Skip to main content

Pancreatitis Nursing Guide

Content created/revised by: Kathleen Koopmann, RN, BSN

Overview: Pancreatitis

This course is intended as a Quick Reference for infective pancreatitis and will cover an overview as well as nursing considerations utilizing the nursing process.

Pancreatitis Etiology and Epidemiology

Pancreatitis is inflammation of the pancreatic tissue from injury or damage which activates pancreatic enzymes (DynaMed, 2018a). Pancreatic enzyme activation leads to the destruction of the pancreatic cells. Pancreatitis is either acute and rapid or chronic and progressive in onset.

The most common causes of acute pancreatitis are alcohol use, gallstones, or hypertriglyceridemia but can also include:

  • Autoimmune pancreatitis
  • Medications
  • Pancreatic duct injury
  • Genetics
  • Cholangiopancreatography
  • Morbid obesity
  • Diabetes mellitus

Although they are not at increased risk of developing pancreatitis, pregnant women with certain co-existing factors are at higher risk. The co-existing factors include:

  • Existence of biliary sludge or gallstones
  • Secondary hypertriglyceridemia
  • Pre-pregnancy dyslipidemia

Chronic pancreatitis is a progressive inflammation of the pancreas leading to the destruction of the secretory cells (DynaMed, 2018b). Destruction of the secretory cells can lead to malnutrition and diabetes mellitus. Chronic pancreatitis has many common causes including:

  • Alcohol use
  • Smoking
  • Recurrent acute episodes of pancreatitis
  • Pancreatic duct injury or obstruction
  • Autoimmune disorder
  • Metabolic imbalances
  • Cationic trypsinogen gene mutation
  • Systemic lupus erythematosus
  • Infections

Acute pancreatitis results from injury to the pancreas, but chronic pancreatitis typically results in permanent damage to the pancreas structure and function (DynaMed, 2018a). Symptoms that accompany acute pancreatitis include:

  • Sudden constant, severe upper abdominal pain that may radiate to the back
  • Pain that may be aggravated with walking or lying down
  • Nausea
  • Vomiting
  • Diarrhea
  • Bloating
  • Fever
  • Diaphoresis
  • Tachycardia
  • Jaundice

Chronic pancreatitis symptoms include:

  • Constant dull pain in the mid to upper abdomen that may radiate to the back
  • Pain worsens with eating food or drinking alcohol
  • Pain lessens with sitting or leaning forward
  • Attacks become progressively longer and more frequent
  • Weight loss
  • Nausea and vomiting

Over 200,000 hospital admissions annually are related to acute pancreatitis (Mohy-ud-din & Morrissey, 2021). The rate of relapse of acute pancreatitis is less than 5%, and chronic pancreatitis has a much lower annual incidence than acute pancreatitis. Chronic pancreatitis affects approximately 50 out of 100,000 people annually, and the most common age group is 30 to 40. The morbidity and mortality of pancreatitis increase with the severity of the disease.

Pancreatitis has two classifications: Hemorrhagic necrotizing or interstitial (edematous) (DynaMed, 2018a). During acute pancreatitis, the organ can become edematous, necrotic, and surrounded by fat stranding. If the acute pancreatitis is mild, the fat necrosis is minimal. With severe cases of pancreatitis, there is a large area of fat necrosis. Characteristics of chronic pancreatitis are mononuclear infiltrates and fibrosis, and calcifications can be present within the pancreas.

Pancreatitis Diagnosis

An individual with acute pancreatitis usually presents with epigastric pain that radiates to the back. The characteristics of the pain are sharp and often associated with nausea and vomiting. The provider should inquire about a history of hyperlipidemia, previous episodes of pancreatitis, or gallbladder disease.

A detailed history should include:

  • Alcohol use
  • Recent endoscopic retrograde cholangiopancreatography
  • Current medications
  • Family history of pancreatic disorders

Evaluation of vital signs and hydration status is an excellent place to start the exam, which should also include:

  • Presence of jaundice
  • Abdominal examination for tenderness or decreased bowel sounds
  • Grey-Turner sign (ecchymosis of the flanks)
  • Cullen’s sign (ecchymosis around the umbilicus)
  • Mental status exam
  • Questions about the abdominal pain, character, strength, and duration
  • History of nausea or vomiting
  • Appetite changes
  • Weight loss
  • Steatorrhea

Laboratory test for:

  • Serum amylase and lipase will be three times the normal limit
  • Serum triglycerides will usually be elevated
  • Liver enzymes may be elevated
  • Serum bilirubin may be elevated
  • C-reactive protein elevated (higher results indicate more severe disease)
  • Complete blood count (hematocrit is low in severe disease)
  • Urine dipstick for trypsinogen indicates autodigestion of the pancreas

Radiological studies include:

  • Abdominal ultrasound
  • Abdominal X-ray for gas-filled duodenum in severe cases
  • Computer tomography (CT) of the abdomen
  • Magnetic resonance imaging (MRI) of the abdomen

Pancreatitis Management

Treatment of pancreatitis depends upon the severity of the condition. In severe cases, individuals are often admitted to intensive care during initial treatment. In mild cases, individuals are treated in an inpatient medical unit.

Treatment starts with aggressive IV fluid replacement with Ringer’s Lactate (James & Crockett, 2018). Intravenous electrolyte replacement should coincide with fluid replacement. Antibiotics are given prophylactically in moderate to severe pancreatitis to prevent infected necrosis and improve morbidity and mortality. Enteral feedings should be started immediately in individuals who cannot tolerate eating by mouth.

Medications used to treat pancreatitis include:

  • IV antibiotics:
    • Ampicillin (Omnipen®)
    • Ceftriaxone (Rocephin®)
  • IV analgesia for discomfort
  • Protease inhibitors to reduce mortality in moderate to severe disease
  • Somatostatin (Sandostatin®) or octreotide (MYCAPSSA®) to inhibit gastrointestinal and endocrine secretions
  • Insulin drip for hypertriglyceridemia
  • Antacids may reduce pancreatic stimulation and pain:
    • Cimetidine (Tagamet®)
    • Ranitidine (Zantac®)
    • Famotidine (Pepcid®)

An endoscopic retrograde cholangiopancreatography (ERCP) should be performed within the first 72 hours if the cause is from a biliary gallstone (DynaMed, 2018a). Cholecystectomy should be performed for those with gallstones not involving the biliary duct to remove the gallbladder. A cholecystectomy performed as soon as the individual is stable will decrease the chances of recurrent pancreatitis.

For pancreatitis caused by alcohol consumption, counseling regarding stopping or reducing alcohol intake will reduce the recurrence of alcoholic pancreatitis. Smoking cessation counseling is also essential if the individual is an active smoker.

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for pancreatitis are listed below.

Pancreatitis Nursing Care Plan


Assess signs and symptoms, such as:

  • Vital signs
  • History of gallbladder disease or recent ERCP
  • Alcohol use
  • Current smoker
  • Hypertriglyceridemia
  • GI symptoms such as nausea, vomiting, or diarrhea
  • Stools containing fat
  • Abdominal pain characteristics (severity, duration, quality, and location)
  • Fluid status
  • Nutritional intake
  • Respiratory rate and pattern
  • Breath sounds
  • Heart rate and rhythm
  • Abdominal tenderness
  • Jaundice
  • Weight loss
  • Diaphoresis
  • Mental status
  • Grey-Turner sign (ecchymosis of the flanks)
  • Cullen’s sign (ecchymosis around the umbilicus)

Pancreatitis Nursing Diagnosis/Risk For

  • Acute pain related to pancreatitis as evidenced by (Phelps, 2021a):
    • Verbalizes pain
    • Grimacing
    • Guarding
  • Risk for imbalanced fluid volume related to pancreatitis as evidenced by (Phelps, 2021b):
    • Nausea
    • Vomiting
    • Inability to tolerate oral fluids
  • Imbalanced nutrition: Less than body requirements as evidenced by (Phelps, 2021c):
    • Inability to tolerate oral intake
    • Weight loss


  • Monitor vital signs
  • Provide analgesia as ordered
  • Administer medications as ordered
  • Provide oral or enteral nutrition within 24 hours of admission
  • Promote bedrest
  • Decrease noxious odors
  • Administer antacids as ordered
  • Monitor intake and output
  • Monitor for nausea/vomiting
  • Monitor daily weight
  • Monitor for increased abdominal girth
  • Monitor mental status
  • Monitor skin for signs of petechiae
  • Keep suction apparatus at the bedside
  • Administer IV fluids as ordered
  • Monitor laboratory results
  • Replace electrolytes as ordered
  • Insert nasogastric tube if ordered
  • Monitor glucose levels as ordered
  • Encourage choice of food to prevent nausea

Expected Outcomes

  • Verbalizes relief of pain
  • Demonstrates no evidence of organ damage
  • Shows no recurrent episodes of pancreatitis
  • Normalization of laboratory values
  • Understands disease process and how to prevent a recurrence
  • Changes in lifestyle to prevent a recurrence

Individual/Caregiver Education

  • Condition, treatment options, and expected outcomes
  • Notify healthcare provider or seek immediate medical care for:
    • Return of previous symptoms
    • Fever > 100.4°F
    • Worsening abdominal pain
    • Return of nausea or vomiting
    • Changes in mental status
  • Lifestyle changes to prevent a recurrence:
    • Smoking cessation
    • Eliminate or decrease alcohol consumption
  • Recommended follow-up with healthcare provider

Learn more and earn CEU credit with's extensive continuing education course catalog.

Caring for Patients with Pancreatitis CE Course

1.0 Contact Hours

Additional Information

Release Date

Content Expiration

Kathleen Koopmann, RN, BSN

The content was created by Kathleen Koopmann, RN, BSN. Kathleen earned her Associate Degree in nursing in 1987 at Mid-Michigan Community College and her Bachelor of Science in nursing in 2018 from Western Governor’s University. She has training from the North Carolina Statewide Program for Infection Control and Epidemiology through NCDHHS and the University of North Carolina. Kathleen has worked in long-term care, outpatient care, acute care, and nursing education. She has hospital experience in Med-Surg, OR/PACU, Critical Care, Telemetry, and outpatient experience in Occupational Health. Kathleen has experience as a clinical instructor for the LPN program at Susquehanna County Career and Technical Center in Pennsylvania. Most recently, she worked in long-term care as a Staff Development Coordinator and Infection Control Practitioner.

Kathleen Koopmann, RN, BSN has no relevant financial or non-financial relationship(s) with ineligible companies to disclose.

Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.

All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.




View all Clinical Guides