Nursing diagnosis: acute Pain related to Obstruction of pancreatic, biliary ducts, Chemical contamination of peritoneal surfaces by pancreatic exudate, autodigestion of pancreas, Extension of inflammation to the retroperitoneal nerve plexus
Possibly evidenced by
Reports of pain
Self-focusing, grimacing, distraction or guarding behaviors
Autonomic responses, alteration in muscle tone
Desired Outcomes/Evaluation Criteria—Client Will
Report pain is relieved or controlled.
Follow prescribed therapeutic regimen.
Demonstrate use of methods that provide relief.
Nursing intervention with rationale:
1. Investigate verbal reports of pain, noting specific location and intensity (0 to 10 scale). Note factors that aggravate and relieve pain.
Rationale: Pain is often diffuse, severe, and unrelenting in acute or hemorrhagic pancreatitis. Severe pain is often the major symptom in client with chronic pancreatitis. Isolated pain in the right upper quadrant (RUQ) reflects involvement of the head of the pancreas. Pain in the left upper quadrant (LUQ) suggests involvement of the pancreatic tail. Localized pain may indicate development of pseudocysts or abscesses.
2. Maintain bedrest during acute attack and provide quiet, restful environment.
Rationale: Decreases stimulation of pancreatic secretions, thereby reducing pain.
3. Promote position of comfort, such as on one side with knees flexed or sitting up and leaning forward.
Rationale: Reduces abdominal pressure and tension, providing some measure of comfort and pain relief. Note: Supine position often increases pain.
4. Provide alternative comfort measures including repositioning and back rub,and quiet diversional activities such as TV or radio. Encourage relaxation techniques, such as guided imagery and visualization.
Rationale: Promotes relaxation and enables client to refocus attention; may enhance coping.
5. Keep environment free of food odors.
Rationale: Sensory stimulation can activate pancreatic enzymes, increasing pain.
6. Administer intravenous (IV) analgesics in timely manner, and in smaller, more frequent doses, during acute episode. Consider use of patient-controlled analgesia (PCA), if appropriate.
Rationale: Severe or prolonged pain can aggravate shock and is more difficult to relieve, requiring larger doses of medication, which can mask underlying problems and complications and may contribute to respiratory depression.
7. Maintain meticulous skin care, especially in presence of draining abdominal wall fistulas.
Rationale: Pancreatic enzymes can digest the skin and tissues of the abdominal wall, creating abscesses and ulceration.
8. Administer medication, as indicated, for example: Opioid analgesics, such as meperidine (Demerol), morphine sulfate, and tramadol (Ultram)
Rationale: Meperidine is usually effective in relieving pain and may be preferred over morphine, which may have a side effect of biliary-pancreatic spasms. Paravertebral block has been used to achieve prolonged pain control. Note: Pain in clients who have recurrent or chronic pancreatitis episodes may be more difficult to manage because they may develop tolerance to normal doses of the opioids given for pain control.
9. Sedatives such as diazepam (Valium) and antispasmodics such as atropine
Rationale: Potentiate action of opioid to promote rest and to reduce ductal spasm, thereby reducing metabolic needs and enzyme secretions.
10. Histamine blockers, such as lansoprazole (Prevacid), cimetidine (Tagamet), ranitidine (Zantac), and famotidine (Pepcid)
Rationale: Decreasing production of hydrochloric acid inhibits pancreatic enzyme activity and associated pain.