TY - CHAP M1 - Book, Section TI - Pancreatitis A1 - Bolesta, Scott A1 - Montgomery, Patricia A. A2 - DiPiro, Joseph T. A2 - Talbert, Robert L. A2 - Yee, Gary C. A2 - Matzke, Gary R. A2 - Wells, Barbara G. A2 - Posey, L. Michael Y1 - 2017 N1 - T2 - Pharmacotherapy: A Pathophysiologic Approach, 10e AB - Patient Care Process for the Treatment of PancreatitisAcute Pancreatitis CollectPatient characteristics (e.g., age, sex, pregnancy status)Patient history (past medical, social—dietary habits, tobacco use)Current and recent (see Table 39-2) medicationsMedication allergiesReview 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 39-5Objective 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 outputAssessDetermine if medications could be a causative factor (see Table 39-2)Assess and determine nutrition and fluid statusDetermine if the condition could be caused by infectious etiologiesPlanNutrition support including preferred route and caloric requirementsFluid support including choice and dosePain management with specific medication choice, route and doseAntimicrobial therapy regimen for suspected or identified infection(s) Continuous hemodynamic monitoringImplementConsultation 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 sensitivitiesFollow-up: Monitor and EvaluateDetermine pain control and the development of constipation if opioids are prescribedMeasure 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 resultsHemodynamic parameters for signs of decreased intravascular volume and shockNutrition 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 CollectPatient characteristics (e.g., age, sex, pregnancy statust)Patient history (past medical, social—dietary habits, tobacco use)Current and recent (see Table 39-2) medicationsMedication allergiesReview 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)AssessPatient use of alcohol and tobacco Current status of abdominal painTrends in weight, nutrition status, serum glucose, and stool consistency and frequency (assess for constipation if patient taking opioids)PlanTailored lifestyle modifications (e.g., abstinence from alcohol, smoking cessation; see Figure 39-4)Nutrition support and dietetic counselingTherapy 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 utilizedTherapy for malabsorption (see Figure 39-5 and Tables 39-6 and 39-7)Treatment of concomitant diabetes mellitus if presentImplementConsultation with additional providers as necessary (e.g., dietician, pain management specialist, infectious diseases, gastroenterology, endocrinology)Lifestyle modifications (e.g., smoking cessation)For patients with malabsorption due to chronic pancreatitis initiate appropriate pancreatic enzyme therapy (see Figure 39-5)Follow-up: Monitor and EvaluateAlcohol intake and smoking status utilizing motivational interviewingWeight and effects of diet on abdominal pain and malabsorption symtomsEfficacy pancreatic enzymes on symptoms of malabsorption (see Figure 39-5)Serum blood glucose along with signs and symptoms of diabetes mellitus SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1148573681 ER -