Mod 6 Flashcards
What are S/S of Acute Pancreatitis?
- Severe abdominal pain and tenderness and back pain
- Typically the pain occurs in the midepigastric region
- Pain is acute in onset, occurring 24-48 hours after a heavy meal or alcohol ingestion, and it may be diffuse and difficult to localize
- more severe after meals and is unrelieved by antacids
- abdomen distention/decreased peristalsis
- nausea and vomiting that fails to relieve pain or nausea
- Abdominal guarding
- A rigid or board-like abdomen is an ominous sign
- Ecchymosis in the flank or around the umbilicus
- fever, jaundice, confusion, and agitation
- HTN
- tachycardia, cyanosis, cold, clammy skin, acute renal failure, respiratory distress and hypoxia, dyspnea, tachypnea, and abnormal ABGs
- Myocardial depression, hypocalcemia, hyperglycemia, and disseminated intravascular coagulation (DIC) may occur
- Stools are often bulky, pale, and foul-smelling
what are Nursing interventions for Acute Pancreatitis?
- Relieve pain with parenteral opioids, preferably morphine or hydromorphone
- Oral feedings are withheld to decrease the formation and secretion of secretin
- parenteral fluids
- N/G suction may be used to relieve N&V or treat abdominal distention and paralytic ileus
- Oral hygiene
- maintained on bed rest to decrease the metabolic rate and reduce secretion of pancreatic and gastric enzymes
- watch for hemorrhage of pancreas
- placing patient in semi-Fowler’s position
- monitor of pulse ox
- Turn, cough, and deep breath
- take daily wt
Once Acute Pancreatitis subsides what kind of diet will the client need to be on?
gradually reintroduce oral feedings of high carb and low fat and protein. The patient should avoid heavy meals and alcohol
Is a patient with acute pancreatitis at risk for impaired skin integrity?
yes they are at risk for breakdown b/c of poor nutritional status, enforced bed rest, and restlessness. Patient may have drains or surgical incision. Assess wounds, drainage sites, and skin for infection, inflammation, and breakdown. Perform wound care, skin care, or consult with enterostomal therapist. Turn patient q2h.
what potential complications should the nurse monitor for when having a patient with acute pancreatitis?
- fluid and electrolyte disturbances are common b/c of N&V
- movement of fluid from vascular to peritoneal cavity, diaphoresis, fever, and use of N/G suction.
- Assess patient’s fluid and electrolyte status by noting skin turgor and moistness of mucous membranes.
- Daily wt, measure I&O, assess for ascites by measure abdominal girth. Fluids are IV.
- Keep emergency meds available b/c of risk of circulatory collapse and shock. The nurse promptly reports decreased blood pressure and reduced urine output (hypovolemia) monitor for neurologic, cardiovascular, renal, and respiratory dysfunction.
- Shock and multiple organ failure may occur with acute pancreatitis.
What lab values would the nurse want to monitor with a patient with acute pancreatitis?
In 90% of cases, serum amylase and lipase levels rise in excess of 3 times their normal upper limit within 24 hrs. Serum amylase usually returns to normal within 48-72 hrs, but serum lipase levels may remain elevated for 5-7 days. Urinary amylase levels also become elevated and remain longer than serum. The WBC count is usually elevated; hypocalcemia is present and correlates well with the severity of pancreatitis. Transient hyperglycemia and glucosuria and elevated bilirubin levels occur in some patients with acute pancreatitis. H&H are used to monitor the patient for bleeding. Peritoneal fluid, obtained thru paracentesis or peritoneal lavage, may contain increased levels of pancreatic enzymes. The fat content of stools is 50-90% (normal is 20%) Low serum magnesium, low serum calcium. Acid-base imbalance.
What is Criteria for Predicting Severity of Pancreatitis?
CRITERIA ON ADMISSION TO HOSPITAL: Age >55 WBC >16,000 mm Serum glucose >200 mg/dl Serum LDH > 350 IU AST >250U/ml CRITERIA WITHIN 48 HRS OF HOSPITAL ADMISSION Fall in HCT >10% BUN increase > 5mg/dl Serum Calcium 4 mEq/L Fluid retention or sequestration >6 L PO2
How do you treat acute pancreatitis?
- relieving s/s and preventing or treating complications. -All oral intake is withheld, to inhibit stimulation of the pancreas and its secretion of enzymes.
- Parenteral nutrition is usually an important part of therapy; particularly in debilitate patients b/c of the extreme metabolic stress associated with acute pancreatitis.
- Patient who do not tolerate enteral feeding require parenteral nutrition.
- NG suction may be used to relieve N&V, abdominal distention and paralytic ileus.
- H2 (tagamet or Zantac) may be prescribed to decrease pancreatic activity by inhibiting secretion of hydrogen chloride.
- PPI may be used for patients who do not tolerate H2 antagonists.
What is a Cullen’s sign?
It is black-blue bruising around the umbilicus. This sign takes 24-48 hours to appear and predicts a severe attack of acute pancreatitis, with mortality rising from 8-10% to 40%. It may be accompanied by Grey-Turner’s sign (bruising of the flank).
Why is resting the pancreas important?
The pancreas enzymes are digesting it, you must rest the pancreas to stop the production and enzymes to allow it to heal.
How does smoking adversely impact the pancreas?
Smoking stimulates the pancreas to release pancreatic enzymes. The risk for pancreatic cancer increases as the extent of cigarette smoking increases.
How does alcohol impact the pancreas?
- Instruct patient to eliminate alcohol and refer to AA. -Alcohol intake produces further damage to pancreas and precipitates attacks of acute pancreatitis.
- Long-term use of alcohol is commonly associated with acute episodes of pancreatitis, but the patient usually has had undiagnosed chronic pancreatitis before the 1st episode of acute pancreatitis occurs.
- Alcohol consumption in Western societies and malnutrition worldwide are the major causes of chronic pancreatitis.
- Excessive and prolonged consumption of alcohol accounts for 70-80% of all cases of chronic pancreatitis. -The incidence of pancreatitis is 50 X’s greater in people with alcoholism than those without.
- Long term alcohol use causes hypersecretion of protein in pancreatic secretion, resulting in protein plugs and calculi within the pancreatic ducts. Alcohol also has a direct toxic effect on the cells of the pancreas.
What is a whipple procedure?
it is the pancreaticoduodenectomy. The end result of resection of carcinoma of the head of the pancreas or ampulla of Vater. The common duct is sutured to the end of the jejunum, and the remaining portion of the pancreas and the end of the stomach are sutured to the side of the jejunum. (removal of the head of the pancreas, the entire duodenum, a portion of the jejunum, the distal third of the stomach, and the lower half of the CBD, with the reestablishment of continuity of the biliary, pancreatic, and GI tract systems)
What are complications of a whipple procedure?
- Hemorrhage,
- vascular collapse,
- hepatorenal failure
what are the Nursing interventions post op?
- nursing care is directed toward promoting comfort, preventing complications
- assisting the patient to return to and maintain as normal and comfortable a life as possible.
- Monitor IV and arterial line, patient will be on ventilator post op.
- Monitor and report changes in v/s, ABGs and pressures, pulse ox, lab values, and urine output.
- Assess for bleeding.
- Malabsorption and diabetes mellitus.
- Patient should have N/G tube and parenteral nutrition to allow the GI tract to rest while promoting adequate nutrition.
- Monitor glucose, b/c with removal of part of pancreas, diabetes will occur.
