Disease Overview
- acute pancreatitis – a severe inflammation of the pancreas;
- alcohol abuse, gall stones, infection, injury;
- the leak of enzymes;
- steady and severe pain, often felt as back pain;
- nausea, running temperature, rapid heart;
- gene mutations (hereditary).
Acute pancreatitis is a severe inflammation of the patient’s pancreas caused by gall stones, alcohol abuse, infection, or injury. When digestive enzymes that typically stay in one part of the pancreas leak into its other parts, this causes swelling and acute abdominal pain. It often transfers to the patient’s back and remains steady and severe regardless of the cause of the disease. It may be accompanied by nausea, vomiting, rapid heart, or increased body temperature. The disease is hereditary for some people since gene mutations determining the patient’s disposition for the disease have been discovered (Banks et al., 2013).
Diagnosis and Medications Summary
- unceasing abdominal pains, rigid muscles, bowel sounds;
- alcohol-abuse, gall bladder problems;
- blood and imaging tests;
- no specific medications;
- supportive pharmacotherapy;
- intravenous (IV) fluid hydration, antibiotics, analgesics.
Acute pancreatitis is suspected in patients who feel unceasing abdominal pain, those who drink a lot of alcohol, or suffer from gallbladder problems. Abdominal wall muscles are rigid while the abdomen is tender; bowel sounds are heard. Blood and imaging tests allow confirming the diagnosis. There are no medications specifically meant to treat this condition. Pharmacotherapy is supportive and relieves pain. Intravenous (IV) fluid hydration, antibiotics, and analgesics are typically prescribed (Zerem, 2014).
Analgesics
- Acetaminophen (Aspirin-free Anacin, Fever all, Tylenol);
- unsuitable for intense pain;
- Tramadol (Ultram, Rybix, Ryzolt);
- soothes moderate pain;
- Meperidine (Demerol);
- opioid; suitable for severe cases.
Since patients feel pain practically all the time, pain management is essential for their treatment. Acetaminophen (Aspirin-free Anacin, Fever all, Tylenol) may cope with elevated body temperature and pain. However, it is unsuitable for cases of intense pain. Tramadol (Ultram, Rybix, Ryzolt) helps with moderate pain by altering the patient’s response to it and by inhibiting the uptake of serotonin and norepinephrine. Meperidine (Demerol) is an opioid analgesic suitable for the most severe cases (Zerem, 2014).
Antibiotics
- helpful in the event of biliary or acute necrotizing pancreatitis;
- Imipenem and cilastatin (Primaxin) – beta-lactam antibiotics with a broad antimicrobial spectrum;
- inhibit dehydropeptidase activity and decrease cilastatin metabolism;
- potentially toxic;
- Ampicillin – an alternative when the patient cannot take medications orally;
- Ceftriaxone (Rocephin) – cephalosporin, gram-negative against gram-positive organisms.
Antibiotics can be helpful in the event of biliary or acute necrotizing pancreatitis, in which enteric aerobic and anaerobic gram-bacilli microorganisms cause the disease. The regimen is adjusted accordingly. Imipenem and cilastatin (Primaxin) are beta-lactam antibiotics with a broad antimicrobial spectrum and high potency. They inhibit dehydropeptidase activity and decrease cilastatin metabolism; however, they are potentially toxic. Ampicillin is a good alternative when the patient cannot take medications orally. Ceftriaxone (Rocephin) is gram-negative cephalosporin acting against gram-positive organisms. It arrests bacterial growth (Tenner, Baillie, DeWitt, & Vege, 2013).
Nursing Interventions
- control intense pain;
- restore the patient’s Fluid Balance;
- improve the respiratory function;
- improve the patient’s nutrition status;
- improve skin integrity;
- eliminate anxiety concerning surgeries.
The major task of nurses to enhance the positive effects of medications. They may help control pain by quickly identifying their duration, character, alleviating factors, etc. Since they can evaluate laboratory data, it is easy for them to administer replacements to restore adequate fluid balance. Assessing breath to reveal signs of respiratory distress is another important intervention. Furthermore, nurses monitor daily nutrition and enzyme intake to keep cholesterol and glucose levels balanced. They also carefully investigate wounds and provide skin care. Finally, they help patients realize the necessity to resort to surgical intervention.
Conclusion
- acute pancreatitis – life-threatening condition;
- no specific medications;
- supportive pharmacotherapy;
- analgesics, antibiotics;
- nursing interventions;
- change of lifestyle.
Acute pancreatitis is a life-threatening disease. Unfortunately, there are no specific medications for it, which makes treatment supportive. Nursing interventions may significantly relieve pain. Yet, the entire change of lifestyle is required.
References
Banks, P. A., Bollen, T. L., Dervenis, C., Gooszen, H. G., Johnson, C. D., Sarr, M. G.,… Vege, S. S. (2013). Classification of acute pancreatitis—2012: Revision of the Atlanta classification and definitions by international consensus. Gut, 62(1), 102-111.
Tenner, S., Baillie, J., DeWitt, J., & Vege, S. S. (2013). American College of Gastroenterology guideline: Management of acute pancreatitis. The American Journal of Gastroenterology, 108(9), 1400-1415.
Zerem, E. (2014). Treatment of severe acute pancreatitis and its complications. World Journal of Gastroenterology: WJG, 20(38), 13879-13882.