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Concordia College

College of Nursing

Case
Study
On
Acute
Pancreatitis
Prepared by:
De Castro, Richelle Sandriel C.
BSN III-D

Submitted to:
Mrs. Cedie Loo RN, MSN

I. INTRODUCTION
Acute pancreatitis is an acute inflammatory process with variable involvement of
adjacent and remote organs. Although pancreatic function and structure eventually
return to normal, the risk of recurrent attacks is nearly 50% unless the precipitating
cause is removed. Initial manifestations and exacerbations of chronic pancreatitis
may be indistinguishable from attacks of acute pancreatitis. And they should be
treated as such. The inflammation begins in the perilobular and peripancreatic fatty
tissue, manifested by edema and spotty fat necrosis. The disease may progress to
the peripheral acinar cells, pancreatic ducts, blood vessels, and bordering organs. In
severe cases; patchy areas of the pancreatic parenchyma become necrotic.

II. OBJECTIVES

General:

After this case study, I will be able to know what Acute Pancreatitis is, causes of
Acute Pancreatitis, how it is acquired and prevented, its treatments and prevention
its occurrence.

Specific:

After the completion of this study, I will be able to:


• Define what is Acute Pancreatitis
• Trace the pathophysiology of Acute Pancreatitis
• Enumerate the different sign and symptoms of Acute Pancreatitis
• Identify and understand different types of medical treatment necessary for
the treatment of Acute Pancreatitis

III. PATIENT’S PROFILE

Name: E.S
Address: San Juan City
Age: 65 years old
Sex: Female
Nationality: Filipino
Religion: Roman Catholic
Date & Time of Admission: April 16, 2010 (09:34 pm)
Mode of Arrival: wheelchair
Chief Complaint: Severe Abdominal Pain
Source of Information: Patient, Chart, SO
Final Diagnosis: Acute Pancreatitis, Acalculous Cholecystitis, Multiple Hepatic Cysts

IV. NURSING HISTORY


PAST MEDICAL HISTORY
According to the patient’s SO, she had completed his childhood
immunization. He had no allergy to foods or medications. She has hypertension and
takes Amiodipine and Metropolol to manage her illness. On June 2006, the patient
was admitted at a government hospital due to Polycystitis.

HISTORY OF PRESENT ILLNESS

According to the patient’s SO, 3 days prior to admission the patient


experienced sudden onset of abdominal pain, diffuse. No meds taken or
consultation made. 2 days PTA the patient still have the same abdominal pain, this
time was more severe and they monitored it. The patient is negative to bladder
change. Few hours PTA, the patient could not any more tolerate the pain; she was
brought to OLLH hence admitted.

FAMILY HEALTH HISTORY

According to the patient’s SO, both his maternal and paternal have a history
Hypertension and Kidney Problem: Polycystic Kidney.

PERSONAL / SOCIAL HISTORY

The patient is the 4th among 6 siblings. She is living with 7 other family
members. His spouse is unemployed and so was she. They are only financially
supported with their children who are working.

V. Laboratory Works
NURSING NORMAL ABNORMAL
TEST PURPOSE
CONSIDERATIONS VALUES RESULTS
1. Serum Levels of The patient need 26 to 102 A marked increase
amylase amylase in a not fast before units/L (more than three
blood sample test but must (SI, o.4 to 1.74) times the upper
Most abstain alcohol. limit of normal) in
commonly If severe the level strongly
used test to abdominal pain suggests acute
diagnosis of occur, obtain pancreatitis.
acute sample before After the onset of
pancreatitis. therapeutic acute pancreatitis,
To evaluate intervention. levels of amylase in
possible Handle sample the blood rise
pancreatic gently to prevent within six to 12
injury caused hemolysis. hours, peak within
by abdominal 12 to 48 hours and
trauma. remain elevated for
three to five days in
uncomplicated
attacks.
2. Serum Determines Instruct less than 160 Increased levels
lipase levels of lipase patient to fast units/L suggest acute
in a blood overnight (SI,<2.72 pancreatitis or
sample before test. µkat/L) pancreatic duct
Elevated Handle obstruction. After an
serum lipase sample gently acute attack, levels
levels help to to prevent remain elevated for
confirm the hemolysis. up to 14 days.
pancreatic Increased levels
origin of may occur in other
elevated pancreatic injuries
serum amylase such as perforated
levels. peptic ulcer with
chemical
pancreatitis caused
by gastric juices.

3. To aid in the Instruct Pancreas Alterations in the


Ultrasonograp diagnosis of patient to fast demonstrates size, contour and
hy (Pancreas) pancreatitis, for 8 to 12 a coarse, parenchymal
pseudocysts, hours before uniform echo texture of the
and pancreatic the test to pattern pancreas suggest
carcinoma. reduce bowel (reflecting possible pancreatic
for initial gas. tissue density) disease.
evaluation Instruct to and is usually An enlarged
when biliary abstain from more pancreas with
causes are smoking echogenic than decreased
suspected. before the the adjacent echogenicity and
The sensitivity test to liver. distinct borders
of this study in eliminate the suggests
detecting risk of pancreatitis.
pancreatitis is swallowing air An ill-defined mass
62 to 95 while inhaling, with scattered
percent. which internal echoes, or a
interferes with mass in the head of
test results. the pancreas
(obstructing the
common bile duct)
and a large
noncontracting
gallbladder suggest
pancreatic
carcinoma.
4. Particularly Provide a fat- Gallbladder is Mobile, echogenic
Ultrasonograp useful for free meal in sonolucent and areas, usually linked
hy identifying the evening pear-shaped; to an acoustic
(Gallbladder & gallstones in before the its outer walls shadow, suggest
Biliary the gallbladder test. normally apper gallstones within
system) or in the ducts Tell patient sharp and gallbladder lumen
that drain the that he must smooth. or the biliary
gallbladder as fast for 8 to The common system.
the cause of 12 hours bile duct has a May not be visible
acute before the linear when the
pancreatitis procedure. apperance but gallbladder is
However, this During the is sometimes shrunken or filled
test cannot scan, instruct obscured by with gallstones.
identify the to exhale overlying A fine layer of
more serious deeply and bowel gas. echoes that slowly
abnormalities hold his gravitates to the
associated breath, when dependent portion
with moderate requested. of the gallbladder
and severe as the patient
pancreatitis changes position,
suggests biliary
sludge within the
gallbladder lumen.

5. Abdominal Reveal a The bowel gas The size, shape, or location


X-ray normal pattern (stomach,of the bladder or kidneys
appearance of small and large may be abnormal. Kidney
the digestive bowel) and soft stones may be seen in the
tract or tissue densities kidney, ureters, bladder, or
abnormalities (liver, spleen, urethra.
(paralysis of kidneys, and Abnormal growths, such as
regions of the bladder) are large tumors, or ascites
small intestine normal in size, may be seen
and spasm of shape, and In some cases, gallstones
part of the location. can be seen on an
colon). abdominal X-ray.
The walls of the intestines
may look abnormal or thick
A collection of air inside the
belly cavity but outside the
intestines (caused by a
hole in the stomach or
intestines) may be seen.
6. Chest X-ray To evaluate The diaphragm Elevation of diaphragm,
any looks normal in collection of fluid in the
abnormalities shape and chest cavity collapse of the
on the chest. location base of the lungs and
No abnormal inflammation of the lungs.
collection of fluid
or air is seen, and
no foreign
objects are seen.
The lungs look
normal in size
and shape, and
the lung tissue
looks normal. No
growths or other
masses can be
seen within the
lungs.

7. For Instruct patientThe Changes in the pancreatic


Compute diagnosing to fast after pancreatic size and shape suggests
d acute administration parenchyma carcinoma and
tomograp pancreatitis of oral contrast displays a pseudocysts.
hy scan for medium. uniform Acute pancreatitis, either
(pancreas determining Check density, edematous (interstitial) or
) the extent of patient’s especially necrotizing (hemorrhagic),
pancreatitis. history for when an I.V. produces diffuse
enlargement recent barium contrast enlargement of the
or abnormal studies and for medium is pancreas.
contours of hypersensitivit used. In acute edematous
the pancreas, y to iodine, The gland pancreatitis, parenchyma
inflammation seafood, or thickens from density is uniformly
of the tissues contrast tail and has a decreased.
surrounding media. smooth In acute necrotizing
the pancreas, Describe surface. pancreatitis, the density is
collection of possible non-uniform because of
fluid around adverse the presence of necrosis
the pancreas, reactions to and hemorrhage.
and collection the medium In acute pancreatitis,
of gas in the (nausea, inflammation typically
pancreas or flushinf, spreads into the
in the tissues dizziness, peripancreatic fat.
behind the sweating) and Pseudocysts, may be
pancreas. tell to report unilocal, multi-local,
these appear as sharply
symptoms. circumscribed, low-
density areas that may
contain debris.
VI. PATHOPHYSIOOGY
VII. ANATOMY AND PHYSIOLOGY

Pancreas

• Pancreas is an organ located behind the stomach and next to the liver and the gall
bladder. Pancreatic juices contain Enzymes, which help digest or break down food
proteins. Normally the juices leave the pancreas via a duct like channel and join the
common bile duct, which carries the secretions from the gallbladder, and pour the
mixture into the duodenal portion of the stomach.

VIII. DISCHARGE PLANNING
 MEDICATIONS:
- Metoclopromide (Plasil)
- Omeprazole ( Omepron) 40mg
- Metronidazole 500mg
- Amikacin ( Konmalin) 500mg
- Calcibloc 5mg
 ECONOMIC STATUS:
E.S. a housewife, supported financially by her children who are working, can
afford for to pay for her medications, and other necessities by using the money sent
to her.
 TREATMENT:
The client should be encouraged to learn and use of relaxation techniques
including guided imagery and music therapy are used to shift the focus of the brain
away from the pain, decrease muscle tension, and reduce stress. Tension and stress
can also be reduced through biofeedback. Being massaged or applying backrub is
very relaxing and helps reduce stress.
 HEALTH TEACHINGS:
- Encourage to take a well - balanced diet.
- Encourage a healthy lifestyle.
- Educate patient in pain management.
 OPD VISITS:
Teach patient that if acute abdominal pain or biliary tract disease (as evidenced
by jaundice, clay- colored stools, and darkened urine) occurs, she should notify it to
the physician. She may report to the physician after 7 to 10 days to know the
indictor of disease or response progression.
 DIET:
The client should be instructed to avoid alcohol, spicy foods, any caffeine-
containing foods, heavy meals, high fatty foods. Small, frequent feeding of bland
diet.
 SPIRITUAL CARE:
Encourage client to pray in accordance with their beliefs. Ask for help to God for
complete recovery.
DAILY DIARY

29 April 2010 (Thursday)

I woke up at 4:30am and did my everyday routine. Took a bath,


dressed up and ate. Then went to school to fetch Cess then headed to Our
Lady of Lourdes Hospital in Mandaluyong. We stayed in the waiting are only
to find out that Mrs. Loo was our C.I. I got ecstatic and excited at the same
time because I admit that she’s one of my favorite C.I’s (no joke to ma’am
ah).  Then Mrs. Loo took the endorsement form and jot down important
things that we need to know with our oatients then she assigned it to us one
by one. I got a patient in room 415A. Me and April were assigned there. It’s
my first time to handle a patient that has NGT tube, Jackson Pratt, and T-
tube. I was so excited to drain all of those.  We did the taking of Vital Signs
then we recorded it. Then off to morning care. I sponged bathed my patient
with the help of my duty mate, Lyka. Then we also did perineal care. After
that we went to the station to plot the vital signs. Then we were assigned to
have the first break. After which, we went to our room and told us to do a
Nursing Care Plan of our patient. Mrs. Loo then told us the requirements. We
did the NCP then have it checked. Glad I got 8/10.  Then by 12nn, we did
the VS again, recorded it then plot it. Then before we left, I drained the NGT,
JP and T-Tube of my patient. I was so glad of that day’s duty. 

REFLECTION
This is the second time that I am handled by Mrs. Loo. And yet again, she
never failed us to give insights and new learnings about the things in the
ward. This is our first time to have a duty in St. Anthony Unit in Our Lady of
Lourdes Hospital. Yet, the things to do are the same with the ones in the St.
Vincent Unit. This time, the patients are less and our ratio is 1:1. I have a
patient with NGT, T-Tube and JP. I’m tasked to drain those at the end of our
shift. I felt really excited because it is my first time to handle a patient with
those tubings. I’m glad that our c.i, Mrs. Loo was very patient to teach me
the things I need to do with my patient. I felt great that day because we’re
not that kind of busy and at the same time we had a lot of time to talk about
things under the sun. 

De Castro, Richelle Sandriel C.


BSN III-D
Journal

Scorpion venom may help treat pancreatitis

Researchers at North Carolina State University and East Carolina University have
gained insight into scorpion venom’s effects on the ability of certain cells to release
critical components - a finding that may prove useful in understanding diseases like
pancreatitis or in targeted drug delivery.

A common result of scorpion stings, pancreatitis is an inflammation of the


pancreas.
ECU microbiologist Dr. Paul Fletcher believed that scorpion venom might be used as
a way to discover how pancreatitis occurs - to see which cellular processes are
affected at the onset of the disease.

Fletcher pinpointed a protein production system found in the pancreas that seemed
to be targeted by the venom of the Brazilian scorpion Tityus serrulatus and then
contacted NC State physicist Dr. Keith Weninger, who had studied that particular
protein system.

"This particular protein system has special emphasis at two places in the body - the
pancreas and the nervous system," Weninger says. "In the pancreas, it is involved
in the release of proteins through the membrane of a cell."

The pancreas specializes in releasing two kinds of proteins using separate cells:
digestive enzymes that go into the small intestine and insulin and its relatives that
go into the bloodstream, yet this same release mechanism is important in all of our
cells for many processes.

Cells move components in and out through a process called vesicle fusion. The
vesicle is a tiny, bubble-like chamber inside the cell that contains the substance to
be moved, stored and released - in this case, proteins like enzymes or hormones.
The vesicle is moved through the cell and attaches to the exterior membrane,
where the vesicle acts like an airlock in a spaceship, allowing the cell membrane to
open and release the proteins without disturbing the rest of the cell’s contents. The
proteins that aid in this process are known as Vesicle Associated Membrane
Proteins, or VAMPs.

Weninger provided Fletcher with two different VAMP proteins found in the pancreas,
VAMP2 and VAMP8. They were engineered to remove the membrane attachments
so they could be more easily used for experiments outside cells and tissues.
Fletcher’s team demonstrated that the scorpion venom attacked the VAMP proteins,
cutting them in one place and eliminating the vesicle’s ability to transport its
protein cargo out of the cell.i
i
http://timesofindia.indiatimes.com/life/health-fitness/health/Scorpion-venom-may-help-treat-
pancreatitis/articleshow/5742047.cms

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