Case Analysis-Medicine-Pancreatitis

SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE
NCM116 (CARE OF THE CLIENTS WITH PROBLEMS IN NUTRITION & GI, METABOLISM
AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC-RLE)

LUCBAN, QUEZON
CASE ANALYSIS: PANCREATITIS
SUBMITTED BY:
MABAIT, IVAN KARL D.
MENDOZA, MARIA ALESSANDRA A.
BSN3 (GROUP 2)
SUBMITTED TO:
PROF. MARIA ROWENA S. ORACION
MEDICINE 1 – CLINICAL INSTRUCTOR
MARCH 2022
1
OVERVIEW
The pancreas is a long, flat gland located behind the stomach in the upper belly. The
pancreas makes digestive enzymes and hormones that control how your body handles sugar
(glucose). It is formed like a flat pear and is surrounded by the stomach, small intestine, liver,
spleen, and gallbladder. On the right side of the body, the head is located, which refers to the
wide end of the pancreas. The central portions are made up of the neck and body. On the left
side of the body, the tail is placed, where the slender end of the pancreas can be found. Two
critical blood arteries are the superior mesenteric artery and vein, which pass beneath the
pancreas' neck and in front of the uncinate process. The pancreas is an exocrine and
endocrine gland that is responsible for digestion and blood sugar regulation.
In this paper, a discussion regarding a case analysis involving pancreatitis will be
provided. Below are the comprehensive details about the said case.
CASE SCENARIO
A 35-year old man, named Mr. Reyes, visited the hospital for his check-up. He brought
up his chief complaint, which is a boring abdominal pain that radiates to the back or left
shoulder. He also states that there is gnawing continuous abdominal pain with acute
exacerbations. Upon assisting him in the hospital bed, he was seen in a knee-chest position
and exclaims with the pain. The nurse observes that Mr. Reyes was excessively sweating, has
a yellowish colored skin, and shows signs of body malaise and fatigue.
Upon assessment, it was seen that he has an edematous abdomen. His SO claims that
he has sudden weight loss of 10 kilos this month, but seems that his abdomen is still large in
size. When the laboratory results came, it showed the following:
Elevated serum amylase.
Elevated serum lipase.
Elevated white blood cell count (WBC)
Elevated cholesterol.
Elevated glucose due to labile effect on glucose control.
Elevated bilirubin.
CT scan shows inflammation.
Chest x-ray show pleural effusion.
Due to this, the doctor ordered Total Parenteral Nutrition (TPN), Hydrocodone,
Morphine, and Pancreatic Enzymes for his enzyme replacement Therapy.
DEFINITION
Pancreatitis is a condition in which the pancreas becomes inflamed, ranging from
moderate to severe. Acute pancreatitis and chronic pancreatitis are the two kinds of
pancreatitis. Acute pancreatitis is a short-term inflammation of the pancreas, but chronic
pancreatitis is a long-term inflammation of the pancreas that does not improve or goes away,
eventually causing irreversible damage. Over time, chronic pancreatitis impairs a person's
capacity to digest food and create pancreatic hormones.
ETIOLOGY
 Pancreatitis develops when digestive enzymes are activated while still in the
pancreas, irritating and inflaming the pancreatic cells.
 Impairment to the pancreas can occur as a result of repeated acute pancreatitis,
leading to chronic pancreatitis. The pancreas may develop scar tissue, resulting in loss
of function.
 Conditions that can lead to acute pancreatitis include:
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• Gallstones - Pancreatitis is frequently caused by gallstones. Gallstones,

which are formed in the gallbladder, can escape and clog the bile duct,
preventing pancreatic enzymes from reaching the small intestine and
driving them back into the pancreas.
• Alcoholism - Alcohol is broken down into chemicals that are harmful to
the pancreas as it is consumed. Pancreatitis might develop as a result of this
over time.
• Certain medications - Medicines can trigger pancreas inflammation in
some people. Antibiotics, immune-suppressing medications, blood pressure
medications, amino salicylates, diuretics, corticosteroids, estrogen, diabetes
medications, Valproate, general anesthetics, and antidepressants are among
them.
• Hypertriglyceridemia - A rare but well-known “cause” of acute pancreatitis
is hypertriglyceridemia. The identified risk factor is a blood triglyceride
level of more than 1000 to 2000 mg/dl. Acute pancreatitis or recurrent acute
pancreatitis are the most common symptoms.
• Hypercalcemia - Pancreatitis caused by hypercalcemia is a rare occurrence.
Hypercalcemia is usually caused by hyperparathyroidism (HPT), and
parathyroid adenoma is the most common cause of HPT. We present a case
of recurring pancreatitis that aided in the diagnosis of a parathyroid
adenoma that was otherwise clinically silent.
• Pancreatic cancer - pancreatic cancer produces upstream obstructive
pancreatitis
• Cystic fibrosis - Pancreatic damage in people with CF is marked by acinar
cell loss, fatty replacement, and interstitial fibrosis.
• Infection - Viruses (hepatotropic virus, Coxsackie virus, cytomegalovirus
(CMV), human immunodeficiency virus (HIV), herpes simplex virus
(HSV), mumps, varicella-zoster virus, and other viruses) and bacteria
(hepatotropic virus, Coxsackie virus, cytomegalovirus (CMV), human
immunodeficiency virus (HIV), herpes simplex virus (HSV) (mycoplasma,
legionella, salmonella).
 The procedure for treating gallstones, endoscopic retrograde
cholangiopancreatography (ERCP), can also cause pancreatitis.
 Sometimes, a cause for pancreatitis is unknown. This is called as idiopathic
pancreatitis.
SIGNS AND SYMPTOMS
a) ACUTE PANCREATITIS
- starts in your upper abdomen slowly or suddenly
- can spread to your back at times
- can range from mild to severe
- could last several days
OTHER SYMPTOMS
- fever
- nausea and vomiting
- tachycardia
- swollen or tender abdomen
* People with acute pancreatitis usually look and feel seriously ill and need to see a doctor
right away.
b) CHRONIC PANCREATITIS
The pain in the upper abdomen is felt by the majority of people with chronic pancreatitis,
though some people experience no pain at all.
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The pain could:

- wrap your arms around your back
- become more frequent and severe
- worsens after eating
- pass as your condition worsens
OTHER SYMPTOMS
- diarrhea
- nausea
- steatorrhea
- vomiting
- weight loss
* People with chronic pancreatitis may not have symptoms until they have complications.
c) SEVERE PANCREATITIS
* If you experience any of the following severe pancreatitis symptoms, seek medical help right
away.
- severe abdominal pain or tenderness that persists or worsens
- nausea and vomiting
- fever or chills
- tachycardia
- bradypnea
- jaundice
* These symptoms may be a sign of:
- serious infection
- inflammation
- blockage of the pancreas, gallbladder, or a bile and pancreatic duct
* These problems can be fatal if left untreated.
RISK FACTORS
The following are the risk factors for pancreatitis:
 Excessive alcohol consumption

Alcoholic beverages have a variety of ingredients, but they all contain varying
percentages of pure alcohol. When alcohol is consumed and digested, free radicals and
other harmful byproducts of alcohol can damage pancreatic acinar cells. The enzymes
are generally secreted in the digestive tract and activate once they reach the small
intestine, but they can also become active inside the pancreas, causing the pancreas to
"digest" itself, according to the American Addictions Center. Consider what would
happen if the pancreas digested or ingested harmful metabolites and radicals produced
by alcohol metabolism. This is when the pancreas becomes inflamed, which can lead
to severe damage.
In most studies, as cited by Chen, Herzig, Genin, Masson, Cooper, & Ferec
(2021), the alcohol consumption that is associated to pancreatitis for men are >80g/d
(grams per day), while 60 g/d for women. Not only does alcohol affect the nervous
system, it further plays a part of different adverse effects related to GI tract systems,
and other organ systems in the body. The authors also cited that excessive alcohol
consumption are said to be the most well-known risk factor of pancreatitis for 25 years,
alongside the newly discovered genetic risk factors of this disease. Also, according to
Singh, Yadav, and Garg (2019), in the United States, cases of chronic pancreatitis
reach a prevalence of 43-73 per 100,000 adults, with an environmental factor
associated with alcohol abuse, those having more than 5 drinks per day than those of
abstainers and light drinkers.
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 Cigarette smoking
Another sort of widespread vice, cigarette smoking, is known to be a risk factor
for pancreatitis. In a cohort study of men and women's exposure to risk factors for
pancreatitis published in 2009, smoking was described as a "rare" factor for the
condition. According to Tolstrup, Kristiansen, and Becker (2009), 15 to 24 grams of
tobacco per day increases the risk of pancreatitis. In this cohort study, smoking is
responsible for around 46% of the cases.
The effects on the pancreas' exocrine functions can be impacted by smoking, as
evidenced by estimates of amylase and lipase activity in serum samples from smokers
with pancreatitis. According to Barretto (2015), these human trials replicated mouse
tests in which nicotine was found to enhance amylase and trypsinogen release from
rat pancreatic acini by 95 and 400 percent, respectively. “Nicotine induces damage
through signal transduction pathways in pancreatic acinar cells, leading to elevated
levels of intracellular calcium release and/or impaired pancreatic blood flow.
Moreover, nicotine also alters gene expression in the exocrine pancreas, which affects
the ratio of trypsinogen to its endogenous inhibitor” (Ye, Lu, Huai, & Ding, 2015).
According to the same source, for those people who are former smokers, the
risk of developing pancreatitis is decreased. This may be due to the fact that the longer
the exposure to nicotine, the more it exacerbates the diagnosis of the disease.
 Obesity
Obesity is thought to be a poor predictive factor for acute pancreatitis,
according to Kim and Han (2012). It is because of obesity's underlying mechanism,
which causes inflammation and necrosis in the pancreas, as well as a rise in intra- and
peripancreatic fat.
Despite the obviously stated physiologic factors of obesity, obesity also
increases the risk of acute pancreatitis due to the development of the following: (a)
Cholelithiasis - Stones, sludge, or microlithiasis in the biliopancreatic passages cause
acute pancreatitis by producing bile reflux or increasing pancreatic duct pressure; (b)
Hypertriglyceridemia - it is possible that severe acute pancreatitis is caused by the
lipolysis of circulating triglycerides and the resultant unsaturated fatty acids (UFAs);
(c) Therapeutic interventions for obesity – e. g. Bariatric surgery, Duodeno-jejunal
bypass liner, and gastric balloons. (Khatua, El-Kurdi, & Singh, 2017).
According to a news article focusing on researchers at the Mayo Clinic in
Arizona, pancreatitis accounts for around 300,000 instances in the United States each
year, with symptoms including acute abdomen discomfort. The enzyme PNLIP
(pancreatic enzyme), which can generate fatty acids that cause multisystem failure,
which is significantly more common in acute pancreatitis, is responsible for the fast
decomposition of fat that occurs in pancreatitis.
 Diabetes
According to Ariel Precision Medicine (2021), there is no direct causative link
that connects diabetes to pancreatitis. However, people with diabetes have 174%
chance of developing acute pancreatitis, and 140% are more likely to suffer from
chronic pancreatitis. This is due to the reason that these two conditions share many of
the same causes. These two complications serve as proof that the physiological aspect
of the body produces compensatory mechanisms. “Diabetes is a relatively common
complication of chronic pancreatitis. The NHS states that around 50 per cent of people
with chronic pancreatitis will go on to develop diabetes. Forms of diabetes caused by
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other medical conditions are referred to as being secondary diabetes.” (Global

Diabetes Community, 2019).
 Familial history of pancreatitis

Based on the National Library of Medicine, there exists a genetic condition,
which is hereditary pancreatitis as characterized by the recurrent episodes of
inflammation of the pancreas. The prevalence of this hereditary condition exists for up
to 3-6 million cases in Europe. Such episodes of pancreatitis can lead to permanent
tissue damage and even loss of pancreatic function. Such condition was associated
with the discovery of the trypsinogen mutation in families with hereditary pancreatitis,
which makes the rapid progress of the inflammation possible.
According to Raphael and Willingham (2016), this was first discovered in 1952,
having common mutations in genetic makeup consisting of PRSS1, CFTR, SPINK1,
and CTRC genes. New mutations continue to become discovered, which was
supported by Mayerle, Sendler, Hegyi, Beyer, Lerch, & Sahin-Toth (2019),
Approximately 90% of PRSS1-mutation–positive HP families carry the p.N29I,
p.R122C, or p.R122H mutation in the heterozygous state.
 Black Americans
According to Tang, MD (2019), African Americans are at a higher risk than
any other age group. There is an annual incidence of acute pancreatitis in Native
Americans with 4 per 100,000 population; in whites, 5.7 per 100,000 population; and
in blacks, 20.7 per 100,000 population.
There are still lack of literatures why Black Americans are considered to be at
most risk for pancreatitis.
 Age
According to Weiss, Laemmerhirt, and Lerch (2019), alcohol-related acute
pancreatitis has a peak incidence age of 35 to 44 years in men and 25 to 34 years in
women. This was supported by Tang (2019) where he provided median age of onset
of pancreatitis depending upon its etiology:
o Alcohol-related - 39 years
o Biliary tract–related - 69 years
o Trauma-related - 66 years
o Drug-induced etiology - 42 years
o ERCP-related - 58 years
o AIDS-related - 31 years
o Vasculitis-related - 36 years
For the chronic pancreatitis, studies show that it is more prevalent on middle-aged
citizens. This is probably due to the poor prognosis and effectiveness of the therapeutic
regimen of the human system.
 Male gender
According to Drake, Dodwad, Davis, Kao, Cao, and Co (2021), acute
pancreatitis have no significant difference in both sexes, but the incidence of chronic
pancreatitis is more common in males. This could be based of the stratified etiology
for both sexes; wherein women have higher rates of gallstone-induced acute
pancreatitis, while men are usually exposed to more predisposing factors, such as
alcohol intake, tobacco exposure, and others. Authors also concluded that direct
effects of sexual hormones and steroid hormone-related stress response may play a role
in the development of pancreatitis.
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In this large cohort of patients admitted for AP, despite being significantly
older, we found that females had significantly improved clinical outcomes, including
lower mortality, compared to males. Further prospective studies are needed to
accurately understand these differences to guide clinical practice. (Sharma, S.,
Weissman, S., Aburayyan, K., Acharya, A., Aziz, M., Systrom, H. K., ... & Pandol,
S. J. (2021)
COMPLICATIONS
Pancreatitis can cause serious complications, including:

 Kidney failure. Kidney failure can result from acute pancreatitis, which can be
treated with dialysis if it is severe and long-term.
 Breathing problems. Acute pancreatitis can lead to chemical changes in the
body that compromise lung function, resulting in dangerously low oxygen
levels in the blood.
 Infection. If you have acute pancreatitis, your pancreas may become prone to
bacteria and infection. Pancreatic infections are hazardous and require prompt
treatment, which may include surgery to remove affected tissue.
 Pseudocyst. As a result of acute pancreatitis, fluid and debris might gather in
cyst-like pockets in your pancreas. Internal bleeding and infection can occur
when a big pseudocyst ruptures.
 Malnutrition. Your pancreas may produce less enzymes as a result of acute or
chronic pancreatitis, which are important for breaking down and processing
nutrients from food. Malnutrition, diarrhea, and weight loss can occur even if
you eat the same meals or the same amount of food.
 Diabetes. Insulin-producing cells in the pancreas are damaged by chronic
pancreatitis, which can lead to diabetes, a disease that affects how your body
uses blood sugar.
 Pancreatic cancer. Pancreatic cancer is linked to chronic pancreatitis, which
causes long-term inflammation in the pancreas.
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PATHOPHYSIOLOGY
Predisposing Factor: Elevation of Cholesterol

levels Narrowing of ducts
 Overweight/Obesity
Fatty build-up Blockage in ducts

(+) Knee-chest position
when in pain
Ischemia
Over-distension of Obstruction in Pancreatic
Pancreas duct
Bacterial growth
Epigastric Pain
Stasis of trypsin enzyme
Gnawing continuous
abdominal pain Infection
Pancreatic inflammation
Hydrocodone ; Morphine
Elevated WBC
CT Scan shows inflammation
Release of Amylase and
Lipase
Inability to digest Autodigestion
replacement therapy
Pancreatic enzyme
Exocrine pancreatic Pancreatic necrosis

Elevated amylase
insufficiency Elevated lipase
Extravasation of exudates
Weight loss
Compression of bile
duct Ecchymosis
Portal
Hypertension Biliary stasis (+) Cullen’s sign
TPN
(+) Turner’s sign
Sphlacnic arterial Elevated bilirubin Pancreatic scarring

vasodilation
PANCREATITIS Affected acinar cells

Arterial vascular
underfilling
Chest x-ray showing pleural
effusion Depletion of insulin
Na and H2O retention
Nausea &
Fatigue Elevated glucose; (+)
Vomiting
Ascites blood glucose
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COMPLETE PHYSICAL ASSESSMENT

PHYSICAL ASSESSMENT
Name: __Mr. Reyes ___ Age: __34__ Sex: _Male__ Civil Status: _Married_
Address: _123 Mabait St., Brgy. 1, Tayabas, Quezon_ Place of Birth: _December 15, 1972_
Religion: _Roman Catholic_ Occupation: __High School Teacher__ Nationality: Filipino
Admitting Diagnosis: _Pancreatitis_
GENERAL APPEARANCE
 seen with (+) Patient in knee-chest position in pain; seen with body malaise and fatigue; seen
with guarding behavior on epigastric area abdomen; seen with excessive sweating; is
agitated but conscious
VITAL SIGNS
Temperature -37.8C Weight – 5’4
Pulse Rate – 99bpm Height – 180 lbs
Respiratory Rate – 20bpm BMI – 30.9
Blood Pressure – 130/90mmHg
HEALTH HISTORY
REASONS FOR SEEKING HEALTHCARE
“nangingirot-ngirot ang aking tiyan, kaya naman
Characteristic nakakapasuka’t di ako makakain ng maayos”
-rated pain scale as 8 out of 10
Onset “mag-iisang buwan na ring ganito”
“ditto sa may bandang sikmura, sumasakit likod at kaliwang
Location
balikat”
“natagal yung sakit ng ilang minute o kaya’y pagkainom
Duration
kong gamut ay nawawala naman”
Severity “mga 8 yung sakit nya”
“namimilipit ako sa sakit pero di pa rin nawawala, di ko alam
Pattern
gagawin ko”
“ito nababawasan timbang ko pero nalobo tiyan ko, ako’y
Associated Factors nanghihina rin tsaka may pasa pasa ako sa tiyan di naman ito
napapatama kung saan”
 is diagnosed as hypertensive for 5 years; denies any
PAST HEALTH HISTORY
injury and surgery
FAMILY HEALTH  mother diagnosed with Hypertension
HISTORY  father died due to DM
 does not have any maintenance medication
LIFESTYLE AND HEALTH
 tries exercising, but stopped after a week
PRACTICES
 drinks occassionally
PHYSICAL ASSESSMENT
Skin  inspected skin with jaundice, with (+) Cullen’s sign & (+) Turner’s sign
Gastrointestinal  seen nauseous and vomits 4 times in an hour
 inspected with large abdomen
Abdomen  palpated with edematous abdomen
 palpated epigastric region of abdomen as stiff, tender to touch
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APPENDIX
10
NURSING CARE PLAN
Acute Pain
Cues/Clues Nursing Diagnosis Nursing Goal Plan Nursing Rationale Evaluation
Assessment Intervention
Subjective Data: Acute pain related to After 8hrs of nursing Establish rapport To lessen the client’s After 8 hrs of nursing
- “sakit sakit ng tiyan overdistention of intervention, the anxiety intervention, the
ko, parang tumutusok pancreas secondary to patient will report client verbalized “di
tusok. Sobrang pancreatitis as 4/10 in pain scale and Monitor client’s vital To establish a na masakit ang tiyan
lalim.” as verbalized evidenced by knee- demonstrates use of signs baseline data ko di gaya kanina”
- rated pain scale as 8 chest position and methods that provide and rated pain scale
out of 10 elevated glucose level relief. Maintain bedrest Decreases metabolic as 4 out of 10. Also,
during acute attack. rate and GI seen performing deep
Objective Data: stimulation and breathing exercises
- (+) knee-chest secretions, thereby and changing of
position when in pain reducing pancreatic positions while in
- seen excessively activity. bed.
sweating
- seen with body Provide quiet, restful To lessen anxiety and Vital Signs:
malaise and guarding environment. promote relaxation T - 37.1C
behavior on stomach PR – 98bpm
RR – 20bpm
Assist in comfortable To reduce abdominal BP – 120/80mmHg
Vital Signs: position on one side pressure and tension,
T - 37.8C with knees flexed, providing some
PR – 99bpm sitting up and leaning measure of comfort
RR – 20bpm forward. and pain relief.
BP – 130/90mmHg
Encourage relaxation Promotes relaxation

techniques, such as and enables patient to
deep breathing refocus attention;
exercise. may enhance coping.
Keep environment Sensory stimulation

free of food odors. can activate
pancreatic enzymes,
increasing pain.
Monitor for To denote

worsening of exacerbation of
abdominal pain, condition
nausea and vomiting.
Collaborate with Pancreatitis involves

physician. collaborative care.
Administer analgesics Severe and prolonged

in timely manner, pain can aggravate
such as hydrocodone shock and is more
or morphine difficult to relieve,
requiring larger doses
of medication, which
can mask underlying
problems and
complications and
may contribute to
respiratory
depression.
Withhold food and Limits and reduces

fluid as indicated. release of pancreatic
enzymes and
resultant pain.
Imbalanced Nutrition: Less Than Body Requirements

Subjective Data: Imbalanced nutrition After 8hrs of nursing Establish rapport To lessen the client’s After 8 hrs of nuring
- “palagi na lamang related to loss of intervention, the anxiety intervention, the
syang nagsusuka, enzymes as evidenced patient will client verbalized
napansin ko.” As by weight loss and demonstrate a Monitor client’s vital To establish a “unti-unti na akong
verbalized by SO elevated glucose level homeostatic state, as signs baseline data nagkakagana at di na
seen with decreasing rin ako masyado
Objective Data: glucose level near Provide frequent oral Decreases vomiting nagsusuka.” Client
-seen with excessive standard range. care stimulus was also monitored
sweating for blood glucose with
-seen with body Monitor color, Steatorrhea may 129 g/dL.
malaise and fatigue consistency and develop from
-seen always resting amount of stools. incomplete digestion
head in bed Note frothy of fats Vital Signs:
-covers mouth consistency and foul T - 37.1C
whenever feels like odor PR – 98bpm
belching RR – 20bpm
-seen SO placing Assess for hereditary To determine if client BP – 120/80mmHg
bucket near patient condition of diabetes have increased risk to
-noted with weight mellitus. developing DM
loss of 10 kilos
Assess for signs of May warn of
Vital Signs: increased thirst and developing
T - 37.8C urination or changes hyperglycemia
associated with
PR – 99bpm in mentation and increased release of

RR – 20bpm visual acuity glucagon or
BP – 130/90mmHg decreased release of
insulin
Monitor laboratory Early detection of

results, especially inadequate glucose
urine for sugar and utilization may
acetone prevent development
of ketoacidosis
Advice to maintain Prevents stimulation

NPO status and release of
pancreatic enzymes
Educate to resume Oral feedings given

oral intake with clear too early in the course
liquids and advance of illness may
diet slowly to provide exacerbate
high-protein, high- symptoms. Loss of
carbohydrate diet, pancreatic function
when indicated and reduced insulin
production may
require initiation of a
diabetic diet
Monitor serum Indicator of insulin

glucose. needs because
hyperglycemia is
frequently present
Collaborate with Hyperglycemia is

physician. considered as a
collaborative type of
care.
Provide insulin as Corrects persistent

indicated hyperglycemia
caused by injury to
cells and increased
release of
glucocorticoids
Ineffective Tissue Perfusion

Subjective Data: Ineffective tissue After 8hrs of nursing Establish rapport To lessen the client’s After 8hrs of nursing
- “bumababa timbang perfusion related to intervention, the anxiety intervention, the SO
nya, kaso anlaki pa decreased sphlacnic patient will maintain verbalized “lumiit
rin ng tiyan nya.” As arterial bloodflow as maximum tissue Monitor client’s vital To establish a naman kahit papaano
verbalized by SO evidenced by ascites perfusion to vital signs, especially BP baseline data yung tiyan niya, hindi
and pleural effusion organs as evidenced and PR na katulad ng dati.”
Objective Data: by slowly diminishing
- weight loss ascites. Assess for probable Early detection of the
- palpated with contributing factors source facilitates Vital Signs:
abdominal edema related to temporarily
quick, effective T - 37.1C
(ascites) impaired arterial
management PR – 98bpm
- noted with weight blood flow RR – 20bpm
loss of 10 kilos BP – 120/80mmHg
- chest x-ray show Strictly monitor GI Decreased blood flow
pleural effusion function, noting to mesentery can turn
anorexia, decreased out to GI
or absent bowel dysfunction, loss of

Vital Signs: sounds, nausea or peristalsis
T - 37.8C vomiting, abdominal
PR – 99bpm distension, and
RR – 20bpm constipation
BP – 130/90mmHg
Monitor intake, Reduced intake or
observe changes in unrelenting nausea
urine output. may consequence in
lowered circulating
volume, which
negatively affects
perfusion and organ
function
Monitor for urine To denote hydration

specific gravity as status of patient
necessary
Educate patient about Malnutrition

nutritional status and contributes to
the importance of anemia, which
paying special further compounds
attention to obesity, the lack of
hyperlipidemia, and oxygenation to tissues
malnutrition
Teach patient to Early assessment

recognize the signs facilitates immediate
and symptoms that treatment
need to be reported to
the nurse
Collaborate with Ascites is considered

physician. as a serious issue as it
is related with
pancreatic necrosis in
pancreatitis patients.
Administer IV fluids Sufficient fluid intake

as ordered maintains adequate
filling pressures and
optimizes cardiac
output needed for
tissue perfusion
DRUG STUDY
DRUG NAME SPECIFIC MECHANISM OF INDICATIONS CONTRAINDICATIONS ADVERSE NURSING

ACTION ACTION EFFECTS RESPONSIBILITIES
Generic Name:  Opioid A type of  Used for relief of  Hypersensitivity to  GI: Dry mouth, Preparation:
Hydrocodone Analgesic medication that is a moderate to hydrocodone constipation, 1. Check doctor’s
phenanthrene moderately severe nausea, order.
Brand Name: derivative opiate pain vomiting. 2. Must be placed in
Hycodan agonist that binds to  Symptomatic  CNS: Light- a tight, light-
the CNS opioid relief of headedness, resistant
receptors, which hyperactive or sedation, container.
causes the inhibition nonproductive dizziness, Administration:
of the ascending cough drowsiness, 1. Provide 5 mg po q4-q6
pain pathways. This euphoria, prn
creates an altering dysphoria. 3. Do not crush or
perception and  Respiratory: break tablet as it
response to pain. Respiratory can lead to fatal
depression. overdose.
 Skin: Urticaria,
rash, pruritus. Assessment:
1. Monitor for
effectiveness of
drug for pain
relief.
2. Monitor vital
signs, especially
blood pressure.
3. Monitor for
nausea and
vomiting,
especially in
ambulatory
patients.
4. Monitor
respiratory status
and bowel
elimination.
Patient & Family

Education:
1. Advice to
hazardous
activities until
response to drug
is determined.
2. Only provide
when patient has
the ability to
swallow and can
tolerate enteral
feedings.
3. Educate to avoid
intake of alcohol
or other CNS
depressants as it
may cause
additive CNS
depression.
4. Drink plenty of
liquids for
adequate
hydration.
5. Advice to not
take larger doses
than prescribed
since abuse
potential is high.
Generic name:  Opioid Morphine provides  Symptomatic  Hypersensitivity to  Body as a Preparation:
Morphine analgesic the same relief of severe opiates; Whole: 1. Verify correct IV
mechanism of action acute and chronic  increased intracranial Hypersensitivity concentration
Brand Name: as hydrocodone. pain after pressure; [Pruritus, rash, and rate of
Analgesia, euphoria nonnarcotic  convulsive disorders; urticaria, edema, infusion/injection
and dependence are analgesics have acute alcoholism; hemorrhagic for administration
thought to be due to failed and as  acute bronchial asthma, urticaria (rare), to neonates,
its action at the µ-1 preanesthetic chronic pulmonary anaphylactoid infants, or
receptors while medication; diseases, reaction (rare)], children with
respiratory  also used to  severe respiratory sweating, skeletal physician.
depression and relieve dyspnea of depression; muscle flaccidity; 2. Dilute 2–10 mg in
inhibition of acute left  chemical-irritant cold, clammy at least 5 mL of
intestinal ventricular failure induced pulmonary skin, sterile water for
movements are due and pulmonary edema; hypothermia. injection.
to action at the µ-2 edema and  CNS: Euphoria, 3. Store at 15°–30°
 prostatic hypertrophy;
receptors. Spinal  pain of MI. insomnia, C (59°–86° F).
 diarrhea caused by
analgesia is disorientation, Avoid freezing.
poisoning until the
mediated by visual Refrigerate
toxic material has been
morphine agonist disturbances, suppositories.
eliminated;
action at the κ dysphoria, Protect all
receptor.  undiagnosed acute formulations
paradoxic CNS
abdominal conditions; from light.
stimulation
 following biliary tract
(restlessness,
surgery and surgical
tremor, delirium, Administration:
anastomosis; 1. Give a single
insomnia),
 pancreatitis; convulsions dose over 4–5
 acute ulcerative colitis; (infants and
 severe liver or renal children); min. Avoid rapid

insufficiency; decreased cough administration.
 Addison's disease; reflex,
 hypothyroidism drowsiness, Assessment:
dizziness, deep 1. Monitor
sleep, coma, laboratory results,
continuous such as amylase
intrathecal and lipase.
infusion may 2. Obtain baseline
cause respiratory rate,
granulomas depth, and
leading to rhythm and size
paralysis. of pupils before
 Special Senses: administering the
Miosis. drug.
 CV: Bradycardia, Respirations of
palpitations, 12/min or below
syncope; flushing and miosis are
of face, neck, and signs of toxicity.
upper thorax; Withhold drug
orthostatic and report to
hypotension, physician.
cardiac arrest. 3. Observe patient
 GI: Constipation, closely to be
anorexia, dry certain pain relief
mouth, biliary is achieved.
colic, nausea, Record relief of
vomiting, pain and duration
elevated of analgesia.
transaminase 4. Be alert to
levels. elevated pulse or
respiratory rate,
 Urogenital: restlessness,
Urinary retention anorexia, or
or urgency, drawn facial
dysuria, oliguria, expression that
reduced libido or may indicate
potency need for
(prolonged use). analgesia.
 Other: Prolonged 5. Differentiate
labor and among
respiratory restlessness as a
depression of sign of pain and
newborn. the need for
 Hematologic: medication,
Precipitation of restlessness
porphyria. associated with
 Respiratory: hypoxia, and
Severe restlessness
respiratory caused by
depression (as morphine-
low as 2–4/min) induced CNS
or arrest; stimulation (a
pulmonary paradoxic
edema. reaction that is
particularly
common in
women and older
adult patients).
6. Monitor for
respiratory
depression; it can
be severe for as
long as 24 h after
epidural or
intrathecal
administration.
7. Monitor carefully
those at risk for
severe respiratory
depression after
epidural or
intrathecal
injection: Older
adult or
debilitated
patients or those
with decreased
respiratory
reserve (e.g.,
emphysema,
severe obesity,
kyphoscoliosis).
8. Continue
monitoring for
respiratory
depression for at
least 24 h after
each epidural or
intrathecal dose.
9. Assess vital signs
at regular
intervals.
Morphine-
induced
respiratory
depression may
occur even with
small doses, and
it increases
progressively
with higher doses
(generally max:
90 min after SC,
30 min after IM,
and 7 min after
IV).
10. Encourage
changes in
position, deep
breathing, and
coughing (unless
contraindicated)
at regularly
scheduled
intervals.
Narcotic
analgesics also
depress cough
and sigh reflexes
and thus may
induce atelectasis,
especially in
postoperative
patients.
11. Be alert for
nausea and
orthostatic
hypotension
(with light-
headedness and
dizziness) in
ambulatory
patients or when
a supine patient
assumes the head-
up position or in
patients not
experiencing
severe pain.
12. Monitor I&O
ratio and pattern.
Report oliguria or
urinary retention.
Morphine may
dull perception of
bladder stimuli;
therefore,
encourage the
patient to void at
least q4h. Palpate
lower abdomen
to detect bladder
distention.
Patient & Family

Education:
1. Avoid alcohol
and other CNS
depressants while
receiving
morphine.
2. Do not use of any
OTC drug unless
approved by
physician.
3. Do not smoke or
ambulate without
assistance after
receiving drug.
Bedside rails are
advised.
4. Use caution or
avoid tasks
requiring
alertness (e.g.,
driving a car)
until response to
drug is known
since morphine
may cause
drowsiness,
dizziness, or
blurred vision.
Generic Name:  Pancreatic Facilitates the  Replacement  History of allergy to  GI: Anorexia, Preparation:
Pancrelipase Enzyme hydrolysis of fats therapy in hog protein or nausea, 1. Open capsule and
Replacement into glycerol and symptomatic enzymes; vomiting, sprinkled
Brand Name: Therapy fatty acids, starches treatment of  esophageal strictures; diarrhea. contents on soft
Pancrease into dextrins and malabsorption  pancreatitis;  Metabolic: food, which
sugars, and proteins syndrome due to  porcine protein Hyperuricosuria. should be
into peptides for exocrine hypersensitivity swallowed
easier absorption. without chewing
pancreatic to prevent mucus

insufficiency. membrane
irritation. Follow
with a full glass
of water or juice.
Cimetidine,
ranitidine, or an
antacid may be
prescribed to be
given before
pancrelipase to
prevent drug's
destruction by
gastric pepsin and
acid pH.
2. Determine
dosage in relation
to fat content in
diet (suggested
ratio: 300 mg
pancrelipase for
each 17 g dietary
fat).
Assessment:
1. Monitor I&O and
weight. Note
appetite and
quality of stools,
weight loss,
abdominal
bloating,
polyuria, thirst,
hunger, itching.
Pancreatic
insufficiency is
frequently
associated with
steatorrhea, bulky
stools, and
insulin-dependent
diabetes.
Patient & Family
Education:
1. Learn proper
timing of
medication in
relation to meals.
LABORATORY ANALYSIS
LIVER FUNCTION TEST

TEST RESULTS NORMAL VALUES INTERPRETATION NURSING RESPONSIBILITIES
Bilirubin (Total) 2.0mg/dL 0.2-1.3mg/dL ELEVATED (DUE TO Pre-test:
BILIARY STASIS) 1. Explain the procedure to be done, how long it will take, and what to expect.
2. Advice the patient to relax as the procedure is done and avoid any
unnecessary movements.
3. Advice to avoid any liquids and solids for 8-12 hours. Liquids may be given
as long as it is provided in sips and are clear.
Posttest:
1. Apply pressure over puncture site.
2. Monitor for any signs of infection, such as redness, abscess, swelling, and
severe pain.
Assessment:
1. Assess the medications taken by patient.
2. Assess skin color and note for changes in complexion, such as developing
jaundice.
3. Palpate epigastric region of abdominal area as tolerated by patient.
4. Monitor intake and output.
Patient Education:
1. Advice to maintain healthy diet.
2. Encourage to avoid smoking and alcohol intake as much as possible to
avoid any complications.
3. Advice to take medications as prescribed to avoid damaging liver.
4. Advice to increase fiber intake.
5. Advice to continue hydration with 2L of fluids, as tolerated.
TEST RESULTS NORMAL VALUES INTERPREATION NURSING RESPONSIBILITIES

Amylase 150U/L 25-130U/L ELEVATED (DUE TO Pre-test:
STASIS OF TRYPSIN) 1. Explain the procedure to be done, how long it will take, and what to expect.
Lypase 165U/L 10-140U/L ELEVATED (DUE TO 2. Advice the patient to relax as the procedure is done and avoid any
STASIS OF TRYPSIN) unnecessary movements.
3. Advice to avoid eating or drinking anything except water for at least 2 hours
before the test.
Posttest:
severe pain.
Assessment:
2. Inspect abdominal area for changes.
3. Assess exacerbation of abdominal pain.
4. Palpate for Blumberg’s sign to differentiate peptic ulcer disease from
pancreatitis. Noting the swelling of the pancreas.
5. Assess presence of Cullen’s and Turner’s sign.
7. Monitor for signs and symptoms of nausea and vomiting.
Patient Education:
1. Encourage to continue avoiding alcoholic beverages.
2. Explain the results to the patient.
3. Encourage to continue healthy diet.
4. Encourage to conduct exercises as tolerated.
5. Advice to take pancreatic enzyme replacement therapy, as ordered.
COMPLETE BLOOD COUNT

TEST RESULTS NORMAL RANGE INTERPRETATION NURSING RESPONSIBILITIES
WBC 11,500 cells/mm3 4,500-10,500 cells/mm3 ELEVATED (MAY Pre-test:
INDICATE 1. Explain the procedure to be done, how long it will take, and what to expect
INFECTION) during the procedure.
2. Encourage to avoid stress if possible as altered physiologic status influences
and changes normal hematologic values.
3. Explain that fasting is not necessary.
Posttest:
1. Apply manual pressure over puncture site.
2. Monitor puncture site for signs of infection.
3. Instruct to resume normal activities and diet as tolerated.
Assessment:
1. Monitor vital signs to establish baseline data.
2. Monitor exacerbation of increased WBC count.
3. Assess capillary refill.
4. Assess mental status.
5. Advice to inform about any exacerbation of abdominal pain.
7. Assess for sores in mouth, throat, and near anal region.
8. Assess breath sounds.
Patient Education:
1. Place client on reverse isolation.
2. Inform the clients to wear personal protective equipment, such as face
mask.
3. Advice visitors to avoid exposure to patient especially if they show signs of
respiratory tract infection.
4. Inform SO to wear face mask upon visitation.
5. Educate about proper handwashing technique to maintain sterility.
6. Advice to increase intake of iron-rich foods, such as beans, fortified grains,
eggs.
7. Advice to increase intake of foods rich in folic acid, such as green leafy
vegetables. Also, increase intake of vitamin C for increased immunity, such
as citrus fruits.
TEST RESULTS NORMAL VALUES INTERPREATION NURSING RESPONSIBILITIES

Cholesterol 250g/dL <200mg/dL ELEVATED (MAY BE Pre-test:
DUE TO OBESITY) 4. Explain the procedure to be done, how long it will take, and what to expect.
Glucose 14g/dL <140g/dL ELEVATED (DUE TO 5. Advice the patient to relax as the procedure is done and avoid any
IMPAIRMENT OF unnecessary movements.
PANCREAS) 6. Advice to avoid eating or drinking anything except water for at least 2 hours
before the test.
Posttest:
severe pain.
Assessment:
Patient Education:
6. Encourage to continue avoiding alcoholic beverages.
8. Encourage to continue healthy diet, such as the DASH diet to help lower
cholesterol.
9. Avoid too much intake of sweets, such as chocolates and candies.
10. Encourage client to ingest more unsaturated fats, such as avocado and
canola oil, and avoid trans fat, such as processed foods.
11. Encourage to conduct exercises as tolerated.
COMPUTER TOMOGRAPHY SCAN

TEST RESULTS INTERPRETATION NURSING RESPONSIBILITIES
CT Scan Inflammation of pancreas PANCREATITIS Pretest:
1. Explain to the patient the need to lie still, relax, and breathe normally
during the procedure.
2. Assess for iodinated dye or shellfish allergies.
3. Advice to maintain NPO status.
4. Discuss information about contrast medium.
5. Explain that the test is painless and takes 10-30 minutes.
6. Encourage client to remove all jewelry and metal placed on body.
7. Secure informed consent.
Assessment:
12. Note presence of Cullen’s and Turner’s sign.
Patient Education:
16. Encourage to resume usual diet, such as the orders for Total Parenteral
Nutrition and intake solids whenever tolerated.
17. Encourage the client that fluids are helpful to promote excretion of dye.
(if contrast is given).
X-RAY SCAN
TEST RESULTS INTERPRETATION NURSING RESPONSIBILITIES
Chest X-ray Shows pleural effusion SUPPORTING Pretest:
DIAGNOSIS FOR 1. Explain to the patient the need to lie still, relax, and breathe normally
ASCITES during the procedure.
2. Assess ability to hold breath.
3. Explain that the test is painless and takes 5-10 minutes.

4. Encourage client to remove all jewelry and metal placed on body.
5. Secure informed consent.
Patient Education:
2. Encourage to share feelings and thoughts, especially when exacerbation
of ascites is noted.
3. Place client in supine or semi-fowler’s position for comfort.
References:
Barreto SG. How does cigarette smoking cause acute pancreatitis? Pancreatology. 2016 Mar-Apr;16(2):157-63. doi: 10.1016/j.pan.2015.09.002. Epub 2015 Sep 18. PMID:
26419886.
Chen, J.-M., Herzig, A. F., Génin, E., Masson, E., Cooper, D. N., & Férec, C. (2021). Scale and Scope of Gene-Alcohol Interactions in Chronic Pancreatitis: A
Systematic Review. Genes, 12(4), 471. doi:10.3390/genes12040471
Kim, Ho Gak; Han, Jimin (2012). Obesity and Pancreatic Diseases. The Korean Journal of Gastroenterology, 59(1), 35–. doi:10.4166/kjg.2012.59.1.35
Mayerle, J., Sendler, M., Hegyi, E., Beyer, G., Lerch, M. M., & Sahin-Tóth, M. (2019). Genetics, Cell Biology, and Pathophysiology of Pancreatitis. Gastroenterology,
156(7), 1951–1968.e1. https://doi.org/10.1053/j.gastro.2018.11.081
Sharma, S., Weissman, S., Aburayyan, K., Acharya, A., Aziz, M., Systrom, H. K., ... & Pandol, S. J. (2021). Sex differences in outcomes of acute pancreatitis: Findings
from a nationwide analysis. Journal of Hepato‐Biliary‐Pancreatic Sciences, 28(3), 280-286.
Singh VK, Yadav D, Garg PK. Diagnosis and Management of Chronic Pancreatitis: A Review. JAMA. 2019;322(24):2422–2434. doi:10.1001/jama.2019.19411
Tolstrup JS, Kristiansen L, Becker U, Grønbæk M. Smoking and Risk of Acute and Chronic Pancreatitis Among Women and Men: A Population-Based Cohort Study.
Arch Intern Med. 2009;169(6):603–609. doi:10.1001/archinternmed.2008.601
Willingham, F., & Raphael, K. (2016). Hereditary pancreatitis: current perspectives. Clinical and Experimental Gastroenterology, Volume 9, 197–207.
https://doi.org/10.2147/ceg.s84358
Ye, X., Lu, G., Huai, J., & Ding, J. (2015). Impact of Smoking on the Risk of Pancreatitis: A Systematic Review and Meta-Analysis. PLOS ONE, 10(4), e0124075.
https://doi.org/10.1371/journal.pone.0124075
https://americanaddictioncenters.org/alcoholism-treatment/effects-of-alcohol-on-the-pancreas
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-led-study-links-obesity-with-pancreatitis/
https://www.diabetes.co.uk/conditions/pancreatitis.html
https://arielmedicine.com/is-there-a-link-between-diabetes-and-
pancreatitis/#:~:text=There%20is%20no%20direct%2C%20causative,to%20suffer%20from%20chronic%20pancreatitis.
https://medlineplus.gov/genetics/condition/hereditary-pancreatitis/#:~:text=Hereditary%20pancreatitis%20is%20a%20genetic,sugar%20levels%20in%20the%20body.
https://www.medscape.com/answers/181364-14300/does-acute-pancreatitis-have-a-racial-
predilection#:~:text=African%20Americans%20are%20at%20a,blacks%2C%2020.7%20per%20100%2C000%20population.
https://www.medscape.com/answers/181364-14298/what-age-groups-are-most-affected-by-acute-pancreatitis

Case Analysis-Medicine-Pancreatitis

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SOUTHERN LUZON STATE UNIVERSITY

COLLEGE OF ALLIED MEDICINE

SOUTHERN LUZON STATE UNIVERSITY

CASE ANALYSIS: PANCREATITIS

• Gallstones - Pancreatitis is frequently caused by gallstones. Gallstones,

SIGNS AND SYMPTOMS

The pain could:

The following are the risk factors for pancreatitis:

 Excessive alcohol consumption

other medical conditions are referred to as being secondary diabetes.” (Global

 Familial history of pancreatitis

Pancreatitis can cause serious complications, including:

Predisposing Factor: Elevation of Cholesterol

Fatty build-up Blockage in ducts

Exocrine pancreatic Pancreatic necrosis

(+) Turner’s sign

Sphlacnic arterial Elevated bilirubin Pancreatic scarring

PANCREATITIS Affected acinar cells

COMPLETE PHYSICAL ASSESSMENT

NURSING CARE PLAN

Encourage relaxation Promotes relaxation

Keep environment Sensory stimulation

Monitor for To denote

Collaborate with Pancreatitis involves

Administer analgesics Severe and prolonged

Withhold food and Limits and reduces

Imbalanced Nutrition: Less Than Body Requirements

PR – 99bpm in mentation and increased release of

Monitor laboratory Early detection of

Advice to maintain Prevents stimulation

Educate to resume Oral feedings given

Monitor serum Indicator of insulin

Collaborate with Hyperglycemia is

Provide insulin as Corrects persistent

Ineffective Tissue Perfusion

or absent bowel dysfunction, loss of

Monitor for urine To denote hydration

Educate patient about Malnutrition

Teach patient to Early assessment

Collaborate with Ascites is considered

Administer IV fluids Sufficient fluid intake

DRUG NAME SPECIFIC MECHANISM OF INDICATIONS CONTRAINDICATIONS ADVERSE NURSING

Patient & Family

 severe liver or renal children); min. Avoid rapid

Patient & Family

pancreatic to prevent mucus

LIVER FUNCTION TEST

TEST RESULTS NORMAL VALUES INTERPREATION NURSING RESPONSIBILITIES

COMPLETE BLOOD COUNT

TEST RESULTS NORMAL VALUES INTERPREATION NURSING RESPONSIBILITIES

COMPUTER TOMOGRAPHY SCAN

3. Explain that the test is painless and takes 5-10 minutes.

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