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MONTECALVO, GRACE J.
JOY RAMOS
BSN 3-3
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 Cells are replaced by fibrous tissue with
repeated attacks of pancreatitis.
 The end result is mechanical obstruction of
the pancreatic and common bile duct s and
duodenum.
 | 
 mn addition, the secreting cells of the pancreas
become inflamed and destruction ensues.
 Alcohol consumption in Western societies and
malnutrition worldwide are the major causes.
 Among alcoholics, the incidence of
pancreatitis is 50 times the rate in the
nondrinking population.
    
 |      produces
hypersecretion of protein in pancreatic
secretions.
 The result is protein plugs and calculi within
the pancreatic ducts.
 Alcohol has a direct toxic effect on the cells of
the pancreas.
 Damage is more severe in patients with diets
low in protein and very high or very low in fat.
 |! 
 Recurring attacks of severe upper abdominal
and back pain, accompanied by vomiting;
narcotics may not provide relief.
 There may be continuous severe pain or dull,
nagging, constant pain.
 Risk of addiction to opiates is high because of
the severe pain.
 Weigh loss is a major problem.
 |! 
 Altered digestion r  "of foods
r "results in #$ 
 %  &
 r "
 As disease progresses, calcification of the
gland may occur and calcium stones may form
within the ducts.
 
 Assess presence and character of pain, its
relationship to eating and to alcohol
consumption: note effect of patient͛s efforts
to obtain pain relief.
 Assess nutritional and fluid status and history
of gallbladder attacks and alcohol use.
 Elicit history of Gm problems: fatty stools,
diarrhea, nausea and vomiting.
 
 Assess respiratory status, including rate,
pattern, and breath sounds.
 Assess abdomen for pain, tenderness,
guarding, and bowel sounds; note boardlike or
soft abdomen.
 D ! 
    
   r
|" is the most
useful study.
 A   evaluates pancreatic
islet cell function.
 D 
 Acute pain and discomfort related to edema,
distention of the pancreas, and peritoneal
irritation.
 mmbalanced nutrition: Less than body
requirements related to inadequate dietary
intake, impaired absorption, reduced food
intake, and increased metabolic demands.
 D 
 mneffective breathing pattern related to severe
pain, pulmonary infiltrates, pleural effusion,
and atelectasis.
 mmpaired skin integrity resulting from poor
nutritional status, bed rest, surgical wound.
 !!
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'
 ›ain and discomfort are relieved with
analgesics.
 ›atient should avoid alcohol and foods that
produce abdominal pain and discomfort. No
other treatment will relieve pain if patient
continues to consume alcohol.
 !!
 Diabetes mellitus resulting from dysfunction
of pancreatic islet cells is treated with diet,
insulin, or oral hypoglycemic agents. ›atient
and family are taught the hazard of severe
hypoglycemia related to alcohol use.
 ›ancreatic enzyme replacement therapy is
instituted for malabsorption and steatorrhea.
 !!
 Surgery is done to relieve abdominal pain and
discomfort, restore drainage of pancreatic
secretions, and reduce frequency of attacks
r  ((  "
 Morbidity and mortality after surgical
procedures are high because of patient͛s poor
physical condition before surgery and
concomitant occurrence of cirrhosis.
 !

D  
üAdminister morphine as ordered. This is the drug
of choice.
üWithhold oral fluids to decrease formation and
secretion of secretin.
üUse nasogastric suctioning to remove gastric
secretions and relieve abdominal distention; avoid
tension on tube and use water- soluble lubricant
around nares; give frequent oral hygiene.
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D  
üBed rest
ü›rovide explanations about treatment ;patient
may have clouded sensorium from pain, fluid
imbalances, and hypoxemia.
 !
   

üMonitor laboratory test results, daily weights, and
anthropometric measures.
üAssess nutritional status and increased metabolic
requirements (note increased body temp.,
restlessness, inc. physical activity) and fluid lost
through diarrhea.
ü›rovide mouth care; patient N›O during an attack.
 !
   

üAdminister fluids, electrolytes and ›N as
prescribed.
üMonitor serum glucose level every 4-6 hrs, and
give insulin as prescribed.
ümntroduce oral feedings gradually as symptoms
subside.
üAvoid heavy meals, alcoholic beverages, excessive
use of coffee, and spicy foods.
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 ) 
üMaintain patient in semi- Fowler͛s position to
decrease pressure on diaphragm.
üChange position frequently to prevent atelectasis
and pooling of respiratory secretions.
 !
  
 ) 
üAdminister anticholinergic medications to
decrease gastric and pancreatic secretions; dry
respiratory tract secretions.
üAssess respiratory status frequently (pulse
oximetry, ABG values) and teach patient
techniques of coughing and deep breathing
exercises.
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  * |
üAssess the wound, drainage sites, and skin
carefully for signs of infection, inflammation, and
breakdown.
üCarry out wound care as prescribed, and take
precautions to protect intact skin from contact
with drainage; consult appropriate skin care
devices and protocols.
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  * |
üTurn patient every 2 hrs; use of specially beds may
be indicated to prevent skin breakdown. Surgical
wound may be irrigated and repacked every 2-3
days.