Severe pancreatitis is a special type of pancreatitis (SAP), which is mainly caused by overeating, alcohol dependence, and biliary system diseases. A survey found that 15% to 20% of SAP patients have severe acute pancreatitis. If these patients are not treated and cared for properly, it may lead to an increase in complications and mortality rates. Therefore, preventive nursing work for patients can improve their pain level and enhance treatment effectiveness. This requires first identifying the causative factors of the disease and determining the treatment and nursing process according to the cause of the disease in order to improve the patient's prognosis.
1. Causes of SAP: Approximately 70% -80% of SAP patients are caused by digestive system diseases, overeating, alcohol abuse, and other unhealthy lifestyle habits. The most common causes of SAP can be attributed to the following: gallstones. In clinical practice, patients with severe pancreatitis may have gallstones when receiving treatment at the hospital, but there is no clinical research to confirm a necessary correlation between SAP and gallstones. Therefore, some experts speculate that gallstones can block the biliary tract, causing pancreatic juice and bile to flow into the pancreas, leading to inflammation. Therefore, while treating this disease clinically, it is also necessary to prevent gallstones. The stones in this area are mainly composed of bilirubin particles, and their formation is closely related to factors such as smoking, alcohol abuse, cirrhosis, and bile stasis. Daily attention should be paid to protecting liver health, and it is best not to drink alcohol. At the same time, the surface of these small stones is rough and the volume is relatively small. If they slide into the pancreatic duct after exercise, it can also cause clinical symptoms such as viral infection. Therefore, the smaller the volume of gallstones, the higher the probability of sliding into the pancreas and inducing the disease. Clinically, it is generally recommended that patients with a high number of small stones in the gallbladder use excision surgery to remove the stones and prevent the onset of severe pancreatitis.
Functional impairment. Dysfunction of the sphincter in the area where the hepatopancreatic ampulla is located can increase ampulla resistance, hinder the normal metabolism of pancreatic juice and bile in the body, and lead to bile reflux, thereby causing the disease. American researcher Welega conducted a clinical trial in 1998 and found that the muscle strength of the hepatopancreatic ampullary sphincter, common bile duct, and duodenal duct in patients with severe SAP was significantly higher than that in normal individuals. Therefore, preventing dysfunction of the hepatopancreatic ampullary sphincter is the most effective way to prevent SAP. The muscles in this area often experience obstacles under the stimulation of frequent heavy drinking. It can be seen that it is necessary to improve daily diet and lifestyle habits to reduce the probability of diseases caused by such reasons.
Overeating and excessive drinking. People who frequently overeat, drink alcohol, and eat greasy food in daily life have a higher probability of developing SAP. After overeating, chyme directly slides into the duodenum, and alcohol can promote increased secretion of pancreatic juice, causing spasms in the hepatopancreatic ampulla sphincter and triggering SAP.
2. Nursing methods
Nursing preparation. After admission, the patient undergoes a comprehensive physical examination to observe the specific condition of their organ function, such as liver, kidney, and intestinal function. Determine the required nutritional intake for early enteral nutrition treatment based on the examination results.
Psychological care. Over the years, severe SAP has been one of the problems that doctors cannot solve. In particular, the incidence rate and mortality of the disease are increasing year by year. Patients will gradually form some negative emotions after hospitalization, which will affect the treatment effect. Nursing staff should patiently treat and care for patients, and help them solve psychological problems; We need to communicate more with patients, understand their emotions, develop targeted mental health counseling plans, and provide more effective psychological treatment for patients. And it can be linked with the patient's family to provide sincere care and love, reduce the patient's negative emotions, and ensure timely recovery.
Disease observation. Carefully observe changes in the patient's temperature, breathing, pulse, normal blood pressure, and urine output. Abdominal examination is dynamic to understand the degree of abdominal muscle tension, tenderness, and the extent of ascites; Monitor the patient's white blood cell count, blood and urine amylase levels, electrolyte solution, and blood gas changes. If necessary, X-rays should be performed CT、 Imaging examinations such as contrast-enhanced ultrasound. Detailed records of the patient's urination and defecation (time interval, color, characteristics, quantity), as well as the specific situation of drinking water and urination within 24 hours. For patients who cannot tolerate the treatment process, the infusion rate should be reduced. For patients who experience serious local tissue complications, systemic complications, multiple organ failure, and other clinical symptoms during the treatment process, the attending physician should immediately notify them to take emergency corrective measures.
Dietary care. Given that the substance chyme in protein foods may be introduced into the duodenum, it can cause secretion from the duodenal glands and exacerbate organic lesions. Therefore, during the acute phase of the disease, strict fasting is necessary. When the mouth is dry, wet cotton swabs should be used to moisten the lips. After the clinical symptoms have basically disappeared and the blood routine and urine amylase are normal, high-fat, high carbohydrate, and easily digestible foods such as fresh fruit juice and porridge can be fed; Protein should not be excessive in the diet. Adequate carbohydrates and fats should be provided comprehensively, easily digestible foods should be avoided, and overeating should be avoided. It is important to ensure that the patient's stomach tube remains unobstructed and to record the amount of intake and output more accurately. Strict restrictions on fasting time and types of food after fasting are crucial for the treatment of this disease.
Complications care. After treatment, the patient's intestinal peristalsis function was enhanced and mucosal edema was reduced. Considering that patients have different constitutions, those with weaker constitutions may experience serious gastrointestinal metabolic complications. In the process of basic nursing, patients' clinical symptoms should be closely observed. When adverse reactions such as nausea, vomiting, and constipation occur, doctors should be notified in a timely manner for targeted treatment. If there are gastrointestinal reactions, the concentration of hydrogen ions in the nutrient solution should be reduced and the speed of infusion should be slowed down. If aspiration occurs, enteral feeding should be stopped as soon as possible, the airway should be kept unobstructed, the patient's head should be tilted to one side, and residual nutrients in the stomach should be promptly absorbed.
Dental health care. Dental care is indispensable. Given that essential nutrients are infused through nutrient tubes, most patients are unable to eat, saliva secretion is reduced, and oral mucosa is relatively dry, which is conducive to the growth of bacteria and fungal microorganisms. Therefore, oral health care should be strengthened to prevent oral inflammation.
Circulation care. If the patient is accompanied by symptoms such as vomiting, persistent high fever, decreased blood pressure, reduced visceral vascular perfusion, hypovolemic shock, etc., emergency corrective measures should be taken to quickly replenish blood volume and achieve rapid and effective volume resuscitation, maintain two or more venous pathways, and ensure that drug intake and rapid volume expansion are carried out simultaneously. When infusing liquids, it is necessary to strictly record the amount of liquid in and out within 24 hours.
In summary, severe SAP is a common severe disease in clinical practice, and the condition progresses rapidly. If symptoms appear, timely medical attention should be sought to prevent the condition from worsening.