pancreatitis case study

8/9/2019 Pancreatitis Case Study

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#n the Philippines, there is !. / " of the total population who has pancreatitis as of year

!!/. 0orldwide, the incidence of pancreatitis ranges between ' and -! per 1!!,!!! populations.

As of !!2, there are ',!3 ,!&! people reported that have gallstones in the population of

-2, &1,2/3. 4According to http5++www.rightdiagnosis.com+g+gallstones+stats%country.htm6

Pancreatitis can be treated through pharmacologic treatments or surgical management. #t

depends upon the prognosis and type of disease occurring in a specific client.

The group chose this case because it appears to be uni7ue and interesting among the

cases available in the Surgery 0ard.

II.OBJECTIVES:

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General Objective:

This study aims to ac7uire knowledge about gallstones, pancreatitis, the disease process,

its prognosis, complications, and treatment and to apply the nursing interventions suitable for the

client with effectiveness and efficiency.

Specific Objectives:

Assess the client properly and gain baseline data by building rapport with the client and

his+her significant others .

8ormulate the correct diagnosis based from the thorough assessment done to the client.

Plan the nursing actions that are to be done through the problem which has been

addressed and found through the assessment.

Apply the appropriate nursing interventions with efficiency and with observance to the 11

core competencies.

Achieve the e*pected outcomes and gain a positive response from the client with the

interventions done.

III.NURSING ISTOR!

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BIOGR"# IC"$ D"T"

9ame 5 Patient :Age 5 1ender 5 MaleAddress 5 Sta. $ruz, Makati$ivil Status 5 Single

9ationality 5 8ilipino;eligion 5 $atholicate of Admission 5 ?une 12, !1

>ate of #nterview 5 ?une &, !1

#nformant 5 Patient : and significant other

;eliability 5 /!"

Source of information 5 Patient and Significant other

$riteria for reliability 5

A. )*tent of data gathered demographics, history habits @ !"


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ISTOR! O% #RESENT I$$NESS:

Patient :, a 1 year old male was admitted to the hospital with a complaint

of abdominal pain.

1 month prior to admission, client was e*periencing pain in his left upper

7uadrant part of the abdomen but he Bust ignores it. Pain was intermittent and he doesnCt take in

pain medication. =e also e*periences the same kind of pain when he is full or whenever he Bust

finished his meal. $lient also feels fullness of the stomach and indigestion. $lient did not go to

the hospital for check%up because he did not take it seriously. =e was fond of eating foods rich in

fat and he is an occasional alcohol drinker.

1 week prior to admission, pain e*perience became continuous even to the

point that he is having a hard time to go to sleep making him feel restless. (ne event that he feels

fullness he drank 1 bottle of coke and red horse to make himself burp. =owever, there was no

relief of symptoms upon burping.

1 day prior to admission, client e*perience e*treme pain and he is having

difficulty of breathing that is why he sought for medical assistance.

$lient was admitted at the emergency room of (spital ng Makati ?une 12,

!1 at around pm% pm, he e*perienced 1 episode of vomiting and no relief from abdominal

pain now located in the epigastric area, crampy in character, radiating to the back. $lient was

hooked to 1 P9SS * - hours. =e also stated that blood was e*tracted from him for laboratory

purposes. $lient was moved to the Surgery 0ard ?une 13, !1 .

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#"ST &EDIC"$ ISTOR!:

$lient doesnCt have hypertension or diabetes. =e has no known allergies.

=is last hospital visit was !!2 in (spital ng Makati, Malugay due to tonsillitis.

#ERSON"$ "ND SOCI"$ ISTOR!

Patient : was a habitual smoker since he was 1' years old. =e consumes

'%1! sticks of cigarette a day. =e is also a fre7uent alcohol drinker and he consumes bottles of

'!!ml of red horse beer to make himself sleep.

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%"&I$! ISTOR! O% I$$NESS

8ather Mother

4D6 allstones

Sister Sister eceased

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IV. GORDON'S %UNCTION"$ E"$T #"TTERN

#"TTERN O%E"$T

#RIOR TOOS#IT"$I("TION

DURINGOS#IT"$I("TION

"N"$!SIS "NDINTER#RET"TION

#. =ealth Perception

and =ealthManagementPattern

According to the

patient, he is not fondof going to the hospitalwhenever he feelssomething wrong withhis body. =e oftenignores it and Bust goesto the hospital if he canno longer tolerate thefeeling of alteration.$lient doesnCt take hishealth seriously

because he believesthat he needs to enBoylife. $lient is a habitualsmoker. =e startedsmoking when he was1' years old andconsumes '%1! sticks aday. =e said that he is

an occasional alcoholdrinker but then hestated that everyday isan occasion for him.0hen he drinks withfriends, he said ETulogna silang lahat akoumiinom paF. )verynight he takes in

bottles of red horse

which is '!! ml per bottle.

According to the

patient, he now seesthe importance ofhealth as an integral

part of life. =e is nowconscious about hishealth especially whenthe nurses or thestudent nurses areadministering hisdrugs.

;eadiness for

enhanced self%=ealthManagement

(Page 425 of Nurses Pocket Guide 12th

Edition by Doengeset., a !

##. 9utritional andMetabolic Pattern

According to the patient, he likes eatingfoods high in fat suchas liempo, and lechong

According to the patient, he is not ableto eat anything since heis in 9P( from the day

#mbalanced 9utrition5ess than bodyre7uirements

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kawali. =e drinks -glasses of water a day.=e has a good appetiteand he eats more than 1cup of rice especiallywhen his viand is highin fats. =e drinksalcoholic beveragesespecially beer. =e alsoloves drinking softdrinks. =e seldom eatsvegetables and fruits.

of his admission. =eacknowledges that hegets nutrition from theintravenous linesconnected to him.

(Page 5"4 of Nurses Pocket Guide 12th Edition by Doengeset., a !

###. )liminationPattern

According to the patient he normally has

his bowel movementonce daily in themorning. Stoolcharacteristics wereusually formed, dark

brown in color, hardand dry. =e doesnCtfeel constipation. =enever used la*atives.0hen he knew that he

didnCt have his bowelmovement he usuallyfeels uncomfortableand he will domanagement such asdrinking water to passout stool. =e urinatesregularly and morefre7uent when he takesin alcoholic beverages.Grine characteristicswere usually amber%yellow in color anddonCt have any foulodor.

According to the patient, he still has his

bowel movement oncea day but now stoolcharacteristic is fluidsince he is in 9P(.$lient also has anindwelling foleycatheter.

Altered defecationdue to diet

(Page 122# of $unda%enta s of Nursing & th Edition by 'o ier et., a !

#H. Sleep I ;estPattern

According to the patient he usually

According to the patient, he doesnCt

>isturbed sleep pattern

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sleeps - hours or moreduring the night. =edoesnCt sleeps nortakes an afternoon nap.After sleeping he feelsrested and energized.

sleep - hours duringhis hospital stay. =eonly sleeps about &hours or less due to thehospital activities and

because of the pain. =esometimes feelsunrested and wheneverhe gets awaken by ahealth care provider.=e is e*periencingdifficulty going back tosleep again because heis in hourly

monitoring.

(Page &&5 of Nurses Pocket Guide 12th Edition by Doengeset., a !

H. Activity and)*ercise Pattern

According to the client,he doesnCt do e*ercisedaily. =e seldom plays

basketball. =e can perform activities ofdaily living withoutany assistance.

According to the client,he cannot perform theactivities of dailyliving by himself. =eoften needs assistanceand he cannot movefreely because his painincreases especiallywhen he is moving.

Activity #ntolerance

(Page ") of Nurses

Pocket Guide 12th Edition by Doengeset., a !

H#. $ognitive IPerceptual Pattern

According to the client,he has normal visionand hearing. =edoesnCt e*periencedifficulty in terms ofreading,comprehending, andcommunicating withothers. =e can speak

both in 8ilipino and)nglish. =e can easilyinteract with others. =esaid that he has a goodtolerance in pain that

According to the client,he still has normalsenses. =is perceptionabout his life is still thesame. The client statedthat Egusto ko nggumalingF.

;eadiness forenhanced $omfort

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he doesnCt want to take pain medications. =e isa college undergrad.$lient perceiveseverything as part oflife and everythinghappens for a reason.

(Page 1## of Nurses Pocket Guide 12 th Edition by Doengeset., a !

H##. $oping IStress Tolerance IPerception+ Self$oncept Pattern

According to the client,family and friends arevery important for him.=e likes the companyof his friends andspecially his specialsomeone. 0henever he

is stressed, he oftendrinks alcohol with hisfriends.

According to the patient, he accepts hiscondition and he saidthat he cannot stop hisvices when he getsdischarged from thehospital

>efensive coping

(Page 25* of Nurses

Pocket Guide 12th


H###. Se*uality and;eproductivePattern

According to the clienthe had his first coituswhen he was 1/ yearsold. =e has beense*ually active and heuses condom for his

protection. =e only has

1 se*ual partner.

According to the clienthis feeling of se*ualityis a little bit affected

because he has foleycatheter.

#neffective se*uality pattern

(Page &4# of Nurses Pocket Guide 12th


#:. ;ole;elationship Pattern

According to the clienthe is not yet married

but he has a girlfriendand they are togetherfor years already. =eis currentlyunemployed though heused to work as a staffin the $ity =all.

According to the client,whenever a familymember or hisgirlfriend is in thehospital to take care ofhim, he feels loved andenBoys how they treathim.

;eadiness forenhanced ;elationship

(Page "") of Nurses Pocket Guide 12th Edition by Doengeset., a !

:. Halue I


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prayers. -ook!

V. REVIE) O% S!STE&

S!STE&S S!TO&S

#ntegumentary

;espiratory

astrointestinal

EMedyo masakit ang tinurukan sa aking brasoF

EMinsan nahihirapan akong humingaF

EMasakit ang aking tyan, sa tagiliran hangganglikod lalo na kapag gumagalaw akoF

P I provokes I mobilization,Palliates % immobilization

J % cramping; I epigastric to back S I 1!+1!T I during mobilization and ambulation.

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VI. # !SIC"$ "SSESS&ENT

Date: ?une &, !1

Ti*e: -5!2 am

General s+rve,:$lient was lying on the bed on a moderate high back rest, conscious and coherent. 8acial

features of the client were symmetrical with movements. Skin color is even, intact e*cept fromhis right forearm which has his peripheral parenteral nutrition and noticeable bruise his leftforearm due to #H insertion.


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Palpationdepending uponthe skin tone

Moisture5 Moist

Te*ture5 Smooth

Turgor5 skin7uickly returns toits originalshape.

Temperature5warm

tone, even

4D6 moist

4D6 smooth

Skin 7uicklyreturns tooriginal shape

4D6warm

9ormal

9ormal

9ormal

9ormal

=air #nspection )ven distribution

$olor5


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Palpation

)yelids54%6 Masses )yelids5

4%6 Masses

9ormal

)ars #nspection Symmetrical

4%6 discharges

4%6 lesions

4%6 nodules

4%6 redness

Symmetrical

4%6 discharges

4%6 lesions

4%6 nodules

4%6 redness

9ormal

9ormal

9ormal

9ormal

9ormal

9ose #nspection Symmetrically

aligned

4%6 discharge

4%6 flaring ofnares

Symmetrically

aligned

4%6 discharge

4%6 flaring ofnares

9ormal

9ormal

9ormal

Mouth #nspection

Palpation

#nspection

ips$olor5 Pinkish

4D6Moist

4%6 lesions

4%6 lumps

4%6 mass

Tongue5$olor5 Pink I red

ips$olor5 >ark %Pale

4D6 dryness

4%6 lesions

4%6 lumps

4%6 mass

Tongue5$olor5 Pink but

AbnormalK darkcolor of lipsindicate the long

term of smokingK paleness is anindication ofanemia due to

blood loss

Abnormal, mayindicatedehydration dueto 9P( diet

9ormal

9ormal

9ormal

9ormal

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4%6 lesions

4%6 thrush

Teeth5$olor5 white

ums5

$olor5 Pink I;ed

(ral Mucosa5

$olor5 Pinkish

4D6 Moisture

4%6 lesions

4%6 odor

with whitish film

4%6 lesions

4%6 thrush

Teeth5$olor5 white

ums5

$olor5 Pink I;ed

(ral Mucosa5

$olor5 Pale% pink

4D6 Moisture

4%6 lesions

4%6 odor

9ormal

9ormal

9ormal

9ormal

AbnormalK

indication of low;


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Palpation

Auscultation

4%6 retraction

4D6 smooth

4D6 warm

4D6 dry

4D6 normal breath sounds

4%6 adventitioussound

4%6 retraction 4D6 smooth

4D6 warm

4D6 dry

4D6 normal breath sounds

4%6 adventitioussound

9ormal

9ormal

9ormal

9ormal

9ormal

=eart #nspection

Auscultation

4%6 visible PM#

4D6 regularrhythm

4%6 thrills

4%6 murmurs

4%6 visible PM#

4D6 regularrhythm

4%6 thrills

4%6murmurs

9ormal

9ormal

9ormal

9ormalGpper)*tremities

#nspection

Palpation

Gpper)*tremities4%6 pallor

4%6 rashes

4%6 bruise

4%6 contraptions

4%6 swelling

4%6 edema

Gpper)*tremities4%6 pallor

4%6 rashes

4D6 bruise on theleft forearm

4D6 peripheral parenteralnutritioninsertion

4D6 tattoo on leftdeltoid area

4%6 swelling

4%6 edema

9ormal

9ormal

AbnormalK bruiseis due to the 1 st insertion of the#H cannula

9ormal

9ormal

9ormal

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4D6 ;adial and


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4D6 indwellingfoley catheter

ower)*tremities

#nspection 4%6 pallor

4%6 rashes

4%6 bruise

4%6 swelling

4%6 edema 4D6 popliteal,

posterior tibial,and dorsalis

pedis pulses

4%6 pallor

4%6 rashes

4%6 bruise

4%6 swelling

4%6 edema 4D6 popliteal,

posterior tibial,and dorsalis

pedis pulses

9ormal

9ormal

9ormal

9ormal

9ormal

9ormal

( na ysis and nter/retation 0eference Essentia s of nato%y and Physio ogy, " th edition 3ea th ssess%ent ade ncredib y isua !

VII. COURSE IN T E )"RD

D"TE - S I%T DOCTOR'SORDER

NURSE'SRES#ONSIBI$ITIES

#T. RE"CTIONEV"$U"TION

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?une &, !1

?une ', !1

%Maintain on 9P(

%$ontinue HS and#L( monitoring 71

%$ontinue giving

meds

%;efer accordingly

%9P(

%PP9 1&!! kcal *&hrs

%)*plain to the clientthe importance of theorder.

%Maintain oral hygieneand give sips of waterto prevent dryness ofthe lips and relievethirst.

%Monitor Hital Signshourly and document

%Administer medication

with the right dosage,route and fre7uencyKand without addinginBury to the patient.

%;efer if there arealterations

%)*plain to the client

the importance of theorder.

%Maintain oral hygieneand give sips of waterto prevent dryness ofthe lips and relievethirst.

%Make sure that clientreceives the rightsolution without addinginBury and assuringaseptic techni7ue.

%Patient understandthe importance of theorder.

%Patient feelscomfortable and thirsthas been relieved.

% $lient wasmonitored and

checked thoroughly

%Patient understood

the importance of theorder.

%Patient feelscomfortable and thirsthas been relieved

%Patient received the proper nutritionneeded.

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%#H8 P9SS 1 hrs *1&gtts+min

%Monitored andregulated the #H fluid to

prevent fluid deficit oroverload.

%$heck the #H site forsigns of phlebitis orinfiltration

%$lient did note*perience fluiddeficit or overload.

%$lient did not haveany signs of phlebitisor infiltration.

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indicate anemia

(Essentia s of nato%y and Physio ogy, " th edition /g. 64!

>ifferential $ount

)osinophils 9eutrophils

!.! %!.!& !.!1 AbnormalK decreased

Segmenters !.'!%!.3! !.- AbnormalK #ncreasedK#ndication forinfection

(Essentia s of nato%y and Physio ogy, " th edition /g. 64!

ymphocytes !. !%!.&! !.1! AbnormalK decreasedMonocytes !.! %!.!' !.!3 AbnormalK increase

may indicate chronicinfection

(Essentia s of

nato%y and Physio ogy, " th edition /g. 64!

Platelet $ount 1'!%&'!*1!N/+ / 9ormal

?une 13, !1 Arug was administeredto the patient safely.

$lient stateunderstanding about thedug therapy.

Dr+4 Na*e Classificati/n D/sa4e R/+te "cti/n N+rsin4 C/nsi0erati/ns Eval+ati/n

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%re6+enc,

Generic Na*e:

PiperacillinTazobactam

Bran0 Na*e:

Tazocin, Qosyn

#3ar*ac/l/4ic:

Penicillin, beta%lactamase inhibitor

T3erape+tic:

Anti%infective

&.'g+ #H+ 7- A9ST "cti/n:

Piperacillin

#nhibits

bacterial cellwall synthesis

$ell death

In0icati/n:

#nfection

Assess clientCscondition before the drugtherapy.

Perform skin testing tocheck if client has

hypersensitivity with thedrug.

Assess #H site for signsof phlebitis andinfiltration.

Monitor for signs andsymptoms ofsuperinfection.


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DI"GNOSIS INTERVENTIONS

S+bjective

7 EMasakit angtyan ko sa maytagiliranhanggang salikod.F Asverbalized by the

patient.P I provokes Imobilization,Palliates %immobilizationJ % cramping; I epigastric to

back S I 1!+1!T I during

mobilization andambulation.

Objective:

4D6 facialgrimace4D6 guarding

behavior

Pain related tocurrent diseasecondition

(rganinflammation4pancreatitis6

Abdominalrigidity andtenderness

Pain

S3/rt5ter*G/al:

After ! mins of nursing

intervention,clientCs pain

e*perience will be lessening

from the scale of 1! to 2.

$/n4 ter*G/al:

After days ofnursingintervention,

client willeventually knowhow to managehis pain.

In0epen0ent:

)ncourage theclient to verbalizeabout the pain.

Promote comfortmeasures and deep

breathing e*ercise.

)ncourage theclient to dodiversionaryactivities such as

listening to music or reading books ornewspaper.

Depen0ent:

Administer painmedications such astramadol as ordered

Promotescooperation and itcan help in thethoroughassessment. These activitiescalm the patientand makinghim+her feel painrelief.

To divertclientCs attentionaway from painthus making

him+her lessen thecognition about

pain.

After ! mins of nursingintervention,clientCs pain wasrelieved from the

pain scale of 1! to3.

oal partiallymet.

After days ofnursingintervention,client knows how

to manage his pain.

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4D6 rigid GJ toJ

4D6 abdominaltenderness 4 GJto J6

by the attending physician.

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CUES NURSINGDI"GNOSIS

IN%ERENCE GO"$ NURSINGINTERVENTION

R"TION"$E EV"$U"TION

SubBective5E9ahihirapanakong humingalalo na kapagnagsasalitaF

(bBective54D6 use ofaccessorymuscle when

breathing

;;@ cpm

#neffective breathing pattern relatedto pain

>iaphragmatic breathing

Affects the siteof pain

#ncreases painspecially when

talking

$lient breathesmore fre7uent

#ncreased ;;

#neffective breathing pattern

After !minutes ofnursingintervention,clientCs

breathing will be improvedand ;; will benormalized

#ndependent5%Maintain or putclient on high backrest or in fowlerCs

position.

%)ncourage client totake slower anddeeper respirations.

%Teach client to learn breathing e*ercise.

%Assist client in theuse of rela*ationtechni7ues.

$ollaborative5Monitor Aifficultyturning

4D6 Jcramping painthat radiates tothe back with a

pain scale of 1!duringmobilizationand ambulation.

Activityintolerance r+t

pain ordiscomfort

Pain

>ifficulty inmoving

>ecreasedmovement

Activity

intolerance

After ! minutesof therapeuticcommunication,the client will beable to verbalizeunderstanding

and gaincooperation ofhis situation.

#ndependent5% #nstruct use ofside rails overheadtrapeze roller padsfor positionchanges or transfer.

% Support affected body parts using pillow+rollsK airmattress especiallythe bony

prominences.% Provide for safetymeasure and asindicated byindividual situationincluding,environmentalmanagement+ fall

prevention.

%9ote clientCsreport of weakness,fatigue pain%Promote comfortmeasures and

provide for reliefof pain

% To promotesafety to theclient.

% To preventulceration and or

bed sores.

%To enhanceability to

participate inactivities.

The patientverbalizedunderstanding of his situation orrisk factors andindividual

treatmentregimen andsafety measures.

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IN%ERENCE GO"$ NURSINGINTERVENTION


SubBective5E>i na akomakatulog ngmaayos dahil sasakit nanararamdamankoF(bBective54D6 periorbital

puffiness4D6 restlessness

>isturbedsleeping

pattern relatedto pain

$urrentmedical

condition

Pain

>isturbance tosleep

;estlessness

Short term5After 1' minsof therapeuticcommunicationclient willverbalize ofunderstandingon how toimprovesleeping pattern

ong term goal5After days ofnursingintervention,client willreport of

enhancedsleeping pattern

#ndependent5% Advice client todo his routine

before sleeping% Advice client todo rela*ationtechni7ues%>etermine clientand significantotherCse*pectations ofade7uate sleep.%Promote comfortmeasures such astherapeutic touch,change of positionin bed.

>ependent5%Administer painmedications asordered.

%To promote betterway of getting tosleep.

%To help client fallasleep faster.

%Provideopportunity toaddressmisconceptions orunrealistice*pectations.

%To provide

nonpharmacological pain managementand promote sleep.

%To lessen oreliminate feeling of

After 1' mins of therapeuticcommunicationclient verbalizedunderstandingon how toimprovesleeping pattern.

After days ofnursingintervention,client stated ofenhancedsleeping pattern

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pain and achievesedation effect.


IN%ERENCE GO"$ NURSINGINTERVENTIONS


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(bBective5

4D6 8oley$atheter

4D6 #H 8luid

4D6 PeripheralParental

9utrition

;isk forinfection r+tinade7uate

primarydefenses

>isease process

owered

primarydefences

;isk for infection

After 1 hr ofnursinginterventionsthe clientverbalize

understandingof individualcausative or risk factor.

% Monitor clientCsvisitors forrespiratory illnesses

% Administermedication regimen.

% ;ecommendroutine or

preoperative bodyshower or scrubswhen indicated

%Stress proper handhygiene to healthcare provide andclient.

%Provide regular perineal care

% To limite*posures, thusreducing crosscontamination

% To determineeffectiveness oftherapy or

presence of sideeffects

%To reduce bacterialcolonization

%A first linedefense againstnosocomialinfection.

%To reduce riskof ascendingGT#

After - hrs. ofnursingintervention theclient was ableto verbalize

understanding of individualcausative or riskfactor.

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%Maintain aseptictechni7ue whengiving #H meds andPP9

%To preventcontaminationof the #H line.

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1IV.DISC "RGE #$"N:

&e0icines

o #nstructed the client and his significant others to continue the medications as

ordered by the physician.

o Stress the importance of compliance to prescribed medication.

E8ercise:

o Advised the client to do light e*ercises.

o Stressed to the client the importance of rest.

o )ncourage patient rest and deep breathing e*ercise

o )ncourage patient to resume daily activities which aides in achieving andmaintaining an optimum level of wellness and heath.

Treat*ent

o )ncourage the patient to seek nearest hospital as soon as possible if symptoms areobserved and canCt be relieved by the medications.

o Advise the patient to comply prescribed medications

ealt3 Teac3in4

o #nstructed the client on the time of the administration of the drug.

o #nstructed the client about the drugCs side effects or adverse effects such as5

diarrhea, increased heart rate etc.

o #nstructed the client to take the prescribed medicines.

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o Teach the client or significant to others on how to clean the operative site to

prevent infection.

o Teach the patient or significant to others to wash hands before changing and after

disposing of dressing.

o Teach the patient when to notify the physician of complications 4infection , an

unhealed wound and an*iety and to report any sudden chest pain or difficulty of

breathing 6

o )*plore the patientCs drinking pattern.

O+t 9 #atient

o #nstructed the client to have follow%up check up to monitor her condition.

Diet

o )ncourage the client to eat foods less in fat and sodium

o )ncourage the client to increase oral fluid intake and restrain from drinking

alcoholic beverages.

=eight I 'C2

0eight I ' kg

Desire0 B/0, )ei43t DB); T/tal Ener4, Re6+ire*ent

>


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@A?@4ra*s$=(9@ 1!!kcal * .1' @ 1' kcal R & @ . @ 4ra*s8at @ 1!!kcal * . ' @ ' 'kcal R / @ @ .AA 4ra*s

SAMP ) A$TGA M)A P A95

inner5

1 cup of rice

1 cup stir I fried vegetables

1 slice of apple

Spirit+al

o )ncourage the client to keep, praying and visiting their church.

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pancreatitis case study

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