Nursing Student Asked:

A 45-year-old female patient is admitted with acute pancreatitis. She reports severe epigastric pain radiating to the back, nausea, and vomiting. Her laboratory results reveal elevated serum amylase and lipase levels. The provider orders the following interventions: NPO status, IV fluids at 125 mL/hour, and pain management with hydromorphone IV as needed.

Tasks:

1. Develop a nursing care plan for this patient, including two priority nursing diagnoses and two interventions for each.

2. Describe how you would evaluate the effectiveness of these interventions.

3. Explain the pathophysiology of acute pancreatitis and how it leads to the symptoms experienced by the patient.

1. Nursing care plan:

   • Priority diagnosis #1: Acute pain related to inflammation of the pancreas.

     • Interventions:

       1. Administer IV hydromorphone as prescribed and evaluate pain relief.

       2. Maintain NPO status to reduce pancreatic enzyme stimulation.

   • Priority diagnosis #2: Risk for fluid volume deficit related to vomiting and third spacing of fluid.

     • Interventions:

       1. Administer IV fluids at 125 mL/hour as prescribed.

       2. Monitor intake/output and assess for signs of dehydration (e.g., hypotension, tachycardia).

2. Evaluation of interventions:

   • For acute pain: Decreased pain ratings reported by the patient and reduced guarding behavior.

   • For fluid volume deficit: Stabilization of blood pressure, heart rate within normal limits, and balanced intake/output.

3. Pathophysiology of acute pancreatitis: Acute pancreatitis occurs due to premature activation of pancreatic enzymes, leading to autodigestion of the pancreas. This causes inflammation, tissue necrosis, and systemic effects such as severe pain, elevated amylase/lipase levels, and third spacing of fluid.