Outcome Evaluation

• Monitor for adequate pain control and the need for escalation or de-escalation of analgesia.

Patient Care and Monitoring

1. Determine whether ethanol is a contributing causative factor. If so, reinforce counseling on the need for abstinence and provide appropriate resources to maintain abstinence (e.g., professional counseling, alcoholics anonymous).

2. Obtain a thorough history of prescription, nonprescription, and dietary supplement use to identify products that may exacerbate chronic pancreatitis.

3. Refer the patient for nutritional counseling if there is decreased caloric intake and weight loss. Compare actual body weight to ideal body weight.

4. Make a plan for analgesia, in conjunction with a pain management service if possible, to control and prevent pain. Recommend an analgesic with ease of dosing and minimal side effects, realizing that patients with chronic pancreatitis may require large doses of opioids.

5. Optimize pancreatic enzyme supplementation, starting first with a nonenteric-coated enzyme supplement and a histamine2-receptor antagonist. When pain and diarrhea are stabilized, consider switching to an enteric-coated enzyme supplement for ease of dosing.

6. Develop a plan for reassessing pancreatic enzyme supplementation and analgesia on an outpatient basis.

7. Assess improvement in quality of life measures such as physical, psychological, and social functioning and well-being.

• If pain relief is achieved by avoiding ethanol or fatty meals, encourage continuation of these practices.

• When dietary malabsorption exists, monitor patients for weight gain or loss, activity level, and ability to perform activities of daily living.

• Ask patients to monitor the frequency and consistency of stool output as an indicator of malabsorption.

• Educate patients that compliance with and proper use of dietary pancreatic enzyme supplementation is key to improved outcomes.32,35,41-43

Abbreviations Introduced in This Chapter

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