New here and need some help!

  1. First of all, I would like to say that this forum is wonderful. I have been a lurker for quite a while now and decided to join.

    I need some help with my careplan!!!! I am sooo lost and it is due monday. My pt. had acute pancreatitis with renal failure as a secondary diagnosis and I have no idea where to begin.

    I also am having a problem with why one of his labs is like it is. His ALT's were high,and the only reason that I can find to explain is hepatitis but he doesn't have it. Is there some other liver problem going on or can it be because of the pancreatitis and renal failure?? Any suggestions would be helpful.

    Thankyou in advance,
    Tina
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  2. 5 Comments

  3. by   Imafloat
    I think the pancreatitis can lead to liver problems, look in your patho book. I had a patient with panc once and one of my diagnoses was acute pain, pancreatitis is very painful.
  4. by   P_RN
    One of my most favorite sources is the FP Notebook site.
    Aspartate Aminotransferase

    I had pancreatitis not too long ago as a result of sphincter of oddi disorder. My liver labs shot through the ceiling.

    Think of your patients "needs" Think of why he needs it.
    Think of what you can do to ease, help or understand those needs.

    I'm not sure what outline/hierarchy your care plan is taking do you now.
  5. by   Daytonite
    hi, tina!

    first of all, i want to make sure that you know about these threads on the nursing student forums even though you say you have been lurking for a while. much of what i say in answer to questions about care plans is also posted in replies on these threads as well:
    ok. now, start with the nursing process. writing a care plan is the nursing process on paper. first step is to collect data. what data have you collected on this patient? all i know from what you posted is that he has an elevated alt (alanine aminotransferase). and, by the way, alt is found to be elevated in people who have pancreatitis so this is not a surprise to me. in order to complete a care plan, however, you need more data than just lab results. what did you learn about this patient's ability to perform his adls? what kinds of statements did he make to you that might have set off a red flag in your mind? what signs and symptoms did the physician list for this patient on his history and physical? what kinds of medications and treatments were ordered? all these things are information that will help you in planning this patient's care. only after developing this list of abnormal data can you begin to choose nursing diagnoses for him. then, you proceed to the formulation of outcomes and nursing interventions. so, i can't help you any further with a care plan without any other assessment data.

    with regard to the pathophysiology of acute pancreatitis, i have some weblinks that you might find helpful. in general, the majority of people who get pancreatitis are abusing alcohol or drugs. that's not to say that all are involved in these behaviors. when there is alcoholism involved the patient is continually ill with this disease because the ingestion of alcohol keeps aggravating the condition. liver disease and cirrhosis are usually not far behind.

    http://arbl.cvmbs.colostate.edu/hboo...ion/index.html - pathophysiology of the digestive system. this is for medical students, but still has some good information although it is very basic.

    http://www.nlm.nih.gov/medlineplus/t.../htm/index.htm - this is a real nice tutorial on pancreatitis designed for patients, but you should take a look at it for the good information in it. if you don't want to see it as a slide show you can just download a text version of the script.

    http://jama.ama-assn.org/cgi/content/full/291/23/2902 - information on pancreatitis from jama

    http://search.nlm.nih.gov/medlineplu...itis&x=94&y=10 - links to information on pancreatitis

    http://www.clevelandclinicmeded.com/...n/acutepan.htm - a really good discussion by physicians about acute pancreatitis, its definition, prevalence, etiology, pathophysiology, signs and symptoms, diagnosis, treatment and outcomes.
    http://www.clevelandclinicmeded.com/...hpan/chpan.htm - about chronic pancreatitis from the same source.

    some of the nursing diagnoses that you are going to want to consider for this patient will probably be:
    • acute pain
    • diarrhea
    • nausea
    • imbalanced nutrition: less than body requirements
    • deficient fluid volume (if he is vomiting)
    • excess fluid volume (if his kidneys have shut down and he's not making urine)
    if you have more information that i can work with, please post it so i can help you out.

    welcome to allnurses!
  6. by   RNtobe08
    Thankyou so much for your help everyone. I really need it. This is my first care plan! I have gotten the majority of it figured out now thanks to your replies. Could I ask another question? I have to correlate results to nursing care for the labs and am having trouble finding out what to put for this on the WBC. My patients WBC count was elevated (as to be expected because of the inflammation from the pancreatitis), but I dont know what to put down for the nursing care portion. It would be a big help to lead me in a general direction.THANKS!!
  7. by   Daytonite
    here is information on the white blood cell count test. http://www.labtestsonline.org/unders.../wbc/test.html

    my reference here at home (mosby's diagnostic and laboratory test reference, fourth edition, page 896) states that elevated white blood cell counts are seen in:
    • infection
    • leukemic neoplasia
    • trauma
    • stress
    • tissue necrosis
    • inflammation
    the elevated white count is a manifestation of the patient's stress and inflammation. it will be one of your items following the "aeb" portion of the nursing diagnosis addressing these. what do you do for abnormal lab results (nursing interventions)? you continue to monitor the patient's wbc's for changes, either up or down. you observe the patient for symptoms of further stress or inflammation and document it. you contact and notify the physician when you find abnormally elevated wbcs or new symptoms of inflammation.

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