Nursing care plan pancreatitis

I. Pathophysiology
a. Inflammation of pancreas with premature activation of pancreatic
enzymes resulting in localized damage to the pancreas,
autodigestion, and fibrosis of the pancreas
b. Leads to wide range of metabolic consequences and lifethreatening
complications, such as hypovolemia, shock,
acute renal failure, diabetes, acute respiratory distress syndrome
(ARDS), and multiorgan failure
II. Types
a. Acute
i. Sudden inflammation occurs over a short period of time.
ii. Severity ranges from mild abdominal discomfort to a
life-threatening illness.
iii. Can result in bleeding into the gland, serious tissue
damage, infection, and cyst formation
iv. Release of enzymes and toxins into bloodstream can
damage other vital organs, including the heart, lungs, and
kidneys.
b. Chronic
i. Commonly follows acute episode when inflammation is
ongoing
ii. Development may be delayed, as in alcohol abuse.
III. Etiology
a. Acute
i. Biliary tract disease, such as obstruction by gallstones, is
most common cause—about 40% (Gardner et al, 2008).
ii. Alcohol abuse—approximately 35% (Gardner et al,
2008)
iii. Trauma: blunt or penetrating
iv. Procedures: endoscopic or surgical
v. Viral infections: mumps, mononucleosis, varicella
vi. Bacterial infections: Mycoplasma pneumoniae,
salmonellosis, tuberculosis
vii. Drugs: sulfonamides, glucocorticoids, thiazide diuretics,
nonsteroidal anti-inflammatory drugs (NSAIDs)
viii. Unknown cause—about 10% to 15% of cases
b. Chronic (Obideen & Yashke, 2008)
i. Intraductal obstruction: alcohol abuse, stones, or tumors
ii. Alcohol abuse—about 60% of cases
iii. Direct toxins and toxic metabolites
iv. Recurrent acute pancreatitis that heals with fibrosis
v. Ischemia from obstruction and fibrosis exacerbates or
perpetuates disease, rather than in initiating disease
vi. Autoimmune disorders: primary biliary cirrhosis, renal
tubular acidosis
IV. Statistics
a. Morbidity: An estimated 87,000 individuals are diagnosed
with chronic pancreatitis annually in the United States
(Obideen & Yashke, 2008); more than 220,000 were estimated
to be hospitalized for acute pancreatitis in 2007
(Gardner et al, 2008).
b. Mortality: Rate is less than 1% for mild acute pancreatitis,
but can approach 10% to 30% for severe acute pancreatitis
(Lie, 2007); biliary pancreatitis associated with higher
mortality rate than alcoholic pancreatitis; in presence of
necrosis without organ failure, mortality rate is near zero,
but with organ failure rate is approximately 30%
(Gardner et al, 2008).
c. Cost: More than $2 billion is spent annually in the
United States (Fagenholz, 2007).

Care Setting
The client is treated in an inpatient acute medical unit or
intensive care unit (ICU) for initial incident or exacerbations
with serious complications; otherwise, condition is managed
at the community level.

Related Concerns
Alcohol: acute withdrawal,
Substance dependence/abuse rehabilitation,
Diabetes mellitus/diabetic ketoacidosis,
Peritonitis,
Psychosocial aspects of care,
Renal failure: acute,
Sepsis/septicemia,
Total nutritional support: parenteral/enteral feeding,

Nursing Priorities
1. Control pain and promote comfort.
2. Prevent and treat fluid and electrolyte imbalance.
3. Reduce pancreatic stimulation while maintaining adequate
nutrition.
4. Prevent complications.
5. Provide information about disease process, prognosis,
and treatment needs.

Discharge Goals
1. Pain relieved or controlled.
2. Hemodynamically stable.
3. Complications prevented or minimized.
4. Disease process, prognosis, potential complications, and
therapeutic regimen understood.
5. Plan in place to meet needs after discharge.

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