Cirrosis/Pancreatitis/Liver Ca/Pancreatic Ca Flashcards
Two causes of pancreatits
Gallstones/Alcohol use
Acute pancreatitis
Release of pancreatic enzymes that “audodigest” the pancreas.
It is reversible
Symptoms of Acute Pancreatitis
LUQ epigastric pain** that is deep and sharp, it intensifies when eating fatty foods ** Abdominal fullness Gas bloating Hiccups and indigestion Fever/Tachy/Hypotension
Diagnosis of Acute Pancreatits
Physical exam: Guarding, rebound tenderness, brusing around umbilicus/flank (indicate bleeding)
Lab tests: Metabolic panel, hemotological, Specific Pancreatic tests (amylase & lipase Most important) elevated BUN (renal function, in sever pancreatitis, indicator of mortality/shock) , Liver enzymes, WBC
Acute pancreatitis management
NPO-prevent release of pancreatic enzymes
IV Fluid-Several L followed by high maintenance fluid to maintain Intravascular volume (lactated ringers/ colloids)
IC level of care if organs involved
Treat cause of pancreatitis
necrotic (IV) vs inflammed (no IV)
Gall bladder vs alcohol
Medications used for patients with Acute pancreatitis
Opiod analgesics Anticholinergics Histamine blockers Pancreatic enzymes Antibiotic therapy
Complication acute pancreatitis
Necrotizing pancreatitis
High rate of complications/mortality
Caused by the pancreatic enzymes that eat through the pancreas and surrounding tissues. Can also cause hemorrhaging from rupture of surround BV
Two types of necrotizing pancreatitis
sterile areas free of bacteria
infected caused by bacteria
Nursing: How would a patient with acute pancreatitis present in hospital (ie vitals, pain level, labs)
Sudden onset of acute unbearable abdominal pain
Elevated heart rate and respiratory rate & low BP
Pain
Elevated serum lipase, amylase, glucose values
Hypocalcemia
Steatorrhea: clay colored stools
MODS: ARDS, PE, Hypoxia, Hypovolemia
What would you assess in a patient with acute pancreatitis
Vital signs O2 status Pain location intensity & duration Abdominal assessment Grey Turners+/o cullens signs Serum lipase & amylase
Serum calcium in acute pancreatitis
Trosseau sign & Chvostek sign
NM irritability bc of the low calcium levels and the the accumulation of fatty acids which cheleate with calcium salts causing deposits in the abd
Trosseau: Hand spasms
Chvostek: :Facial spasms
Why is stool clay colored in acute pancreatits
Obstruction of the bile flow
Nutritional intake acute pancreatits
Loss of appetite because of the pain, or NPO monitor length of NPO and how well they tolerate feedings
Nursing interventions & MEDS acute pancreatits
NPO status
NGT low suction as ordered prevent abd distension
Administer meds: Analgesics, antiemetics, histamine blockers, sedatives/antianxiety meds
What position should acute pancreatits be in bed
Semi fowlers position or fetal position
Encourage coughing and deep breathing