Acute Pancretitis Case Study

Case Study:Acute Pancreatitis
Patient Profile
 Name: Zareena
 W/O :Ghulam Hussain
 Age: 37 years
 Gender: Female
 MR No: 200867
 Bed No:05
 Occupation: House Wife
 Medical History: Hypertension (controlled with medication), no known
allergies
Chief Complaint
 Zareena presented to the emergency room with severe abdominal pain that
began suddenly.
 The pain was located in the upper abdomen, radiating to his back, and was
described as “sharp and persistent.”
 She reported associated nausea and vomiting, which did not provide pain
relief.
Initial Assessment
Vital Signs
 Temperature: 38.1°C (100.6°F)
 Blood Pressure: 100/60 mmHg (Hypotension relative to baseline)
 Heart Rate: 110 bpm (tachycardia)
 Respiratory Rate: 24 breaths per minute
 Oxygen Saturation: 95% on room air
Physical Examination
 General Appearance: Appeared in acute distress due to pain
 Abdomen: Tender in the epigastric region with guarding, positive for
rebound tenderness
 Other Findings: No jaundice; skin was warm and clammy
History of Present Illness

 Zareena reported experiencing mild, intermittent abdominal discomfort
over the past week, which he attributed to acid reflux.
 She denied any recent trauma, unusual diet changes, or significant changes
in bowel habits.
Laboratory and Diagnostic Findings

 Serum Amylase: Elevated
 Serum Lipase: Elevated
 ALT (Alanine Aminotransferase): Elevated
 AST (Aspartate Aminotransferase) and Alkaline Phosphatase: Elevated
 Bilirubin: Elevated
 White Blood Cell Count (WBC): Elevated (leukocytosis)
 Hematocrit: Elevated
 Calcium: Hypocalcemia
 Glucose: Hyperglycemia
 BUN (Blood Urea Nitrogen) and Creatinine: Elevated
 Triglycerides: Elevated
 Abdominal Ultrasound: Identify gallstones, assess bile duct dilation, and
rule out other causes of abdominal pain.
Diagnosis
Acute Pancreatitis
 Based on clinical presentation, elevated pancreatic enzymes (serum amylase
and lipase), and imaging studies, Zareena was diagnosed with acute
pancreatitis.
Signs and Symptoms

 Abdominal Pain
 Nausea and Vomiting
 Fever
 Abdominal Tenderness
 Tachycardia and Hypotension
 Jaundice (if bile duct obstruction is present)
 Grey Turner’s Sign: Bluish discoloration on the flanks.
 Cullen’s Sign: Bluish discoloration around the umbilicus.
Causes of Acute Pancreatitis

 Gallstones
 Alcohol Use
 Hypertriglyceridemia
 Medications
 Infections
 Trauma
 Surgery
 Autoimmune diseases
 Genetic factors
Risk Factors
 Lifestyle Factors
 Family History
 Existing Medical Conditions
 Surgical Procedures
 Medications
 Infections
Complications
 Pancreatic Necrosis
 Pancreatic
 Abscess
 Shock and Hypotension
 Acute Respiratory Distress Syndrome (ARDS)
 Renal Failure
 Infection and Sepsis
 Chronic Pancreatitis:
 Diabetes
Treatment Plan
Initial Management
 Fluid Resuscitation: Aggressive IV fluid administration with Lactated
Ringer’s solution to maintain blood pressure and prevent hypovolemia.
 Pain Management: IV morphine was administered for pain control, with
close monitoring to avoid respiratory depression.
 NPO (Nothing by Mouth): Patient was kept NPO to rest the pancreas.
 Antiemetics: Ondansetron was administered as needed for nausea.
 Electrolyte Management: Serial electrolyte monitoring and adjustments to
IV fluids.
 Antibiotics: Prophylactic antibiotics were not started initially, as there was
no indication of infection or pancreatic necrosis.
 Nutritional Support: Once pain and symptoms began to subside, enteral
feeding through a Naso-jejunal tube was considered.
Nursing management for acute pancreatitis

 Administer IV analgesics (e.g., morphine or fentanyl) as prescribed and
assess pain levels frequently to adjust pain control measures.
 Help the patient find a comfortable position, often with the head of the bed
elevated or the patient leaning forward, which may relieve abdominal pain.
 Watch for signs of increasing pain or rigidity, which may suggest
complications like infection or perforation.
 Administer isotonic IV fluids (e.g., Lactated Ringer’s solution) as prescribed
to manage hypovolemia and maintain hemodynamic stability.
 Regularly check electrolyte levels (especially calcium, magnesium,
potassium) and administer supplements if needed.
 Track intake and output strictly to assess kidney function and overall
hydration status. An output of at least 0.5 mL/kg/hr is desired.
 Maintain NPO (nothing by mouth) status initially to rest the pancreas and
minimize enzyme secretion.
 As symptoms improve and pain subsides, transition to clear liquids, and
then to a low fat, soft diet as tolerated.
 If the patient requires prolonged fasting, consider a Nasojejunal feeding tube
to deliver enteral nutrition without stimulating the pancreas.
 Check vital signs frequently, watching for tachycardia, hypotension, fever,
and respiratory distress. Monitor laboratory values for trends in amylase,
lipase, CRP, WBC, and renal function.
 Due to the risk of respiratory complications, assess for signs of hypoxemia,
Pleural effusion, and shallow breathing.
 Regularly assess for signs of shock, renal impairment and multi organ
failure, particularly in severe cases.
 Insert a nasogastric (NG) tube for patients with severe vomiting or ileus to
decompress the stomach and prevent aspiration.
 Administer antiemetics as needed to manage nausea and vomiting, which
can exacerbate dehydration.
 Educate the patient on adhering to a low fat diet, avoiding spicy foods, and
eating smaller, more frequent meals to reduce pancreatic stimulation.
 Offer counseling and resources for alcohol and smoking cessation, as both
are risk factors for recurrent pancreatitis.
 Emphasize the importance of taking medications as prescribed, particularly
Antihypertensive drugs and any lipid lowering agents.
 Teach the patient to recognize signs of recurrence, such as severe abdominal
pain, jaundice, or nausea, and to seek medical attention if these symptoms
develop.
 Document pain assessments and responses to interventions.
 Keep accurate records of fluid intake, output, and electrolyte levels.

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Acute Pancretitis Case Study

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Case Study:Acute Pancreatitis

History of Present Illness

Laboratory and Diagnostic Findings

Signs and Symptoms

Causes of Acute Pancreatitis

Nursing management for acute pancreatitis

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