February 15, 2011
Pancreatitis Case Study
Pancreatitis is a painful inflammatory condition in which the pancreatic enzymes are prematurely activated resulting in auto-digestion of the pancreas (American Pancreatic Association, 2010). The most common cause of pancreatitis are biliary tract disease and alcoholism, but can result from such things as abnormal organ structure, blunt trauma, penetrating peptic ulcers, and drugs such as sulfonamides and glucocorticoids (American Gastroenterological Association, 2010). Pancreatitis may be acute or chronic, with symptoms mild or severe. In severe cases, hemorrhage, infection, pseudo cyst, and permanent tissue damage may occur. The signs and symptoms vary in people including: fever, extreme abdominal pain, nausea, vomiting, weight loss, diarrhea, and oily stools. The focus of this case study is to discuss Mrs. L who recently was diagnosed with hemorrhagic pancreatitis with pseudo cyst caused by gallstones. Mrs. L is a 58 –year–old Caucasian female who has been married for 38 years. She has two daughters and one grandson. Her mother past away from lung cancer at the age of 75 and her father is healthy and still living. She is the oldest of five healthy siblings, two sisters and two brothers. Mrs. L works as a principle for the past 29 years at Linden High school. She plays the piano at First Southern Baptist Church for 15 years. Her hobbies are reading, writing poetry and gardening. She does not have a history of drinking, smoking or recreational drug use. She has been hospitalized for the past six weeks for acute hemorrhagic pancreatitis with a pseudo cyst. The pancreatitis was caused by gallstones. Mrs. L spent three weeks in intensive care, and then underwent surgery for removal of the gallstones and to insert drains into the pseudo cyst. Prior to discharge she had progressed to a soft, high carbohydrate, low fat diet; had all drains removed; and was able to walk in the hall approximately 20 feet. Mrs. L was referred to the community home health agency in her home town for continue follow up. The home health nurse Miss. D, assess Mrs. L at home after she was discharge from the hospital. She is thin and appears anxious and tired. She states that she lost 25 pounds during her hospitalization and now weights 101. She is 5 feet 4 inches tall. Her vital signs are within normal limits. The heart and lungs are normal. During this visit her non-fasting blood glucose is slightly elevated at 112. Her laboratory studies upon discharge from the hospital were low serum hemoglobin at 8.8, low serum hematocrit at 29.0, with elevated lipase. Liver chemistries are normal. Mrs. L has a well-healed upper abdominal scar and two round wounds (from drains) on each side of her abdomen. The wounds are closed but still have scabs with mild epigastria tenderness. Her skin is cool and dry. Her color is pallor and turgor is poor. She is alert and oriented and responds appropriately to questions. Mrs. L learns best by reading and listening. She states that her main problems are lack of energy and lack of appetite for the low-fat diet that has been ordered. Mrs. L husband and three daughters express concern about their ability to provide care. Although they have been taught all about the disease and how to provide care, they still are not sure they know exactly what should be done now that Mrs. L is at home. Mrs. L has a prescription for pain medication: Percocet 10 mg every 3 to 4 hours. She voiced concern that she would be addicted to the pain medicine and presently her pain level was a six out of 10 (10 being the worse pain). The new medication that Mrs. L will be taken is an iron tablet daily, calcium tablet daily and a vitamin D tablet daily. Mrs. L was screen for depression during the home health assessment and patient denies any signs and symptoms. Miss. D, together with Mr. and Mrs. L and the two daughters, develop a...