Critical care - Acute pancreatitis: Nursing

Acute pancreatitis is an inflammation of the pancreas causes include damage to the pancreas from biliary conditions such as gallstones.

Chronic alcohol use certain medications like sulfonamides and corticosteroids. Certain endoscopic procedures like endoscopic retrograde cholangiopancreatography or ercp and abdominal trauma.

As the nurse, you'll provide patient centered care for critically ill patients with acute pancreatitis. So the pancreas is a large gland located behind the stomach.

Its endocrine function involves regulation of glucose by producing hormones like insulin and glucagon. While its exocrine function aids in digestion, as far as its digestive function goes, the acinar cells of the pancreas produce and release inactivated digestive enzymes into the small intestine.

Here, they're activated into amylase lipase and protease which break down carbohydrates, fats and proteins. Now, in acute pancreatitis, the pancreatic acinar cells are injured and the inactivated enzymes leak into surrounding pancreatic tissue where they become prematurely activated and begin the process of autodigestion of the tissue.

As the pancreatic tissue is damaged by its own enzymes. Edema, hemorrhage fibrosis and necrosis occurs along with localized inflammation as inflammation progresses, enzymes and inflammatory mediators are released into the systemic circulation and travel to other organs like the liver kidneys and lungs causing widespread organ damage.

Acute pancreatitis can progress to systemic inflammatory response syndrome, which leads to increased systemic vascular permeability.

Third spacing of fluid loss of circulatory volume and hypovolemic shock as well as multiple organ failure and potentially death.

All right. So, clinical manifestations will depend on the severity of the damage to the pancreas and the degree of systemic complications.

Typically, there is an acute onset of pain that's often described as a knifelike or twisting sensation located in the epigastric to periumbilical region that radiates to the back and improves when leaning forward or lying in a semi fetal position.

The pain is also usually associated with nausea and vomiting. Other clinical manifestations include fever, hypoactive bowel sounds, abdominal distension and tenderness and guarding.

In severe cases, there can be ascites, jaundice, palpable abdominal masses and signs of hypovolemic shock, including tachypnea, hypotension and tachycardia.

Rarely signs of retroperitoneal hemorrhage occur manifested as bluish discoloration of the flanks, known as gray turner sign or of the umbilical region called Cullen sign.

In addition, laboratory results will show elevated lipase and amylase levels. White blood cell count and inflammatory markers like c reactive protein and procalcitonin peritonitis or sepsis may develop due to translocation of intestinal bacteria into the bloodstream hyperglycemia may also be present if the pancreatic tissue damage compromises the endocrine function of the pancreas.

When caring for your critically ill patient with acute pancreatitis. Your goals of care include correcting fluid electrolyte and metabolic imbalances, managing pain and providing nutritional support.

Begin by assessing their airway breathing and circulation or ABC S and placing them on a continuous monitor for any emergent life threatening findings, activate emergency protocols as needed.

Next. Administer the prescribed IV fluids to address hypovolaemia and ensure perfusion to vital organs.

Closely monitor your patient's intake and output. Noting any decreases in output which could indicate hypoperfusion.

Be sure to assess their skin to identify cool extremities. That may also indicate poor perfusion.

Additionally, administer and titrate vasopressors as prescribed to maintain your patient's mean arterial pressure or map within the prescribed goal.

As far as electrolyte and metabolic imbalances, go watch closely for signs of hypocalcemia like VST sign, which is facial twitching when the cheek is tapped and trousseau sign, which is spasming of the hand and wrist when BP is taken a prolonged QT interval on ECG can also indicate hypocalcemia.

Whereas other dysrhythmias may indicate hypokalemia along with weakness and irritability, administer electrolyte replacements as prescribed and monitor lab results closely also keep a close eye on your patient's other labs including glucose, lipase and amylase.

Be sure to regularly assess your patient's pain level and administer the prescribed analgesics to promote comfort. In addition, you can offer relaxation techniques, distraction or other complementary therapies to help manage their pain.

Also provide nutritional support as prescribed for your critically ill patient. This may include inserting a nasogastric tube to administer enteral feedings.

Finally be sure to notify the health care provider. If your patient's condition worsens or if you identify new signs and symptoms.

All right, it's a quick recap. Acute pancreatitis is an inflammation of the pancreas that occurs when pancreatic enzymes leak into the pancreatic tissue causing damage.

Clinical manifestations include pain, nausea, vomiting, fever and weakness and in severe cases, ascites jaundice, abdominal masses and hypovolemic shock.

When caring for your critically ill patient with acute pancreatitis. Your goals of care include correcting fluid, electrolyte and metabolic imbalances, managing pain and providing nutritional support.