5 Pancreatitis Nursing Care Plans

Acute Pain

Pancreatitis is associated with acute pain due to multiple factors. The obstruction of the pancreatic and biliary tract can cause a buildup of pressure, leading to pain. In addition, inflammation can extend to the retroperitoneal nerve plexus, which can cause severe pain. Autodigestion of the pancreas also releases digestive enzymes that can damage surrounding tissues and cause pain.

Nursing Diagnosis

• Acute Pain

May be related to

• Obstruction of pancreatic, and biliary ducts
• Chemical contamination of peritoneal surfaces by pancreatic exudate/autodigestion of the pancreas
• Extension of inflammation to the retroperitoneal nerve plexus

Possibly evidenced by

• Reports of pain
• Self-focusing, grimacing, distraction/guarding behaviors
• Autonomic responses, alteration in muscle tone
• Observed evidence of pain
• Guarding behavior
• Protective gestures
• Positioning to avoid pain
• Sleep disturbances (eyes lackluster, beaten look, fixed or scattered movement
• Expressive behavior (restlessness, moaning, crying, vigilance, irritability, sighing)
• Distraction behavior (pacing, seeking out other people)
• Change in muscle tone
• Diaphoresis

Desired Outcomes

• The client will report relief/control of pain.
• The client will follow the prescribed therapeutic regimen.
• The client will verbalize nonpharmacologic methods that provide relief.
• The client will demonstrate the use of relaxation skills and diversional activities, as indicated, for the individual situation

Nursing Assessment and Rationales

1. Investigate verbal reports of pain, noting specific location and intensity (0–10 scale). Note factors that aggravate and relieve pain.
Pain is often diffuse, severe, and unrelenting in acute or hemorrhagic pancreatitis. Severe pain is often the major symptom in patients with chronic pancreatitis. Isolated pain in the RUQ reflects the involvement of the head of the pancreas. Pain in the left upper quadrant (LUQ) suggests the involvement of the pancreatic tail. Localized pain may indicate the development of pseudocysts or abscesses.

Nursing Interventions and Rationales

1. Maintain bedrest during an acute attack. Provide a quiet, restful environment.
Decreases metabolic rate and GI stimulation and secretions, thereby reducing pancreatic activity.

2. Promote a position of comfort on one side with knees flexed, sitting up, and leaning forward.
Reduces abdominal pressure and tension, providing some measure of comfort and pain relief. Note: Supine position often increases pain.

3. Provide alternative comfort measures (back rub), encourage relaxation techniques (guided imagery, visualization), and quiet diversional activities (TV, radio).
Promotes relaxation and enables the patient to refocus attention; may enhance coping.

4. Keep the environment free of food odors.
Sensory stimulation can activate pancreatic enzymes, increasing pain.

5. Administer analgesics in a timely manner (smaller, more frequent doses).
Severe and prolonged pain can aggravate shock and is more difficult to relieve, requiring larger doses of medication, which can mask underlying problems and complications and may contribute to respiratory depression.

6. Maintain meticulous skin care, especially in presence of draining abdominal wall fistulas.
Pancreatic enzymes can digest the skin and tissues of the abdominal wall, creating a chemical burn.

7. Withhold food and fluid as indicated.
Limits and reduces the release of pancreatic enzymes and resultant pain.

8. Maintain gastric suction when used.
Prevents accumulation of gastric secretions, which can stimulate pancreatic enzyme activity.

9. Administer medication as indicated:

• 9.1. Narcotic analgesics: meperidine (Demerol), fentanyl (Sublimaze), pentazocine (Talwin)
  Meperidine is usually effective in relieving pain and may be preferred over morphine, which can have a side effect of biliary-pancreatic spasms. Paravertebral block has been used to achieve prolonged pain control. Note: Pain in patients who have recurrent or chronic pancreatitis episodes may be difficult to manage because they may become dependent on the narcotics given for pain control.

• 9.2. Sedatives: diazepam (Valium); antispasmodics: atropine
  Potentiates action of narcotics to promote rest and to reduce muscular and ductal spasms, thereby reducing metabolic needs, and enzyme secretions.

• 9.3. Antacids: Mylanta, Maalox, Amphojel, Riopan
  Neutralizes gastric acid to reduce the production of pancreatic enzymes and to reduce the incidence of upper GI bleeding.

• 9.4. Cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid)
  Decreasing the secretion of HCl reduces stimulation of the pancreas and associated pain.

10. Prepare for surgical intervention if indicated.
Surgical exploration may be required in presence of intractable pain and complications involving the biliary tract, such as a pancreatic abscess or pseudocyst.

11. Accept the client’s description of pain
Pain is a subjective experience and cannot be felt by others.

12. Provide comfort measures.
To promote nonpharmacological pain management.

13. Encourage adequate rest periods.
To prevent fatigue

14. Administer analgesics as indicated to maximum dosage, as needed.
To maintain an acceptable level of pain.

15. Evaluate and document the client’s response to analgesia and assist in transitioning or changing the drug regimen based on individual needs.
Increasing or decreasing dosage, stepped program (switching from injection to oral route, increased time span as the pain lessens) helps in self-management of pain.