Pancreatitis is a painful inflammatory condition in which the pancreatic enzymes are prematurely activated resulting in auto-digestion of the pancreas (American Pancreatic Association, 2010). The most common cause of pancreatitis are biliary tract disease and alcoholism, but can result from such things as abnormal organ structure, blunt trauma, penetrating peptic ulcers, and drugs such as sulfonamides and glucocorticoids (American Gastroenterological Association, 2010). Pancreatitis may be acute or chronic, with symptoms mild or severe. In severe cases, hemorrhage, infection, pseudo cyst, and permanent tissue damage may occur.
The signs and symptoms vary in people including: fever, extreme abdominal pain, nausea, vomiting, weight loss, diarrhea, and oily stools. The focus of this case study is to discuss Mrs. L who recently was diagnosed with hemorrhagic pancreatitis with pseudo cyst caused by gallstones. Mrs. L is a 58 –year–old Caucasian female who has been married for 38 years. She has two daughters and one grandson. Her mother past away from lung cancer at the age of 75 and her father is healthy and still living. She is the oldest of five healthy siblings, two sisters and two brothers.
Mrs. L works as a principle for the past 29 years at Linden High school. She plays the piano at First Southern Baptist Church for 15 years. Her hobbies are reading, writing poetry and gardening. She does not have a history of drinking, smoking or recreational drug use. She has been hospitalized for the past six weeks for acute hemorrhagic pancreatitis with a pseudo cyst. The pancreatitis was caused by gallstones. Mrs. L spent three weeks in intensive care, and then underwent surgery for removal of the gallstones and to insert drains into the pseudo cyst.
Prior to discharge she had progressed to a soft, high carbohydrate, low fat diet; had all drains removed; and was able to walk in the hall approximately 20 feet. Mrs. L was referred to the community home health agency in her home town for continue follow up. The home health nurse Miss. D, assess Mrs. L at home after she was discharge from the hospital. She is thin and appears anxious and tired. She states that she lost 25 pounds during her hospitalization and now weights 101. She is 5 feet 4 inches tall. Her vital signs are within normal limits. The heart and lungs are normal.
During this visit her non-fasting blood glucose is slightly elevated at 112. Her laboratory studies upon discharge from the hospital were low serum hemoglobin at 8. 8, low serum hematocrit at 29. 0, with elevated lipase. Liver chemistries are normal. Mrs. L has a well-healed upper abdominal scar and two round wounds (from drains) on each side of her abdomen. The wounds are closed but still have scabs with mild epigastria tenderness. Her skin is cool and dry. Her color is pallor and turgor is poor. She is alert and oriented and responds appropriately to questions. Mrs. L learns best by reading and listening.
She states that her main problems are lack of energy and lack of appetite for the low-fat diet that has been ordered. Mrs. L husband and three daughters express concern about their ability to provide care. Although they have been taught all about the disease and how to provide care, they still are not sure they know exactly what should be done now that Mrs. L is at home. Mrs. L has a prescription for pain medication: Percocet 10 mg every 3 to 4 hours. She voiced concern that she would be addicted to the pain medicine and presently her pain level was a six out of 10 (10 being the worse pain).
The new medication that Mrs. L will be taken is an iron tablet daily, calcium tablet daily and a vitamin D tablet daily. Mrs. L was screen for depression during the home health assessment and patient denies any signs and symptoms. Miss. D, together with Mr. and Mrs. L and the two daughters, develop a teaching plan based on the information and concerns that are address. Age and developmental issues The American middle age adults 45 – 65 are quite healthy, especially those who are college-educated, white, and middle class (with annual income over $35,000).
Mrs. L is a principle at Linden high school for the past 29 years. Her husband is a teacher at the same school. Their house is paid off and they are financial set for retirement. The most common health problems experienced during middle age are arthritis, asthma, bronchitis, coronary heart disease, diabetes, genitourinary disorders, hypertension, mental disorders and cva’s (Cliffnotes, 2010). Mrs. L has suffered with arthritis, but has no other problems before this illness. She considered herself healthy and “better off than most her age”.
She walks a mile a day with her husband and has strong family support. She has a sound relationship with her husband and does not appear to be worried about her future. Effect on quality of life The impact of disease and the treatment on the patient’s overall well-being and functioning has become a topic of growing interest not only in clinical research but also in practice. The benefits of the specific treatments as well as the health-care system will be more and more judged on the basic on how much of the changes in the patient’s activity or well-being will correspond to their expectations.
Thus, health related quality of life, subjectively perceived by the patient, is becoming a major issue in the evaluation of any therapeutic intervention. The World Health Organization (WHO) defined health as the “complete state of physical, mental and social well-being and not merely the absence of infirmity” (WHO 2009). WHO acknowledged an individual who is technically “cured” of disease may not necessarily be “well” and indicated three dimensions of well-being. The first dimension is physical well-being assumes the ability to function normally in activities such as bathing, dressing, eating, and moving around.
The second dimension is mental well-being implies that cognitive faculties are intact and that there is no burden of fear, anxiety, stress, depression, or other negative emotions, and the last dimension is social well-being. This dimension relates to one’s ability to participate in society, fulfilling roles as family member, friend, and coworker, citizen, and any engaging in interactions with others. Mrs. L physical well-being will need assistance with her activity of daily living. She refused for home health to send a bath technician to her home.
Her youngest daughter lives two blocks and is a stay home mother. She volunteered to help Mrs. L with her ADL’s. Her mental well-being is positive. She does appear anxious but calm done during the assessment as questions were being answered. Mrs. L is aware that because of her illness and surgery she may take some time to gain her strength back. She did complain that she is weak and has no strength at this time. Miss D requested that a physical therapist visit three times a week to help Mrs. L with an exercise plan. The patient and her family agreed and are elated.
Patient perceived challenges Mrs. L knows that chronic pancreatitis is a begin disease that can be control through medication and diet. She verbalized that following her diet and decreasing stress would decrease exocrine and endocrine enzymes. For most patients, medical treatment is a good option, especially in those that required substitutive therapy for either exocrine or for endocrine insufficiency; however, controlling the pain remains the main therapeutic challenge. Efforts should be made in order to identify more efficacious therapies capable of controlling this symptom.
Summary Pancreatitis is an inflammation of the pancreas, a very important organ of the body. This disease may start as an acute disease and develop into a chronic one. Thanks to medical advances, several treatment options are available to help manage and prevent painful attacks. If not treated, pancreatic can be life threatening. Treatment also depends on healthy living habits, such as avoiding alcoholic beverages and decreasing the amount of fatty foods. With proper treatment, people with pancreatitis can live a healthy life and avoid recurring pain and possible complications.
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