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NRSG 200: Med Surg 3 > [Exam 1/Final] Chapter 50 - Assessment and Management of Patients with Biliary Disorders > Flashcards

[Exam 1/Final] Chapter 50 - Assessment and Management of Patients with Biliary Disorders Flashcards

1
Q

Anatomy - Gallbladder: Main function of the gallbladder?

A

Its a storage depot for bile, and can impact pancreas if it becomes blocked up.

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2
Q

Anatomy - Pancreas: What are the two functions?

A

Endocrine and Exocrine functions

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3
Q

Anatomy - Pancreas: What is the endocrine function?

A

Hormone secretion. Regulates blood sugar through insulin, glucagon, and somatostain.

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4
Q

Anatomy - Pancreas: What is the exocrine function?

A

The enzyme actions, such as lipase, amylase, and trypsin

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5
Q

Anatomy - Pancreas: Function of insulin?

A

Can decrease glucose levels

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6
Q

Anatomy - Pancreas: Function of glucagon?

A

Is used to increase blood glucose levels. Glycogen converts glycogen stored in liver to increase glucose levels

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7
Q

Anatomy - Pancreas: Function of Somatostatin?

A

Has a hypoglycemic effect and interferes with growth hormones of pituitary and glucagon from pancreas. Interference decreases glucose levels.

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8
Q

Anatomy - Pancreas: What does Lipase do?

A

Aids in digestion of fats

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9
Q

Anatomy - Pancreas: What does amylase do?

A

Aids in the digestion of carbs

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10
Q

Anatomy - Pancreas: What does trypsin do?

A

Aids in the digestion of protein

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11
Q

Pancreatitis: What is this?

A

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.

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12
Q

Pancreatitis: What are the two types of Pancreatitis?

A

Interstitial Endematous and then Necrotizing.

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13
Q

Pancreatitis: What is Chronic Pancreatitis?

A

Goes undetected because it is difficult to diagnose and by the time symptoms appear, 90% of the pancreas function may be lost.

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14
Q

Pancreatitis: Chronic can be characterized by what?

A

Acute exacerbations where they have acute signs and symptoms.

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15
Q

Acute Pancreatitis - CMs: What mostly causes this?

A

Gallstones or sustained alcohol abuse.

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16
Q

Acute Pancreatitis - CMs: Very common for alcoholics to have what type of episodes?

A

Acute episodes of pancreatitis.

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17
Q

Acute Pancreatitis - CMs: What will you see on the body when assessing?

A

Bruising around the umbilicus.

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18
Q

Acute Pancreatitis - CMs: What kind of pain will they experience?

A

Severe abdominal pain and usually onset 24-48 hours after they’ve been on alcohol binge or after heavy meal.

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19
Q

Acute Pancreatitis - CMs: What signs may they have?

A

Abdominal distention, decreased peristalsis, N/V (BIG). Will be guarding abdomen

Fever, Jaundice, Mental Confusion.

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20
Q

Acute Pancreatitis - CMs: What is a sign that they have developed an infection within the peritoneum?

A

Board-like abdomen, showing they have peritonitis.

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21
Q

Acute Pancreatitis - CMs: How will their nutrition be?

A

Poor because they are nauseated and vomiting. Dehydrated and not wanting to take in fluids. May be hypotensive leading to hypovolemic shock.

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22
Q

Acute Pancreatitis - CMs: What problems can dehydration cause?

A

Kidney problems, and BUN and Creatinine can be elevated due to dehydration.

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23
Q

Pancreatitis - Medical Mx: A big management will be what?

A

Relieve of symptoms, by giving opioids like idlated or morphine IV.

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24
Q

Pancreatitis - Medical Mx: Why does pain meds need to be IV push?

A

Because you want to rest the digestive tract and not give anything PO

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25
Q

Pancreatitis - Medical Mx: How will nutrition be fixed?

A

You will want to give them enteral/parenteral nutrition. May require a NG.

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26
Q

Pancreatitis - Medical Mx: What will be used to inhibit secretion of gastric acids?

A

H2 Antagonists and PPIs

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27
Q

Pancreatitis - Medical Mx: What replacements do they need?

A

Fluid and elecytrolyte because they are dehydrated. Want to prevent hypovolemic shock and AKI.

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28
Q

Pancreatitis - Medical Mx: Respiratory care is provided why?

A

Because they are in a lot of pain and guraded. We want to make sure they are okay from a respiratory perspective.

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29
Q

Pancreatitis - Surgery, Endoscopic Retrograde Cholangiopancreatrography (ERCP): what is this?

A

A scope of the gallbladder and the pancreas.

30
Q

Pancreatitis - Surgery, Endoscopic Retrograde Cholangiopancreatrography (ERCP): What may show that the pancreas is inflamed?

A

Some type of imaging like CT. Can show inflammation or gallstone and will perform ERCP to help relieve patient.

31
Q

Pancreatitis - Medical Mx: How will the lab values appear?

A

Digestive enzymes increased. Amylase and lipase elevated.

32
Q

Pancreatitis - Medical Mx: Normal Lipase range?

A

0-160

33
Q

Pancreatitis - Medical Mx: Normal Amylase range?

A

23-85

34
Q

Pancreatitis - Medical Mx: Normal Trypsin range?

A

115-350

35
Q

Pancreatitis - Medical Mx: Does amylase or lipase stay elevated longer?

A

Lipase

36
Q

Pancreatitis - Medical Mx: Because of the inflammatory process, what else may be increased?

A

The WBC count.

37
Q

Pancreatitis - Medical Mx: What diagnostics can be performed to help diagnose this?

A

CT, MRI, or even X-Ray

38
Q

Pancreatitis - Medical Mx: What is done if this is related to a gallstone?

A

ERCP

39
Q

Pancreatitis - Post Acute Mx: This includes what after surgery?

A

May have some type of drain, so make sure to monitor drain.

Monitor for signs of infection, internal bleeding, and pain for that.

40
Q

Nursing Process: Care of Pt with Acute Pancreatitis - Assessment: This will include what/

A

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,

41
Q

Nursing Process: Care of Pt with Acute Pancreatitis - Diagnosis: Most common ones?

A

Acute pain, imbalanced nutrition, fluid/electrolyte imblaance, ineffective breathing pattern

42
Q

Nursing Process: Care of Pt with Acute Pancreatitis - Interventions: This will focus on what?

A

The nursing diagnosis such as giving pain medication, giving them IV fluids, parenal feedings like TPN, and monitoring respiratory status.

43
Q

Nursing Process: Care of Pt with Acute Pancreatitis - Interventions: Education on what?

A

Diet, and addressing alcohol concerns if needed and getting them set up with support groups and rehab.

44
Q

Nursing Process: Care of Pt with Acute Pancreatitis - Complications: Biggest one?

A

Fluid and electrolyte disturbances , so monitor their BMP, Na, K, and monitoring kidney funcntion

45
Q

Nursing Process: Care of Pt with Acute Pancreatitis - Complications: What should we do for fluid disturbances?

A

Monitor their I/Os and make sure they have adequate output

46
Q

Nursing Process: Care of Pt with Acute Pancreatitis - Complications: What is pancreatic necrosis?

A

It is when the pancreas becomes so inflamed that it starts to become necrotic or they’ve had the necrotic form of pancreatitis

47
Q

Nursing Process: Care of Pt with Acute Pancreatitis - Complications: What labs will be monitored in nectoric form?

A

Monitor temperatue and WBC count

48
Q

Nursing Process: Care of Pt with Acute Pancreatitis - Complications: What to monitor with Shock/ Multi Organ Dysfunction Syndrome?

A

Are they hypovolemic or getting septic, bleeding out, hemorrhagic shock? Can monitor this with Vital Signs.

49
Q

Chronic Pancreatitis - Assessment: What is this?

A

Its a progressive desturction of the pancreas where healthy cells become replaced with fibrous tissue.

50
Q

Chronic Pancreatitis - Assessment: What can cause chronic pancreatitis?

A

Prolonged alcohol because it will cause an increased secretion of protein and those proteins plug up the pancreas. Smoking can have similar effect.

51
Q

Chronic Pancreatitis - CMs: what kind of pain will they have?

A

Abdominal pain, some back pain, N/V, and become dependent on opioids to treat this pain.

52
Q

Chronic Pancreatitis - CMs: What physical changes will occur?

A

Will have weight loss, and will also have fatty stools.

53
Q

Chronic Pancreatitis - Diagnosis: How will this be diagnosed?

A

With MRI, CT, ERCP

54
Q

Chronic Pancreatitis - Medical Mx: What will you have to manage?

A

The acute attacks

55
Q

Chronic Pancreatitis - Medical Mx: What happens because the islet cells are destroyed?

A

They will become diabetic so will have to monitor this as well.

56
Q

Chronic Pancreatitis - Surgical Mx, Pancreatic Junoostomy: What is this?

A

They remove part of the pancreas and connect it to part of the jejenum.

57
Q

Cancers of the Pancreas: May develop where?

A

Anywhere in pancreas head, neck, body or tail.

58
Q

Cancers of the Pancreas - CMs: Symptoms depend on what?

A

Where in the pancreas the cancer/tumor is in.

59
Q

Cancers of the Pancreas - CMs: What will they complain of?

A

Pain

60
Q

Cancers of the Pancreas - CMs: What changes may occur?

A

Jaundice, weight loss, glucose increase,

61
Q

Cancers of the Pancreas - Assessment: We will look for what?

A

Jaundice, weight loss, glucose increase, and also pain.

62
Q

Cancers of the Pancreas - Diagnosis: How will this be diagnosed?

A

MRI, CT, ERCP, Tissue Analysis through biopsy.

63
Q

Cancers of the Pancreas - Diagnosis: Is this easy to treat?

A

No. Palliative care may be done

64
Q

Cancers of the Pancreas - Diagnosis: If surgery cannot be done, what is done?

A

Internal radiation or chemo radiation combo

65
Q

Cancers of the Pancreas - Nursing Mx: This will focus on what?

A

Pain control, skin care because jaundice may cause skin to be itchy.

66
Q

Tumors of Head of Pancreas: What percentage of cancers are this?

A

60-80%

67
Q

Tumors of Head of Pancreas: Why is this a problem?

A

It blocks the bile duct, and this is what causes the jaundice.

68
Q

Tumors of Head of Pancreas - Labs: What labs will be done?

A

Liver function, pancreatic function, trying to improve nutrition because anemic.

69
Q

Tumors of Head of Pancreas - Nursing Mx: What will be done?

A

Promote patient comfort, monitor VSs, make sure they are stable, monitor for organ dysfunction, and may decline rapidly and be put on ventilator.

70
Q

Tumors of Head of Pancreas - Pancreatoduodenectomy: If there are a candiate, they may have this done. What is this also known as?

A

Whipple Procedure

71
Q

Tumors of Head of Pancreas - Pancreatoduodenectomy: What happens here?

A

Removal of gallbladder, portion of stomach, duodenum, proximal jejnum, head of pancreas, and distal CBD. Anastomosis of remaining pancreas and stomach to jejenum.

72
Q

Tumors of Head of Pancreas - Surgery Mx: What may happen after pancreatic surgery?

A

They may have multiple pumps in place to irrigate the surgery. This is based on what is going on with the patient.

NRSG 200: Med Surg 3 (46 decks)

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