Correct me if im wrong

problem: severe pain

dx: acute pain and discomfort related to edema, distention of the pancreas and periotoneal irritation

problem: discomfort

dx: discomfort related to nasogastric tube

problem: decreased oral intake

dx: imbalanced nutrition: less than body requirements related to inadequate dietary intake, impaired pancreatic secretions, increased nutritional needs secondary to acute illness and increased body temperature

problem: difficulty breathing

dx: ineffective breathing pattern related to splinting from severe pain, pulmonary infiltrates, pleural effusion and atelectasis

problem: vomiting

dx: risk for deficient fluid volume related to excessive losses: vomiting, gastric suctioning

problem: limited activity intolerance

dx: activity intolerance related to pain

problem: risk for altered tissue perfusion

dx: risk for altered tissue perfusion related to enforced bed rest , poor nutritional status

the appropriate and more correct diagnosis for problems with moving is impaired physical mobility and that can be related to pain as well as decreased endurance and deconditioning (something you were alluding to with activity intolerance). its definition, however, differs from activity intolerance in that in means a limitation in independent, purposeful physical movement of the body or of one or more extremities. [color=#3366ff]impaired physical mobility

nanda does not permit the use of medical diagnoses in the nursing taxonomy and spent a lot of time rewording and changing medical language into what they now call nursing language. for learning purposes though it sometimes helps to stick these "secondary to" statements into diagnostic statements. they can be added to help clarify or define the etiology of the nursing problem if your instructors allow it. using a "secondary to" is a sly way to work the medical diagnosis into the nursing diagnostic statement. it is done to help you see the rational progression in reaching these problem determination decisions as learners. when you graduate and move into the working world you are only expected to know the nursing diagnosis and interventions for it. no one will grill you about why you chose that diagnosis unless you come up with some really bizarre stuff that no one can figure out!

remember back in your other thread, https://allnurses.com/forums/f50/nursing-diagnosis-need-help-326004.html - nursing diagnosis need help, i gave specific information about what a thorough patient assessment included. this applies to all patients and all case scenarios. part of the preparation in getting to the writing of nursing diagnoses for a patient is knowing all about his underlying disease processes--in this case, acute pancreatitis. there is acute and chronic pancreatitis.

first off, the word acute (look it up in a medical dictionary to verify this) differs from chronic.

• acute - having rapid onset, severe symptoms, and a short course; the opposite of chronic - the implication here is that it is reversible, so a cure is a likely outcome
  
• chronic - of long duration; showing little change or of slow progression; the opposite of acute - the implication here is that it is never going away so stabilization or deteriorization are your outcomes

for example, i would write acute pain related to obstruction of pancreatic and biliary ducts, chemical contamination of the peritoneum with pancreatic exudate and byproducts of autodigestion and inflammation of the retroperitoneal nerve plexus secondary to pancreatitis as evidenced by the patient's statement of pain of 10 on a scale of 0 to 10. and everyone reading this is wondering what hat i pulled that out of. i looked at a couple of references although i have taken care of many of these patients. per sue e. heuther on page 1363 of pathophysiology: the biologic basis for disease in adults and children, third edition, by kathryn l. mccance and sue e. heuther "the pain [of acute pancreatitis] is caused by edema, which distends the pancreatic ducts and capsule; chemical irritation and inflammation of the peritoneum; and irritation or obstruction of the biliary tract." also, and this goes back to your problem of nausea, "nausea and vomiting are caused by hypermotility or paralytic ileus secondary to the pancreatitis or peritonitis." there is more on the pathophysiology. . ."abdominal distension accompanies bowel hypermotility and the accumulation of fluids in the peritoneal cavity. hypotension and shock occur frequently because plasma volume is lost as enzymes and kinins released into the circulation increase vascular permeability and dilate vessels. hypovolemia, hypotension, and myocardial insufficiency result. a small percentage of individuals develop tachypnea and hypoxemia secondary to pulmonary edema, atelectasis or pleural effusions caused by circulating pancreatic enzymes. in severe cases hypovolemia decreases renal flow sufficiently to impair renal function. tetany may develop as a result of deposition of calcium in areas of fat necrosis or as a decreased response to parathormone. transient hyperglycemia also can occur if glucagon is released from damaged alpha cells in the pancreatic islets."

these are the diagnoses i would use based on the information you've posted and what i know about acute pancreatitis. they are sequenced in order of priority:

• decreased cardiac output related to decreased preload and afterload and hypovolemia [this is why the patient gets hypotensive and what you were trying to get into with the diagnosis of risk for altered tissue perfusion. when you are specifically dealing with perfusion of the heart you use decreased cardiac output, when you deal with shock you use ineffective tissue perfusion: cardiopulmonary and peripheral]
  
• impaired gas exchange related to ventilation perfusion imbalance secondary to pulmonary edema, atelectasis or pleural effusion as evidenced by hypoxemia
  
• ineffective breathing pattern related to abdominal distension as evidenced by tachypnea
  
• deficient fluid volume related to loss of fluids entrapped in the bowel and vomiting secondary to paralytic ileus
  
• imbalanced nutrition: less than body requirements related to vomiting, npo status, and pancreatic outflow obstruction as evidenced by inadequate food, fluid and electrolyte intake
  
• hyperthermia related to disease process
  
• impaired physical mobility related to abdominal pain, decreased endurance and deconditioning
  
• acute pain related to obstruction of pancreatic and biliary ducts, chemical contamination of the peritoneum with pancreatic exudate and byproducts of autodigestion and inflammation of the retroperitoneal nerve plexus secondary to pancreatitis as evidenced by the patient's statement of pain of 10 on a scale of 0 to 10.
  
• disturbed body image related to skin discoloration secondary to obstructed common bile duct [due to jaundice]
  
• deficient knowledge (discharge needs) related to unacquainted with information resources (diet, allowed physical activity, special medications they need to take, any treatments and tests they need to be doing after discharge, referrals to any outside agencies or support groups, follow up appointments with doctors, teaching materials and/or contact with outpatient professionals for continued care, and that the patient knows what symptoms need to be reported to the doctor if they occur)
  
• risk for infection related to immunosuppression [i'm talking about the infection going septic]
  
• risk for impaired skin integrity related to bedrest and immobility