What are important things to monitor during an acute intervention of pancreatitis?

Pancreatitis is inflammation of the pancreas. It occurs when enzymes in the pancreas start digesting their own tissue, known as autodigestion. Symptoms can range from mild to severe, with pancreatitis being acute or chronic. Acute pancreatitis will cause severe abdominal pain and tenderness often radiating to the back along with abdominal distention, nausea, vomiting, and fever. Chronic pancreatitis may also present with the same symptoms or it may be asymptomatic. 

The most common causes of pancreatitis are gallstones and alcohol abuse. Other potential causes for pancreatitis include genetics, smoking, celiac disease, infections, hypercalcemia, and certain medications. 

Pancreatitis is diagnosed by a physical exam and lab tests, which check for elevated pancreatic enzymes. Ultrasounds and CT scans assess for inflammation and gallstones. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) can reveal strictures. ERCP can repair strictures and remove gallstones. 

Removal of the gallbladder may be necessary if gallstones are the cause of pancreatitis. Otherwise, treatment is supportive including IV fluids, pain management, and diet restriction.  

The Nursing Process  

Nurses can expect to care for patients with pancreatitis in inpatient settings. The pain associated with inflammation and the need for IV fluids requires some patients with pancreatitis to be hospitalized. The nurse can also expect to provide education regarding lifestyle changes such as avoiding alcohol and smoking and making diet changes. 

Nursing Care Plans Related to Pancreatitis 

Acute Pain Care Plan 

Pain associated with pancreatitis can be caused by inflammation of the pancreas and obstruction of the biliary ducts.

Nursing Diagnosis: Acute Pain

Related to: 

• Gallstones 
• Inflammation  
• Obstructed and damaged biliary ducts 
• Autodigestion of the pancreas causing toxins to be released 

As evidenced by: 

• Verbalization of abdominal pain 
• Body language/guarding behavior 
• Facial grimacing 
• Agitation/restlessness 
• Changes in vital signs 

Expected Outcomes: 

• Patient will verbalize reduced pain or relief by pharmacologic pain interventions 
• Patient will follow the prescribed treatment plan to maintain pain relief 

Acute Pain Assessment

1. Assess for pain.
Pancreatitis can cause pain that is often severe and persistent. The nurse can assess pain by asking the patient their pain level on a 0-10 scale, or by using a non-verbal pain scale if the patient is unable to verbalize.

2 . Assess for abdominal tenderness.
Patients with pancreatitis generally present with abdominal pain. Palpating the abdomen is important to know exactly where the pain is, especially if the patient can’t verbalize the exact location. It’s also important to note any guarding with palpation.

3. Observe changes in vitals and nonverbal cues.
Assess the patient for nonverbal signs of pain including sweating, restlessness, grimacing, and changes in vital signs. Use these observations along with the patient’s verbal reports of pain (if they’re able to verbalize their pain) to assess if interventions are effective.

Acute Pain Interventions

1. Administer pain medications routinely.
Administering pain medications frequently, as ordered, is important in managing pain. Smaller, more frequent doses of pain medications are preferred over larger doses. Larger doses of pain medications can cause complications for a patient with pancreatitis, including respiratory depression.

2. Maintain NPO status and suctioning.
Eating will likely worsen abdominal pain and any nausea or vomiting. Patients will likely be placed on NPO status and a nasogastric tube may be inserted to allow the pancreas to rest. IV fluids will be given for hydration.

3. Provide alternative pain management.
The patient may experience pain relief by participating in distraction activities (TV, games, music) or activities that promote relaxation such as massage, guided imagery, and hot/cold therapy.

4. Promote a position of comfort.
The supine position often increases a patient’s pain. Encourage patients to lay on their side with knees slightly flexed to decrease abdominal pressure. This aids in pain relief and comfort.

Imbalanced Nutrition: Less Than Body Requirements Care Plan 

Patients with pancreatitis can experience an imbalance in nutrition due to their lack of appetite and impaired digestion from inflammation in the pancreas.

Nursing Diagnosis: Imbalanced Nutrition

Related to: 

• Vomiting 
• Impaired digestion 
• Lack or loss of appetite 
• NPO status or dietary restrictions 

As evidenced by: 

• Reports of insufficient food intake 
• Weight loss 
• Aversion to food 
• Poor energy 
• Decreased muscle tone 
• Nutritional deficits identified through lab work 

Expected Outcomes: 

• Patient will maintain their weight or will not lose more than 5 pounds while inpatient 
• Patient will verbalize dietary recommendations upon discharge 
• Patient will maintain lab values within normal range 

Imbalanced Nutrition: Less Than Body Requirements Assessment

1. Assess current nutrition.
Perform an in-depth assessment of the patient’s current nutritional habits. This information can then be used to decide if the patient’s nutrition is adequate or if there is something in their diet that could have brought on pancreatitis.

2. Assess for hyperglycemia.
Patients with chronic pancreatitis are at a high risk of hyperglycemia due to damaged cells in the pancreas and the inability to regulate glucose. The nurse should monitor the patient’s glucose levels.

3. Monitor labs.
Lab values may be abnormal when a patient has imbalanced nutrition. Lab values also give an idea of inflammation in the body and how the patient’s pancreas is healing over time. Amylase and lipase monitor digestive enzyme levels and will be elevated with pancreatitis.

Imbalanced Nutrition: Less Than Body Requirements Interventions

1. Provide nutritional support.
The patient’s nutritional habits may not be supportive of healing. They will most likely need education on what to eat and drink, and what to avoid. Usual recommendations include high protein and nutrients found in fruits, vegetables, and whole grains. Patients should avoid alcohol and greasy or fried foods.

2. Provide optimal oral hygiene.
Increasing the patient’s appetite is important. Providing good oral hygiene can stimulate their appetite by creating a more pleasant sensation after vomiting and from dry mucous membranes.

3. Administer antiemetics when needed.
Vomiting not only causes an imbalance in electrolytes but creates an aversion to eating. Administering an antiemetic before mealtime can help.

4. Provide nutritional supplements.
Chronic pancreatitis causes altered metabolism and absorption. Regular lab work will monitor nutritional deficits. Patients may need vitamin supplements such as multivitamins, calcium, iron, folate, and vitamins A, D, E, and B12.

Deficient Knowledge Care Plan 

Patients with pancreatitis may not know what triggered the onset and what they can do, or what they can avoid, to help symptoms from recurring. 

Nursing Diagnosis: Deficient Knowledge

Related to: 

• Lack of exposure 
• Lack of recall 
• Cognitive limitation 
• Lack of interest 
• Poor access to resources 

As evidenced by: 

• Inability to remember instructions 
• Verbalizes a lack of understanding 
• Denies a need to learn/uninterested  
• Worsening of pancreatitis 

Expected Outcomes: 

• Patient will verbalize an understanding of pancreatitis and potential complications 
• Patient will demonstrate adherence to prescribed medications and diet 
• Patient will verbalize an understanding of required testing and follow-up 

Deficient Knowledge Assessment

1. Assess willingness to learn.
Assess whether the patient is willing to learn. A patient seeking information and education is open to learning. This will set a foundation for where to start with educating the patient.

2. Assess learning styles.
Evaluate how the patient prefers to learn and what’s most effective. Verbalization can be supported by written materials. Ensure material is suited to the patient’s education and health literacy level.

3. Assess the patient’s knowledge.
Assess what the patient already knows about their treatment plan and pancreatitis. Do not assume the patient understands. Have the patient teach-back information previously provided.

Deficient Knowledge Interventions

1. Use multiple learning techniques.
Offer a variety of learning techniques after assessing which way the patient learns best. Evaluate which techniques work best for the patient by asking them questions to assess how much they have retained.

2. Ensure a comfortable learning environment.
Ensure the environment is calm and conducive to learning. Also, ensure the patient’s pain is controlled. Someone that is distracted by pain, loud noises, and staff interruptions will not be able to focus on learning.

3. Provide supportive treatment resources.
Alcohol abuse is the most common cause of chronic pancreatitis. Collaboration with a social worker or case manager may be necessary to ensure the patient has resources available to seek treatment. Educate the patient on the effects alcohol and smoking has on their health and how pancreatitis can develop again.

4. Stress the importance of follow-up.
Educate the patient on the importance of following up to ensure they are healing properly. Inform them of symptoms to look for and when to notify their doctor. Doctor’s appointments, lab work, substance abuse resources, and dietician guidelines are important for the patient to adhere to.

References and Sources

1. Acute Pancreatitis – National Pancreas Foundation Brochure. (n.d.). The National Pancreas Foundation. Retrieved March 24, 2022, from https://pancreasfoundation.org/wp-content/uploads/2017/02/AcutePancreatitis-Brochure.pdf
2. Barnard, Neal D., editor. “Pancreatitis.” Nutrition Guide for Clinicians, 3rd ed., Physicians Committee for Responsible Medicine, 2020. https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342009/all/Pancreatitis
3. Goulden, M. R. (n.d.). The pain of chronic pancreatitis: a persistent clinical challenge. NCBI. Retrieved March 23, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590150/
4. Lakananurak, N. (2020, May 6). Nutrition management in acute pancreatitis: Clinical practice consideration. Baishideng Publishing Group. Retrieved March 24, 2022, from https://www.wjgnet.com/2307-8960/full/v8/i9/1561.htm
5. Pancreatitis. (n.d.). Johns Hopkins Medicine. Retrieved March 23, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/pancreatitis
6. Pancreatitis – Causes – Treatment | familydoctor.org. (2021, January 27). FamilyDoctor.org. Retrieved March 23, 2022, from https://familydoctor.org/condition/pancreatitis/
7. Pancreatitis – Diagnosis and treatment. (2021, September 24). Mayo Clinic. Retrieved March 24, 2022, from https://www.mayoclinic.org/diseases-conditions/pancreatitis/diagnosis-treatment/drc-20360233
8. Villa, L. (2022, January 4). Drug Use and the Pancreas | Signs & Symptoms of Drug Abuse. DrugAbuse.com. Retrieved March 24, 2022, from https://drugabuse.com/addiction/health-issues/pancreas/

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