CASE STUDY

“ACUTE PANCREATITIS”

By: Alagar, Mariana Mikaela Danielle

BSN 3A/ Grp 1

Submitted to: Mrs. Ma. Cecilia I. Vico

CASE SCENARIO:

Mrs. C is a 38-year-old Hispanic female admitted to the intensive care unit from the

emergency department (ED) in hypovolemic shock. Mrs. C was initially diaphoretic,

unresponsive, and pale with a blood pressure of 70 systolic. After fluid resuscitation in

the ED, his blood pressure increased to 90 systolic and responsiveness was restored.

Mrs. C is a migrant worker from Mexico who speaks limited English and is married with

four children. All family members live in Mexico, except her uncle. Mrs. C’s uncle

verbalizes that her niece has been complaining of severe abdominal pain for the past

few days, with frequent episodes of nausea and vomiting.

Mrs. C is in a fetal position, complaining of nausea and intolerable knifelike abdominal

pain, radiating to his back. A physical examination reveals that Mrs. C is restless, obeys

commands, and moves all extremities. Capillary refill greater than 3 seconds, peripheral

pulses are 1+, abdomen is distended and tenderness and guarding, hypoactive bowel

sounds, and tympany are noted. Trousseau’s sign (carpopedal spasm with inflation of

blood pressure cuff) and Chvostek’s sign (muscle spasm of the face with tap on facial

nerve) are present. Skin is cool, pale, and dry. Mr. C’s vital signs include blood pressure

of 92/68 mm Hg, pulse of 122 beats/min that is thready and weak, respiratory rate of 26

breaths/min, temperature of 100.8° F. IV fluids are Ringer solution at 200 mL/hr and

Foley catheter draining amber urine at 20 mL/hr.

 DIAGNOSTIC AND LABORATORY EXAMINATION

Complete Blood Count

Examination Result Normal Value Analysis
WBC 19,600 units/L 4,500 – 11,000 Indicates
units/ L inflammation
associated with
pancreatitis
Hematocrit 48.3% 38.3 – 48.6% Normal
Hemoglobin 11.6 g/dL 13.5 – 17.5 g/dL Due to low RBC,
hemoglobin count
also decrease
RBC 4.12 x 1012/L (L) 4.50 - 5.50 x The pancreatitis
10^12/L can cause anemia
(L)

BASIC METABOLIC PANEL

Examination Result Normal Value Analysis
Blood Urea 18 mg/dL 7-20 mg/dL Normal
Nitrogen
Creatinine 1.2 mg/dL 0.7-1.3 mg/dL Normal
Amylase 280 Somogyi 60 – 120 Somogyi A sign of acute
units/mL units pancreatitis
Lipase 71 u/L 7 - 60 u/L A sign of acute
pancreatitis
Sodium 140 mEq/L 135-145 mEq/L Normal
Potassium 2.9 mEq/L 3.5 - 5.5 mEq/L Due to dehydration
of the patient
Calcium 5.8 mg/dL 8.6 - 10.3 mg/dL Patient is (+)
Chvostek’s sign &
Trousseau’s sign
Albumin 2.8 g/dL 3.4 - 5.4 g/dL Due to presence of
inflammatory in
pancreas
Magnesium 0.9 mg/dL 1.7 – 2.2 mg/dL Due to dehydration
of the patient
Lactate 3 mmol/L 0.5 - 1 mmol/L Indicator of shock
state of the patient
 ACTUAL NURSING CARE PLAN

ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Subjective: Fluid volume deficit After 2 hours of • Measure I&O • Indicators of Short – term:
• The patient’s and impaired tissue nursing including vomiting, replacement Goal was partially
uncle verbalized perfusion with intervention the gastric aspirate, needs and met, patient was able
that the patient pancreatitis due to patient will be able diarrhea. Calculate effectiveness of to maintain stable
has been massive fluid loss to: 24-hr fluid balance. therapy. vital signs but still
complaining of and hypovolemia • Patient will • Record color and feels nauseous.
severe abdominal that occurs with maintain fluid character of gastric • Risk of gastric
pain for the past nausea and volume at a drainage, measure bleeding and
few days. vomiting. functional level pH, and note hemorrhage is Long – term:
• Has frequent as evidenced presence of occult high. Goal was met, patient
episodes of by individually blood. was able to maintain
nausea and adequate • Note poor skin adequate hydration,
urinary output, • Further good skin turgor, etc.
vomiting turgor, dry skin and
stable vital physiological and verbalized ways
mucous
Objective: signs.
• BP: 92/ 68 membranes, reports indicators of on how to change
• Pulse Rate: 112 After 2 days of of thirst. dehydration. lifestyle.
bpm, weak nursing • Watch out for signs
• RR: 26 bpm intervention the and symptoms of
• (+) diaphoretic patient will be able calcium deficiency. • Symptoms of
• (+) pale to: Observe and report calcium

• (+) capillary refill • Maintain coarse muscle imbalance.

greater than 3 adequate tremors, twitching, Calcium binds

seconds hydration as positive Chvostek’s, with free fats in

evidenced by Trousseau’s sign, the intestine and
stable vital tetany, cramps, is lost by excretion
signs, good carpopedal spasm, in the stool.
skin turgor, and seizures.
prompt • Administer fluid
capillary refill, replacement as
strong indicated (saline
peripheral solutions, albumin,
pulses, and blood, blood
demonstrate products, dextran).
behaviors, • Choice of
lifestyle replacement
changes to solution may be
regain and/ or less important
maintain than rapidity and
appropriate adequacy of
weight. volume
restoration. Saline
solutions and
albumin may be
used to promote
mobilization of
fluid back into
vascular space.
• Replace • Decreased oral
electrolytes (sodium, intake and
potassium, chloride, excessive losses
calcium as greatly affect
indicated). electrolyte and
acid-base
balance, which is
necessary to
maintain optimal
cellular and organ
function.
 DRUG STUDY

Drug Dosage and Mechanism of Side Effects Contraindications Nursing Responsibilities

Indication Action
Generic Name: Dosage: Centrally acting The common side Hypersensitivity to Assessment & Drug Effects
Tramadol PO 50–100 mg q4– opiate receptor effects of tramadol tramadol or other • Assess for level of pain relief
Hydrochloride 6h prn agonist that inhibits can include: opioid analgesics; and administer prn dose as
the uptake of • dizziness patients on MAO needed but not to exceed the
Brand Name: Indication: norepinephrine and • headache inhibitors; patients recommended total daily dose.
Ultram, Zydol Effective agent for serotonin, • drowsiness acutely intoxicated • Monitor vital signs and assess
control of moderate suggesting both • nausea and with alcohol, for orthostatic hypotension or
Classification: to moderately opioid and nonopioid vomiting hypnotics, centrally signs of CNS depression.
Central severe pain. mechanisms of pain • constipation acting analgesics, • Discontinue drug and notify
Nervous relief. May produce • lack of energy opioids, or physician if S&S of
System opioid-like effects, • sweating psychotropic hypersensitivity occur.
Agent; but causes less • dry mouth drugs; substance • Assess bowel and bladder
Analgesic; respiratory abuse; patients on function; report urinary
Narcotic depression than obstetric frequency or retention.
morphine. preoperative
(Opiate) medication; abrupt • Use seizure precautions for
Antagonist discontinuation; patients who have a history of
alcohol seizures or who are
intoxication; concurrently using drugs that
pregnancy lower the seizure threshold.
(category C); • Monitor ambulation and take
lactation; children appropriate safety
<16 y. precautions.

Patient & Family Education

• Exercise caution with
potentially hazardous activities
until response to drug is
known.
• Understand potential adverse
effects and report problems
with bowel and bladder
function, CNS impairment, and
 any other bothersome adverse
effects to physician.
• Do not breast feed while taking
this drug.

Drug Dosage and Mechanism of Side Effects Contraindications Nursing Responsibilities

Indication Action
Generic Name: Dosage: Nonsystemic Common side effects or Prolonged use of Assessment & Drug Effects
Aluminum PO 600 mg t.i.d. antacid with health problems may high doses in • Note number and
Hydroxide or q.i.d. moderate include: presence of low consistency of stools.
neutralizing action. • Nausea serum phosphate; Constipation is common
Brand Name: Indication: Decreases rate of • Vomiting pregnancy and dose related. Intestinal
Amphojel Reduces gastric gastric emptying • Rebound (category C). obstruction from fecal
acidity by and has demulcent, hyperacidity concretions has been
Classification: neutralizing the adsorbent, and • Aluminum- reported.
Gastrointestinal stomach acid mild astringent intoxication • Lab tests: Monitor periodic
agent; Antacid; content. properties. serum calcium and
Adsorbent Aluminum Reduces acid phosphorus levels with
carbonate lowers concentration and • Low blood prolonged high-dose
serum phosphate pepsin activity by phosphates therapy or impaired renal
by binding dietary raising pH of (hypophosphatemia) function.
phosphate to form gastric and • Chalky taste
insoluble intraesophageal • Constipation (this Patient & Family Education
aluminum secretions. could lead to • Increase phosphorus in diet
phosphate, which hemorrhoids or when taking large doses of
is excreted in bowel obstruction) these antacids for
feces. • Fecal impaction prolonged periods;

• Stomach cramps hypophosphatemia can

• Milk-alkali syndrome develop within 2 wk of

• Softening of the continuous use of these

bones antacids. The older adult in

a poor nutritional state is at
high risk.
• Note: Antacid may cause
stools to appear speckled
or whitish.
• Report epigastric or
abdominal pain; it is a
clinical guide for adjusting
dosage. Keep physician
informed. Pain that persists
beyond 72 h may signify
serious complications.
• Seek medical help if
indigestion is accompanied
by shortness of breath,
sweating, or chest pain, if
stools are dark or tarry, or if
symptoms are recurrent
when taking this
medication.
• Seek medical advice and
supervision if self-
prescribed antacid use
exceeds 2 wk.
 Drug Dosage and Mechanism of Side Effects Contraindications Nursing Responsibilities
Indication Action
Generic Name: Dosage: Has high selectivity Common side Known Assessment & Drug Effects
Cimetidine PO 300 mg for histamine H2- effects of hypersensitivity to • Ulcer healing may occur
q.i.d. or 400 mg receptors on cimetidine include: cimetidine or other within the first 2 wk of therapy
Brand Name: b.i.d. or 800 mg parietal cells of the • headache H2 receptor but generally requires at least
Tagamet h.s. stomach and is an • dizziness antagonists; 4 wk in most patients. Short-
IM/IV 300 mg q6–8h H2-receptor • sleepiness lactation, term (i.e., 8 wk) therapy of
Classification: antagonist. By • enlarged pregnancy active duodenal ulcer does
Gastrointestinal Indication: inhibition of breasts in men (category B). not prevent ulcer recurrence
agent; Blocks the H2- histamine at the H2- • confusion when drug is discontinued.
Antisecretory receptors on the receptor sites, it (elderly) • Monitor pulse of patient during
(H2-receptor parietal cells of the suppresses all • impotence first few days of drug regimen.
antagonist) stomach, thus phases of daytime • diarrhea Bradycardia after PO as well
decreasing gastric and nocturnal basal • nausea as IV administration should be
acid secretion, gastric acid • vomiting reported. Pulse usually
raises the pH of the secretion in the returns to normal within 24 h
stomach and, stomach. Indirectly after drug discontinuation.
thereby, reduces reduces pepsin • Monitor I&O ratio and pattern:
pepsin secretion. secretion; it is not a Particularly in the older adult,
cholinergic. Has no severely ill, and in patients
effect on lower with impaired renal function.
esophageal • Report loss of bowel sounds,
sphincter pressure, absence of bowel movement
gastric motility or or flatus, vomiting, crampy
emptying. pain, abdominal distention.
Adynamic ileus has been
reported in patients receiving
cimetidine to prevent and treat
stress ulcers.
• Lab tests: Periodic
evaluations of blood count
and renal and hepatic function
are advised during therapy.
• Be alert to onset of
confusional states,
particularly in the older adult
 or severely ill patient.
Symptoms occur within 2–3 d
after first dose. Report
immediately: drug should be
withdrawn. Symptoms usually
resolve within 3–4 d after
therapy is discontinued.
• Check BP and report an
elevation to the physician, if
patient complains of severe
headache.
• Cimetidine impairs absorption
of protein-bound vitamin B12;
therefore patient who takes
cimetidine in divided doses to
continuously suppress acid
gastric secretion is at risk for
vitamin B12 deficiency (no risk
for patient who takes drug at
 bedtime to suppress nocturnal
acid production).

Patient & Family Education

• Cimetidine must be taken
exactly as prescribed. Sudden
discontinuation of therapy
reportedly has caused
perforation of chronic peptic
ulcer.
• Seek advice about self-
medication with any OTC
drug.
• Report breast tenderness or
enlargement. Mild bilateral
gynecomastia and breast
soreness may occur after 1
mo of therapy. It may
 disappear spontaneously or
remain throughout therapy.
• Report recurrence of gastric
pain or bleeding (black, tarry
stools or "coffee ground"
vomitus) immediately, and
notify physician if diarrhea
continues more than 1 d.
• Avoid driving and other
potentially hazardous
activities until reaction to drug
is known.
• Duodenal or gastric ulcer is a
chronic, recurrent condition
that requires long-term
maintenance drug therapy.
• Maintenance therapy at
reduced dosage after healing
of active duodenal ulcer
 appears to limit recurrence,
particularly if patient
undertakes other antiulcer
therapeutic measures: no
smoking, life-style that
promotes reduced stress.
• Do not breast feed while
taking this drug.
REFERENCES:
• https://www.rxlist.com/consumer_cimetidine_tagamet/drugs-
condition.htm#what_are_side_effects_associated_with_using_cimetidine
• https://www.rxlist.com/consumer_aluminum_hydroxide_alternagel/drugs-
condition.htm#what_are_side_effects_associated_with_using_aluminum_hydroxi
de_alternagel
• https://www.healthline.com/health/tramadol-oral-tablet#side-effects
• https://emedicine.medscape.com/article/181364-medication#1
• https://nurseslabs.com/5-pancreatitis-nursing-care-plans/
• http://www.robholland.com/Nursing/Drug_Guide/
• https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-
notes/pancreatitis-nursing-care-plans/