In this pancreatitis piece, we’ll go through different nursing assessments and interventions.
The pancreas is an important gland that is situated next to the gut and is responsible for releasing essential digestive enzymes and hormones.
A usual scenario for clients with pancreatitis is a complaint of pain originating from the left upper quadrant of the abdomen. However, not all complaints of left upper quadrant pain automatically equate pancreatitis; some conditions are also related to that.
The pancreas sits at the left upper quadrant of the abdomen, adjacent to the spleen and kidneys. When analyzing what a client might be having, you have to ask a series of questions concerning the location of the pain. Therefore, OPQRST assessment must take place.
When assessing for pancreatitis, you have to consider a couple of things:
- The quality of pain
- What provoked the pain
- The onset of the pain
The Main Provoker
With pancreatitis, the main provoker would be food. Eating triggers the pancreas to shoot out specific enzymes that, instead of going into the duodenum, they explode within the pancreas. Such enzymes are protease, lipase, and amylase. Once these enzymes get activated inside the pancreas, they cause inflammation; thus, pancreatitis happens.
Pancreatitis Signs and Symptoms
A client who is suffering from pancreatitis would display the following signs and symptoms:
- Increased respiratory rate that is rapid and shallow due to the presence of pain.
- Increased heart rate, also because of the pain.
- Abdominal distention
- A tender left upper quadrant
- Decreased or absent bowel sounds caused by the activation of enzymes inside the pancreas instead of the small intestine which leads to undigested and unabsorbed food.
Healthcare providers looking after clients with pancreatitis should be wary of the following laboratory results:
- Increased amylase (carbohydrate enzyme)
- Increased lipase (fat enzyme)
- Increased blood sugar due to the absence of insulin
- Grey Turner Sign and Cullen sign (abdominal bruising caused by internal bleeding due to an inflamed pancreas)
- Decreased albumin
- Hypocalcemia due to a liver issue
- Increased phosphorus or phosphate
- Decreased coagulating factors
The following imaging tests are done to pancreatitis clients:
- X-ray – results will reveal an enlarged pancreas and liver.
- CAT scans or computerized tomography – a type of x-ray that enables a 360 image result.
- MRI or magnetic resonance imaging – to check for soft tissue injuries.
- Ultrasound – aside from evaluating the pancreas, an ultrasound will also check for gallbladder involvement.
Effective and reliable diagnosis depends on laboratory and imaging results. These tests tend to either rule out or confirm that the client is experiencing pancreatitis.
Involvement of Other Organs
When dealing with pancreatitis clients, you always have to consider the connection and proximity of the pancreas to its neighboring structures like the gallbladder and liver because these organs share pathways. Meaning, if the bile or hepatic duct gets stuck due to, for example, a stone, backing up of fluid and blood will happen and so will inflammation.
For videos concerning pancreatic enzymes and liver functions, you can check out Simple Nursing’s website and YouTube channel.