Question

  PANCREATITIS,

A 44 year old male patient has been admitted to the medical surgical unit of the hospital for after seeking treatment for nausea, vomiting, and intense pain in the right upper quadrant the evening before and waited for a few hours before seeking treatment. He has a history of substance abuse and has been in rehabilitation for both alcoho and methamphetamines, despite previous.

Following diagnosis and continued administration of the pain medication, the patient still complaing of pain. the nurse notes several areas of petechiae on his abdomen, particularly in the right upper quadrant.While once complainning vocally about the pain, the patient now is more quiet, lethergic, grimacing, and guarding the abdomen. His vital signs are: Hr 102bpm, RR22/mm,BP 94/68mmHg: Tempreture 101. the nurse cantact the physician, who leaves orders for blood pressure support medication, supplemental oxygen, and antibiotics. the patient is transfer to icu for further care.

Nursing care plan on PANCREATITIS,

nursing diagnosis

Nursing Interventions/ rational

Planning goal

1. What types of diagnostic tests would most likly be ordered that could determine the cause of this type of abdominal pain.

2. What effecs would the patient history of drug and alcohol abuse have on his abdominal pain.

3.Why is pain control such an important component of management of acute pancreatitis.

4. Based on the diagnosis of acute pancreatitis, What changes in the laboratory values would the nurse expect to see in this patient.

5. What types of complications do the patient's signs and symptoms indicate.

6. In addition to contacting the physician, how should the nurse intervene in this situation.

what is the risk factor and etiology.

Answer 1

the patient has been diagnosed to have pancreatitis that is severe pancreatitis.

Nursing care plan

Nursing diagnosis	Goal	intervention	Rational e
1.acute pain related to edema and inflammation of pancreas as evidenced by grimace face	His pain is relieved	. assess the severity of the pain .advise him bed rest .provide comfortable position and ask him to knee flex ,and lean forward Provide relaxation therapy like music Ensure the environment free from food smells . Administer analgesic	It helps to provide better care It helps decrease metabolic demands and reduce the secretion of enzymes by avoiding Gastrointestinal stimulation It helps to relieve abdominal pressure It helps to divert his mind Food smells increase gastric stimulation and that causes increase of pancreatic enzymes To decrease pain
Fluid volume deficit related to vomiting as evidence by the hypotension	His vomiting can be reduced	Assess the fluid status of the patient Monitor intake and output Provide small and frequent fluids Monitor vital signs Administer fluid if necessary	It helps to provide baseline data It helps to asses fluid status of the patient It helps to absorb fluids. Full loaded abdomen causes vomiting It helps to not fluid status Intravenous fluid may compensate fluid deficit
3 increase in body temperature related to infection as evidenced by his body temperature showed 101 F	His body temperature is reduced	Assess the vital signs Do the hand washing in every procedure Provide liquid bland diet Provide tepid sponging Monitor temperature every 4 th hourly Administer antipyretic and antibiotic	It helps to provide base line data It helps reduce cross infection It helps to meet the body demands It helps to decrease temperature by conduction it helps to analysis any change in temperature it helps to decrease temperature and infection
4. imbalanced nutrition less than body requirements related to reduced intake of food and alcohol as result of vomiting, nausea	His nutrition is improved	.assess the nutritional status . help the patient to prefer the type of food and fluid to be consumed . educate to do mouth care .monitor hi s blood glucose Provide nutritional diet which contain ADCK vitamins Assess the weight daily Administer antiemetic	It helps to provide care Because his consumption of food is affected by the alcohol Mouth care enhances to consume food and reduce vomiting His glucose may be elevated in case of pancreatitis Because it may be absent in pancreatitis It helps to assess his nutritional status daily To reduce vomiting
5.fatigue related to increased temperature, poor nutrition, low blood pressure   as evidenced by lethargic experience	His fatigue is relieved	Assess the fatigue level of the patient .provide comfortable position Advice him not to strain in any activity Provide him diet as tolerable Provide supplemental oxygen	It helps to decrease the fatique It helps to relieve tiredness It increase the consumption of energy It helps to meet demands It helps to meet oxygen demands

1. The following diagnostic test can be advised in patient with pancreatitis that is serum amylase and lipase helps to diagnose the pancreatitis and helps to diagnose pain. Liver function test also done to identify the enzyme level of liver. It helps to identify the pain. CT scan and XRAY are done to assess the causes of pain

2. There are 2 reasons for pancreatitis. They are ;Digestive enzymes are released in the pancreas and pancreas are stimulated by the cholecystokinin and that results in the production of pancreatic enzymes

3. Pain in the pancreatitis patient, may be severe continuous pain, sudden onset, deep and tenderness .it is often aggravated by intake of food. Because food stimulates the digestive enzymes in the pancreas, results in pain. The patient assumes various positions to relieve pain. Pain is not relieved even by vomiting. it is important to control pain in pancreatitis

4. The complete blood count is done in which white blood cells are elevated which indicates infection and inflammation of the pancreas. Hematocrit and hemoglobin helps to assess the bleeding tendency Liver function is done in which all enzymes are elevated because of alcoholism. Mostly serum amylase may be elevated within 24 hours and will decline in 48 to 72 hours whereas serum lipase is elevated 48 hours and remain in high for 5to 7 days. Urine glucose and amylase is done to identify leakage of amylase and glucose in urine. Commonly, Serum electrolytes are done in which hypocalcaemia and hyperglycemia can be identified. CT scan and X-ray are done in order to differentiate from other disease. stools test reveals bulky and bad smeeling

5. Hypotension and vomiting, nausea indicates fluid and electrolyte reduction complication. The patient has petechiea in the right upper quadrant that indicates the blood is seeping from the pancreas. Abdominal pain and fever is result from the inflammation of the pancreatitis. tachycardia is result of pain

6. Risk factor and etiology of this pancreatitis is chronic use of alcohol and substance use for this patient. after contacting the physician, nurse the explain the patient need of intensive care unit for him and obtains consent from him. she transfers him to intenisve care unit after informing the intensive care unit staff. she handover all records of the patient to staffs. the patient is transferred to intensive care unit in wheel chair.or structure with fowler psoition because pain is increased in lying position