Proceso de atención de enfermería en pacientes con pancreatitis aguda severa

Abstract

Introduction: Pancreatitis is the inflammation of the pancreas that is characterized histologically by the destruction of the acinar cells, whose origin results from an abnormal activation of the pancreatic enzymes causing the autodigestion of the gland and that, in general, requires hospitalization, manifests itself in acute or chronic form. Worldwide, the incidence per year ranges from 13 to 45 cases per 100,000 in the first, while in the second it varies between 5 to 12 per 100,000, the most common cause being biliary pancreatitis in 32-49%, followed by of the alcoholic with 20-31-8%, 10% is related to hyperlipemia, viral infections, pancreatic perfusion, impaired, ductal obstructions, drugs, hypercalcemia. Between 20-30% of patients with PA have a severe course, with the appearance of sepsis, respiratory distress syndrome, renal failure and multiorgan failure with a mortality rate of 25% due to complications derived. Case presentation: A 21-year-old female patient went to the Emergency Area at the Hospital Teófilo Dávila for presenting a clinical picture of 6 days of evolution characterized by moderate-intensity abdominal pain that has progressed at high intensity accompanied by nausea that carries to vomit several times, 24 hours ago thermal boost is added and not quantified and coordinated for the performance of laboratory tests, (white blood cells: 21.69 UL, neutrophils: 83.7%, lymphocytes: 8.9%, hematocrit: 38.6%, glucose: 113 mg / dl, total bilirubin: 1.61 mg / dL, direct bilirubin: 1.05 mg / dl, creatinine: 0.43 mg / dl, amylase of 1.322 UL and lipase of 1.319 U / L), whose results influenced hospital admission with diagnosis Severe acute pancreatitis physician to the intensive care unit General Objective: To analyze the case of a patient with severe acute pancreatitis through the review of the clinical history and the bibliographic search for the elaboration of nursing care plans that allow to restore their health. Method: The review of the patient's unique clinical history was made, as well as a bibliographic search in databases such as Pub Med, Scielo, Science Direct, Redalyc and NNN Consult, with the purpose of finding current scientific evidence regarding the case. Results: The findings of interest found as: age, sex, risk factors, clinical manifestations, diagnosis, laboratory tests (amylase / lipase), imaging studies, treatment and complications coincide significantly with that reported by researchers. . In this case, the patient was admitted to the ICU on November 13, 2018 for strict observation by the health personnel, its evolution was unsatisfactory. Conclusions: the theory of Virginia Henderson was taken into account, about the 14 basic needs of the human being, being the most affected: 2: feeding and hydration; 4: mobilization and 9: safety / protection, whose care plans were focused on the following nursing diagnoses: acute pain, risk of infection, nutritional imbalance, deterioration of physical mobility, and ineffective management of the therapeutic regimen. The process of nursing care applied in patients with severe acute pancreatitis, highlights the role of nursing professionals when considering this scientific method in the academic and work environment.