Fever, chills and night sweats can signal a pancreatitis flare or a secondary infection and can quickly lead to sepsis and multi-organ involvement. Patients should be advised to report these symptoms immediately. For fevers 101.5 degrees or above, patients should seek immediate medical attention at the closest emergency department.
Patients often need continued narcotics post discharge for several weeks due to ongoing inflammation and drain site pain. Pain medication needs should be assessed regularly in the ambulatory setting as weaning can often start a week or two post discharge, even if it is in very slow increments. Complications and flares are also common and may necessitate increased pain medications for a short duration. Assessment should include the patient’s ability to perform ADL’s and daily ambulation. If a patient is unable to ambulate due to pain, complications can ensue, namely respiratory complications that can lead to fluid in the lungs, atelectasis and pneumonia.
*See FAQ page for specific pain recommendations and treatment plans.
Repeated bouts of inflammation and injury lead to permanent damage to the pancreas resulting in chronic pain and pain episodes. There are two common forms of pain in chronic pancreatitis patients, one is persistent pain with flare-ups or exacerbations of pain; and the other is relatively pain free durations with intermittent flare-ups and exacerbations. Management of chronic pancreatitis can be very challenging. The average patient gets only 30 percent reduction in pain over the long term and there is no data to suggest an improvement in function with opioid management.
*See FAQ page for specific pain recommendations and treatment plans.
Pain and pain medications, diet intolerance and intestinal slowing due to inflammation related to pancreatitis can all cause nausea or vomiting. If nausea is persistent it is recommended to:
Dehydration is a common issue with pancreatitis patients for the reasons listed in the nausea or vomiting section and often leads to re-admission to the hospital. Dehydration signs and symptoms and regular assessment of oral hydration by the patient and physician is important. Supplementing meals with nutritional drinks (example: Boost/Ensure) improves hydration.
Use this formula to calculate patient fluid needs:
For example:
Body weight = 125 pounds
125 pounds x 16 = 2000mL
2000mL divided by 240mL = 8 cups/day
Walled-off pancreatic necrosis often requires drain placement, which often remains after hospitalization. Unfortunately, drain issues can lead to complications or re-admissions.
The most frequent issues patients experience with drains are:
Below are printable education materials given to patients to help them care for their drains. If you are unfamiliar with drain care, these resources should provide some guidance.
It is estimated that 50 percent of patients with chronic pancreatitis have depression, especially those dependent on opioid use. This must be recognized and addressed as part of any treatment plan. Repetitive exposure to stressors leads to psychological and behavioral response to chronic pain, which can be a vicious cycle. Ongoing psychological processes, i.e. catastrophizing, poor coping and low self-efficacy can worsen or sustain pain.
If you are concerned that your patient is suffering from depression, please strongly consider enlisting the help of a mental health professional.
Here are some examples of psychosocial interventions:
Abstinence from alcohol is imperative as it is one of the leading causes of chronic pancreatitis. Smoking is equally imperative as it is an independent risk factor, resulting in pancreatic damage and functional impairment.