Presentation Subtitle

ACUTE
PANCREATITIS
NURSING
HEALTH
HISTORY
 DEMOGRAPHIC DATA
We have a case 18 years old,
female, Filipino, Roman Catholic,
currently living in Caloocan City.
She was born on February 04,
1993 at Samar. She was admitted
in Tondo Medical Center last July
05, 2011. We gather information
from our patient with her mother
and we interviewed her lasts July
07, 2011 and conducted in Tondo
Medical Center.
 CHIEF COMPLAINTS

• Abdominal Pain

PATIENT RELIABILITY
• The patient reliability is 90-95%.
 HISTORY OF PRESENT
ILLNES
• One week prior to admission after
eating, the patient had
experienced abdominal pain at
epigastric area accompanied by
difficulty in breathing, and body
malaise/weakness. Last wednesday
morning she suddenly experienced
pain in abdominal pain in
epigastric area accompanied with
difficulty in breathing,
and body malaise/weakness that
lasts up to 5 minutes. She takes
mefenamic acid 500 mg/tab to
relieve pain but the pain does not
relieve. That’s why the mother
prompted to sent her to hospital
when the severe abdominal pain
occurs and she was diagnosed that
she has Acute Pancreatitis. She is
given to take Omeprazole 20 mg
TIV OD. Tramadol 500 mg/tab ½
amp TIV q8..Her attending
physician Dr. Santos.
 PAST HISTORY

• The patient has a history of

long-term alcohol use and
smoking.

ALLERGIES
• The client denies for any
allergies on food, medication
and environment.
CURRENT MEDICATION

• The patient is currently taking

Omeprazole 20 mg TIV OD.
Omeprazole is an antisecretory
drug and proton pump inhibitor.
Tramadol 500 mg/tab ½ amp TIV
q8. Tramadol is an analgesic and
opiod analgesic. It relieve moderate
to severe pain as prescribed by the
physician.
 IMMUNIZATION

• The patient denies for complete

vaccination

HABITS
• She drinks alcoholic beverages
occasionally, once a week and
she smoke and consume 1 stick
per week.
 PERSONAL AND SOCIAL
HISTORY

• She is alcoholic drinker and

smoker. She was influenced by
her friends and also with her
family. Both her parents are
alcoholic and her friends are
alcoholic drinker and smoker.
 FAMILY HEALTH HISTORY

• The patient has

heredofamilial disease such as
Hypertension, Asthma and
Tuberculosis in intestine. Her
Mother has Hypertension and
Tuberculosis in intestine. Her
father has asthma. The patient
and also the parents are
alcoholic ddrinker.
GENOGRAM
REVIEW OF SYSTEM
PERSON’S
GORDON
APPROACH
SELF-PERCEPTION - SELF-
CONCEPT PATTERN
• The patient denies that she was
depressed and shy during our
interview because of her
condition.
 ROLE- RELATIONSHIP
PATTERN
• She is alcoholic drinker and
smoker. She was influenced by
her friends and also with her
family. Both her parents are
alcoholic and her friends are
alcoholic drinker and smoker.
SEXUALITY AND REPRODUCTIVE
PATTERN
• None
 COGNITIVE PERCEPTUAL
PATTERN

• The client has no difficulty in

hearing and vision. She is
conscious and well oriented to
time, place and person. Her
memory status is still in normal
condition.
 COPING STRESS AND
TOLERANCE

• The patient denies that pain it’s

a sharp pain in her chest that
went through to the back. She
calls her mother to make her
comfortable.
 VALUE BELIEF PATTERN

• She was afraid on what will

happen to her after she was
diagnosed having acute
pancreatitis. Her mother
decided to bring her to the
hospital when severe pain
accompanied with difficulty of
breathing occurs.
 ELIMINATION

• She drinks 2-3 glasses per day.

She urinates 4-5 times a day
with minimal amount, yellow in
color.
 REST AND ACTIVITY
Activity Exercise Pattern
• After the patient is admitted in
the hospital, she can no longer
walk like what she is doing
before.
Sleep Rest Pattern
• The patient has difficulty in
sleeping because of pain that she
experience.
 SAFE ENVIRONMENT

• She patient denies for having

any allergies on food,
medication and environment.
• She was only influenced by her
friends in using tobacco.
 OXYGENATION

• The client respiratory rate is

32cpm. Her nail plate color is
pale. Color of skin is pallor and
the color of her lips is pale and
have cracked.
 NUTRITION (24 hour
DIETARY RECALL)

• Height: 5’2
• Weight: 50 kg
• BMI (Normal -> 18.5-22.9):
20.01 NORMAL
• Desirble Body Weight: 51.82
• TOTAL ENERGY ALLOWANCE:
1560  1550 kcal
 Food Fluid Energy
intake intake (kcal)
Breakfast - 200 kcal
200
Lunch 400+41 - 441 kcal
Dinner 400+86+ - 502 kcal
16
TOTAL:
1143
kcal
• Ideally patient should consume
1550 kcal per day but according
to her 24 Hour dietary recall,
patient was able to take 1143
kcal only, if not intervene, it
could lead to malnourishment
and decrease energy source
due to inadequate
carbohydratess, protein and
fats intake.
 PHYSICAL
ASSESSMENT
• General Appearance
She has stooped posture.
Vital Sign:
RR: 31 cpm
Pain scale: 8/10
• Mental Status
She is conscious and coherent.
She is oriented to time, place
and persons. She is shy during
our interview.
• Skin
Skin is of the pallor. Warm to
touch. Oily and smooth in
texture.
• Nails
Nail bed color is pale.
• Head & Face
Facial grimace
• Eyes
None
• Ears
None
• Nose
None
• Mouth
Lips are pale & have cracks
• Chest & Lungs
Upon auscultation, crackles was
heard. The patient denies for
difficulty of breathing
Chest pain
• Breast
None
• Abdomen
Muscle guarding. Abdominal pain
• Lower & Upper Extremities
None
• Genetalia
None
DIAGNOSTIC
PROCEDURE
COMPLETE BLOOD
COUNT
 Exam Name Result Unit Normal Value
COMPLETE
Hemoglobin 105 BLOOD
low COUNT
g/L 110 - 150
Hematocrit 0.323 low 0.37 - 0.45
WBC Count 18.7 high 10^g/L 4.6 - 10
Differential
Count
Segmenters 0.857 high 0.50 - 0.70
Lymphocytes 0.122 low 0.20 - 0.40
Monocytes 0.005 0 - 0.07
Eosinophils 0.013 0 - 0.05
Basophils 0.003
MCV 81.9 fL 80.9 - 99.9
MCH 26.6 low pg 27 – 31
MCHC 32.5 low % 33.0 - 37.0
Platelet Count 237 10^g/L 150 - 400
Blood Type A+
 AMYLASE TEST

Test Result Flag Unit Normal

Name Range
Amylase 2297.8 H (DT) U/L 20 - 110
 URINALYSIS
Physical Chemical
Color Yellow Albumin Negative
Transparenc Clear Sugar Negative
y
Reaction 6.0 Ketones -
Specific 1.020
Gravity
Cells. Epithelium
Red Blood 1 - 2/hpf Squamous Few
Cell Cells
Pus Cells 2 - 4/hpf Renal Cell -
SODIUM-POTASSIUM TEST

Test Round Value Normal Value

Sodium 137.8 134 - 145

mmol/L
Potassium 3.64 3.3 - 4.5 mmol/L

Chloride - 98 - 106 meq/L

PATHOPHYSIOLOGY
 SALIENT FEATURES:

• Abdominal pain accompanied with

Chest pain
• Difficulty of breathing
accompanied with RR of 32 cpm.
• Activity tolerance accompanied
with muscle weakness/body
weakness
• Imbalance between oxygen supply
and demand.
 LIST OF PRIORITIZED
NURSING DIAGNOSIS
NURSING RANK JUSTIFICATION
DIAGNOSIS

Ineffective breathing Inflammation of pancreas

pattern related to
irritation of diaphragm
secondary to
1 cause by vasodilation
inflammation of pancreas
as evidenced by
respiratory rate of
32cpm.
and increase vascular
permeability and which
secretions irritates the
diaphragm which could
lead to dyspnea .
Respiratory is vital to
patients with pancreatitis
 NURSING RANK
DIAGNOSIS
Acute pain related to
activation chemical
mediators secondary to
inflammation of
pancreas as evidenced
2 chemical mediators such
by pain scale of 8/10.
JUSTIFICATION
Pain occurs due to
as bradikinin
prostaglandin which
causes increase cell
permeability released by
macrophages being
accumulated to the
infection site. This
chemical mediator
increase pain that is
being produced due to
the irritation of plasma to
free nerve ending of
pancreas
 NURSING DIAGNOSIS RANK
Activity intolerance
related to imbalance
oxygen supply and
demand as evidenced by
3 between oxygen and
generalized weakness
JUSTIFICATION
There is imbalance
supply due to
vasodilation which
causes decrease cardiac
output and hypotension.
Blood volume is
decreased and ;less blood
circulated which carries
the oxygen throughout
the system which is
needed to produce the
ATP that is needed for
creation energy; this
leads to body weakness
therefore there is activity
intolerance.
DRUG
STUDY
 OMEPRAZOLE
Drug interaction:
• Omeprazole belongs to a group
of drugs called proton pump
inhibitors. Omeprazole
decreases the amount of acid
produced in the stomach.
Omeprazole is used to treat
symptoms of gastroesophageal
reflux disease (GERD) and other
conditions caused by excess
stomach acid. It is also used to
promote healing of erosive
esophagitis (damage to your
esophagus caused by stomach
acid).
Omeprazole may also be given
together with antibiotics to treat
gastric ulcer caused by infection
with helicobacter pylori (H.
pylori).
Omeprazole is not for immediate
relief of heartburn symptoms.
Omeprazole may also be used
for other purposes not listed in
this medication guide.
 DRUG ANALYSIS:
• Omeprazole- Omeprazole has
recently been described as a
modulator of tumour
chemoresistance, although its
underlying molecular mechanisms
remain controversial. Since
pancreatic tumours are highly
chemoresistant, a logical step
would be to investigate the
pharmacodynamic, morphological
• and biochemical effects of
omeprazole on pancreatic
cancer cell lines.
 TRAMADOL
Drug interaction:
• This medication is used to help
relieve moderate to moderately
severe pain. Tramadol is similar
to narcotic analgesics. It works in
the brain to change how your
body feels and responds to pain.
DRUG ANALYSIS:

• Tramadol- The resulting pain is

the main symptom of acute
pancreatitis and it should be
alleviated as soon as possible.
NSAIDs are the first line therapy
for pain and theyare generally
administered to acute
pancreatitis patients upon
admission to the hospital. In
• addition, these drugs have also
been used to prevent post-
endoscopic
cholangiopancreatography
(ERCP) acute pancreatitis.
CLIENT’S DAILY PROGRESS
CHART
Date Diagnostic Diet Activity Medication Treatment
Procedure

July 5, 2011 Blood NPO Complete Bed Omeprazole IV fluid

morphology rest
Tramadol
Urinalysis

Blood
Chemistry
July 6, 2011 Electrolytes NPO Complete Bed Omeprazole IV fluid
rest
Blood Tramadol
chemistry

July 7, 2011 NONE NPO Complete Bed Omeprazole IV fluid

rest
Tramadol
THANK YOU!
PREPARED BY: BSN-TRI-B-0