lipase,
and amylase, among others). These enzymes are passed into the duodenum through a
channel called the pancreatic duct. In the duodenum, the enzymes begin the process of
breaking down a variety of food components, including, proteins, fats, and starches.
Acute pancreatitis occurs when the pancreas suddenly becomes inflamed but improves.
Patients recover fully from the disease, and in almost 90% of cases the symptoms
disappear within about a week after treatment. The pancreas returns to its normal
architecture and functioning after healing from the illness. After an attack of acute
pancreatitis, tissue and cells of the pancreas return to normal. With chronic pancreatitis,
damage to the pancreas occurs slowly over time. Symptoms may be persistent or
sporadic, but the condition does not disappear and the pancreas is permanently impaired.
Pancreatic tissue is damaged, and the tissue and cells function poorly.
Patients with gallstones fall into three groups – those who have symptoms, those
who do not have symptoms, and those whose condition is complicated by, for example,
cholecystitis, pancreatitis, or obstructive jaundice.
34
Asymptomatic gallstones--Many gallstones are asymptomatic and many go
undiagnosed. Increasingly, asymptomatic stones are discovered incidentally during
investigations of other problems. This trend reflects the increasing use of abdominal
imaging, particularly ultrasonography, in the investigation of non-specific abdominal
symptoms. Most gallstones that are asymptomatic remain so. Roughly 10% of patients
with asymptomatic stones will develop symptoms within five years of diagnosis and
roughly 20% by 20 years.30 31 The rate of symptom development is maximal in the early
years after diagnosis. This then tapers off to give an annual rate of 1-2% of asymptomatic
patients becoming symptomatic.32 Small bile duct stones may also be asymptomatic and
may pass spontaneously, but choledocholithiasis increases the rate of symptom
development and the incidence of complications such as obstructive jaundice and
pancreatitis to around 20% over five years.
Comparison of Cholelithiasis and Cholecystitis:
A. Cholelithiasis
 Epigastric pain
 Heartburn
 Right upper abdominal pain – radiation to scapular.
 Jaundice – obstruction of bile ducts
 Intolerance to fatty foods.
B. Cholecystitis
 Fever
 Increase WBC
 Abdominal guarding with rebound tenderness- peritoneal
involvement.
 Increase Serum Bilirubin
 Increase Alkaline Phosphatase
 Increase serum amylase and lipase (pancreas involved)
2. Predisposing/ Precipitating Factors
** Predisposing Factors:
 Family history - Abnormalities in one or more genes may
predispose some people to pancreatitis.
 Age – teenagers are more prone in having gallstones due to

excessive eating of high in sodium foods like junk foods.
 Sex - Pancreatitis occurs more frequently in men, possibly because

men are more likely to abuse alcohol than women are.
35
 Ethnicity - Black Americans are more likely to develop
pancreatitis.
 Other medical conditions - Certain inherited diseases, particularly

cystic fibrosis, increase your risk of pancreatitis.
**Precipitating Factors:
 High fat diets - most especially an increase in sodium foods results
in the formation of gallstones.
 Obesity – having a high fat diet increases your risk in being obese.
 Sedentary lifestyle – lacks exercise and other physical activities

that contribute to the increase in fat accumulation in the body.
 Smoking - Some researchers theorize that the stress of

metabolizing drugs, tobacco and even pollution may damage your
pancreas.
Signs and Symptoms
Acute pancreatitis usually begins with a sharp, severe pain in the upper
abdomen that may last for a few days. It may be constant pain that is just in
the abdomen or it may reach to the back and other areas. The pain may be
sudden and intense or it may begin as a mild pain that is aggravated by eating
and slowly gets worse. In addition, the abdomen may be swollen and very
tender. Other symptoms may include nausea, vomiting, fever and an elevated
pulse.
Pancreatitis typically presents with the following signs and symptoms:
 Abdominal pain – is the major symptom of pancreatitis. Abdominal pain

and tenderness and back pain result from irritation and edema of the
inflamed pancreas, which stimulate the nerve endings.
 Ecchymosis (bruising)- in the flank or around the umbilicus may indicate

severe pancreatitis.
 Hypotension – typical and reflects hypovolemia and shock caused by the

loss of large amounts of protein- rich fluid into the tissues and peritoneal
cavity.
 Abdominal distension leading to cyanosis
36
 Jaundice- accumulation of bile due impaired excretion from the liver and to
the skin.
 Nausea and Vomiting-due to reflux of bile from common bile duct which
will stimulate the CTZ of the labyrinth of the brain.
 Boring epigastric pain, which is exacerbated in the supine position; it is

poorly localized and radiates to
the back.
3. Health Promotion and Preventive Aspects of the Disease
Most people with acute pancreatitis recover completely. But even if you
experience no lingering symptoms, it's important to take steps to keep
your pancreas as healthy as possible:
o Avoid excessive alcohol use – Overuse of alcohol is the leading

cause of chronic pancreatitis and a contributing factor in many
acute attacks. If you can't voluntarily stop drinking alcohol, get
treatment for alcoholism. Abstaining from alcohol may or may not
reduce your pain, but it will reduce your risk of dying of your
disease.
o Stop smoking – Tobacco use increases your risk of pancreatitis,

especially if you also drink alcohol.
o Limit fat in your diet - Eating a high-fat diet can raise your
blood-fat levels and increase your risk of gallstones — both risk
factors for pancreatitis. A healthy diet emphasizes fresh fruits and
vegetables, whole grains, and lean protein, and limits fats,
especially saturated fats such as butter. Limiting fat will help
reduce loose and oily stools that result from a lack of pancreatic
enzymes. Discuss with your doctor or a dietitian how much fat to
eat each day because some fat is essential.
o Eat smaller meals - The more you eat during a meal, the greater
the amount of digestive juices your pancreas must produce. Instead
of large meals, eat smaller, more frequent meals.
o Drink plenty of liquids - be sure to drink enough liquids so that

you don't become dehydrated. Dehydration may aggravate your
pain by further irritating your pancreas.
37
Pathophysiology Book-based
Acute Pancreatitis 2nd to Cholecystolithiasis
Predisposing Factors: Precipitating Factors:
Family history High fat diets
Age Obesity
Sex Sedentary lifestyle,
Ethnicity Long term alcohol abuse, smoking and drugs
Other medical conditions Cholesterol
Types of stones (insoluble)
Pigment
Decrease bile acid synthesis
Unconjugated pigments
in the bile
Increase cholesterol synthesis in liver
Precipitate to
form stones
Infection
Bile super saturation with cholesterol
Liver cancer
Hemolysis
Gallstone formed
38
Gallstone
formation
Cholelithiasis Acute Pancreatitis
Obstructed cystic
duct Pancreatic Duct
obstructed
Gall bladder contracts

Lodge @ the
Common bile ampulla of vater
duct obstructed
Bile duct obstructed already
Spasm
Gall bladder Inflammation Infection &
becomes edema
distended
Release of Reflux of Pancreatic
chemical mediator bile juice
Fundus of the
gallbladder
Fever occurs Activation of Trypsin
and secretin Erosion
Hemorrhage
Becomes
Over in contact in
distention Tenderness in right Increase
th th
the abdominal
causes pain wall upper quadrant10
At 9 and (RUQ) vascular
Necrosis
IC Cartilage Vasodilatation permeability
Irritation occurs/ edema
Radiating in During deep

the back inspiration
39
Shorter deep shallow
inspiration
Abdominal
tenderness
40
Pathophysiology (Book-based):
Before cholecystitis occurs, there would be first a trigger that will cause
the inflammation of the gall bladder. And these are the stones that formed and will lodges
to the duct. Sooner, it will accumulate on the common bile duct where it will occlude the
release of enzyme that aids in carbohydrate, protein and fat digestion. According to
research, there are two types of stones where different origin has; it is either pigment
stone or cholesterol stone. Let’s first differentiate these two before proceeding to the
physiology of it.
The first stone that is known is called pigment stone. According to the research,
there are different factors which contribute to the formation of pigment stone. It’s either
due to hemolysis, liver cancer or infection. Due to these conditions, there are affectations
occurs. For example, if the patient has liver cancer, all we known that liver aids in fats
and bile emulsification. So, if the liver is impaired, there is no hepatocytes that will
release and aid in emulsification. Thus, it’s creating unconjugated bile after which sooner
or later, it will form a gall stone.
The last known cause of gall stone formation is due to supersaturated cholesterol.
If there is an abnormal decrease in level of bile acid that will emulsify cholesterol. There
is a tendency that fat deposition occurs, because there is already no substance that will
emulsify fats thus it will only become supersaturated and will form stone.
So gall stone formed, there is an occlusion will occur either on the cystic duct or
on the pancreatic duct. Again, dividing this occlusion into two will help us to understand
the disease.
First, if the gall stone will lodge in the cystic duct where gall bladder passes its
enzyme, it will now call it obstructed cystic duct. So, as the process goes on and on, too
many factors that will contribute to the formation of the stone then lodge on the duct, and
accumulate etc... In the next time that the patient will eat and digest foods. Gall bladder
will contract in order to facilitate that digestion. However, there is already an obstruction
that will make the gall bladder distended. In order to analyze it very well, I will compare
the gall bladder to a gall bladder that when a balloon is over inflated, there is a tendency
that it will burst. That’s how gall bladder it will look like if that scenario happens. Then
due to over distention, inflammation occurs that will result to release of chemical
mediators such as histamine and serotonin that will cause fever due to vasodilation and
increase in blood vessel permeability that will attract other WBC cells to migrate from
the site of infection. So, as the result of infection, fever occurs. Now, due to over
distention of the gall bladder, the fundus of the gall bladder will come in contact with the
abdomen that will cause pain that will radiating on the back due to over pressure that
applies on the nociceptor. Also, the over distended fundus will affect the 9th and 10th
Intercostals cartilage that will result to tenderness on the Right Upper Quadrant, so one of
the manifestation of the disease is dyspnea.
41
Secondly, if the gall stone will lodge on the pancreatic duct (duct where common
bile duct consist), there would be a tendency that it will obstruct the common bile duct or
either the ampulla of vater. And Acute Pancreatitis will likely to occur. Let assume that
the ampulla of vater obstructed, there will be over spasm on the area thus it will lead to
edema. Due to spasm, there will be a reflux of bile and pancreatic juice.
Then assuming that the patient will attempt to eat again food, there will be the
activation of trypsin and secretin that also aid in digestion. But obstruction impede the
release thus it will cause autodigestion. Due to this, there will be inflammation and fever
occurs. But the severe result may cause necrosis or erosion on the lining that will cause
hemorrhage thus irritation occurs and abdominal pain occurs.
So, summarizing the manifestations, the common manifestation of acute

pancreatitis is abdominal pain. Now, it will only depend on the person of how she/he can
tolerate the pain that inflicting to it.
42
Pathophysiology (Patient-centered)
Acute Pancreatitis 2nd to Cholecystolithiasis
Predisposing Factors: Precipitating Factors:

Family history High fat diets
Age Obesity
Sex Sedentary lifestyle,
Ethnicity Long term alcohol abuse, smoking and drugs
Other medical conditions e.g. mumps
Cholesterol stone Eat a lot of junk

foods rich in fats
Decrease bile acid

Past illness due synthesis Decrease Water intake
to mumps and increase
carbonated soft drinks
Increase
cholesterol
synthesis in the
liver
43
Super saturation of bile
occurs with cholesterol
Cholelithiasis Occurs
Obstructed cystic duct Pancreatic Duct

Acute Pancreatitis obstructed
Gall bladder contracts

Lodge @ the
Common bile ampulla of
duct obstructed vater
Bile duct obstructed already
Spasm &
Gall bladder becomes edema
distended Inflammation
Activation of Trypsin
and secretin
Reflux of bile that

Fundus of the Becomes in contact in triggers Nausea and
gallbladder the abdominal wall vomiting
Over distention
causes pain At 9th and 10th
IC Cartilage
44
Erosion
Vasodilatation
Tenderness in right
Radiating in the upper quadrant (RUQ)
back that
manifested last
year (2006) and During deep Increase
reoccurs last inspiration vascular
month. permeability
Necrosis
Shorter deep shallow inspiration
As evidenced by Respiratory
rate ranging from 23-28 breaths
per minutes.
Hemorrhage
Irritation occurs/ edema
Abdominal tenderness
that manifested last
year (2006) and
reoccurs last month.
45
Pathophysiology (Patient-centered)
Before cholecystitis occurs, there would be first a trigger that will cause
the inflammation of the gall bladder. And these are the stones that formed and will lodges
to the duct. Sooner, it will accumulate on the common bile duct where it will occlude the
release of enzyme that aids in carbohydrate, protein and fat digestion. The patient fond of
eating junks foods and drinking carbonated soft drinks that contribute to the disease.
Partly, previous illness shows that the patient experienced mumps which causes by virus
that may consider a probable cause of the disease.
The gall stone formation is due to supersaturated cholesterol. The patient had an
abnormal decrease in level of bile acid that will emulsify cholesterol due to over
consumption of carbonated drinks. There is a tendency that fat deposition occurs, because
there is already no substance that will emulsify fats thus it will only become
supersaturated and will form stone.
So gall stone formed, there is an occlusion will occur either on the cystic duct or
on the pancreatic duct. Again, dividing this occlusion into two will help us to understand
the disease.
First, the gall stone was lodged in the cystic duct where gall bladder passes its
enzyme; it will now call it obstructed cystic duct. So, as the process goes on and on, too
many factors that will contribute to the formation of the stone then lodge on the duct, and
accumulate etc... In the next time that the patient ate and digested foods. Gall bladder will
contracted in order to facilitate that digestion. However, there is already an obstruction
that will make the gall bladder distended. Then due to over distention, inflammation
occurs Now, due to over distention of the gall bladder, the fundus of the gall bladder will
come in contact with the abdomen that will cause pain that will radiating on the back due
to over pressure that applies on the nociceptor. Also, the over distended fundus will affect
the 9th and 10th Intercostals cartilage that will result to tenderness on the Right Upper
Quadrant, so one of the manifestation of the disease is dyspnea. This symptoms were
already manifested last year but reoccurred last month.
Secondly, the gall stone was lodged on the pancreatic duct (duct where common
bile duct consist), there would be a tendency that it will obstruct the common bile duct or
either the ampulla of vater. And Acute Pancreatitis will likely to occur. The ampulla of
vater obstructed, there will be over spasm on the area thus it will lead to edema. Due to
spasm, there will be a reflux of bile and nausea and vomiting occurs.
Then assuming that the patient attempted to eat again food, there will be the
activation of trypsin and secretin that also aid in digestion. But obstruction impeded the
release thus it will cause autodigestion. Due to this, there will be inflammation and fever
occurs. But the severe result may cause necrosis or erosion on the lining that will cause
hemorrhage thus irritation occurs and abdominal pain occurs.
46
V. THE PATIENT AND HIS CARE
A. MEDICAL MANAGEMNET
a. IVF’s
Medical Date ordered General description Indications or Clients response to the treatment
management/treatment /Date purposes
performed/
Date Changed
1. D5 LRS (Lactating Date Ordered: General LR solution is given Upon administering the IVF solution, the
Ringer’s Solution)--- Description: fluid to the patient patient did not manifest any untoward
Hypertonic Aug 18-22, and electrolyte because it induces responses. Nor did not also show any progress
2007 supplement/replace blood/fluid loss due to her hematocrit level.
ment to over distention of
Date the tissue site on her However, her electrolytes level did not change.
Performed: gall bladder due to As evidenced by:
secretion of
Aug 18-22, cholecystokinin that Electrolytes:
2007 allows contraction Sodium: 138 normal: 136-
on the gall bladder 145 mmol/L
Date Changed: that causes trauma Potassium: 3.8 normal: 3.5- 5.0
or over spasm. The mmol/L
Aug 23, 2007 LR is used because Chloride: 108 normal: 101-
the byproducts of 111 mmol/L
lactate metabolism
in the liver It means that her ideal level of electrolytes is
counteract acidosis, still sustainable to function on different body
which is a chemical parts. It also educes the risk of edema. Thus,
imbalance that through regulation of urine output. It also
occurs with acute stabilizes her Blood Pressure within normal
fluid loss. range.
47
Noticing that her
Hematocrit level is
on border of low to
normal level. It
means that due to
fluid/blood loss, the
amount of solute
(RBC) is higher
than the solvent,
which is the plasma
that acts as a
suspension.
Solute Solvent
Due to Fluid loss of

the patient, plasma
tends to go out side
the blood cell that
makes it hypotonic
(solute is greater
inside than the
outside).
So it happens that
the patient is at risk
for Dehydration and
electrolyte losses
due to over-spasm
of the pancreas or
excretion problem
48
that led to
inadequate blood
volume which, in
turn, may result
from a combination
of fluid loss from
vomiting, internal
bleeding, or oozing
of fluid from the
circulation into the
abdominal cavity in
response to the
pancreas
inflammation, a
phenomena known
as Third Spacing
Nursing responsibilities:
Prior:
1. Prepare the necessary equipments.
2. Wash hands thoroughly.
3. Explain the procedure to the patient.
4. Check to see if there are any special circumstances surrounding administration to the patient.
5. Be certain that you know the expected action, safe dosage, range, and special instruction for administration. And adverse
effects associated with it.
6. For inserting IV bottles to an IV line: Do not touch the upper head of the IV. Instead, hold the neck of it properly as you
inserting the IV line into the bottle.
7. Be careful in inserting the needle if vein for insertion is detected. Just be calm, and stay on focus on the procedure.
49
8. After needle was inserted, properly place the micro pore on the respective area and for aesthetic purpose.
9. Check if there’s doctor’s order of KVO (Keep vein out).
During:
1. Always observe aseptic technique in preparing and administering
2. Regulate the flow rate or drop rate as the doctor’s order
3. Always check the needle of the IV, if it is in the vein:
a. Bring the IV bottle lower than the patient’s arm.
b. Pinch the IV tubing
*If the needle is in the vein, observe for the backflow of blood in the distal portion of the IV tubing.
After:
1. Assess for any signs of edema or bulging of vein if it is not properly inserted.
2. Chart the procedure including time, name and dosage and the patient’s response to the administration.
3. Properly put all used materials after the insertion on the garbage.
50
Medical Date ordered General description Indications or Clients response to the treatment
management/treatment /Date performed/ purposes
Date Changed
2. D5 0.9 % NaCl Date Ordered: General D5 .9% NaCl When patient was administered
(Sodium Chloride)--- Description: fluid solution or in simple saline solution, it shows good
Hypertonic Aug 23, 2007 replacements. term “Saline”. It is hydration on her body. If you
given to the patient notice that her electrolytes level
Aug 24, 2007 because she cannot were still in normal range:
tolerate to intake
Aug 25, 2007 foods or either oral Electrolytes:
fluids and has NPO Sodium: 138
Date Performed: DIET from August normal: 136- 145 mmol/L
18-20, 24 and 25,this Potassium: 3.8
Aug 23, 2007 was ordered to normal: 3.5- 5.0 mmol/L
prevent from further Chloride: 108
Aug 24, 2007 activation of the normal: 101- 111 mmol/L
pancreas and the gall
Aug 25, 2007 bladder to secretes Interpreting her result, it means
certain enzyme that that there is no any sign of
Date Changed: causes acute dehydration occurs due to
------ inflammation, as an normal level of electrolytes.
(Continue meds) example is that, if the There is no abruptly decrease of
patient starts to eat electrolytes level.
some foods that is
rich in fats, her
pancreas and gall
bladder will
stimulates enzymes
(Exocrine) that will
breaks down large
molecules to small
51
molecules, but due to
the obstructed portion
on the gall bladder,
there will be an
accumulation and
formation that causes
inflammation. She
may experience some
symptoms of
inflamed gall bladder
like vomiting,
abdominal pain and
nausea. Due to
vomiting and
abdominal pain, there
is large possibilities
that her body might
loss fluids and at the
same time,
electrolytes. To
replenish her body
from mush fluid loss.
52
Prior:
4. Check to see if there are any special circumstances surrounding administration to
the patient.
5. Be certain that you know the expected action, safe dosage, range, and special
instruction for administration. And adverse effects associated with it.
6. For inserting IV bottles to an IV line: Do not touch the upper head of the IV.
Instead, hold the neck of it properly as you inserting the IV line into the bottle.
7. Be careful in inserting the needle if vein for insertion is detected. Just be calm,
and stay on focus on the procedure.
8. After needle was inserted, properly place the micro pore on the respective area
and for aesthetic purpose.
9. Check if there’s doctor’s order of KVO (Keep vein out).
During:
2.Regulate the flow rate or drop rate as the doctor’s order
c. Bring the IV bottle lower than the patient’s arm.
d. Pinch the IV tubing
*If the needle is in the vein, observe for the backflow of blood in the distal portion of the
IV tubing.
After:
1. Assess for any signs of edema or bulging of vein if it is not properly inserted.
2. Chart the procedure including time, name and dosage and the patient’s response
to the administration.
3. Properly put all used materials after the insertion on the garbage.
53
b. Drugs
Name of Date ordered/Date Route of administration/ Indications or Clients response to the treatment
drugs/generic Performed/Date Dosage/frequency of purposes
name/brand name Changed administration
1.Meperidine/Demer Date Ordered: Route/dosage/frequency: General action: Client feels relieve from pain upon
ol analgesics painkiller administered. As evidenced
/Stadol/Talwin/ Aug 18-25, 2007 Meperidine 25 mg IV by report of gradual decrease in pain
Pethanol NOW Meperidine is severity and unguarded abdominal
Date performed: indicated for the area. And no side effect documented
Route/dosage/frequency: treatment of on the patient.
Aug 18-25, 2007 moderate to
Meperidine TAB 1 tab OD severe pain. Due
Date Changed: to its mechanism
----- of action which
(Continue Meds) act as an agonist
at the kappa-
opioid recpetor
site. Which at the
same time, an
anticholinergic
stimulator.
When the patient

stimulates an
unpleasant stimuli
either mechanical
due to trauma on
54
the pancreas and
gall bladder, and
chemical which
either due to
secretion of
enzyme
trypsin/secretin
which was
occluded due to
obstructed
ampulla of Vater
to the common
bile duct going to
the gall bladder
that resulted to
autodigestion on
the pancreas. That
stimulates an
unpleasant
sensory impulses,
then the
nociceptor (pain
recpetor) sense
the stimuli which
will send action
(nerve-pain
impulse) from the
nerve-endings
going to the
higher brain, then
the nerve-pain
55
impulse travels
into either
Neospinothalamic
(Fast pain) which
consist of a-delta
fibers that has
wide diameter. Or
to the
Paleospinothalam
ic (Slow pain)
which consist of
C-fibers and a-
beta fibers
together with
substantia
gelatinosa that
has small
diameter, to travel
along to the
Dorsal root of
ganglion going to
the CNS, and if a-
delta fibers
reaches first. It
tends to close the
opening of the
ganglion in order
to blocked the
passing of C-
fibers. Now, the
action of here
56
Drug is that
before nerve-pain
impulse reaches
the brain,
meperidine
content already
binds to the
terminal nerve-
endings of the
brain which either
periphery or
centrally which
prevents of
further
transmission of
impulses.
Specific Nursing responsibilities:

1. Assess also for has a history of seizures or epilepsy, has an enlarged prostate or urinary retention problems, or suffers from
hyperthyroidism, asthma, or Addison's disease.
2. Advise patient that the drug may impair mental and/or physical ability required for the performance of potentially hazardous
tasks (e.g., driving, operating heavy machinery).
3. Discourage use of MAOI’s drug such as sibutramine, procarbazine or phenelzine which when administered together may cause
dangerous side-effects such as suffer agitation, delirium, headache, convulsions, and/or hyperthermia.
4. Women of childbearing potential who become, or are planning to become pregnant should be advised to consult their physician
regarding the effects of analgesics and other drug use during pregnancy on themselves and their unborn child.
5. Patients should be advised to report pain and adverse experiences occurring during therapy. Individualization of dosage is
essential to make optimal use of this medication.
57
General Nursing responsibilities:
Prior:
1. Check the written medication order for completeness. It should include the drug name, dosage, and route of administration,
frequency and duration of the therapy.
2. Wash your hands.
3. Inform the patient about the action of the drug and what are the expected side effects on it.
4. Assess for renal function, it must not given for patient having renal failure.
5. Use with caution, such as noting for any color, shape and precipitating color of the drug (If IV use).
6. Assess for Hepatic function, as the liver is responsible for detoxifying harmful substances.
7. Keep in mind for the TEN R’s for administering drugs such as right Patient, amount/dosage, and right route.
8. Assess for history of medication used.
9. Be certain that you know the expected action, safe dosage, range, special instruction for administration. And adverse effects
associated with the drugs.
10. Do not touch label or capsule with your hands. Pour the required no. Into the bottle cap then into the medication cup.
During:
1. Read the desired route for administering the drug.
2. If IV ordered, check for the patency of the IV if it is flowing.
3. Assess for edema on the IV site.
4. Do not confuse on the other contraptions attached on the IV fluid.
5. If Oral route desired, offer the patient Ice cube to suck so that to prevent any unwanted taste of the drug.
6. Also for oral route, follow up water or liquids after the medication is administered.
After:
1. Instruct patient to take the medication as directed for the full course of the therapy.
2. Document Response to the medication.
3. Advise Patient to increase Fluid intake if permitted. Due to adverse-effects of the medication such as constipation and dry
mouth
58
Name of Date Route of administration/ Indications or Clients response to the treatment
drugs/generic Ordered/Date Dosage/frequency of purposes
name/brand Performed/Date administration
name Changed
2.Omeprazole/Lo Date Ordered: Route/dosage/frequency: General action: Upon administering the medication,
sec/Prilosec/Prilos Anti-ulcer agent. patient has not elicited any untoward or
ec OTC./Zegerid Aug 18-22, 2007 Omeprazole 40 mg IV OD undesired response to the medication. No
Omeprazole was signs of dizziness, drowsiness and fatigue,
Date Performed: ordered to the which are the side effects of the drug.
patient to avoid
Aug 18-22, 2007 further
complication.
Date
Reperformed: As the General
action implies, it
Aug 24, 2007 prevents the
patient from
Aug 25, 2007 acquiring
ulcerative form.
Date Changed Due to low
/Discontinued: lymphocyte level,
the patient has a
Aug 23, 2007 low immune
system that
causes neutrophil
to increase in
value, which
means the patient
59
is at risk for
infection.
Omeprazole was
given to prevent
any further
infections that
can cause ulcer,
such as peptic
ulcer, or duodenal
ulcer. Although
ph content
stomach is very
acidic due to
secretion of
gastrin that
secretes
pepsinogen, HCl,
intrinsic factor
and parietal cells,
some bacterial
infections can
live. H. Pylori,
they are thought
be a acidophile
bacteria (2-4 ph)
60
Specific Nursing Responsibilities:
1.Do not confuse with Prisolec with Prinivil.
2. Capsules should not be swallowed nor crushed or chewed.
3. For patients who have difficulty swallowing capsules, the contents of a PRILOSEC Delayed-Release Capsule can be added
to applesauce.
4. PRILOSEC Delayed-Release Capsules should be taken before eating.
5. Assess for renal and hepatic function in order to evaluate the functional ability of the organs.
General Nursing Responsibilities:

Prior:
1. Inform the patient about the action of the drug and what are the expected side effects on it
2. Assess patient routinely for epigastric or abdominal pain and frank occult of blood in stool or emesis.
3. Check Laboratory test CBC with differential count, upon the therapy.
During:
1. Administer the dose before meals, preferably in the morning. Capsules should be swallowed whole, do not cruch or chew.
2. Maybe adminitered concurrently with antacids.
3. Read the desired route for administering the drug.
4. If IV ordered, check for the patency of the IV if it is flowing.
5. Assess for edema on the IV site.
6. Do not confuse on the other contraptions attached on the IV fluid.
7. Always check the needle of the IV, if it is in the vein before administering the drug by any of the following method:
 *If the needle is in the vein, observe for the backflow of blood in the distal portion of the IV tubing
61
8. Clean the injection port with cotton swab without alcohol.
9. Inserted the needle into the injection port and inject the drug slowly for a period of 1-7 minutes.
10. Regulate the drop rate as desired.
After:
1. Instruct patient to take the medication as directed for the full course of the therapy.
2. Document Response to the medication.
3. Instruct patient to increase in fluid intake as permitted.
4. Caution patient to avoid other activities requiring alertness until response is known to the medication.
5. Advise patient to avoid alcohol, NSAID’s drug or aspirin that may increase GI irrtitation.
6. Advise Patient to report onset of stools, diarrhea, abdominal if experience.
Name of Date ordered/Date Route of Indications or purposes Clients response to the treatment
drugs/generic Performed/Date administration/
name/brand name Changed Dosage/frequency
of administration
3.Metronidazole/AP Date Ordered: Route/dosage/freq General action: anti- From the very first day the
O-Metronidazole/ uency: infective. medication is administered, it
Metric21/MetroCrea Aug 18, 2007 showed a relatively value that
m/Metro Gel/Flagyl Metronidazole 500 Metronidazole was given to infection is impending so the action
Aug 19, 2007 mg q 6 hrs. the patient due to its of drug is needed in immediate time.
neutrophil value, which is As evidenced by laboratory results
Aug 20, 2007 low. Due to an acute of:
inflammation of the
Date Performed: Pancreas, neutrophil Aug 18, 2007
accumulates on the site of WBC Count: 13.4
Aug 18, 2007 inflammation to phagocytes normal: 5- 10 x 10 g/l
(cell eating) any invading
Aug 19, 2007 microorganism such as Neutrophils: 0.91
62
bacteria or virus. The action normal: 0.45- 0.65
Aug 20, 2007 of the drug to the patients
body (Pharmacodynamic) is Lymphocytes: 0.09
Date Changed: to convert any aerobic normal: 0.20- 0.35
bacteria to an anaerobic form
Aug 21, 2007 by the enzyme redox After 3 days of continuous
enzyme pyruvate- medications of the patient,
ferredoxin oxidoreductase laboratory exam were taken and
that disrupting the Helical results were as follows:
DNA structure of the
Bacteria that inhibiting B. Aug 21, 07
nucleic acid synthesis.
WBC Count: 5.9
And If this so happen to the Normal: 5- 10 x 10 g/l
patient, metronidzole potent
effect will do. Neutrophils: 0.76
Normal: 0.45- 0.65
Lymphocytes: 0.24
Normal: 0.20- 0.35
Results shows that Lymphocyte and

WBC count of the patient came back
to normal value except for
neutrophils, which still has a high
count, means that the patient is still
at risk for infection. As far as we
remember, the action of the
neutrophil is that during the acute
phase of inflammation, particularly
as a result of bacterial infection,
63
neutrophils leave the vasculature and
migrate toward the site of
inflammation in a process called
chemotaxis.

1. Assess for infection at the beginning and duing the theapy.
2. Obtain specimen for culture and sensitivity.
3. Monitor Neurologic status duing and after the administration.
4. Monitor intake and output and daily weight the patient especially for patient on sodium restriction.
5. Administer on a empty stomach

Prior:
5. Be certain that you know the expected action, safe dosage, range, and special instruction for administration. And adverse
effects associated with the drugs.
6. Check Laboratory test for the result of AST, ALT AND LDH that may be altered.
12. obtain a history of culture and sensitivity beofre initiating therapy.
During:
1. Administer on an empty stomach, or may administered with food or milk to minimize GI irritation.
64
2. Tablets may crushed for patient with difficulty of swallowing (dyspahgia)
3. Always check the needle of the IV, if it is in the vein before administering the drug by any of the following method:
*If the needle is in the vein, observe for the backflow of blood in the distal portion of the IV tubing.
4. Always observe aseptic technique in preparing and administering drugs.
After:
1. Chart the procedure including time, name and dosage of drug and the patient’s response to the administration.
2. Advise patient not to perform any activities, which requires massive movement. Due to adverse-effect of lightheadedness, this
puts patient at risk for injury.
Caution patient not to take alcoholic beverages at least 1 day after the treatment.
4. Vamine Glucose Date Ordered: Route/dosage/frequency: General action: When vamine glucose was
glucose supplement. administered, it shows that patient
Aug 18-20, 2007 Vamine Glucose 500 cc expected reaction was seen, such as
IV in AM to run for 8 Vamine glucose is able to answer questions
Date Re-ordered: hours. given to the patient appropriately, when she was asking
because she has or underwent assessment because a
Aug 22-25, 2007 restricted parenteral sign of decrease glucose level in
nutrition, insufficient the brain is that being manifested
Date performed: or is contra-indicated. by confusion, irritability and
It has Glucidic and decrease mental capacity to initiate
Aug 18-20, 2007 nitrogenized caloric a response, considering her
intake (acid amino of condition, the glucose which is
65
Date the series L). essential for functioning sustained
reperformed: in her body. Although there are
Our patient was kept certain times, that patient became
Aug 22-25, 2007 on NPO for a number irritable due to the pain that she
of days. Due to feels. It does not alter the proper
Date Changed: absence of any level of functioning.
----- nutrition that she
(Continue Meds) needs, especially,
carbohydrates,
proteins and fats. As
we know,
carbohydrates serve as
our energy source,
which will be
converted into glucose
after a series of
conversion that after
which, will be release
on the islet of
langerhan in the form
of glucagons by
gluconeogenesis
which will be facilitate
by gluconeolysis
particularly in the
alpha cells. Vamine
glucose will act as
glucose replacement
for those patients who
have disorder in the
Gastrointestinal tract
66
such as the condition
of the patient. Due to
administering
intravenously, vamine
glucose do not need to
undergo directly to the
mucosal line of the GI
that may initiate an
activation of organs
related to it which will
again may cause an
secretion of digestive
enzymes. Thus it will
flow directly into the
veins, which will be
distributed to those
particular parts of the
body, without
initiating any
activation.
Prior:
6. Assess for history of medication used. That may cause cross-sensitivity of the patient on it.
7. do not confuse on othe rcontraptions that were attached on the main line.
During:
67
*If the needle is in the vein, observe for the backflow of blood in the distal portion of the IV tubing
After:
1. Assess for any signs of edema or bulging of vein if it is not properly the needle is not properly inserted.
2. Chart the procedure including time, name and dosage and the patient’s response to the administration.
3. Properly put all used materials after the procedure on the garbage.
5. Intralipid Date Ordered: Route/dosage/frequency: General action: When Intralipid was administered, it did
nutritional not manifest any loss of nutrients or
Aug 18-20, 2007 Intralipid 500 cc IV in PM supplement electrolytes either. Based on the result:
to un for 8 hours (especially fats)
Date Re-ordered: Electrolytes:
As previously stated Sodium: 138 normal:
Aug 22-25, 2007 a while ago, just like 136- 145 mmol/L
Vamine glucose. Potassium: 3.8 normal:
Date performed: Intralipid also was 3.5- 5.0 mmol/L
given to the patient in Chloride: 108 normal:
Aug 18-20, 2007 order to prevent the 101- 111 mmol/L
gall bladder from
Date reperformed: activating the enzyme It shows that the medication that was
cholecystokinin to given to her is effective. But were not
Aug 22-25, 2007 emulsifies fats and only considering this result, because
68
neutralized acids in there are certain instances that the
Date Changed: the digested foods. As effectively of the drugs may not be
----- the result of potent enough. As notice, Intralipid was
(Continue Meds) dislodged/occlusion being alter to Vamine glucose, its
on the gall stone in synergism effect help each other sustain
either on the ampulla body’s functioning.
of Vater or on the
common bile duct. In
which the over-
distended organ will
be inflammed as soon
as there any
stimulation.
The purpose also of

giving intralipid
intravenously is that
her lipase level is in
high value. Which
inhibiting the
stimulation of
different enzyme
from digestion
process.
Lipase:
RESULT:
Hi – 510 U/L
NORMAL RANGE:
2.3 - 300
69
Prior:
7. Do not confuse on othe rcontraptions that were attached on the main line.
During:
A. Bring the IV bottle lower than the patient’s arm. B. Pinch the IV tubing
*If the needle is in the vein, observe for the backflow of blood in the distal portion of the IV tubing
After:
1. Assess for any signs of edema or bulging of vein if it is not properly the needle is not properly inserted.
2. Chart the procedure including time, name and dosage and the patient’s response to the administration
3. Properly put all used materials after the procedure on the garbage.
Name of Date Route of administration/ Indications or Clients response to the

drugs/generic ordered/Date Dosage/frequency of purposes treatment
name/brand Performed/Date administration
name Changed
6. Tramadol Date Ordered: Route/dosage/frequency: General actions: Client feels relieve from
/Ultram Analgesia for pain upon painkiller
Aug 23-25, 2007 Tramadol 50 mg IV q 8 moderate to administered. As evidenced
hours moderately severe by report of gradual
Date performed: pain. decrease in pain severity
and unguarded abdominal
70
Aug 23-25, 2007 Just like meperidine, area.
Tramadol was also
Date changed: given to the patient.
----- But the only
(Continue Meds) differences it has is
that it binds on the
mu-opioids receptors
(which has high
affinity to
enkephalins and beta-
beta-endorphine) that
inhibit the reuptake
of serotonin and
norepinephrine. They
are commonly
located
presynaptically or
postsynaptically. As
the process, when the
patient stimulates an
unpleasant stimuli
either mechanical due
to trauma on the
pancreas and gall
bladder, and chemical
which either due to
secretion of enzyme
trypsin which was
occluded due to
obstructed ampulla of
Vater to the common
71
bile duct going to the
gall bladder that
resulted to
autodigestion on the
pancreas. That
stimulates an
unpleasant sensory
impulses, then the
nociceptor (pain
recpetor) sense the
stimuli which will
send action (nerve-
pain impulse) from
the nerve-endings
going to the higher
brain, then the nerve-
pain impulse travels
into either
Neospinothalamic
(Fast pain) which
consist of a-delta
fibers that has wide
diameter. Or to the
Paleospinothalamic
(Slow pain) which
consist of C-fibers
and a-beta fibers
together with
substantia gelatinosa
that has small
diameter, to travel
72
along to the Dorsal
root of ganglion
going to the CNS,
and if a-delta fibers
reaches first. It tends
to close the opening
of the ganglion in
order to blocked the
passing of C-fibers.
Now, the action of
here Drug is that
before nerve-pain
impulse reaches the
brain, meperidine
content already binds
to the terminal nerve-
endings of the brain
which either
periphery or centrally
which prevents of
further transmission
of impulses.

1. Monitor patient for seizures. May occur within recommended dosage range.
2. Assess Blood pressure and Respiratory rate during and periodically.
3. Assess Bowel function routinely. Because the common side effect of the drug is constipation.
4. Prepare an antidote, which is Narcan if overdosing occurs.
5. May be administered without meals.
73
Prior:
7. do not confuse on othe rcontraptions that were attached on the main line.
8. Assess the type, location, and intensity of pain before and 2-3 hours (peak) after administration.
9. may cause an increase in creatinine, liver enzymes, decrease hemoglobin, and proteinuria.
During:
1. Do not confuse with tramadol and Toradol.
2. Regularly administered doses may be more effective than prn administration.
3. May be given without regards to meals.
4. Should be discontinued gradually after long-term use to prevent withdrawal symptoms.
After:
1. Instruct the patient on how and when to ask for pain medication.
2. caution patient to avoid driving or other activities that require alertness until response to medication is known. Because side-
effect of tramadol is dizziness.
3. advise patient to changes position slowly to minimize orthostatic hypotension.
4. avoid patient to avoid concurrent use of alcohol.
5. encourage patient to turn, cough,a nd breathe every 2 hours to prevent atelectasis.
74
Name of Date ordered/Date Route of administration/ Indications or purposes Clients response to the
drugs/generic Performed/Date Dosage/frequency of treatment
7. Buscopan/ Date ordered: Route/dosage/frequency: General action: anti- When buscopan was
Butylscopolamine/ spasmodic administered, NO signs of
scopolamine Aug 23-25, 2007 Buscopan 1 ampule IV q spasm occur such as pain. As
butylbromide 8 hours Buscopan was given to the evidenced by, no report of pain
hyoscine Date performed: patient in order to prevent upon peak of action of the
butylbromide further contraction of the medication. Patient does not
Aug 23-25, 2007 smooth muscle located on guarded her abdomen. No side-
the common bile duct, effect documented.
Date changed: which is sometimes called
----- colic.
(Continue Meds)
Due to the over-spasm of
the patient’s gall bladder ,
“again” which is because
of occluded
calculi/gallstone, the organ
tend to contract more to
dislodged or to get rid of
out the occlusion of the
duct. And may be, due to
over crowded number of
calculi that stuck into it,
then it tends abrupt
severely. Due to it, the
result is involuntary
75
contraction of it thus
resulting into sudden burst
of pain. Buscopan does
not relieve pain since it
doesn't 'mask' or 'cover
over' the pain, but rather
works to prevent painful
cramps and spasms from
occurring in the first place.

1. Assess the Bowel sound routinely.
2. May be given without regards to meals.
3. Monitor Vital signs Every 1 hour.
Prior:
7. Do not confuse on other contraptions that were attached on the main line.
During:
1. Regularly administered doses may be more effective than prn administration.
2. Should be discontinued gradually after long-term use to prevent withdrawal symptoms.
After:
1. Instruct the patient on how and when to ask for pain medication.
2. Avoid patient to avoid concurrent use of alcohol.
76
77
c. Diet
Type of Date ordered/date General Indication( Specific Client

Diet performed/date descriptio s) or foods response
changed n purposes taken and
reaction
to the
medicatio
n
1. NPO Date ordered: No foods Prevent NO Upon

(NOTHIN that are further FOODS restricting
G Aug 18, 2007 must be stimulation ALLOWE patient
PERORE Aug 19, 2007 taken. different D TO BE from
M Aug 20, 2007 enzymes TAKEN intake of
/ that would any forms
NOTHING Date reordered: lead to auto of foods
BY digestion of which
MOUTH) Aug 24, 2007 the either solid
Aug 25, 2007 pancreas or liquid
and the gall form. Due
Date Performed: bladder. to the
feelings
Aug 18, 2007 that patient
Aug 19, 2007 experience
Aug 20, 2007 s, she
restricts
Date reperformed: herself
from
Aug 24, 2007 eating
Aug 25, 2007 foods.
Because it
Date changed: may cause
Aug 21, 2007 irritation to
Aug 22, 2007 her
Aug 23, 2007 inflamed
bodily
organs.
Prior:
1. Check the doctor’s order.
2. Assure IV fluid therapy if patient is NPO.
3. Instruct SO not to give anything through the mouth.
78
During:
1. Assure that nothing is taken through the mouth either liquid or solid.
2. Assess client’s condition.
3. Place “NPO” sign on the on the bed where the patient can see it always.
4. Remove foods and drinks on patient’s side.
After: Observe patient’s response on the diet.
Type of Date General Indication(s) Specific foods Client

diet ordered/date description or purposes taken response
performed/date and
changed reaction to
the
medication
2. SOFT Date ordered: Food The purpose Foods The patient

LIQUID tolerances of these is to moderately is able to
DIET Aug 21, 2007 vary with designed low in fibers, tolerate soft
Aug 22, 2007 individuals. patient that soft texture liquid diet
Aug 23, 2007 Tender foods who cannot and as far she
(not ground tolerate moderately can. Also
Date or pureed) general diet. seasons. Avoid the Soft
Performed: are used fried foods liquid diet
unless the and spicy also aids in
Aug 21, 2007 individual foods. giving good
Aug 22, 2007 needs hydration
Aug 23, 2007 additional The following of the
modifications are patient.
Date changed: to the diet. recommended: That’s one
Most raw good
Aug 24, 2007 fruits and >milk, coffee, reason that
vegetables tea, fruit juice risk for
and course dehydration
79
breads and >all fruit was rid-out.
cereals are juices
eliminated.
>cooked or
ready cereals
>cooked
vegetables
>potatoes
without skin.
1. Explain the purpose of the diet.
2. Emphasize the importance of it.
3. Monitor patient Intake and output.
4. Chart the I & O of the patient if needed.
5. Give the patient according to what are prescribed.
6. Do not tolerate the patient if she’s requesting foods that are not under soft liquid
diet.
7. Determine any degree of circumstances such as the patient is ongoing NGT
feeding. Inform the patient about the condition.
d. Activity/ Exercise
Type of Date ordered General Indications or Client’s
Exercise Date performed Description Purposes response to the
Date changed activity
May turn side 08-18-07 The patient This is to The patient
to side may move facilitate complained of
on bed as recovery to pain when
tolerated. normal moving. With a
functioning of pain scale of
the body. 9/10 and facial
grimaces.
Prior:
1. Check the physician’s order.
2. Explain to the purpose of positioning for his safety.
3. Place a draw sheet and rubber sheet under patient’s back and head.
During:
1. Logroll patient to one side every 2 hours.
80
2. Place a small pillow under the patient’s head.
3. Place pillow or rolled towel behind the patient’s back.
4. Put a pillow between patient’s legs and on the abdomen.
5. Run your hand under the patient’s dependent shoulder and move the shoulder
slightly forward.
After:
1 Inspect the patient’s skin.
2 Assess patient’s comfort.
3 Lower height of the bed and elevate side rails.
4 Document patient’s reaction and compliance.
81
Cues Nursing Specific Objectives Nursing Rationale Expected Outcome
Diagnosis Explanation Intervention
Short Term: >Establish > To gain the trust Short Term:
“S” = O Acute Pain R/T Pancreatitis is rapport. of the client and
inflamed body commonly After 3 hrs. of gain cooperation. After 3 hrs. of
“O” organs secondary described as auto nursing nursing
IVF of D5 0.9% to cute digestion of the interventions the >To obtain interventions, the
NaCl at 500 cc pancreatitis pancreas. When pt will >Monitor vital baseline data patient
level regulated at resolved the pt’s pancreatic demonstrate signs. demonstrated
60- 61 gtts/min, cholecysto- duct becomes diversional >To obtain a diversional
lithiasis temporarily activities to direct >Assess baseline data and activities to direct
Patient obstructed due to pain. patient’s know the needs of pain.
manifested: obstruct gall condition. the patient.
>() Abdominal bladder that has
pain calculi or stones Long Term: >To know the Long Term:
> Guarded her along the duct. >Perform pain location and
abdomen And accompanied After one day of assessment quality of pain. After one day of
>Moaning when by hyper nursing comprehend- nursing
pain attacks secretion of the interventions, the sively (pqrst). interventions, the
>Irritability & exocrine gland of pt. will verbalize >To know the patient verbalized
anxiety the pancreas, methods I >Note for non- level of pain. methods and
>Appears restless specifically the relieving pain. verbal cues. techniques in
>Dilated pupils trypsin. Then the >To reduce relieving pain.
>Skin is pale enzyme enters the >Provide tension that is
bile duct, where diversional occurring, thus
Patient may they are activated activities like reduce intensity
manifest: and together with chatting. of pain.
>Difficulty in bile, back up into
turning. the pancreatic >To regain loss
82
> Limited to duct, then the pt. >Encourage energy due to
perform motor Experiences adequate rest untolerated pain.
skills. abdominal pain. periods.
3. NURSING MANAGEMENT
83
Pain serves as a >Stretch linens >Reduce factor
PQRST Pain mechanism to for comfort. that aggravates
Assessment: warm us about the pain.
the potential for
P- provoked by physical harm. >Instruct use of >To increase the
trauma on her Pain is caused by non- release of
abdomen upon actual tissue pharmacologic endorphins and
moving. damage that techniques such enhance the
Q- stabbing pain stimulates the as relaxation, therapeutic effects
R- on her left receptive normal distraction. of it.
upper quadrant receptors. Once
S- 10 out 10 the receptors are >Administer >To improve pt’s
ratings stimulated the medications as condition.
T- 4:00pm impulse they ordered by the
>May manifest discharge travels doctor.
increase pulse, as electrical
increase RR, activity to the >Acknowledge >To establish
elevated BP spinal cord and reality of therapeutic
>Vital signs taken on the brain and situation and relationship.
and recorded: this becomes the feelings of the
experience of client.
Temp: 36.7 c pain, in normal
PR: 81 bpm pathways for
RR: 22 bpm these impulses is
BP: 110/ 60 blocked pain
mmHg since, it doesn’t
>fetal position reach the brain.
when pain attacks There would be
damage on pain
84
system causing
pain.
85
86
Activity Activity Short Term: Short Term:
“S” = O intolerance r/t Intolerance a
generalized body psychological or After 3 hrs of >Monitor vital >To obtain After 3hrs of
“O” = weakness physiological nursing signs. baseline data nursing
secondary to energy to endure interventions interventions
Patient disease condition. or complete patient will >Assess >To obtain a patient identified
manifested: required or verbalize patient’s baseline data and techniques to
>() Restlessness desired daily understanding and condition. know the needs of enhance activity
> Weakness activities. And identify factors the patient. intolerance within
>Difficulty in because she affecting activity her physical
intolerance.
going to the experienced >Assisted pt. to > To prevent limitations.
comfort room. hemorrhage due learn and further possible
>Bed rest the to previous blood demonstrate injuries.
loss through Long Term: appropriate
whole day
>Slowed menstruation. safety
Decreased After one day of measures. Long Term:
movement
oxygen supply, nursing
>Small steps
that result to interventions >Emphasize >To be able to After one day of
decreases muscle patient will importance of regain strength. nursing
Patient may
tone and result to demonstrate adequate interventions
manifest:
body weakness. compliance and periods of rest. patient participated
>Irritability most
able to increase willingly in the
of the time
comfort while >Encourage pt. >To reduce desired activities.
> Limited to
performing to do activity fatigue.
perform motor
activities with appropriate
skills
>Shortness of rest periods.
breath
>Assist pt. in >To avoid further
going to the injury and
comfort room. decrease level of
pain that is
experienced.
87
Cues Nursing Specific Objectives Nursing Rationale Expected
Diagnosis Explanation Intervention Outcome
>Instruct SO to >To prevent the
support pt’s aggravation of
ADL’s. pain.
>Administered >To improve the

medications as pt’s condition.
indicated.
>Encouraged >To stimulate

mix of desired observation as
activities or well as
stimuli such as involvement and
reading participation in
magazines, or activity.
listening to
music.
>Supported > To maintain

affected body position and
parts. reduce risk of
pressure.
88
Knowledge Knowledge Short Term: Short Term:
“S” = O deficit r/t lack of deficit is the lack >Determine pt’ >To check his
understanding of of cognitive After 3 hrs of s ability to level of capability After 3hrs of
“O” = medical and information nursing learn. in learning. nursing
disease condition. related to specific interventions interventions
topic. Which patient will >Review >Provides patient identified
Patient may where the patient identify disease knowledge base appropriate
manifest: ask of about her individually process/prognos from which interventions in
> Statement of illness, because appropriate is. Discuss patient can make promoting sleep.
misconception she do not fully interventions to hospitalization informed choices.
> Information understand its promote sleep. and prospective Effective
misinterpretation. condition. treatment as communication
> Unfamiliarity Long Term: indicated. and support at Long Term:
of information Encourage this time can
resources. After one day of questions, diminish anxiety After one day of
nursing expression of and promote nursing
interventions concern. healing. interventions
patient will report patient reported an
improvement in >Provide >To reinforces improvement in
sleep or rest written learning process. sleeping patterns.
patterns. information /
guidelines for
the patient.
>Information can
>Provide decrease anxiety.
explanations of/
reasons for test
procedures and
preparation
89
needed.
>To correct
>Provide beliefs and
information promote more
relevant to his reliable
situation. information
90
91
Short term: Short term:
“S” = O Anxiety r/t The client is in >Monitor and >To have a
situational crisis, the state of After 3 hours of record V/S. baseline data. After 3 hours of
“O” = perceived to anxiety because nursing nursing intervention
actual threat to of the problem intervention the >Allow client to >Verbalization the pt. verbalized
Patient health she is pt. will verbalize verbalize and assessment of understanding about
manifested: experiencing. understanding feelings and feelings provide a her situation and
> Irritable Which was her about her concerns. safe outlet for able to build up
> Presence of first time to be situation and able Assess for emotions. trust with her.
pain hospitalized and to build up trust possible
> Poor eye experienced with her. feelings related
contact severe dizziness. to cause of her
> Restlessness Involving the Long term: condition. Long term:
worries of her After one day of After one day of
family care. And nursing >Approach the >Using calm, nursing intervention
also a big threat intervention the client in a calm, unhurried the pt. verbalized
to her health. pt. will verbalize consistent, approach with concerns and fears;
concerns and unhurried explanations worked with the
fears; works with manner. helps to minimize student nurses,
the student nurses the threat of the corrected and
to correct and situation. compensated with
compensate with >Include client >Client’s her present problem
her present in treatment participation and participated in
problem and process and enhances client’s treatment regimen.
participate in inform her control over the
treatment about the things situation and may
regimen. ahead of time if help to instill
possible. hope and promote
decision-making.
> Explain to the > To promote
92
patient her trust and
condition as cooperation of the
well as the patient and
treatment and helping to
procedures. alleviate her
problems.
93
The deficit may Short term: Assess ability to The patient may Short term:
“S” = O Self care deficit be a result of After 3hours of carry out ADL’s only require After 3hours of
related to pain transient nursing like dressing, assistance with nursing
“O” = limitations, such interventions grooming, some self- care interventions,
as those that the patient will be bathing etc. measures. patient was able to
Patient patient able to verbalize verbalize the
manifested: experiences like understanding on Provide privacy importance of self-
> Irritable acute pain. the importance of during dressing. Patient may take care.
> Presence of Careful self care. longer to dress
pain examination of and maybe fearful
> Poor eye the patient’s Long term: of breaches in
contact deficit is required After one day of privacy Long term:
> Restlessness in order to be nursing Provide After one day of
certain that the interventions frequent This will reduce nursing
patient is not patient will safely encouragement energy interventions
failing self- care perform self- care and assistance expenditure and patient was able to
because of lack of activities. as needed with frustration. perform safely self-
materials with dressing. care activities.
arranging the
environment to Encourage pt. to
suit the patient’s comb her own This enables the
physical hair. pt. to maintain
limitations. autonomy for as
long as possible.
Encourage pt. to
perform These will reduce
minimal- facial energy
hygiene expenditure and
whenever she prevents fatigue
94
cannot tolerate and exacerbation.
to do so.
95
2. ACTUAL SOAPIE’s
 August 23, 2007
S=O
O = Received patient lying on bed sleeping with ongoing IVF of D5 0.9% NaCl 1L x 60
gtts/ min @ 900 cc level infusing well on the right arm. Stabbing pain provoked by
trauma on her abdomen upon moving and radiating on her Left upper quadrant, with a
pain scale of 10/ 10.
() Abdominal pain
() Guarded her abdomen
() Irritability
() Moaning when pain attacks
Vital signs were taken and recorded:

Temp: 36.7 C
PR: 81 bpm
RR: 22 bpm
BP: 110/ 60 mmHg
A = Acute Pain
P = After 3 hrs. of nursing interventions, the patient will demonstrate diversional

activities to divert pain.
I > Established rapport

> Monitored Vital signs
> Stretched linens for comfort
> Assessed patient’s condition
> Performed pain assessment comprehensively (pqrst)
> Determined possible pathophysiological causes like pancreatitis & cholecystolithiasis
> Noted client’s behavior towards pain.
> Provided diversional activities such as chatting
> Encouraged verbalization of pain
> Kept patient as NPO as ordered by the doctor.
> Noted medications that are to be taken on time
E = Goal met, as evidenced by demonstrated diversional activity.
 August 25, 2007
S=O
96
O = Received patient lying on bed with an IVF of 0.9 NaCl with a level of 500 mL
regulated at 60 gtts/min, infusing well on the right cephalic vein with a side drip if
Intralipid 10% regulated at 62- 63 gtts/min.
() Restlessness
Vital signs were taken and recorded:

Temp: 37.8 C
PR: 62 bpm
RR: 27 bpm
BP: 110/ 70 mmHg
A = Acute Pain
P = After 3 hrs. of nursing interventions, the patient should verbalize a decrease in pain
from 8/10 to 6/10.
I > Established rapport

> Monitored Vital signs
> Stretched linens for comfort
> Assessed patient’s condition
> Assessed level of pain
> Encouraged verbalization of feelings towards pain
> Observed for non- verbal cues
> Regulated the IV Fluid
> Assisted patient in going to the comfort room
> Provided comfort measures
> Noted medications that are to be administered on time.
> Prescribed medication that is to be taken.
E = After 3 hrs. of nursing interventions patient verbalized a decrease in pain from 8/10
to 3/10.
97
C. VI. Client’s Daily Progress in the Hospital
Admission Day 2 Day 3 Day 4 (Aug Day 5 Day 6 (Aug Day 7 Day 8 (Aug
(Aug 18, (Aug 19, (Aug 20, 21, 2007) (Aug 22, 23, 2007) (Aug 24, 25, 2007)
2007) 2007) 2007) 2007) 2005)
Nursing Problems:
according to
prioritization:
1. Acute Pain * * * * * * * *
2.Imbalanced * * * * * * *
nutrition
3.Activity Intolerance * * * * * * * *
4.Self-care deficit * * * * * * * *
5.Anxiety * * * * * * *
Vital Signs:
1. Temp. Temp: 37.3 Temp: Temp:36.9 Temp: 37 Temp: Temp: 36.7 Temp: Temp: 37.5
2. Pr Pr: 76 bpm 37.1 Pr: 71bpm Pr: 60bpm 37.2 Pr: 81 bpm 37.1 Pr: 80 bpm
3. Rr Rr: 26 bpm Pr: 68bpm Rr: 28bpm Rr:25bpm Pr: 64 Rr: 22 bpm Pr: 81 Rr: 23 bpm
4. BP Bp: 110/ Rr:22bpm Bp: 110/ Bp:100/ 70 bpm Bp: 100/ 60 Rr: 22 Bp: 110/ 70
70mmHg Bp:100/ 70mmHg mmHg Rr: 24 mmHg bpm mmHg
70 mmHg bpm BP:
Bp: 100/ 110/70
70 mmHg mmHg
Diagnostic/Lab
procedures:
1.CBC *
99
2. creatinine *
3. Alkaline *
phosphatase
4.BUN *
5. SGOT *
6. SGPT *
7.LDH *
8. RBS *
Medical management
1. IVF’S 1. D5 LRS 1. D5 LRS 1. D5 LRS 1. D5 LRS 1. D5 LRS 1. D5 0.9 % 1. D5 0.9 1. D5 0.9 %

2. Blood 1L x 30- 31 1L x 30- 1L x 30- 1L x 30- 31 1L x 30- NaCl x 60 % NaCl x NaCl x 60
Transfusion gtts/ min 31 gtts/ 31 gtts/ gtts/ min 31 gtts/ gtts/ min 60 gtts/ gtts/ min
3. NGT feeding min min min min
DRUGS * * * * * * * *
1.Meperidine 25 mg
2.Omeprazole 40g * * * * * * * *
3.Metronidazole * * * * * * * *
500mg
4. Vamine Glucose x 8
hrs. alternate with * * * * * * *
Intralipid x 8 hrs.
B.I.D.
100
5. Tramadol 50 mg IV * * * * * * * *
q 8 hrs.
6 .Buscopan 1amp IV * * * * * * * *
q 8 hrs.
DIET
NPO * * * * * * *
*
SOFT LIQUID DIET
ACTIVITY
/EXERCISES *
*
May turn side to side * * * * * *
101
Discharge Planning
S
O- Received patient on bed conscious and
 Body malaise
 Restlessness
 Pain felt on the abdominal are
 Facial grimaces
 Irritability
V/S
T- 37.3 RR- 19
PR-98 BP- 130/80
A = Home Maintenance and Management
P = After 3 hours of nursing interventions, patient will be able to verbalize understanding
on the health teachings for promotion and maintenance of health.
I = METHOD
Medications: Instructed patient the following home medication
 Omeprazole (Anti-ulcer) 40mg two tablets three times a day. Report any sign of
adverse effects.
Exercise:
 Instructed to avoid strenuous and stressful activities such as laundry, straining and
bending over and lifting heavy objects.
 Encouraged to perform tolerable exercises of activities of daily living such as
sweeping the floor and cooking.
Treatment:
 Emphasized to patient strict compliance to medical regimen.
 Take home medications as ordered
 Health Teachings:
 Instructed to go to JBLMRH for checkup once a month.
 Instructed to avoid foods that are high in fats, cholesterol, oily foods and most
especially salty foods.
 Encouraged rest in between periods of activities
 Instructed to avoid lifting heavy objects
 Encouraged relaxation technique such as listening to radio and watching
television.
 Emphasized the importance of taking medications strictly as ordered
103
 Stressed the importance of compliance to medical regimen
OPD follow-up:
 Instructed to come back on September 3, 2007 at Medicine-OPD section near the
gate.
 Diet:
 Instructed to eat low fat, low salt diet
VII. CONCLUSIONS AND RECOMMENDATIONS
Acute pancreatitis is an acute inflammatory condition of the pancreas that may

extend to local and distant extra pancreatic tissues. Acute pancreatitis is sudden
inflammation of the pancreas that may be mild or life threatening but that usually
subsides. The exact cause of acute pancreatitis may differ among different patients, but in
general it is not well understood. It is thought that enzymes normally secreted by the
pancreas in an inactive form become activated inside the pancreas and start to digest the
pancreatic tissue. Generally the patient needs hospitalization with administration of
intravenous fluids to help restore blood volume. Medication for pain and nausea are
provided to ease these symptoms and food is withheld until these symptoms have
subsided considerably.
As a student nurse, it is our responsibility to be knowledgeable enough about the

disease our patients have. This is very important to understand their condition and to
know why they experience such. Enough information about diseases will help us to know
the proper interventions we can provide to our patients. Learn to care and love the
patients we are handling, this will help us lessen the pressure and tiredness especially
during toxic days of duty. We should also keep our experiences with every patient,
because we might encounter the same case in the future.
Upon concluding this study, I am fortunate enough to understand the disease

condition of our patient. It helps me a lot to read more topics about her condition and find
ways to help her. It also gives me awareness that Acute pancreatitis resolved
cholecystolithiasis is not only a ordinary illness. It is an illness that can threaten life and
puts a person into a danger. It also helps me to understand her different medications that
she has, and how it would affect her normal functioning.
I only recommend to the different concern citizen to be more aware about the
cause of this illness. Let us learn from the experience of our patient, excessive intake of
junkfood and carbonated drinks would lead to her illness. Recommend them to be
consciously enough to limit Fatty rich foods, or foods rich in monosodium glutamate
(MSG). and know priorities of what foods are essential.
After conducting this case study concerning Acute Pancreatitis, we recommend this in
particular with the chain- smokers, alcoholics and other folks that are fond of eating high
sodium foods, high caloric diet.
104
VIII. BIBLIOGRAPHY
http://www.medicinenet.com/pancreatitis/article.htm
http://www.facs.org/spring_meeting/gs09murr.pdf
http://www.emedicine.com/radio/byname/pancreatitis-acute.htm
http://www.medscape.com/viewarticle/488046_2
http://en.wikipedia.org/wiki/Acute_pancreatitis
http://www.pancreasfoundation.org/Docs/pancreatitisinchildhood2.doc
http://pathology2.jhu.edu/pancreas/digestsy.cfm
*http://en.wikipedia.org/wiki/
*http://wrongdiagnosis.com/
*http://www.medicinenet.com/script/main/hp.asp
*Davis’s drug guide for nurses, tenth edition by Judith Hopfer Deglin and April Hazard
Vallerand
*Medical-surgical Nursing by Brunner and Suddarth.
*^ Ginsburg, Ph.D., J.N. (2005-08-22). "Control of Gastrointestinal Function", in

Thomas M. Nosek, Ph.D.: Gastrointestinal Physiology, Essentials of Human Physiology.
Augusta, Georgia, United State: Medical College of Georgia, p. 30. Retrieved on 2007-
06-29.
*^ Laboratory 38. Stomach, Spleen and Liver, Step 14. The Gallbladder and the Bile
System. Human Anatomy (Laboratory Dissections). SUNY Downstate Medical Center,
Brooklyn, NY (2003-11-17). Retrieved on 2007-06-29.
*Abdominal dissection, gall bladder position emphasized (JPG). Human Anatomy

(Laboratory Dissections). SUNY Downstate Medical Center, Brooklyn, NY (2003-11-
17). Retrieved on 2007-06-29.
*Slide 5: Gall Bladder. JayDoc HistoWeb. University of Kansas. Retrieved on 2007-06-

29.
105
*Physiology at MCG 6/6ch2/s6ch2_30
*New Standard Encyclopedia, 1988. Volume P Page 68
*Cutler, Anne G., et al., eds. Stedman's Medical Dictionary. Baltimore: The William and
Wilkins Company, 1976 ed.
*Norman/Georgetown pancreas
*Histology at BU 10404loa
*Harper, Douglas. Pancreas. Online Etymology Dictionary. Retrieved on April 4, 2007.
*http://www.moondragon.org/nutrition/diet/softdiet.html
106

Acute Pancreatitis

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Acute Pancreatitis

Hochgeladen von

Copyright:

Verfügbare Formate

Angeles University Foundation

A. Current trends about the disease condition.

Acute Pancreatitis in Oceania (Extrapolated Statistics)

Coffee Can Reduce Risk Of Pancreatitis, Scientists Discover

Article Date: 16 Mar 2006 - 10:00 PDT

Pancreatitis is a condition in which the pancreas becomes inflamed, causing severe

"At the moment there is no specific pharmacological treatment for pancreatitis. As a

B. Reasons for choosing such case for presentation.

As well as to have an experience and be familiar in handling, managing and

C.2. (Patient- centered)

II. NURSING ASSESSMENT

Died @ old Died @ old Died @ old Died @ old age

Sis 1 Bro Bro Snowhite Sis 2 Bro

Physical Assessment (August 23, 2007)

Lacrimal gland, Lacrimal sac,

The Ear and Hearing

The Nasal Cavity

Buccal Mucosa and Back teeth

The Neck and Lymph nodes

The Thorax and Lungs

The Peripheral Pulses

The Breast and Axillae

The Bones and Joints

Cranial Nerve Assessment

Physical Assessment (August 3123, 2007)

The eyes and vision

Lacrimal gland, Lacrimal sac,

The Nasal Cavity

Buccal Mucosa and Back teeth

The Neck and Lymph nodes

The Thorax and Lungs

The Peripheral Pulses

The Breast and Axillae

The Bones and Joints

Cranial Nerve Assessment

Cranial Nerve Assessment Expected Responses

F. Diagnostic and Laboratory Procedures

Neutrophils -Are in first

Alkaline DO: - The primary 127.5 - The Alkaline

Specific Specific -normal

Pus cell: Pus cell: -Genitourinary

The liver is not enlarged. Parenchyma is homogenous in echopattern and normal in

Where is the pancreas located?

Function of the Pancreas

The pancreas can also be thought of as having different functional components,

What is pancreatic fluid

IV. THE PATIENT’S ILLNESS

A. Synthesis of the disease

This hormone is called vasoactive intestinal polypeptide (VIP). The pancreas's

Comparison of Cholelithiasis and Cholecystitis:

2. Predisposing/ Precipitating Factors

 Age – teenagers are more prone in having gallstones due to

 Sex - Pancreatitis occurs more frequently in men, possibly because

 Other medical conditions - Certain inherited diseases, particularly

 Sedentary lifestyle – lacks exercise and other physical activities

 Smoking - Some researchers theorize that the stress of

Signs and Symptoms

Pancreatitis typically presents with the following signs and symptoms:

 Abdominal pain – is the major symptom of pancreatitis. Abdominal pain

 Ecchymosis (bruising)- in the flank or around the umbilicus may indicate

 Hypotension – typical and reflects hypovolemia and shock caused by the

 Abdominal distension leading to cyanosis

 Boring epigastric pain, which is exacerbated in the supine position; it is