Nursing: Pancreatic Insufficiency and Medication Management

This article discusses the management of pancreatic insufficiency and medication administration in nursing. It covers the condition, medication, subjective and objective data, interventions, and medication safety.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Answer 1
 Condition: Pancreatic insufficiency
 Medication: Pancrelipase
Answer 2
Mr.X is a 52 year old man who was admitted to hospital with sever abdominal pain.
Subjective data
For the first few days he was suffering from severe abdominal pain along with tenderness in
stomach, loss of appetite, a feeling of fullness and diarrhoea. Pain score was 9 out of 10.
Patient also reported that he smokes 10 cigarettes per day and drinks alcohol once in a week.
Other observations on admission (objective data)
 Blood pressure: 90/50 mm/Hg
 Pulse rate: 120 beats/minute
 Respiratory rate: 25 breaths/ minute
 Temperature: 38.4C
 Sa02: 97 % in room air
 Weak peripheral pulses
Mr X previous medical history includes recurrent chronic pancreatitis or pancreatic
inflammation along with a family history of pancreatitis.
Doctors recommended for endoscopy which revealed inflammation of the pancreas.
Following which MRI CT scan was conducted, confirmedpancreative
insufficiency.Pancreatic insufficiency is a physiological condition in which pancreas fail to

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make adequate enzyme to promote proper digestion of food in the small intestine
(Struyvenberg, Martin and Freedman 2017). He was advised to be on pancreatic lipase orally.
According to Wilcox et al. (2014), pancreatic lipase is delayed release capsules and
triglyceride lipase in nature. It is used improve digestion among the patients suffering from
pancreatic insufficiency. Doctors also recommended 1000mls Hartman’s solution over 6
hours intravenous) in order to regularize the electrolyte balance of the body plus Morphine
15mg intramuscularly (IMI) for management of the stomach pain.
Answer 3
The doctor advised oral administration of the pancreatic lipase. According to Wilcox
et al. (2014) pancreatic lipase is taken by mouth. The pancreatic enzyme supplements come
in the form of capsule. Inside capsule there contains small beds that are filled with digestive
enzyme. Each bed is covered with special enteric coating and the coating enables the breads
to get dissolved once in the small intestine. The digestive enzymes are then released inside
the lumen of the small intestine helping to digest food. Thus oral administration of the
medicine will promote dissolving of the capsules through the HCL present the stomach while
taking aid of the saliva.
The medicine is mainly given in order to treat exocrine pancreatic insufficiency. The
medicine must be given at least half an hour before meal. This is because, Wilcox et al.
(2014) stated that it takes 45 to 60 minutes for the enzyme to act their action in the process of
digestion. Taking the medicine before meal will help in the effective digestion of
carbohydrate, protein and fats.
The specific safety requirements around the administration of the medication include
washing of hands before and after the administration of the medication in order to avoid the
chances of cross-infection of hospital acquired infection. The nurses also are also require to

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take proper follow from the doctors and extract information from the clinical handover in
order to gain information related to change in the medication dosage, route and time of
administration. This will help to prevent medication error.
Education of the patient includes education about the medication administration and
management. This will include why the medicine is given the projected outcome of the
medication based on its mode of action. The education of the patient will also include the
importance of taking the medication 60 minutes before the meal and the dosage of the
medication used. Nieuwlaatet al. (2014) stated that proper education of the patient about the
disease progression and reason behind a particular medication management helps to increase
the therapy adherence of the patient along with improved disease outcome. The education
about the medication management helps to increase the process of disease awareness among
the patient and therefore helping to improve the quality of life.
Contraindications for the administrationisassociated with individuals suffering from
gout, have previous reported vases of stomach or intestinal tract operation and incidence of
Crohn's disease. Other associated contradictions include inadequate absorption of the
nutrients due of intestinal obstruction or high amount of uric acid in blood and formation of
fibrous tissues in the colon (Wilcox et al. 2014). Moreover, administration of the pancreatic
lipase is also not suitable among the individuals who have allergies toward the externally
supplied enzymes like amylase, lipase and protease (Wilcox et al. 2014).
Potential side effects/adverse effects associated with the administration of the
pancreatic lipase include nausea, diarrhoea, abdominal cramping, head ache, neck pain, nasal
congestion, development of rash over skin, swelling of lower extremities of the body like
feet. Other associated side-effects include high blood glucose level, viral infection, renal cyst,
asthma and muscle spasm (Wilcox et al. 2014).

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Answer 4
Intervention 1
Observance of the “easy-to-digest” diet plan rich in soup and other fluids like fruit
juice: The palatable diet plan helps to ensure easy digestion. Easy digestion will help to
promote development of hunger, decrease in the abdominal pain arising out of indigestion
and helping to maintain the proper electrolyte balance. Bornhorst and Paul Singh (2014) are
of the opinion that development of appetite is associated with the process of digestion.
Creating provision for easy digestion helps to regulate the process of appetite generation and
thereby helping to improve the overall state of physiological status. In case of Mr X, it can be
said that development of hunger and insurance of easy digestion will help to increase faith of
Mr X over the medication management and thereby helping to promote medication adherence
and improve quality of life. Wilcox et al. (2014) stated observance of the palatable diet helps
in improve the efficacy of pancreatic lipase.
Intervention 2
Monitoring of the vital signs: Periodic monitoring of the vital signs like the
respiratory rate, blood pressure and pulse rate will help to ensure the stability of the
physiological state of Mr. X. This will helping to ascertain the effectiveness of the medication
management and accordingly the change in the medication dosage can be done.
Intervention 3
Conduction of mild to moderate physical exercise like mobilization of the patient
within the hospital ward, practice of deep breathing will help to ensure proper digestion by
promoting peristaltic movements of the stomach and preventing the rate of occurrence of

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diarrhoea (Klare et al. 2015). This will help to improve the quality of life of Mr. X and also
increasing medication adherence and improving overall health outcome.
Answer 5
According to the standard 4 of the National Safety and Quality Health Service
Standards by Australian Commission on Safety and Quality in Healthcare (2012), medication
safety is an important consideration while executing patient care. In order to ensure the
medication safety of Mr X, it the duty of the healthcare professionals to refer relevant clinical
workforce to administer medicines. The use of the medication authorisation for the regular
monitoring of the ordering of the medicines (in proper dosage) and dispensing of the
medication will help to avoid the medication error.
According to the standard 6 of National Safety and Quality Health Service Standards
by Australian Commission on Safety and Quality in Healthcare (2012) clinical handover is
extremely important during the time of the medication administration. Clinical handover is
defined as a process of transfer of the professional accountability and responsibility for some
or comprehensive aspects patient care to another nurse or family member on a temporary or
permanent basis. It occurs during change of shift, patient release or patient is transferred to
different ward. Following direction in the clinical handover will help to reduce the chances of
the medication error. Inside the hospital, it is recommended to conduct the transfer of clinical
handover along the expression of the face-to-face manner.
Answer 6
The analysis of the case study helped me to realize that medication safety is an
important consideration of the patients care in order to avoid medication error. Going
forward, in order to increase the parameter of the medication safety, I will make use of the

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electronic health records or computerized physician based order entry system. The electronic
documentation of the patient’s medication related information will help to avoid the chances
of the medication errors during increased workload. The case study also helped me to realize
that effective communication must be executed in order to develop the therapeutic
relationships with the service users. The development of the therapeutic relationships helps to
earn the patient’s trust and thereby helping to understand the patient’s exact care needs.
Moreover, development of therapeutic relationships also helps to improve satisfaction of the
patients and thereby helping to increase the level of therapy adherence. In order to execute
therapeutic relationships, I will work to improve effective communication skills, both verbal
and non-verbal communication skills. Non-verbal communication skills will include
maintenance of proper body language, direct eye contact while communication. The verbal
communication skills include communicating in articulate pronunciation mixed with
compassion and empathy. I will also monitor the vital signs of the patients in a periodic
manner with the help of the pulse oxymetry in order to keep a track of the disease prognosis.
Any change in the vital signs of the patient (negative change) will be noted down in the
clinical handover and patient’s progress note and doctors will be notified simultaneously.

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References
Australian Commission on Safety and Quality in Healthcare. 2012. National Safety and
Quality Health Service Standards. Access date: 25th March 2019. Retrieved from:
https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-
2012.pdf
Bornhorst, G.M. and Paul Singh, R., 2014. Gastric digestion in vivo and in vitro: how the
structural aspects of food influence the digestion process. Annual review of food science and
technology, 5, pp.111-132.
Klare, P., Nigg, J., Nold, J., Haller, B., Krug, A.B., Mair, S., Thoeringer, C.K., Christle, J.W.,
Schmid, R.M., Halle, M. and Huber, W., 2015.The impact of a ten-week physical exercise
program on health-related quality of life in patients with inflammatory bowel disease: a
prospective randomized controlled trial. Digestion, 91(3), pp.239-247.
Nieuwlaat, R., Wilczynski, N., Navarro, T., Hobson, N., Jeffery, R., Keepanasseril, A.,
Agoritsas, T., Mistry, N., Iorio, A., Jack, S. and Sivaramalingam, B., 2014.Interventions for
enhancing medication adherence. Cochrane database of systematic reviews, (11).
Struyvenberg, M.R., Martin, C.R. and Freedman, S.D., 2017. Practical guide to exocrine
pancreatic insufficiency–breaking the myths. BMC medicine, 15(1), p.29.
Wilcox, M.D., Brownlee, I.A., Richardson, J.C., Dettmar, P.W. and Pearson, J.P., 2014. The
modulation of pancreatic lipase activity by alginates. Food chemistry, 146, pp.479-484.