MORA, ABYJAH MARIE A.

BSN 3

CASE STUDY

Acute Pancreatitis
Patient Profile
V.A. is a 55-year-old man admitted to the hospital with acute pancreatitis.
Subjective Data
• Has severe abdominal pain in the LUQ radiating to the back
• States that he is nauseated and has been vomiting
Objective Data
Physical Examination
• Vital signs: Temp 101°F (38.3°C), HR 114 bpm, RR 26, BP 92/58
• Jaundice noted in sclera
Laboratory Tests
• Serum amylase: 400 U/L (6.67 mkat/L)
• Serum lipase: 600 U/L
• Urinary amylase: 3800 U/day
• WBC count: 20,000/uL
• Blood glucose: 180 mg/dL (10 mmol/L)
• Serum calcium: 7 mg/dL (1.7 mmol/L)
Collaborative Care
• NPO status
•NG tube to low, intermittent suction
• IV therapy with lactated Ringer's solution
• Morphine PCA
• Pantoprazole (Protonix) IV

Discussion Questions
1.Explain the pathophysiology of acute pancreatitis.
Acute pancreatitis is a condition where the pancreas suddenly becomes inflamed. It can
range from mild to life-threatening, but usually improves over time. The primary causes of
acute pancreatitis are gallstones and excessive alcohol consumption. The primary symptom
experienced by most people with this condition is severe abdominal pain.
2. What are the most common causes of acute pancreatitis?
Gallstones or heavy alcohol use are the most common causes of acute pancreatitis, but
there are other factors that can also contribute to it. These include taking certain
medications, having autoimmune diseases, being affected by infections, experiencing
trauma, having metabolic disorders, or undergoing surgery.
3. How do the results of V.A.'s laboratory values relate to the pathophysiology of acute
pancreatitis?
During the onset of pancreatitis, it is common for the levels of blood amylase or lipase to
increase up to three times the normal level. This increase in levels is an important indication
of the severity of the condition and can aid in determining the appropriate treatment options.
4. What causes hypocalcemia in acute pancreatitis? How does the nurse assess for
hypocalcemia?
Low levels of calcium in the blood, known as hypocalcemia, can occur when calcium
combines with fatty acids to create insoluble compounds that accumulate in the pancreas.
Nurses can identify hypocalcemia by observing symptoms such as muscle cramps, tingling
sensations, and signs like Chostek's or Trousseau's.
5. Describe the characteristics of the pain that occurs in acute pancreatitis.
Acute pancreatitis commonly causes dull pain that is primarily felt in the left upper quadrant
of the abdomen and can also radiate to the back. The pain is long-lasting and can be made
worse by consuming food.
6.What complications can occur with acute pancreatitis?
Acute and severe pancreatitis often lead to both systemic and local complications. The
former may include pulmonary issues like pulmonary edema and adult respiratory distress
syndrome, while the latter may result in fluid buildup, ascites, pancreatic pseudocyst,
pancreatic necrosis, and infective pancreatic necrosis.
7. Why is V.A. NPO? What is the purpose of the NG tube?
The patient is not allowed to eat or drink anything by mouth in order to give their pancreas a
break and decrease the production of enzymes. Additionally, a nasogastric tube is being
used to remove stomach contents, which helps to reduce stimulation of the pancreas.
8. Identify the purpose of each medication prescribed for this patient. In cases of severe
pain, Morphine PCA is used as a pain management medication. To reduce pancreatic
stimulation by inhibiting gastric acid production, Pantoprazole (Protonix) IV is administered.
When a person suffers from pancreatitis, they may experience dehydration and fluid loss
from vomiting which can lead to hypovolemic shock. To address these issues, lactated
Ringer's solution is given which helps maintain electrolyte balance, correct metabolic
acidosis and support overall circulatory function. This can help with a patient's recovery from
pancreatitis and prevent any complications.
9. Priority Decision: Based on the assessment data presented, what are the priority nursing
diagnoses? Are there any collaborative problems?
The primary nursing diagnoses for a patient with pancreatitis include acute pain caused by
pancreatic inflammation, the risk of imbalanced nutrition due to NPO status, and the risk of
deficient fluid volume caused by vomiting and NPO status. Additionally, there is a
collaborative problem of potential hypocalcemia due to calcium sequestration in the
pancreas. Therefore, it is crucial to prioritize the management of pain, ensure proper
nutritional support, monitor fluid balance, and prevent any complications.