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NUR 145 FINAL > Acute Pancreatitis > Flashcards

Acute Pancreatitis Flashcards

1
Q

What is acute pancreatitis

A

acute inflammation of the pancreas varying from mild edema to severe hemorrhagic necrosis

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2
Q

In whom is it common to have acute pancreatitis

A

middle aged men and women equally

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3
Q

Who has a higher rate of acute pancreatits blacks or whites and by who much?

A

Blacks. Three times higher than whites

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4
Q

First and second most common causes of acute pancreatits?

A
  1. Gall bladder disease which is more common in women

2. chronic alcohol intake which is more common in men

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5
Q

Common acute pancreatitis is associated with what risk factors?

A
  1. Smoking - independent risk factor
  2. Biliary sludge or microlithiasis - mixure of cholesterol crystals and calcium salts found in some patients
  3. Hypertriglyceridemia - 1000mg/dl+
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6
Q

Leas common risk factors associated with acute pancreatitis?

A

Less common:

  1. trauma (post surgical, ab)
  2. viral infections (mumps, HIV)
  3. penetrating duodenal ulcer
  4. cyst
  5. abscesses
  6. cystic fibrosis
  7. Kaposi sarcoma
  8. certain drugs (corticosteroids, oral bc, sulfonamides, NSAIDS, thiazide diuretics)
  9. metabolic disorders (hyperthyroid, renal failure)
  10. Vascular disease
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7
Q

Pancreatitis may occur after surgical procedures on the:

A

pancreas, stomach, duodenum or biliary tract

endoscopic retrograde cholangiopancreatography (ERCP)

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8
Q

How pancreatitis affects the pancreas?

A

injury pancreatic cells or active the pancreatic enzymes in the pancreas and not in the intestine. Which may be due to reflux of bile acids in the pancreatic ducts

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9
Q

Why is it important Trypsinogen or Trypsin (the active form) is only activated in the intestine?

A

Because if its active in the pancrease it digest the pancreas and produces bleeding

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10
Q

Patients with sever pancreatitis have a high risk of developing:

A

pancreatic necrosis
organ failure
septic complications
mortality (25% chance)

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11
Q 
Clinical Manifestations:
Predominant & why =
Location = 
*Onset =
*Description of pain =
A

Predominant = abdominal pain which is dues to a distended pancreas, peritoneal irritation and obstruction of bilary tract

Location: left upper quadrant and maybe the midepigastrium and radiates to the back

Onset: sudden**

Description: sever, deep, piercing and continuous/steady***

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12
Q

Other clinical manifesetations:

A
  • abdominal tenderness with guarding is common
  • decreased or absent bowel sounds
  • paralytic ileus
  • crackles in lungs
  • cyanosis or green areas
  • shock
  • hypovolemia
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13
Q

Disease severity depends on

A

extend of pancreatic destruction

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14
Q

Two complications of acute pancreatitis

A

pseudocyst and abscess

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15
Q

What is a pancreatic pseudocyst?

What are the manifestations?

A

acummulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates surrounded by a wall

manifestations: ab pain, palpable epigastric mass, n/v, and anorexia. Elevated serum amalyse level.

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16
Q

Pancreatic psudocyst diagnostic test and treatment?

A

CT, MRI and endoscopic ultrasound (EUS)

Cyst usually resolve spontaneously within a few weeks by may perforate causing peritonitis or rupture into the stomach or duodenum. Treatment: surgical drainage, percutaneous catheter placment and drainage and endocscopic drainage

17
Q

What is a pancreatic absces?

A

Collection of pus resulting from extensive necrosis in the pancrease and can become infected or perforate into adjacent organs

18
Q

Pancreatic abscess clinlical manifestations

A

upper ab pain
ab mass
high fever
leukocytosis

19
Q

Pancreatic abscess treatment

A

prompt surgical drainage to prevent sepsis

20
Q

Main systemic complication of acute pancreatitis

A

pulmonary complications - PE, atelectasis, pneumonia and acute respiratory distress syndrome

cardiovascular complications - hypotension

tetany caused by hypocalcemia

21
Q

Diagnostic Studies

What are they and which ones are more accurate?***

A

**Serum amylase and serum lipase elevated. Serum lipase is the best because amylase is only elevated 24-72 hours and can be elevated because of other reasons.

Abdominal ultrasound, xray and contrast-enhanced CT scan. CT scan is the bes imaging test for pancreatities and complications to be identified.

Other: ERCP but it can cause pancreatitis. EUS, MRCP and angiography. Chest xray to monitor for pulmonary changesq

22
Q

Collaborative care goals

A
  1. relieve pain
  2. prevent or alleviation of shock
  3. reduce pancreatic secretions
  4. correct fluid and electrolyte imbalance
  5. prevent or treat infections
  6. removal of the precipitating cause if possible

TREATMENT IS FOCUSED ON SUPPORTIVE CARE

23
Q

Conservative care therapy interventions

A
  • aggressive hydration
  • pain meds
  • give dextran or albumin for schock to replace blood volume
  • give lactated ringer solutions or other electrolyte solutions to balance fluid and electrolyte
  • for hypotension give vasoactive drugs to increase vascular resistance (vasocontriction)
  • reduce or suppress pancreatic enzymes to decrease pancreas stimulation, place NPO & then insert NG tube when cured they can eat orally
  • antibiotics if necrosis or infection occur
24
Q

Surgical Therapy

A
  • severe acute pancreatits may require drainage = surgically or under CT guidance or endocopically.
  • percutaneous drainage of cyst can be performed with a tube left in place
  • when pancreatitis is related to gallstones and urgent ERCP plus sphincterotomy may be done
25
Q

Nutritional therapy for pancreatitis**

A
  • Initally NPO to reduce secreations
  • Due to severity eternal feedings may be administered via nose and suctioning**
  • Lipids may be ordered meaning serum triglycerides are monitored
  • moderate - severe = jejunal feedings high in carbs
  • no alcohol
  • may be given fat soluble vitamins
26
Q 
Objective Data Assesment
General
Integumentary
Respiratory
Cardiovascular
Gastrointestinal
Possible Diagnostic Findings
A

general: restlessness, anxiety and low grade fever
integument: flushing daphoresis, discoloration or abdomen and flanks, cyanosis, jaundice, decreased skin turgor and dry mucous membrane
respiratory: tachypnea and basilar crackles
cardiovascular: tachycardia and hypotension

g-i: ab distention, tender and muscle guarding. Diminished bowel sounds

dx findings: increased serum amalase and lipase, leukocytosis, hyper/hypoglycemia, abnormal ultrasound and CT scans of pancreas, abnormal ERCP or MRCP

27
Q

Health Promotion

A
  • asses for predisposing etiology factors
  • treat predisposing factors early to prevent pancreatitis
  • stop alcohol consumption especially if they have pancreatitis hx which could result in milder or no attacks
28
Q

Acute intervention

A

monitor vitals and response to IV fluid
monitor fluid & electrolyte balance
Asses respiratory function - lung sounds and saturation on a regular basis

29
Q

Acute Intervention: hypocalcemia

A

observe for tetany such as jerking, irritability and muscular twitching. Numbness or tingling around the lips and in the fingers is an early indicator. Asses for positive Chvosteks sign or Trousseaus sign. Give calcium gluconate when ordered to treat symptomatic hypocalcemia.

p.s hypomagnesemia may develop monitor serum magnesium levels

30
Q

Acute Intervention: how to aleviate ab pain**

A
  • admin morphine
  • position with trunk flexed and knees drawn to abdomen. side lying with head 45degrees decreases tension on the ab and can help ease pain
31
Q

Acute Intervention: for NPO or NG tube

A
  • frequent oral and nasal care to relieve mouth and nose dryness
  • oral care is essention for peritonities
    anticholinergics dry mouth out the most
32
Q

Acute Intervention: preventing respiratory tract infections

A
  • monitor fever

- turning, couging, deep breathing and assuming a smi-fowlers position help prevent r infections

33
Q

It is important to asses and observe for signs of

A

paralytic ileus, renal failure and mental changes.

Determine baseline for blood glucose to asses damage to beta cells in the pancreas

34
Q

After pancreatic surgery the patient may require

A

special wound care for an anatomoti leak or fistula

prevent skin irritation with skin barriers, pouching and drains

35
Q

Home care needs

A

physical therapy due to muscle weakness

alcohol counseling to prevent future attacks

diet teaching - restriction of fats because they ultimately stimulate the pancreas allow carbs because they are less stimulating and no crash dieting

teach them how to recognize infection, diabetes mellitus and steatorrhea ( foul smelling frothy stool)

36
Q

S/s: Turners & Cullen’s***

A

Turners: bluish discoloration on flanks of the body (love handles)
Cullens: blush discoloration of the peri umbilical (around belly button/ perimeter)

NUR 145 FINAL (17 decks)

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