1. Nursing Process Acute Pancreatitis

2. Assessment
History focussed on abdominal pain and discomfort, alcohol consumption
Gallstone colic
Anyother gastrointestinal problems
Respiratory status
Emotional and psychological status of the patient and his relatives

3. Nursing diagnoses
Include pain related to inflammation, oedema, distention of the pancreas, and peritoneal irritation
Ineffective breathing pattern related to severe pain pulmonary infiltrates, pleural effusion, and atelectasis
Altered nutrtional status
Impaired skin integrity related to poor nutritional status, bed rest, and multiple drains and surgical wound

4. Collaberative problems / potential complications
Fluid and electrolyte disturbances
Necrosis of the pancreas
Shock and multiple organ dysfuntion
Planning and goals:
Relief of pain and discomfort
Improved respiratory function, improved nutritional status maintenance of skin integrity
Absence of complications

5. Nursing interventions
Relieving pain and discomfort – Meperidine
Relieve abdominal distention
Bed rest
Oral feeding withheld
Oral hygiene
Relieve dryness of the mouth
Nasogastric suction
Parenteral fluids
Electrolytes
Fluid balance
If there is no pain relief suspect haemorrhage in the pancreas

6. Improving breath pattern
Semi-Fowler’s position
Frequent changes of postion to prevent atelectasis and pooling of respiratory secretions
Pulmonary assessment and monitoring of pulse oximetry or arterial blood gases
Patient is instructed in techniques of coughing and deep breathing to improve respiratory function and ecouraged and assisted to cough and deep breathe every 2 hours

7. Improving nutritional status
TPN
After acute syptoms subside, oral feedings are reintroduced gradually
Between acute attacks, the patient receives a diet high in carbohydrates and low in fat and proteins . Heavy meals are avoided, as are alcoholic beverages

8. Improving skin integrity
Skin breakdown likely
Pressure sores – guarded against
Drainage sites – protected
Use of special beds

9. Monitoring and managing potential complications
Abdominal girth assessed, skin turgor monitored
Be ready to combat circulatory collapse
Low levels of serum calcium and magnesium levels may occur and require prompt treatment.
Watch for early signs of neurologic dysfunction
cardiovascular, renal, and respiratory dysfunction
Keep the patient’s family informed and they must be allowed to spend some time with the patient.

10. Promoting home and community-based care
Repeat and reinforce the instructions given to the patient while he was acutely ill.
Instruct the family to recognize any complication or adverse situation and report promptly to the physician.

11. Continuing care Referral for home care is often indicated
This enables the nurse to assess the patient’s physical and psychological status and compliance with the therapeutic regimen.
Assess the home situation
Reinforce instructions about fluid and nutrition intake and avoidance of alcohol
Refer to alcoholics anonymous if needed

12. Fowler’s and semifowler’s positions

13. Back to slide 6