{ "name": "Pancreatitis", "slug": "pancreatitis", "url": "https://nursingplex.com/care-plans/pancreatitis", "category": "Gastrointestinal", "summary": "Pancreatic inflammation; NPO rest, severe pain control and fluid resuscitation.", "nursing_diagnoses": [ "Acute pain", "Deficient fluid volume", "Imbalanced nutrition", "Risk for infection" ], "overview": [ "Pancreatitis is inflammation of the pancreas caused by premature activation of its own digestive enzymes, so the gland begins to autodigest. Gallstones obstructing the ampulla and chronic alcohol use account for most cases; others follow hypertriglyceridemia, hypercalcemia, trauma, ERCP, certain drugs, infection or abdominal surgery. Released trypsin, elastase and lipase digest pancreatic tissue and blood vessels, producing edema, hemorrhage and, in severe disease, necrosis.", "Acute pancreatitis presents with sudden severe epigastric or left upper quadrant pain that bores through to the back, worsens after eating and when lying flat, and eases somewhat with the knees drawn up in a fetal or leaning-forward position. Nausea and persistent vomiting that does not relieve the pain are typical. Severe hemorrhagic disease may show Cullen's sign, periumbilical bruising, or Grey Turner's sign, flank bruising.", "The systemic danger is fluid loss. Massive third spacing into the retroperitoneum causes hypovolemic shock, and enzyme release triggers a systemic inflammatory response with acute respiratory distress syndrome, acute kidney injury, DIC and pancreatic pseudocyst or abscess. Hypocalcemia develops as calcium is consumed by fat necrosis and is a marker of severity. Chronic pancreatitis instead produces persistent pain, malabsorption with steatorrhea, weight loss and eventually diabetes as islet cells are destroyed." ], "key_facts": [ { "label": "Diagnostic labs", "text": "Serum lipase is the more specific marker and stays elevated longer; amylase rises early and falls within a few days." }, { "label": "Pain position", "text": "Knees flexed toward the chest, sitting up and leaning forward, or a side-lying fetal position reduces pancreatic capsule tension." }, { "label": "Rest the pancreas", "text": "NPO initially with IV fluids; nasogastric suction if vomiting or ileus is present. Early enteral feeding beyond the ligament of Treitz is preferred over prolonged starvation once tolerated." }, { "label": "Hypocalcemia", "text": "Check Chvostek's and Trousseau's signs; tetany, numbness around the mouth and carpopedal spasm signal severity and need prompt replacement." }, { "label": "Chronic disease", "text": "Pancreatic enzyme replacement is taken with every meal and snack; monitor for steatorrhea, fat-soluble vitamin deficiency and new diabetes." } ], "nursing_priorities": [ "Relieve severe pain and reduce pancreatic stimulation.", "Restore and maintain circulating volume against massive third spacing.", "Monitor for and treat systemic complications — shock, ARDS, renal failure, hypocalcemia.", "Maintain nutrition without provoking enzyme secretion.", "Prevent infection of necrotic tissue.", "Eliminate the cause: alcohol cessation, gallstone management, triglyceride control." ], "assessment": { "subjective": [ "Severe, steady, boring epigastric pain radiating to the back or left shoulder", "Pain worsened by eating, drinking alcohol and lying supine; eased by leaning forward", "Persistent nausea and vomiting that does not relieve pain", "Anorexia, bloating, weight loss and fatty, foul-smelling stools in chronic disease", "Anxiety, restlessness or a sense of doom" ], "objective": [ "Elevated serum lipase and amylase; elevated glucose, WBC, bilirubin and liver enzymes", "Low serum calcium and magnesium; low albumin; elevated triglycerides in some cases", "Tachycardia, hypotension, cool clammy skin and low urine output from third spacing", "Fever, abdominal distention, guarding, rebound tenderness and absent bowel sounds", "Cullen's sign (periumbilical ecchymosis) or Grey Turner's sign (flank ecchymosis)", "Shallow, splinted respirations; crackles, hypoxemia or pleural effusion", "Jaundice when the biliary tract is obstructed", "Steatorrhea, weight loss and hyperglycemia in chronic pancreatitis", "Positive Chvostek's or Trousseau's sign with hypocalcemia" ], "related_factors": [ "Autodigestion of pancreatic tissue by prematurely activated enzymes", "Peritoneal and retroperitoneal inflammation with capsule distention", "Massive fluid shift into the retroperitoneal space and peritoneal cavity", "Persistent vomiting, nasogastric suction and NPO status", "Impaired enzyme delivery causing fat malabsorption", "Alcohol use, biliary obstruction, hypertriglyceridemia or hypercalcemia" ] }, "goals": [ "The patient reports pain at or below the agreed acceptable level within the ordered timeframe.", "Blood pressure, heart rate and urine output stay within target with no signs of shock.", "Serum calcium, glucose and electrolytes return toward normal ranges.", "The patient tolerates the prescribed diet progression without pain recurrence.", "No infection of pancreatic necrosis or pseudocyst develops.", "The patient verbalizes complete alcohol abstinence and a plan for follow-up." ], "interventions": [ { "title": "Relieve pain and rest the pancreas", "points": [ "Assess pain frequently and give the ordered opioid analgesia promptly and on a schedule during the acute phase rather than waiting for severe pain.", "Position the patient side-lying with knees flexed or sitting forward over a pillow to reduce capsule tension.", "Maintain NPO status as ordered and keep the nasogastric tube patent and to the prescribed suction when ileus or vomiting is present, with frequent mouth and nostril care.", "Eliminate the sight and smell of food from the room, since both stimulate pancreatic secretion.", "Provide a calm environment, and combine analgesia with repositioning and relaxation techniques." ] }, { "title": "Restore fluid volume and monitor perfusion", "points": [ "Infuse aggressive isotonic crystalloid as ordered — third spacing can sequester liters, so hypotension appears despite total body fluid excess.", "Track hourly urine output, vital signs, capillary refill, mentation and daily weight; report output under 0.5 mL/kg/hr.", "Maintain accurate intake and output including all nasogastric and emesis losses.", "Follow hematocrit, BUN and creatinine as resuscitation markers, and watch for signs of hemorrhage or DIC.", "Give blood products, albumin or electrolyte replacement as ordered." ] }, { "title": "Monitor for systemic complications", "points": [ "Assess respiratory rate, effort, breath sounds and oxygen saturation at least every four hours; ARDS and effusion are common in severe disease.", "Encourage incentive spirometry, deep breathing and semi-Fowler's positioning to counter splinting and atelectasis.", "Check calcium and magnesium and assess for tetany, perioral numbness and positive Chvostek's or Trousseau's signs; keep seizure precautions for severe hypocalcemia.", "Monitor glucose closely and give insulin as ordered — islet dysfunction is common even in acute disease.", "Report increasing abdominal girth, a palpable mass, persistent fever or rising white count, which suggest pseudocyst, abscess or infected necrosis." ] }, { "title": "Restore nutrition safely", "points": [ "Advance the diet only as ordered: clear liquids, then a low-fat, small-frequent-meal, high-carbohydrate plan; stop and report any pain that returns with eating.", "Support early enteral jejunal feeding when ordered — it protects gut integrity and lowers infection risk compared with prolonged parenteral nutrition.", "Manage total parenteral nutrition with strict aseptic line care and close glucose monitoring when the gut cannot be used.", "Withhold caffeine, spicy foods and, absolutely, alcohol.", "For chronic pancreatitis, give pancreatic enzyme replacement with every meal and snack, do not crush enteric-coated preparations, and supplement fat-soluble vitamins." ] }, { "title": "Prevent infection and support recovery", "points": [ "Use strict aseptic technique for all lines and drains, and give antibiotics as ordered for confirmed infected necrosis.", "Monitor temperature trends and inspect all invasive sites each shift.", "Assist with early mobilization once stable to reduce pneumonia and thromboembolism.", "Provide meticulous skin care around drains, where enzyme-rich drainage rapidly excoriates skin." ] }, { "title": "Address the underlying cause", "points": [ "Discuss alcohol use directly, explain that abstinence is the only way to prevent recurrence and further gland destruction, and monitor for withdrawal.", "Refer to addiction counseling and support programs, and involve family with the patient's consent.", "Prepare the patient for cholecystectomy or ERCP when gallstones are the cause.", "Teach a low-fat diet and triglyceride-lowering plan when hypertriglyceridemia is implicated." ] } ], "patient_teaching": [ "Stop drinking alcohol completely — even small amounts can trigger another attack.", "Eat small, frequent, low-fat, high-carbohydrate meals and avoid caffeine and heavy spices.", "Take pancreatic enzymes with every meal and snack if prescribed, and swallow them whole.", "Watch for and report fatty, floating, foul-smelling stools and unintended weight loss.", "Check your blood sugar as instructed; pancreatitis can lead to diabetes.", "Call your provider for pain that returns with eating, fever, persistent vomiting or increasing abdominal swelling.", "Keep follow-up appointments and imaging to check for a pseudocyst.", "Avoid smoking, which speeds pancreatic damage." ] }