LESSON PLAN
Name of the Teacher :- Ms. Mandeep Kaur
Class- M.Sc (N) Ist Year
Time:- 1 hr
Group – P.B.B.SC (N) Ist year
Topic:- Pancreatitis
Subject:- Medical Surgical Nursing
A.V aids – flash cards, chart, pamphlets, handouts & black board
Method of teaching:- Lecture cum discussion
Teacher Supervisor :- Miss. Amandeep kaur ( lecturer)
Previous knowledge:-Student has little knowledge.
General Objective:- At the end of the lecture , Student will be able to explain about pancreatitis.
Specific Objective:-
Develop Rapport
Assess previous knowledge.
Define pancreatitis.
Describe the types of ancreatitis.
Describe the etiology of Pancreatitis.
Explain the pathophysiology.
Discuss the clinical manifestation Pancreatitis.
Discuss the nursing management.
S.NO. SPECIFIC TIME CONTENT MATTER TEACHING & A.V
OBJECTIVES LEARNING AIDS EVALUATION
ACTIVITIES
1 Develop rapport 1 min Introduction about self :
MyselfMandeep kaur , a student of m.sc nursing 1st year.
Introduction about topic:
Today I will discuss with you about Pancreatitis – definition, etiology ,
types, pathophysiology, clinical manifestations ,diagnostic
findings,medical management, complications & nursing management.
Assess previous Previous knowledge is assessed by asking questions –
knowledge. “what do you mean by pancreatitis ?”
2 2mins Definition :- Defines
Define Pancreatitis to Black
pancreatitis Acute pancreatitis is an inflammation of the pancreas resulting the group by borad Define
from premature activation of pancreatic exocrine enzymes. lecture method. pancreatitis ?
3 2 Or
mins Acute inflammation of the pancreas that can also involing
surrounding tissues remote organ or both.
Describes the
1 Types ofPancreatitis:- types of
Describe the types mins pancreatitis to
of pancreatitis. It has following types:- the group by
Acute lecture method
Chronic. with the help of
flash cards. Flash
4 cards
Describe the Etiological factors:-
etiology.
. Biliary disease:gallstone or microlithiasis common bile Etiological
duct obstruction biliary sludge factors is Chart Enlist the types
Pancreas divisum described to the of pancreatitis.
Alcohal abuse group by lecture
Hypertriglyceridemia cum discussion.
Hypercalcemia
Idiopathic
Abdominal trauma
Certain drug like thiazide diureatic flrosemide
procainamide tetracycline sulfonamide angiotension
Converting nenzyme inhibitor volporic acid
Miscellaneous retrograde cholangiopancrentography
Infection process bacterial Viral.
Bacterial staphylococcal infection scarlet fever
Viral:- as well as the congenital variant of pancreas
divisum
5 Pathophysiology :- The Which factors
Explain mins Etiological factor(gall stone, bile duct pathophysiolog are responsible
pathophysiology. obstruction,hyperglyceridemia) y of pneumonia for causing
is explained to pancreatitis ?
the group by
Pancreas prematurely activated lecture method.
Autodigestion of the pancreas and peripancreatic tissue
Also lead to activated of the enzyme elastase kinases
Elastase can cause dissolution of elastase fibers in blood vessels
Systemic vasodilatation and increase vascular permeability
Edema
Necrosis of the pancreas
Describe the 6 Clinical manifestations:- The clinical
Clinical mins manifestations
manifestation Clinical manifestation is discussed to
Pain:- the pain usually begins abruptly ,often after a large meal or the group by
large intake of alcohol. It may be steady and severe or increase in lecture cum
intensity over several hours. discussion.
Paralytic ileus:- Bowel sounds may be hypoactive or absent due
to decrease intestinal mobility or paralytic ileus.
Grey tuener’s sign:- The presence of a bluish discolouration of
the lower abdominal flankes .
Cullen ‘ signindicate hemorrhage pancreatic and an accumulation
of blood in thease areas.
Tenderness
Irritation Hand
Vomiting outs
Nausea
5 Ecchymosis
. Fever
Jaundice
Hypotension
Tachycardia
Cyanosis
Cold,clammy skin
Acute renal failure
Hypoxia
Dyspnea
Tachypnea
Hypocalcemia
Hyperglycemia
Shock
Toxemia
6 Discuss the 3 Diagnostic findings:-
diagnostic mins Hemoglobin The diagnostic
findings. X-ray examination may show pleural effusion local inflammatory findings of
4 reaction to pancreatic enzymes pulmonary infiltrates or change in pneumonia is
mins the size of the pancreas discuss to the
Computed tomography and ultrasound can provide more group by
complete information aboutethe pancreas and surrounding tissue discussion
to identification an increase in the diameter of the pancreas and to method
detect pancreatic cysts abcessess.
Urine amylase
Glucose
Bilirubin
Alkaline phosphatase
ALT
Angiography
MRI
Magnetic resonance cholangio pancreatography
Ranson’s criteria for acute pancreatitis:- Age>55 yrs
Leukocyte count>16,000/ul Pamphlets
Serum glucose 7200 mg/dl
Serum lactate dehydrogenase>350/ml
Evaluate during initial 48 hours
Fall in hematocrit>10%
Enist clinical
Blood urea nitrogen level rise>5 mg/dl
Serum calcium <8 mg/dl manifestations.
Estimated sequestration> 6 L
Explain medical
management. 8 Medical management:- The medical Black
mins . management is board
Restoration of circulating blood volume with I.V. crystalloid or explained to the
colloid solutions or blood products. Maintenance of adequate group by lecture
oxygenation reduced by pain, anxiety, acidosis, abdominal method.
pressure, or pleural effusions. Maintenance of alkaline hastric pH
with H2-receptor antagonists and antacids to suppress acid drive of
7 pancreatic secretions and to prevent stress ulcer complications of
acute illness. The patient may need to have a nasogastric tube
inserted into stomach and attached to low suction to empty gastric
content and gas.
Fluid and electrolyte replacement:- Patient with severe acute
pancreatitis may have up to 12 L of fluid sequesteation in the
retroperitoneal space or peritoneal cavity. The goal is to administer
enough fluid to obtain a circulating volume sufficient to maintain
organ and tissue perfusion and prevent end stages shock. Colloid
and crystalloid solution such as albumin and ringer ‘s lactate
solution are used for volume replacement, fluid replacement is
evaluated by monitoring intake and output and daily wt.
Pain management:- Pain control is a nursing priority for patient
with acute pancretitis one only because of the extreme discomfort
but because pain increase pancreatitis enzyme secreation adequate
pain control with the use of I/V narcotic, meperidine (opioids)
fentanyl citrate (sublimaze) analegesia should be routinely
administered at least every 3to4 hours.
Restingthe Pancers:-patientwith acute pancreatitis nasogastric
suction is used to docompress the stomach and decrease
stimulation of secretion.Secretion which stimulation production of
pancreatitis secreation is released in response to acid in the
duodenum.Nausea ,vomiting and abdominal pain may decrease
8 when a nasogastric tube is placed and connected to suction early in
treatment. Anasogastric tube is also necessary in patient with
severe gastric distension or a paralytic ileus
Nutritional support:- Lipid administration is avoided to prevent
increasing triglyceride levels Which can exacerbate the
inflammatory process. In the patient with mild acute pancreatitis
oral fluids can usually be restarted with 3to7 days with solid food
introduced slowly and as tolerated
Peritoneal lavage:- The rationale for this therapy is that
peritoneal lavage remove thetoxic substance released by the
damaged pancreas into the peritoneal fluid before systemic effect
can be initiated lavage may be usedif standared therapies have not
9 been effective during the first days of hospitalization.
Surgical management:- Surgery may also be performed if
gallstone are thought to be thecause of the acute pancreatitis a
choleystectomy or ERCP and endoscopic sphineterotomy are
performed.
Incision and drainage of infection and Pseudocysts.
Debridement or pancreatectomy to remove necrotic pancreatic
tissue.
Cholecystectomy for gallstone pancreatitis.
Describe 1 Complications Complications Black
complications. mins Pancreatic ascites,abscess,or pseudocyst is described to board
Pulmonary infiltrates,pleural effusion,acute respiratory distress the group.
syndrome
Hemorrhage with hypovolemic shock.
Which are the
Acute renal failure.
Sepsis and multiple-organ dysfunction syndrome diagnostic
10 Discuss the Nursing management:- findings
nursing 4 performed to
management mins Nursing assessment:- history taking and physical examination detect the
Nursing Assessment: disease?
-To take proper physical history and family history
Assess level of abdominal pain
Assess nutritional status.
Assess for steatorrhea and malabsorption.
Assess for signs and symptoms of diabetes mellitus.
Assess current level of alcohol intake and motivation and
resources available to abstain from drinking such as Alcoholics
11 Anonymous.
Nursing Diagnoses
Acute pain related distention of pancreas evidence by diaphoresis,
change in blood pressure
Deficient Fluid Volume realated to vomiting,NG suction fever, and
fluid shifts evidence by alterd intake,dry skin andmucous
membranes
Ineffective Breathing Pattern related to severe Pain and Pulmonary
complications
Imblanced Nutrition;Less Than Body Requirement related to
impaired digestion evidence by weakness wt loss
Nursing Interventions
Controlling Pain
Administer Opioid analgesics as ordered to control Pain
Assist Patient to a comfortabale Position.
Maintain NPO status to decrease pancreatic enzyme
secretion.
Maintain patency of NG suction to remove secretions and
to relieve abdominal distention,if indicated.
Provide frequent Oral hygiene and care.
Administer antacids or H2-receptor antagonists as
prescribed.
Report increase in severity of Pain,which may indicate
hemorrhage of the pancreas, rupture of a pseudocyst, or
inadequate dosage of the analgesic.
Restoring adequate fluid balance
Monitor and record vital sign skin color and temperature.
Monitor intake and output and weigh daily
Evaluate laboratory data are
hemoglobin,hematocrit,albumin,calcium,potassium,sodium
,and magnesium level and administer replacement as
prescribed.
Observe and measure abdominal girth if pancreatice
ascites is suspected
Report trends in falling blood pressure or urine output or
rising pulse, becoz this may indicate hypovolemia and
shock or renal failure.
Improving respiratory function
Assess respiratory rate and rhythm ,effort ,oxygen
saturation ,and breath sound frequently.
Position in upright or semi –fowler position to enhance
diaphragmatic excursion.
Administer oxygen supplementation as prescribed to
maintain adequate oxygen level
Report sign of respiratory distress immediately.
Instruct patient in coughing and deep breathing to
improving respiratory function.
Improving nutritional status
12
Assess nutritional status history of weight loss and dietary
habits including alcohol intake
Administer pancreatic or H2 receptor antagonists to
prevent neutralization of enzyme supplement as indicated.
Monitor intake and output and daily weight
Assess for GI discomfort with meals and character of stools
Monitor blood glucose level and teach balanced low
concentrated carbohydrate diet and insulin therapy as
13 indicated
Identify food that aggravate symptom and teach low fat
diet.
Patient education and health maintenance
Instruct patient to gradually resume a low fat diet
Instruct patient to increase activity gradually providing for
daily rest periods
If pancreatitis is a result of alcohol abuse the patient needs
to be reminded of the importance of eliminating all alcohol
advise about alcoholics anonymous or other substance
abuse counseling.
Reinforce information about disease process and
precipitating factors stress that subsequent about of acute
pancreatitis may destroy the pancreas cause additional
complication and lead to chronic pancreatitis.
Evaluation expected outcomes
Verbalize reduced pain level
Blood pressure stable ;urine output adequate
Respiration unlabored ;breath sounds clear
Summarizes the Summarization :- Summarizes the
topic I have discussed with you about pancreatitis – definition, etiology , topic to the
types, pathophysiology, clinical manifestations ,diagnostic group.
findings,medical management, complications & nursing
management.
Recaptualizes
Recaptualization :-
What are the medications used for treating pancreatitis.
References :-
o Phipps , monahan , sands ,” medical – surgical nursing “
published by mosby , 7th edition ; page no: 1289-1296
o Brunner & suddarth ,” textbook of medical surgical nursing
“ published by lipponcott
,10th edition ,page no : 520 - 531.
o Lewis heitkemper,dirkson” medical surgical nursing
“,published by mosby,7th edition ,page no. 561 – 568.
o Joyce M . Black “ medical surgical nursing, 8 th
edition,vol-1 page no -1599 – 1600
o Lipponcott “ medical surgical nursing , published by spring
house, page no- 371-376.
Enlist the
complications.
BIBLIOGRAPHY
o Phipps , monahan , sands ,” medical – surgical nursing “ published by mosby , 7th
edition ; page no: 1289-1296
o Brunner & suddarth ,” textbook of medical surgical nursing “ published by
lipponcott
10th edition ,page no : 520 - 531.
o Lewis heitkemper,dirkson” medical surgical nursing “,published by mosby,7 th
edition ,page no. 561 – 568.
o Joyce M . Black “ medical surgical nursing, 8 th edition,vol-1 page no -1599 –
1600.
o Lipponcott “ medical surgical nursing , published by spring house, page no- 371-
376.
