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798 UNIT EIGHT Understanding the Gastrointestinal, Hepatic, and Pancreatic Systems

NURSING CARE PLAN for the Patient With Acute and Chronic
Pancreatitis—cont’d

Intervention Administer analgesics as ordered, before pain becomes severe. Rationale Analgesics are most
effective if given before pain becomes too great. Evaluation Are analgesics effective?

Intervention Assist the patient to a position of comfort, usually high Fowler’s or leaning forward slightly.
Rationale An upright position keeps abdominal organs from pressing against the inflamed pancreas.
Evaluation Does positioning promote comfort?

Intervention Keep the environment free from excessive stimuli. Rationale Quiet, restful, anxiety-free
atmosphere permits the patient to relax and may decrease pain perception. Evaluation Does patient state
atmosphere is relaxing?

Intervention Teach the patient alternative pain control strategies such as guided imagery and relaxation
techniques. Rationale Successful use of pain control strategies may decrease the amount of analgesics needed
and give the patient a greater sense of control. Evaluation Are alternative strategies effective?

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to pain, anorexia, and
treatment

Expected Outcome: The patient will experience improved nutrition as evidenced by stable weight and serum
albumin level greater than 3.5 g/L.

Evaluation of Outcome: Is weight stable? Is serum albumin level greater than 3.5 g/L?

Intervention Assess the patient’s nutritional status by: • Weighing the patient every other day. Rationale A loss
of 1 lb of body weight occurs when the body uses 3500 calories more than is taken in. Evaluation Has patient
lost less than 5% of total baseline body weight?

Intervention • Monitoring serum albumin levels as ordered. Rationale Serum albumin of 3.5–5.5 g/L indicates
normal protein metabolism in the absence of liver or renal disease. Evaluation Is patient’s albumin level above
3.5 g/dL?

Intervention • Observing for nausea or vomiting. Rationale Nausea, vomiting, and pain are risk factors for
inadequate intake. Evaluation Does nausea need to be treated to prevent vomiting? Is intake adequate?

Intervention • Monitoring blood sugar at least every 6 hr if the patient is on parenteral nutrition. Rationale
Patients on parenteral nutrition are more likely to have high blood glucose. Evaluation Is blood sugar
normal?

Intervention • Observing for diarrhea, bloating, or steatorrhea (fatty stools). Report steatorrhea immediately.
Rationale Diarrhea, bloating, or fatty stools may indicate malabsorption syndrome. Steatorrhea (fatty stools)
may indicate that the enzyme replacement doses are not meeting the patient’s needs. Evaluation Are stools
normal?

Intervention Administer nutritional supplements, including pancreatic enzymes, as ordered. Rationale Provides
adequate nutrition. Evaluation Does patient take any supplements?

Intervention Teach the patient to avoid alcohol. Rationale Alcohol may trigger another episode of pancreatitis.
Evaluation Does patient verbalize understanding of importance of avoiding alcohol? Is follow-up support for
alcohol avoidance provided?

Intervention Teach the patient and family the signs and symptoms of diabetes mellitus. Rationale Patients
with pancreatitis are at great risk for developing diabetes mellitus. Evaluation Does patient verbalize signs
and symptoms of diabetes to report?