4. Pancreatitis: inflammatory disease of the pancreas that may result in autodigestion of the pancreas by its own enzymes.
   1. Pathophysiology: proteolytic enzymes within the pancreas are activated by endotoxins, exotoxins, ischemia, anoxia, or trauma. Pancreatic enzymes begin process of autodigestion of pancreas and surrounding tissues; also activate other enzymes that digest cellular membranes. Autodigestion leads to edema, hemorrhage, vascular damage, coagulation necrosis, and fat necrosis.
   2. Risk factors:
      1. Obesity.
      2. Alcoholism, alcohol consumption.
      3. Biliary tract disease.
      4. Abdominal trauma.
      5. Surgery.
      6. Drugs.
      7. Metabolic disease.
      8. Intestinal disease.
      9. Obstruction of the pancreatic ducts.
      10. Infections.
      11. Carcinoma.
      12. Adenoma.
      13. Hypercalcemia.
   3. Assessment:
      1. Subjective data:
         1. Pain:
            1. Sudden onset; severe, widespread, constant, and incapacitating.
            2. Location-epigastrium, right upper quadrant (RUQ) and left upper quadrant (LUQ) of abdomen; radiates to back, flanks, and substernal area.
         2. Nausea.
         3. History of risk factors.
         4. Dyspnea.
      2. Objective data:
         1. Elevated: temperature, pulse, respirations, BP (unless in shock).
         2. Decreased breath sounds related to atelectasis/pleural effusion.
         3. Increased crackles, cyanosis.
         4. Hemorrhage, shock.
         5. Vomiting.
         6. Fluid and electrolyte imbalances, dehydration.
         7. Decreased bowel sounds; abdominal tenderness with guarding.
         8. Stools: bulky, pale, foul smelling, steatorrhea (excessive fat in stools).
         9. Skin: pale, moist, cold; may be jaundiced.
         10. Muscle rigidity.
         11. Supine position leads to increased pain.
         12. Fluid accumulation in the abdomen.
         13. Lab data:
             1. Elevated:
                1. Amylase, serum, and urine.
                2. Serum lipase, AST (SGOT).
                3. Alkaline phosphatase.
                4. Bilirubin, glucose; serum and urine.
                5. Urine protein, WBC.
                6. Leukocytes.
                7. BUN.
                8. LDH (liver function, lactate dehydrogenase).
             2. Decreased:
                1. Serum calcium.
                2. Protein.
         14. Ultrasound for gallstones, CAT scan.
   4. Analysis/nursing diagnosis:
      1. Altered nutrition, less than body requirements, related to nausea and vomiting.
      2. Pain related to inflammatory and autodigestive processes of pancreas.
      3. Fluid volume deficit related to inflammation, decreased intake, and vomiting.
      4. Ineffective breathing pattern related to pain and pleural effusion.
      5. Knowledge deficit related to risk factors and disease management.
   5. Nursing care plan/implementation:
      1. Goal: control pain.
         1. Medications: analgesics-meperidine (not morphine or codeine due to spasmodic effect).
         2. Position: sitting with knees flexed.
      2. Goal: rest injured pancreas.
         1. NPO.
         2. NG tube to low suction.
         3. Medications:
            1. Antiulcers.
            2. Antibiotics.
            3. Antiemetics.
            4. Antispasmodics.
            5. Anticholinergics.
            6. Histamine-2 receptors.
      3. Goal: prevent fluid and electrolyte imbalance.
         1. Monitor: vitals, CVP.
         2. IVs, fluids, blood, albumin, plasma.
      4. Goal: prevent respiratory and metabolic complications.
         1. Cough, deep breathe, change position.
         2. Monitor: blood sugar as ordered.
         3. Monitor calcium levels: Chvostek's and Trousseaus sign positive when calcium deficit exists.
      5. Goal: provide adequate nutrition.
         1. Low-fat diet.
         2. Bland, small, frequent meals.
         3. Vitamin supplements.
         4. Avoid alcohol.
      6. Goal: prevent complications.
         1. Monitor for signs of:
            1. Peritonitis.
            2. Perforation.
            3. Respiratory complications.
            4. Hypotension, shock.
            5. DIC.
            6. Hemorrhage from ulcers, varices.
            7. Anemia.
            8. Encephalopathy.
      7. Goal: health teaching.
         1. Food selections for low-fat, bland diet.
         2. Necessity of vitamin therapy.
         3. Importance of avoiding alcohol.
         4. Signs and symptoms of recurrence.
         5. Importance of rest, to prevent relapse.
         6. Desired effects and side effects of prescribed medications:
            1. Narcotics for pain.
            2. Antiemetics for nausea and vomiting.
            3. Pancreatic hormone and enzymes to replace enzymes not reaching duodenum.
   6. Evaluation/outcome criteria:
      1. Pain is relieved.
      2. No complications, peritonitis, respiratory.
      3. States dietary allowances and restrictions.
      4. Takes medications as ordered; states purposes, side effects.