Skip to Main Content

PATIENT CARE PROCESS

Patient Care Process for the Treatment of Pancreatitis

Image not available.

Acute Pancreatitis

 

Collect

  • Patient characteristics (e.g., age, sex, pregnancy status)

  • Patient history (past medical, social—dietary habits, tobacco use)

  • Current and recent (see Table 39-2) medications

  • Medication allergies

  • Review of systems for the abdomen and gastrointestinal system (e.g., abdominal pain, nausea and vomiting; stool frequency and consistency for chronic pancreatitis; see Tables 39-3 and 39-5

  • Objective data

    • Vital signs (e.g., BP, heart rate, temperature, respiratory rate)

    • Labs (e.g., complete blood count and serum chemistries, albumin, amylase, lipase, transaminases, bilirubin, triglycerides)

    • Microbiology results for any cultured sites or fluids.

    • Oral intake and gastrointestinal output

Assess

  • Determine if medications could be a causative factor (see Table 39-2)

  • Assess and determine nutrition and fluid status

  • Determine if the condition could be caused by infectious etiologies

Plan

  • Nutrition support including preferred route and caloric requirements

  • Fluid support including choice and dose

  • Pain management with specific medication choice, route and dose

  • Antimicrobial therapy regimen for suspected or identified infection(s)

  • Continuous hemodynamic monitoring

Implement

  • Consultation with additional providers as necessary (e.g., dietician, pain management specialist, infectious diseases, gastroenterology, endocrinology)

  • Pain therapy with clearly identified goals for both the provider and patient (Figure 39-4)

  • Fluid and nutrition support as appropriate (Table 39-3).

  • Lifestyle modifications (e.g., smoking cessation)

  • Initiate empiric antimicrobial therapy if necessary and narrow coverage based on cultures and sensitivities

Follow-up: Monitor and Evaluate

  • Determine pain control and the development of constipation if opioids are prescribed

  • Measure fluid and eletrolytes along with kidney and liver function (e.g., serum creatinine, BUN, bilirubin, transaminases)

  • Signs and symptoms of infection along with microbiology culture and sensitivity results

  • Hemodynamic parameters for signs of decreased intravascular volume and shock

  • Nutrition status and support (e.g., prealbumin, albumin, changes in caloric requirements and delivery route)

  • Discontinuation of causative medication(s) on discharge and identification of necessary therapeutic alternative(s)

 

Chronic Pancreatitis

 

Collect

  • Patient characteristics (e.g., age, sex, pregnancy statust)

  • Patient history (past medical, social—dietary habits, tobacco use)

  • Current and recent (see Table 39-2) medications

  • Medication allergies

  • Review of systems for the abdomen and gastrointestinal system (e.g. abdominal pain, nausea and vomiting; stool frequency and consistency for chronic pancreatitis; see Tables 39-3 and 39-5)

  • Physical exam (e.g., weight; assessment for neuropathy, nephropathy and retinopathy with diabetes)

  • Labs (e.g., fasting serum glucose, bilirubin, transaminases, pancreatic function tests, calcium, albumin)

Assess

  • Patient use of alcohol and tobacco

  • Current status of abdominal pain

  • Trends in weight, nutrition status, serum glucose, and stool consistency and frequency (assess for constipation if patient taking opioids)

Plan

  • Tailored lifestyle modifications (e.g., abstinence from alcohol, smoking cessation; see Figure 39-4)

  • Nutrition support and dietetic counseling

  • Therapy for abdominal pain (see Figure 39-4) with analgesics (see Table 39-6) and pancreatic enzymes (see Table 39-7), including the need for treatment of constipation if opioids are utilized

  • Therapy for malabsorption (see Figure 39-5 and Tables 39-6 and 39-7)

  • Treatment of concomitant diabetes mellitus if ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.