Nursing Case Study: Pancreatic Insufficiency Management with PL

This case study focuses on a 5-year-old boy with cystic fibrosis and pancreatic insufficiency (PI), highlighting the use of pancrelipase (PL) for treatment. The study details the child's symptoms, including abdominal pain, malnutrition, and digestive issues, and outlines the prescribed treatment plan involving PL administration before meals. Nursing interventions such as providing a palatable diet, monitoring vital signs, and encouraging social participation are discussed. The case study also emphasizes medication safety, the importance of parental involvement, and effective communication skills for optimal patient care. The analysis underscores the significance of accurate medication management, patient-centered care, and the role of nurses in improving health outcomes for children with PI. Desklib offers a range of solved assignments and past papers for students.

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

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Answer 1
 Condition: Pancreatic insufficiency (PI)
 Medication: Pancrelipase (PL)
Answer 2
A 5 year old boy admitted to emergency department with severe abdominal pain
along with tenderness in the stomach.
Subjective data
His parents reported that the boy is suffering from cystic fibrosis since birth. For the
past one year, the child is found to experience certain digestive problems, which are
manifested in the form of gas formation inside the stomach, indigestion, vomiting and loss of
appetite. The parents reported that the child refuses to take meal and is under-weight and
under-developed in comparison to his fellow mates. He refuses to take part in games and
sports and is very lethargic. Past few days the symptoms have become worse with complete
loss of appetite and frequent diarrhoea along with fatigue and nausea.
Objective data
 Pain score: 9 out of 10
 Drowsy
 Under weight : 12 Kilograms (normal weight 16 to 19 Kilograms)
 Physical appearance: Malnourished
 Behaviour: Cranky and crying loudly at times
 Pulse rate: 70 beats per minute (normal: 75 to 115 beats per minute)
 SaO2: 97 % in room air

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 Weak peripheral pulses
Doctors recommended for endoscopy and the reports revealed chronic inflammation in
the pancreases. The endoscopy results revealed that thick mucus deposition inside the
pancreas.
According to Katkin et al. (2013), PI affects around 85% of the population suffering from
cystic fibrosis (CF). It is one of the common gastro-intestinal complication of CF. the major
consequences of PI is reflected in difficulty in absorption fat due to loss or decreased
production of the pancreatic enzymes. As a result, the patients are vulnerable towards
developing vitamin deficiencies and also suffer from the risk of developing steatorrhea and
malnutrition. This is the reason why the child feels fatigue and drowsy and is under-
developed.
Doctors recommended 500 PL units/kg/meal PO. The doctors also stated that half the
meal time dose must be given with snacks. Doctors also recommended normal saline in order
to manage the electrolyte balance of the child while restoring pulse rate and respiratory rate.
Answer 3
The doctor’s advised oral administration of PL. Whitcomb et al. (2016) stated that PL
are supplements of the pancreatic enzymes that must be taken orally. The PL comes in the
form of capsule and inside the capsule there contains small beds filled with pancreatic
digestive enzymes. The beds are covered with special enteric coating. This enteric coating
enables the capsule bed to get easily dissolved once inside the lumen of the small intestine.
The as the bed gets dissolved, the coated pancreatic enzymes are released in the gastro-
intestinal tract and thereby promoting digestion. The main enzyme coated inside the PL
includes lipase, amylase, and protease that promote fats, starches and proteins respectively.

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The medicine must be injected at least 15 to 30 minutes before the consumption of the
meal and it takes 45 to 60 minutes for the enzyme to reach at the site of action and execute
their required biochemical mechanism. Consumption of medicine before meal helps to
promote effective digestion (Antigua et al. 2016). It is used for the treatment of exocrine
pancreatic insufficiency. It acts as a substitute of the pancreatic enzymes and thereby helping
to promote fat digestion and simultaneous absorption. The presence of fat in the blood stream
helps in the uptake and utilization of the fat soluble vitamins and thereby helping to restore
the nutrient balance of the body (Whitcomb et al. 2016).
The safety requirement for the administration of the medicine includes maintaining
five steps of the hand hygiene as recommended by WHO (2017) before and after the
administration of the medication orally. Maintenance of the hand hygiene helps to reduce the
chances of the nosocomial infection. Since the child is only five years old, he might face
difficulty in swallowing the medicine orally. According to the World Health Organisation
(WHO) (2017), reconstitution of non-sterile oral powder is associated with the risk for
stability and safety. However, in case of paediatric care, oral medicines are required to be
reconstituted with water before ingestion in certain circumstances. It is the duty of the
nursing professionals to ensure that the water used for medicine reconstitution is clean and
filtered. Moreover, the nurse must also ensure that after reconstitution, the solution has a
strict expiration date.
Since the child is only five years old, the education about the disease prognosis must
be directed towards his parents. According to Braithwaite et al. (2018) educating the parents
about the process of the disease prognosis and intended outcome of the therapy plan, helps to
increase the patient engagement in the therapy and improved health outcome of the child. The
education of the parent will mainly entail about development of PI in CF patients and

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importance of administrating PL before consumption of meal as per the prescribed
medication.
The main contradiction for the administration of the medication includes previous
reported history of intestinal tract operation and incidence of Crohn’s disease. Other
contradictions include high level of uric acid in blood and presence of fibrous tissue inside
the colon (Adler and Saif 2018).
Potential side effects of PL are nausea, abdominal cramping, vomiting, developing of
skin rash and pain and swelling in the lower extremities of the body like feet (Petzel and
Hoffman 2017).
Answer 4
Intervention 1: Palatable Diet
Giving palatable diet to the child will help to promote easy digestion and thereby
helping to decrease the symptoms of indigestion and associated side effects like abdominal
pain and diarrhoea (Pitman et al. 2019). Moreover, consumption of palatable diet and
promoting easy digestion will help in the generation of hunger and thereby helping to
improve overall physiological status like body weight, growth and development (Pitman et al.
2019).
Intervention 2: Monitoring of the vital signs and blood parameters
Timely monitoring of the vital signs like pulse rate, stool analysis and total protein in
the blood along with detailed vitamin test will help to ascertain the overall degree of
effectiveness of the medication (Forsmark 2018). Following the vital signs will help to bring
subsequent modification in the dosage of PL.

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Intervention 3: Social participation
The boy refuses to take part in sports and games and stays indoors. Knudsen et al.
(2016) stated that taking part in game or playful activities with the peers help to improve the
mental health well-being of the child and thereby helping to improve the overall
physiological health status. Since the child is weak, extensive games might not be suitable.
Games like playing sand pit, building blocks, or painting games at outdoors will help to
improve his social participation and at the same time, mild to moderate physical activity will
promote digestion along with generation of appetite. This will help to increase the medication
adherence and generation of trust over the therapy from parents’ perspective (Knudsen et al.
2016).
Answer 5
Standard 4 of the National Safety and Quality Health Service Standards (NSQHS) by
Australian Commission on Safety and Quality in Healthcare (ACSQH) (2012) promotes
medication safety. To uplift medication safety, nurses must keep proper documentation of the
medication dosage, route and time of administration. This can be done by the use of
electronic health records (EHRs) and computerised physicians based order entry (CPOE)
(Remus et al. 2015). The digitalised documentation helps to avoid the chances of the manual
error. The ACSAH (2012) also vouch for practising of the effective communication skills
with the multidisciplinary team in order to avoid the chances of error during the
administration of the medication.
NSQHS (2012) also emphasize execution of the proper transfer of the clinical
handover (standard 6) to the change of shift nurses and at the time of patient's discharge in
order to avoid error in therapy plan. The venue of clinical handover for the clinical handover
includes patient's bedside, common staff area and hospital or clinical reception. It is the duty

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of the nursing professional to establish and maintain structured and a well documented
process of the clinical handover. A detailed clinical handover helps the nursing professionals
or the family member to remain aware about the medication requirement of the child along
with a detailed summary of the disease prognosis so far and assisted vital signs (Johnson,
Sanchez and Zheng 2016).
Answer 6
The analysis of the case study helped me to realize that medication safety is an
important consideration of the patient care. Manias et al. (2019) stated that negligence in the
medication safety procedures at any level of the medication management like dosage
documentation, administration route of medicine or ordering from the pharmacy might lead
to medication error. Medication errors increase the length of stay at the hospital, increase in
the cost of care along with increase in the mortality and morbidity. I will make use of the
EHRs in order to avoid the chances of the medication error.
The case study also helped me to understand that parents are the important
stakeholders while procuring care and ascertaining the clinical priority needs of child in case
of paediatric care. Going forward I will engage in active conversation with the parents in
order extract the subjective data and designing patient centred care plan. Curtis et al. (2016)
stated that patient engagement and disease education helps to improve the therapy adherence
of the child.
I will also indulge in effective communication skills with the child in order to increase
his level of comfort and thereby helping to win the cooperation of the child. I will prefer the
presence of the parents during the initial initiation of the communication. Curtis et al. (2016)
stated that presence of parents help the child to stay calm, relaxed and secured. The use of the

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effective communication skills will also help to ensure clinical proper transfer of the clinical
handover during change of shift nurse.

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References
Adler, J.A. and Saif, M.W., 2018. Pancrelipase-Induced Hypersensitivity Reaction: Case
Report and Review of Literature. JOP: Journal of the pancreas, 19(5), p.273.
Antigua, A.D., Tran, J., Lemon, S.J. and Zhang, Y., 2016. Challenges of Administering
Pancrelipase in Pancreatitis Patients. Journal of the American College of Nutrition, 35(4),
pp.334-338.
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
Braithwaite, J., Hibbert, P.D., Jaffe, A., White, L., Cowell, C.T., Harris, M.F., Runciman,
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critically ill children: An integrative review of international literature. Journal of Pediatric
Nursing, 31(3), pp.330-341.
Forsmark, C.E., 2018. Diagnosis and Management of Exocrine Pancreatic
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Johnson, M., Sanchez, P. and Zheng, C., 2016. Reducing patient clinical management errors
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quality, 31(3), pp.245-253.

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Katkin, J., Baker, R.D., Baker, S.S., Motil, K.J., Mallory, G.B., Klish, W.J. and Hoppin,
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