care plan for acute pancreatitis

  1. 0
    hi all!

    its my first post! i need help with my care plan for my patient with admit dx: acute pancreatitis:

    44 y old female, she presented to the er c/o abd.pain/ vomiting x 3 days. she had 4-5 alcoholic drinks prior. hx of severe hypertriglyceridemia and has been off her meds since 11/07, hx of hypothyroidism, anxiety and depression (which may explain why she's drinking), colitis and menorrhagia.
    my assessment findings: she's overweight, when i asked about her diet history she said she has a low fat diet and exercises at least 30 mins every day, until a few weeks ago when she started to not feel well. she has abd pain that radiates up her thorax. labs showed 343 cholesterol, 633 triglycerides, (which probably is what aggravated her pancreas along with the alcohol consumption).
    i want to use nursing dx: ineffective health maintenance r/t deficient knowledge concerning alcohol use and medication, but my nursing diagnosis handbook by ackley and ladwig doesn't have very good interventions that really pertain to my patient's needs. and i need one short term goal and one long term goal and five nursing interventions for each goal (so total of ten interventions). can someone please help? any suggestions or links/websites i can go to get more interventions? your help will be highly appreciated!!!
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  4. 0
    here's the information you asked for:
    are you using acute pain? these patients usually have terrible pain. is she eating or has she been made npo? many times these patients are made npo until the pain subsides indicating the pancreatitis has toned down. are you absolutely sure she doesn't have an alcohol dependency problem?
  5. 0
    she is NPO. according to the patient she drinks "occasionally".
    thank you for your help!
  6. 0
    Quote from daytonite
    here's the information you asked for:
    are you using acute pain? these patients usually have terrible pain. is she eating or has she been made npo? many times these patients are made npo until the pain subsides indicating the pancreatitis has toned down. are you absolutely sure she doesn't have an alcohol dependency problem?
    with my limited knowledge i agree with daytonight, i had my last pt yesterday came in with pancreatitise she was npo and in extreme pain, i think pain would be the major dx, it was the first thing we focused on after she was up from the er. she also wanted water but she was npo and was very upset about not getting water.
  7. 0
    I agree Acute Pain will be more relevant to my patient. She was in pain 7/10 scale and had PRN pain med dilaudid 1 mg IV every 3 hrs for moderate pain, and 2 mg for severe pain.

    Thank you!
  8. 0
    I must agree with the above posters. Lack of knowledge might be the reason that the pt is now in the hospital, but it is not the immediate need of the pt. Pain is an immediate problem, so is fluid balance and nutrition with the pt being npo.

    Think of it this way, what happens to the pt in the next 12-24 hours if you do not address the pain, fluid, nutrition. Talking about why the pt is now in the hospital can wait a few days and therefor should not be a priority.
  9. 0
    Pain.

    Ineffective Gas Exchange, Risk for.

    Skin integrity issues.

    Constipation, Risk for.

    Knowledge deficit.
  10. 0
    ok, let me be more specific. ineffective health maintenance r/t deficient knowledge concerning alcohol use and medication is a nursing diagnosis that addresses a safety need (maslow). your diagnostic statement as written has incorrect related factors (etiologies). your related factor (deficient knowledge concerning alcohol use and medication) is actually a defining characteristic and is one of your pieces of assessment data that supports classifying this patient with this diagnosis. your diagnostic statement really should be constructed as ineffective health maintenance r/t ??? [you need to identify an etiology here--see my next paragraph] aeb deficient knowledge concerning alcohol use and medication

    however, the description of the problem "ineffective health maintenance" is defined by nanda as the inability to identify, manage, and/or seek out help to maintain health. the keyword in this definition is "inability". it means unable, incapable, powerless, incompetent, or no skill at. with ineffective health maintenance the patient may not know/understand why they are not able to follow the plan of care or may not physically be able to. the bottom line reason, or etiology, for their inability to identify, manage, and/or seek out help to maintain healthis what becomes the r/t part of your diagnostic statement here. so you need to think back through what you learned about this patient. is the bottom line cause for her failure to stop drinking and follow the medical plan of care because her brain is finally pickled from all the alcohol abuse (cognitive impairment), is she inherently mentally retarded to begin with (inability to make appropriate judgments), blind and can't read (perceptual impairment), or just doesn't know what's available (lack of resources)

    i think you have a bigger problem.
    1. this patient has all kinds of actual physiological needs that you have not mentioned you have addressed (nutrition, temperature, comfort, adls)
    2. she also has serious psychosocial needs (alcoholism, depression)
    3. ineffective health maintenance is a safety need and lower in priority to physiological needs
    there is in formation on writing care plans on this thread:


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