[Exam 1/Final] Chapter 50 - Assessment and Management of Patients with Biliary Disorders Flashcards
Anatomy - Gallbladder: Main function of the gallbladder?
Its a storage depot for bile, and can impact pancreas if it becomes blocked up.
Anatomy - Pancreas: What are the two functions?
Endocrine and Exocrine functions
Anatomy - Pancreas: What is the endocrine function?
Hormone secretion. Regulates blood sugar through insulin, glucagon, and somatostain.
Anatomy - Pancreas: What is the exocrine function?
The enzyme actions, such as lipase, amylase, and trypsin
Anatomy - Pancreas: Function of insulin?
Can decrease glucose levels
Anatomy - Pancreas: Function of glucagon?
Is used to increase blood glucose levels. Glycogen converts glycogen stored in liver to increase glucose levels
Anatomy - Pancreas: Function of Somatostatin?
Has a hypoglycemic effect and interferes with growth hormones of pituitary and glucagon from pancreas. Interference decreases glucose levels.
Anatomy - Pancreas: What does Lipase do?
Aids in digestion of fats
Anatomy - Pancreas: What does amylase do?
Aids in the digestion of carbs
Anatomy - Pancreas: What does trypsin do?
Aids in the digestion of protein
Pancreatitis: What is this?
This is the auto-digestion of the pancreas and where the pancreatic ducts become obsturcted. Accompanied by increased secretion of the enzymes. Bile backs up here as well causing pancreatitis.
Pancreatitis: What are the two types of Pancreatitis?
Interstitial Endematous and then Necrotizing.
Pancreatitis: What is Chronic Pancreatitis?
Goes undetected because it is difficult to diagnose and by the time symptoms appear, 90% of the pancreas function may be lost.
Pancreatitis: Chronic can be characterized by what?
Acute exacerbations where they have acute signs and symptoms.
Acute Pancreatitis - CMs: What mostly causes this?
Gallstones or sustained alcohol abuse.
Acute Pancreatitis - CMs: Very common for alcoholics to have what type of episodes?
Acute episodes of pancreatitis.
Acute Pancreatitis - CMs: What will you see on the body when assessing?
Bruising around the umbilicus.
Acute Pancreatitis - CMs: What kind of pain will they experience?
Severe abdominal pain and usually onset 24-48 hours after they’ve been on alcohol binge or after heavy meal.
Acute Pancreatitis - CMs: What signs may they have?
Abdominal distention, decreased peristalsis, N/V (BIG). Will be guarding abdomen
Fever, Jaundice, Mental Confusion.
Acute Pancreatitis - CMs: What is a sign that they have developed an infection within the peritoneum?
Board-like abdomen, showing they have peritonitis.
Acute Pancreatitis - CMs: How will their nutrition be?
Poor because they are nauseated and vomiting. Dehydrated and not wanting to take in fluids. May be hypotensive leading to hypovolemic shock.
Acute Pancreatitis - CMs: What problems can dehydration cause?
Kidney problems, and BUN and Creatinine can be elevated due to dehydration.
Pancreatitis - Medical Mx: A big management will be what?
Relieve of symptoms, by giving opioids like idlated or morphine IV.
Pancreatitis - Medical Mx: Why does pain meds need to be IV push?
Because you want to rest the digestive tract and not give anything PO
Pancreatitis - Medical Mx: How will nutrition be fixed?
You will want to give them enteral/parenteral nutrition. May require a NG.
Pancreatitis - Medical Mx: What will be used to inhibit secretion of gastric acids?
H2 Antagonists and PPIs
Pancreatitis - Medical Mx: What replacements do they need?
Fluid and elecytrolyte because they are dehydrated. Want to prevent hypovolemic shock and AKI.
Pancreatitis - Medical Mx: Respiratory care is provided why?
Because they are in a lot of pain and guraded. We want to make sure they are okay from a respiratory perspective.
Pancreatitis - Surgery, Endoscopic Retrograde Cholangiopancreatrography (ERCP): what is this?
A scope of the gallbladder and the pancreas.
Pancreatitis - Surgery, Endoscopic Retrograde Cholangiopancreatrography (ERCP): What may show that the pancreas is inflamed?
Some type of imaging like CT. Can show inflammation or gallstone and will perform ERCP to help relieve patient.
Pancreatitis - Medical Mx: How will the lab values appear?
Digestive enzymes increased. Amylase and lipase elevated.
Pancreatitis - Medical Mx: Normal Lipase range?
0-160
Pancreatitis - Medical Mx: Normal Amylase range?
23-85
Pancreatitis - Medical Mx: Normal Trypsin range?
115-350
Pancreatitis - Medical Mx: Does amylase or lipase stay elevated longer?
Lipase
Pancreatitis - Medical Mx: Because of the inflammatory process, what else may be increased?
The WBC count.
Pancreatitis - Medical Mx: What diagnostics can be performed to help diagnose this?
CT, MRI, or even X-Ray
Pancreatitis - Medical Mx: What is done if this is related to a gallstone?
ERCP
Pancreatitis - Post Acute Mx: This includes what after surgery?
May have some type of drain, so make sure to monitor drain.
Monitor for signs of infection, internal bleeding, and pain for that.
Nursing Process: Care of Pt with Acute Pancreatitis - Assessment: This will include what/
Pain will be biggest, and complaints from patient.
Will perform focused abdominal assessment, what bowel sounds like, is abdomen distended.
Neuro assess - are they alert and oriented.
Resp, O2,
Nursing Process: Care of Pt with Acute Pancreatitis - Diagnosis: Most common ones?
Acute pain, imbalanced nutrition, fluid/electrolyte imblaance, ineffective breathing pattern
Nursing Process: Care of Pt with Acute Pancreatitis - Interventions: This will focus on what?
The nursing diagnosis such as giving pain medication, giving them IV fluids, parenal feedings like TPN, and monitoring respiratory status.
Nursing Process: Care of Pt with Acute Pancreatitis - Interventions: Education on what?
Diet, and addressing alcohol concerns if needed and getting them set up with support groups and rehab.
Nursing Process: Care of Pt with Acute Pancreatitis - Complications: Biggest one?
Fluid and electrolyte disturbances , so monitor their BMP, Na, K, and monitoring kidney funcntion
Nursing Process: Care of Pt with Acute Pancreatitis - Complications: What should we do for fluid disturbances?
Monitor their I/Os and make sure they have adequate output
Nursing Process: Care of Pt with Acute Pancreatitis - Complications: What is pancreatic necrosis?
It is when the pancreas becomes so inflamed that it starts to become necrotic or they’ve had the necrotic form of pancreatitis
Nursing Process: Care of Pt with Acute Pancreatitis - Complications: What labs will be monitored in nectoric form?
Monitor temperatue and WBC count
Nursing Process: Care of Pt with Acute Pancreatitis - Complications: What to monitor with Shock/ Multi Organ Dysfunction Syndrome?
Are they hypovolemic or getting septic, bleeding out, hemorrhagic shock? Can monitor this with Vital Signs.
Chronic Pancreatitis - Assessment: What is this?
Its a progressive desturction of the pancreas where healthy cells become replaced with fibrous tissue.
Chronic Pancreatitis - Assessment: What can cause chronic pancreatitis?
Prolonged alcohol because it will cause an increased secretion of protein and those proteins plug up the pancreas. Smoking can have similar effect.
Chronic Pancreatitis - CMs: what kind of pain will they have?
Abdominal pain, some back pain, N/V, and become dependent on opioids to treat this pain.
Chronic Pancreatitis - CMs: What physical changes will occur?
Will have weight loss, and will also have fatty stools.
Chronic Pancreatitis - Diagnosis: How will this be diagnosed?
With MRI, CT, ERCP
Chronic Pancreatitis - Medical Mx: What will you have to manage?
The acute attacks
Chronic Pancreatitis - Medical Mx: What happens because the islet cells are destroyed?
They will become diabetic so will have to monitor this as well.
Chronic Pancreatitis - Surgical Mx, Pancreatic Junoostomy: What is this?
They remove part of the pancreas and connect it to part of the jejenum.
Cancers of the Pancreas: May develop where?
Anywhere in pancreas head, neck, body or tail.
Cancers of the Pancreas - CMs: Symptoms depend on what?
Where in the pancreas the cancer/tumor is in.
Cancers of the Pancreas - CMs: What will they complain of?
Pain
Cancers of the Pancreas - CMs: What changes may occur?
Jaundice, weight loss, glucose increase,
Cancers of the Pancreas - Assessment: We will look for what?
Jaundice, weight loss, glucose increase, and also pain.
Cancers of the Pancreas - Diagnosis: How will this be diagnosed?
MRI, CT, ERCP, Tissue Analysis through biopsy.
Cancers of the Pancreas - Diagnosis: Is this easy to treat?
No. Palliative care may be done
Cancers of the Pancreas - Diagnosis: If surgery cannot be done, what is done?
Internal radiation or chemo radiation combo
Cancers of the Pancreas - Nursing Mx: This will focus on what?
Pain control, skin care because jaundice may cause skin to be itchy.
Tumors of Head of Pancreas: What percentage of cancers are this?
60-80%
Tumors of Head of Pancreas: Why is this a problem?
It blocks the bile duct, and this is what causes the jaundice.
Tumors of Head of Pancreas - Labs: What labs will be done?
Liver function, pancreatic function, trying to improve nutrition because anemic.
Tumors of Head of Pancreas - Nursing Mx: What will be done?
Promote patient comfort, monitor VSs, make sure they are stable, monitor for organ dysfunction, and may decline rapidly and be put on ventilator.
Tumors of Head of Pancreas - Pancreatoduodenectomy: If there are a candiate, they may have this done. What is this also known as?
Whipple Procedure
Tumors of Head of Pancreas - Pancreatoduodenectomy: What happens here?
Removal of gallbladder, portion of stomach, duodenum, proximal jejnum, head of pancreas, and distal CBD. Anastomosis of remaining pancreas and stomach to jejenum.
Tumors of Head of Pancreas - Surgery Mx: What may happen after pancreatic surgery?
They may have multiple pumps in place to irrigate the surgery. This is based on what is going on with the patient.
