Exam 2 - Pancreatitis Flashcards
1
Q
Pancreatitis
A
Acute inflammatory disorder of the pancreas associated with escape of pancreatic enzymes into surrounding tissue (auto digestion)
- May be acute or chronic
- inflammation varies from mild edema to severe hemorrhagic necrosis
- Severity rated by Ranson criteria
2
Q
Causes of Pancreatitis
A
- Alcohol
- Elevated Triglycerides
- Biliary disease; gallstones
- Trauma
- Infective
- Drug induced: NSAIDS, Steroids, thiazides, TCN, Sulfa
- Idiopathic
3
Q
Mechanism of Pancreatitis
A
AUTODIGESTION
- Proteolytic enzymes prematurely activated
- Activated enzymes digest pancreas and surrounding tissue
- Edema, necrosis, interstitial hemorrhage result
- Injured tissues release histamine, which increase vascular permeability and causes vasodilation, producing more edema
4
Q
Complications
A
- SEPSIS
- Multisystem failure; ARDS, shock, DIC
- Pancreatic pseudocyst, abscesses
- Renal failure
- Metabolic abnormalties: HypoCa+, Hyperlipidemai, Hyperglycemia, metabolic acidosis
5
Q
Clinical Presentation
A
- Sudden pain, after large meal or ETOH use
- Abd distension
- N/V/D
- Decreased bowel sounds
- Low grade fever
- Dehydration, hypovolemic shock, ascites, jaundice
- Grey turner/cullen sign
- hypocalcemia
- Decreased breath sounds
6
Q
Grey Turner’s Sign
A
Bluish discoloration of flank
7
Q
Cullen’s Sign
A
Bluish discoloration around umbilicus
8
Q
S/S Hypocalcemia
A
- Numbness
- Tingling
- Tetany (chvosteks & trousseaus)
9
Q
Nursing Dx
A
FLUID VOLUME DEFICIT
Impaired gas exchange
Acute pain
Altered nutrition
10
Q
Interventions
A
- Pain management (opiates, PCA, side-lying with HOB elevated)
- F&E management (correct hypovolemia
- Suppress pancreatic secretions (NPO, NG tube to suction)
- Respiratory support
- Nutritional Support (TPN)
- Pharmacological support (Antibiotics)
- Peritoneal lavage
- Surgical intervention
