Pancreatitis Nursing Diagnosis & Interventions

Caring for patients with pancreatitis can be daunting, and nurses must comprehensively understand the condition’s causes, symptoms, and treatments. It requires complex clinical interventions to support the patient throughout their entire episode of care – from diagnosis to recovery.

As a healthcare provider, it is essential to remain current on best practices related to nursing assessment and management of pancreatitis to deliver effective treatment that optimizes patient outcomes.

This blog post will explore key components of assessing patients with acute or chronic pancreatitis and provide practical tips for delivering nursing interventions.

What is Pancreatitis?

Pancreatitis is a medical condition you may have heard of but may not understand completely. Simply put, it is inflammation of the pancreas, an organ in the abdomen. This inflammation can cause various symptoms, such as severe abdominal pain, nausea, vomiting, fever, and weight loss. 

There are two types of pancreatitis: 

1. Acute
2. Chronic

Acute: acute pancreatitis is a sudden onset, while chronic pancreatitis is a long-term situation that can permanently damage the pancreas. Though the causes of pancreatitis can vary greatly, alcohol and gallstones are the most common causes in adults. 

Chronic: Proper diagnosis and treatment are crucial in managing this condition and preventing further complications. If you or someone you know is experiencing symptoms associated with pancreatitis, it’s essential to seek medical attention immediately.

Signs and Symptoms of Pancreatitis

It is important to note that not all patients with pancreatitis may experience the same symptoms. However, some common signs and symptoms of acute or chronic pancreatitis exist. These include:

• Severe abdominal pain that often radiates to the back
• Nausea and vomiting
• Fever
• Rapid heart rate
• Weight loss
• Abdominal tenderness when touching the area
• Jaundice (yellowing of the eyes or skin) in severe cases.

Patients with CP may also experience abdominal pain, vomiting, and nausea. The following signs and symptoms may also be present:

• Hyperglycemia
• Steatorrhea
• Jaundice
• Steady weight loss
• Upper abdominal pain with radiation in the back
• Back pain that is spreading
• Steatorrhea

Pathophysiology

The self-digestion of the pancreas characterizes acute pancreatitis due to premature activation of its proteolytic enzymes (trypsin). This may be caused by obstruction of gallstones in the bile duct, which then refluxes back into the pancreatic duct, resulting in inflammation, erosion, and necrosis. 

The condition can often lead to hypovolemic shock, hypotension, or multiple organ dysfunction. Chronic pancreatitis is a long-term complication, usually after an initial acute episode.

Etiology

• Acute: Most acute cases are linked with gallstones and alcohol intake in the US; other possible causes include infections, hypercalcemia, hypertriglyceridemia, trauma, pancreatic cancer, autoimmune disease, and certain medications.
• Chronic: Chronic pancreatitis is most commonly caused by long-term alcohol use, gallstones, hereditary disorders, cystic fibrosis, and hypertriglyceridemia.

Desired Outcome

The goal of treatment for pancreatitis is to prevent obstruction, inflammation, or infection in the pancreas and bile duct while relieving associated pain and vomiting. Patients should ultimately be free from these symptoms.

Treatments

• Fluid replacement and electrolyte monitoring to prevent dehydration.
• Pain relief through opioids or non-steroidal anti-inflammatory drugs (NSAIDs).
• Anti-emetics to reduce nausea and vomiting.
• Low-fat diets reduce digestive stress on the pancreas.
• Endoscopic retrograde cholangiopancreatography (ERCP) to remove gallstones blocking the bile duct, if present.

Nursing Diagnosis Of Pancreatitis Patient

• Acute pain related to inflammation/erosion in the pancreas.
• Disturbed sleeping pattern related to pain
• Discomfort associated to nasogastric tube
• Impaired tissue perfusion related to hypovolemia associated with pancreatitis.
• Fluid and electrolyte disturbances related to hypovolemic shock and vomiting.
• Fatigue related to edema, inflammation, and pain.
• Anxiety related to a new diagnosis or hospitalization for pancreatitis treatment.
• Risk for infection related to acute pancreatic inflammation and erosion.
• Activity intolerance related to fatigue
• Altered discomfort associated to dyspnoea
• Imbalanced nutritional status less than the body needs to be related to pain,
• medical restrictions and treatment

Nursing Diagnoses for Acute Pancreatitis Patient

Diagnosis Thorough A Physical Examination

Physical examination may be conducted to assess for signs and symptoms of pancreatitis.

How Physical Examination is Performed

• Physical assessment includes looking at the abdomen, including listening with a stethoscope.
• Auscultation involves listening to the abdomen with a stethoscope.
• Palpations involve feeling for lumps, masses, or abnormalities beneath the skin by pressing down on various body areas.
• Percussion entails tapping lightly over an area and assessing its sound as it echoes off underlying tissue or bone, used to identify localized abnormalities beneath the surface.
• Jaundice (yellowing of the skin), fever, dark urine, and bright feces are also examined during this exam.
• Right upper abdominal tenderness, rigidity, fever, or chills may occur when pancreatitis is suspected.
• Patients may experience nausea, vomiting, and elevated blood pressure or heart rate when in pain.

Nursing Diagnose for acute pancreatitis using Amylase/Lipase Ratio Test.

The Amylase/Lipase Ratio Test measures the levels of two enzymes in the blood, amylase and lipase. When complex carbohydrates break down, they are converted to simple sugars, broken down further into glucose by lipases found in the pancreas. The ratio between these two enzymes can be used to assess the severity of inflammation in those with acute pancreatitis.

An accurate result can be obtained by measuring both amylase and lipase in blood taken after four hours, as this is when the enzymes reach their peak levels. However, an average ratio does not necessarily mean that patients are free from pancreatitis, as lower values for either amylase or lipase could be due to other conditions unrelated to pancreatitis.

How the Amylase/Lipase Ratio Test Is Done:

• After fasting for 12 hours, the patient will consume a solution including water and juice with a small amount of radioactive glucose.
• Next, they will get an intravenous injection to eliminate any excess pancreatic fluid before taking blood tests in one-hour intervals over three hours.
• To gain more precise results, amylase and lipase levels are measured in the blood sample taken at four hours.

Possible Results of Amylase/Lipase Ratio Test

• The amylase/lipase ratio is calculated by dividing the lipase concentration (in mU/L) by that of amylase (mU/dL).
• A standard ratio should be below one for those suffering from acute pancreatitis, and those on corticosteroids typically have a ratio of less than two.

Nursing Diagnose of Pancreatitis using an X-ray.

An X-ray is usually performed to get an overview of the pancreas and detect any possible blockages in the bile duct and duodenum. The results can reveal any abnormalities and if the pancreas is enlarged or inflamed. It also diagnoses cysts, stones, and tumors contributing to pancreatitis.

How X-rays Are Done

The patient will be asked to stand in front of an X-ray machine, and multiple images of the abdomen will be taken. The radiologist will then review the pictures for any signs of abnormalities or blockages. A computed tomography (CT) scan may be ordered if more detailed imaging is needed.

Possible Results of an X-ray

An X-ray can reveal any blockages or abnormalities in the pancreas, as well as any cysts, stones, or tumors that may be present. It can also help to identify whether there is inflammation and if the pancreas is enlarged.

Nursing Diagnosis of Pancreatitis using A CT scan or MRI (Magnetic Resonance Imaging)

A CT scan or MRI (Magnetic Resonance Imaging) is used to obtain more detailed images of the pancreas. It can reveal any blockages in the bile ducts, the presence of tumors, and other abnormalities not seen on an X-ray. A CT scan or MRI may be ordered if more information is needed regarding the severity of pancreatitis.

How CT Scan or MRI Is Done:

The patient will lie on a table and be inserted into a tunnel-like tube for imaging purposes. The table will move during the procedure as multiple images are taken from different angles.

For an MRI, they will be asked to remain still while strong magnets rotate around them to create detailed images of their abdomen organs.

Possible Results of a CT Scan or MRI

A CT scan or MRI can reveal any blockages in the bile ducts and detect the presence of tumors, cysts, stones, abscesses, and other abnormalities not seen on an X-ray. It is also used to assess for any signs of inflammation and if the pancreas is enlarged. A CT scan or MRI may be ordered if more information is needed regarding the severity of pancreatitis. It can help identify areas requiring further treatment, such as drainage procedures or surgery.

Nursing Diagnosis Of Pancreatitis Using Endoscopic Retrograde Cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) is used to diagnose and treat both biliary and pancreatic diseases. The procedure uses a flexible endoscope inserted through the mouth, down into the stomach and duodenum, and then further advanced into the bile ducts.

How Endoscopic Retrograde Cholangiopancreatography (ERCP) Is Done: 

• Endoscopy requires the insertion of an endoscope, which is a tool with a light and camera attached. It is placed in the mouth and throat to inspect digestive tract sections.
• For this procedure, patients may need either general anesthesia (sedation) or local anesthesia if they are awake and feeling pain.

Possible Results of an ERCP

• An endoscopy may detect any bleeding or ulcers in the pancreas.
• It can also ascertain whether gallstones block bile’s passage from the liver to the intestines.

Nursing Diagnose of pancreatitis using Biopsy

A biopsy is a procedure used to take a tissue sample from the pancreas for testing under a microscope. It can help diagnose pancreatic inflammation, infection, or cancer. A small tissue sample will be removed using a needle and sent to a laboratory for analysis.

How Biopsy Is Done

A small pancreas sample can be taken during an endoscopy, CT scan, or MRI.

Possible Results of a Biopsy

Lab analysis will help to determine if any lasting damage has been caused by pancreatitis, as well as the severity of inflammation when the Biopsy was taken. If it is suspected that cancer may be present, surgical removal of the tumor or cells can be done for further examination and diagnosis.

Diagnoses of Pancreatitis through Taking History

Taking a complete medical history is essential in diagnosing pancreatitis. 

Before their diagnosis, Nurses should be asked essential questions like recent illnesses, medication use, and family history of pancreatic disease. They get an idea of the patient’s overall health status before diagnosis. This can help to identify any underlying causes that may have triggered the development of the condition.

Questions to Ask During History Taking:

• What symptoms are you having?
• Do you take any medications or supplements?
• Have you had any recent infections or illnesses?
• Do you have a family history of pancreatic disease or cancer?
• Has anyone in your family been diagnosed with diabetes?
• Do you drink alcohol regularly? If so, how much?
• Do you have any allergies or food sensitivities?

Nursing Care Plans Related to Pancreatitis

Acute Pain Care Plan

1. Assess the patient’s pain level and location using a 0-10 scale (0 being no pain, 10 being worst possible).
2. Administer prescribed analgesics to control the patient’s pain.
3. Monitor vital signs to assess for any changes in heart rate or blood pressure related to the pain.
4. Provide comfort measures such as applying a heating pad or ice pack to the affected area as needed.
5. Encourage the patient to use deep-breathing exercises and relaxation techniques for pain control.
6. Reassure the patient that their pain can be managed effectively with medication and other interventions.

Nutrition Care Plan

1. Assess the patient’s nutritional status by obtaining a diet history and intake.
2. Provide education on proper diet and nutrition for pancreatitis to help manage symptoms.
3. Encourage the patient to increase their daily fluid intake to 2-3 liters to prevent dehydration.
4. Suggest avoiding fatty and fried foods, caffeine, and alcohol.
5. Recommend consuming small, frequent meals throughout the day instead of three large meals to reduce symptoms of abdominal discomfort.
6. Suggest increasing fiber intake through fruits, vegetables, and whole grains to help aid digestion.
7. Monitor weight weekly to ensure proper caloric needs are met.
8. Provide emotional support and counseling for any anxiety or depression related to changes in eating habits from pancreatitis diagnosis.

Prevention Care Plan

1. Educate the patient about lifestyle modifications that can help prevent flare-ups of pancreatitis, such as maintaining a healthy diet, quitting smoking, limiting alcohol consumption, and avoiding certain medications.
2. Provide the patient with resources to help manage stress, as stress can often trigger pancreatitis attacks.
3. Suggest regular exercise to improve overall health and reduce risks of reoccurring pancreatitis.
4. Advise patients on the importance of follow-up care with their primary healthcare provider to monitor for any changes or progression in symptoms.
5. Encourage patients to seek immediate medical attention if they experience any new or worsening symptoms of pancreatitis like abdominal pain, nausea, vomiting, fever, etc.

Final Words

Acute pancreatitis is a painful and potentially life-threatening condition with many potential causes. Nursing interventions for patients with this condition are essential in managing their symptoms and preventing further complications. 

Nurses should assess the patient’s physical and nutritional status, provide pain management, replace fluids when necessary, monitor for associated complications, and educate the patient on lifestyle modifications that can help reduce their risk of developing the condition again. 

By following these protocols, nurses can ensure their patients receive optimal care for this debilitating condition.