Acute Pancreatitis

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Introduction
AG is 50yo female with a history of Sclerosing Mesenteritits, diabetes, hypothyroidism, smoking and alcohol abuse. She was admitted on 1-27-12 for severe abdominal pain along with nausea and vomiting. CT scan of the abdomen revealed a massive gastric dilation and thickening of the duodenal wall leading to occlusion of the duodenal lumen. I met AG on 2-23-12 when she was three weeks post-operative (post-op), gastrojejunostomy, resection of the pancreatic head mass biopsy, and gastrostomy tube (gtube) placement. The patient had her first episode of acute pancreatitis in 2006 with four recurrences over two years. In 2007 she underwent Laparotomy and had a biopsy of an inflammatory periduodenal mass. She was treated with radiation and chemotherapy for a short period. In 2008 following several episodes of abdominal pain she underwent endoscopic retrograde cholangiopancreatography and had placement of a biliary endoprosthesis. In 2009 she had placement of a feeding jejuostomy for duodenal obstruction. She then underwent the Frey Lateral Pancreaticojejunostomy with resection of the Pancreatic head and Hepaticojejunostomy with Roux-en-Y reconstruction and small bowel resection in 2010. The procedure was complicated by liver abscess requiring percutaneous drainage. Diabetes was diagnosed after her pancreatic surgery in 2010. She is currently on an insulin sliding scale. AG has been dealing with her medical ailments since 2006. She is a recovering alcoholic, who quit several years ago. She admits to smoking half a pack of cigarettes a day for the last 40 years and denies any use of illicit drugs. She is in the process of smoking cessation with the aid of nicotine patches. She has received most of her medical care at a hospital in Mexico City, where she practiced as a surgeon prior to becoming ill herself. The objective of this paper is to give an overview of the nursing care and management of a patient with pancreatitis. Focus will be placed on the pathophysiology of the disease process and the nursing

care considerations, including possible nursing diagnoses and interventions. The paper will take into account the patient’s physical assessment, functional health pattern, current medications, learning needs, and possible risk factors leading to pancreatitis. Physical Assessment

The patient’s vital signs were taken the evening of 02-23-12. She reported a pain score of 2 from a scale of 0-10 coming from the lower abdomen. She described pain as “sore and aching” exacerbated when sitting up for long periods. AG appeared alert and oriented to person, place, and time. Her pupils were equal, round, reactive to light and accommodation measuring 3mm and constricted to 2mm with light. Extra ocular movements were intact. There were no signs of visual field cut or visual disturbances. Her speech was clear and appropriate. There was no tongue deviation. The patient’s face appeared symmetrical. Her fine motor movements were intact; however there was intermittent tremor of the hands. AG was able to move all extremities with some generalized weakness. She ambulates independently with a weak, but steady gait. Her skin was clean, dry and intact with no signs of skin breakdown. She had a midline abdominal incision that was well approximated with sterile strips. No erythema or edema was noted. A nicotine patch was placed on the posterior left shoulder. GTube was clamped and the site was benign. The patient’s lung sounds were clear in all fields. She denied any shortness of breath, cough, or difficulty breathing. Her respiratory rate was 18, even and unlabored and her oxygen saturation was 98%. Her blood pressure was 98/65 and apical pulse was auscultated at 79 beats per minute with a regular rate, quality, and rhythm. There were no adventitious sounds upon auscultation. She reported no chest pain or palpitations. Her dorsalis pedis and posterior tibial were strong...
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