Care Plan for Pancreatitis

Achoo!, LPN · Oct 27, 2006

Pt will report pain less than 4/10 within x time frame?

Are they on a PCA pump? Pt will demosntrate proper use of PCA pump by end of shift?

Pt will verbalize proper understanding of 10/10 pain scale by end of shift?

Daytonite, BSN, RN · Oct 27, 2006

if you have a care plan book please read the beginning chapter(s). the nursing process is almost always fully explained in the beginning of these books. in nanda terminology goals are often used synonymously with the word "outcomes". an easier way to explain goals is that they are often the opposite or the normal state of your patient's nursing diagnosis. for a nursing diagnosis of pain, the ultimate goal would be the opposite of pain--or for the patient to be totally pain free. however, we know that with pancreatitis that may not be totally possible, so we have to make some compromises and look at ways the patient might be able to successfully learn to cope with the pain. i linked you into a couple of care plan constructor sites that specifically address the nursing diagnosis of pain.

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=40 - acute pain guideline for this nursing diagnosis from the gulanick care plan constructor. the three areas listed to focus on outcomes (goals) are comfort level, medication response and pain control.

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=41 - chronic pain guideline for this nursing diagnosis from the gulanick care plan constructor. the three areas listed to focus on outcomes (goals) are pain control, quality of life and family coping.

http://www1.us.elsevierhealth.com/evolve/ackley/ndh6e/constructor/index.cfm?plan=37 - chronic pain guideline for this nursing diagnosis from the ackley care plan constructor. actually lists 5 client outcome statements you can look at.

i have a couple questions about your post. first of all, is this a new onset of pancreatitis for this patient? or, has this happened to the patient before? is there alcohol abuse involved? if so, and the patient doesn't resolve the problem causing the pancreatitis, then this pancreatic pain is going to become chronic pain that (s)he is going to have to learn to live with. part of your assessment of this patient should have been to determine what successful measures the patient has done to relieve the pain, if any. on the flip side of that, what has the patient done that contributes to the pain that (s)he may not be aware of. i am suggesting that there might be a learning component that can become a goal for the patient. part of forumulating your goals will be for you to learn about pain and it's treatment. i saw that siri gave you a nice link to pain management on the city of hope website in the other thread you posted for help. i hope you read through that document.

juliasmommy · Oct 27, 2006

Thank you so much. She has 6 shots 3 or 4 times a week so I know that alcohol is the likely cause. I am goignt o include that in one of my long term goals I am stuck finding another long term goal. She takes over the counter pain meds to control the pain at home.

Daytonite, BSN, RN · Oct 28, 2006

Usually, once an alcoholic gets one bout of pancreatitis they are in for chronic pancreatitis over the long haul. Stopping drinking has to be something the patient may not want to do, but needs to at least be educated about. Since pancreatitis is likely to be a recurrent problem for this patient, one of your goals needs to be for the patient to be able to articulate exactly what pancreatitis is, symptoms, how alcohol ingestion exacerbates it and what they need to do at the first sign of symptoms. Do you have anything on teaching related to NSAIDS? They contribute to kidney and/or liver failure, something this patient doesn't need on top of a bad pancreas. Aspirin will aggravate bleeding factors as well. Did you have an opportunity to see any labwork related to liver enzymes? Is there any liver damage occuring yet? Have you looked at diversional activities for pain control? If alcoholism is at the heart of this, then you should probably also be looking at nutritional interventions. You should be having the patient make a food diary or working on a list of foods that aggravate his pancreatitis--foods he is going to need to stay away from.

A patient who is at risk for chronic pancreatitis is also at risk to become a diabetic as well as develop cirrhosis of the liver.