Pancreas

Question 1

Function of the pancreas

Answer 1

exocrine
Acinar cells synthesize and secrete digestive enzymes to assist in the breakdown of starch, fat and proteins. empty secretions into pancreatic ductal system, which eventually join the common bile duct.
Ampulla of Vater carries bile and pacreatic secretions into the duodenum.
Digests proteins, fat, and starch
Endocrine
Islets of Langerhans secrete insulin, glucagon, and pancreatic polypeptide hormones to aid digestion

Question 2

Hx questions for pancreas

Answer 2

ask about biliary tract disease, ETOH use, DM, medications.
Does pt report anorexia, weight loss, N/V, abd distention?

Question 3

Hallmark S&S of Acute Pancreatitis

Answer 3

Patients with AP typically present with epigastric or left upper quadrant pain. The pain is usually described as a deep, sharp, constant with radiation to the back, chest, or flanks, and increases within minutes of eating food high in fat content. The intensity of the pain is usually severe, but can be variable. The intensity and location of the pain do not correlate with severity.

Question 4

Priority in the ED for pancreatitis

Answer 4

Establish the diagnosis
Volume resuscitation
stabilization of vital signs
Begin pain relief

Question 5

What IV fluids do we give patients with pancreatitis?

Answer 5

several liters of isotonic crystalloids solutions followed by 200-300 ml/hour, monitoring for pulmonary edema

Question 6

Meds for Pancreatitis

Answer 6

Priority is pain relief with opioids – dilaudid or morphine
Anticholinergics – decreases GI motility and pancreatic enzyme release
Anti-spasmodics – relaxes the smooth muscle, relaxes sphincter of Oddi
H2 blockers/PPI – decrease GI acid secretions
When being fed, need pancreatic enzymes to aid in digestion of fats and proteins
Antibiotics – if have necrotizing pancreatitis

Question 7

Priority in the ICU for pancreatitis

Answer 7

-Fluid resuscitation
-Inotropic Support
-Respiratory Support
-Renal Therapy
-Nutritional Support (enteral tube feed)
-Pharmacologic Therapy
-Surgical Intervention

Question 8

Nursing Care of Pancreatitis

Answer 8

Fluid/electrolyte- replace fluid lost thru 3rd spacing and intravascular volume depletion secondary to inflammatory mediators; HYPOCALCEMIA may indicate the presence of pancreatic fat necrosis
N/V leading to hypokalemia
hyperglicemia
elevated triglycerides >1000mg/dL
5-10L/24 hours trying to maintain perfusion and prevent early shock

Pain - priority is to keep pt. comfortable AND and decrease pancreatic enzyme secretion
IV narcotics-dilaudid
Use of NG tube can decrease pain
Pt. positioning - semi or high fowlers

Nutrition

Rest the pancreas

Surgery

Question 9

Signs of severe hemorrhagic pancreatitis

Answer 9

Turner’s sign - brusing of the flanks, retroperitoneal hemorrhage
Cullen’s sign - edema and bruising around the umbilicus

Question 10

Signs of hypocalcemia

Answer 10

Chvostek’s sign - twitching of the facial mucles in response to tapping over the area of the facial nerve
Trousseau’s sign - carpopedal spasm caused by inflating the BP cuff to a level above the systolic pressure for 3 min

Question 11

Complications of DM

Answer 11

Stroke
Retinopathy, cataracts, blindness
Premature CAD
HTN
Autonomic dysfunction-gastroparesis, diahrrea
Nephropathy
Impotence, infertility
Increased risk of infectins
Hyperlipidemia
PVD, amputations
Peripheral neuropathy

Question 12

What is the most common cause of DKA?

Answer 12

Infection (UTI and PNA account for most)

Question 13

What must be present for DKA diagnosis?

Answer 13

Hyperglycemia
Acidosis
Ketosis

Question 14

History for DKA

Answer 14

diabetic regime, appetite, weight loss, thirst, abd bloating, urinary frequency

Question 15

DKA S&S

Answer 15

anorexia, N/V, abd pain, polyuria & polydipsia several days prior
CLASSIC: Kussmaul’s respirations

Question 16

Lab values associated with DKA

Answer 16

BG-250-1200 with mean 600 (high not as high as HHS)
Anion gap > 12 mEq/L

Question 17

Nursing care of DKA

Answer 17

Fluid resuscitation - NS 1 L/hr until stable, then 15-20 ml/k per hour
Insulin therapy - low dose regular insulin IV
Potassium/phosphate replacement if needed
Bicarb if ph < 7.0
Re-establishing metabolic function
Patient education - focus on need for insulin even when not eating or ill

Question 18

HHS

Answer 18

Marked hyperglycemia
Hyperosmolality
NO ketoacidosis
More common in Type II

Question 19

History for HHS

Answer 19

older adult, over past few days more drowsy, less eating, sleeping more until difficult to wake up

Question 20

Symptoms HHS

Answer 20

weakness, polyuria, polydipsia, impaired mental state (confusion to coma) with dehydration S/S include tachycardia, hypotension, low CO, poor skin turgor, rapid respers, non Kussmauls, warm, flushed skin,

Question 21

Lab data HHS

Answer 21

BG 400-4000mg/dL with mean 1,100 mg/dL
High NA and serum osmolality
Not acidotic, so pH low ish, bicarb normal, and anion gap is not elevated so < 12
Serum osmolality is very high and reflects the severe dehydration
High NA secondary to extracelllar NA/H2O losses and they don’t feel thirsty so free water deficit occurs

Question 22

Nursing care HHS

Answer 22

Correcting volume depletion – this is greater than in DKA; critically ill patients, esp older adults, need hemodynamic monitoring while repplacing fluids-I/Os, BP, breath sounds, neuro status, and frequent labs
Controlling Hyperglycemia – low dose, replace slowly so as not to have sudden loss of circulating blood volume, stop insulin as approaching normal and may even need IV D5W to prevent over shoot and hypoglycemia

Id underlying cause and treating it – for example, look for and manage the infection
Mortality rates high among older adults and cant handle fluid volume shifts associated with the treatment
Patient education – newly diagnosed need teaching about disease and side effects of meds, proper diet, use of glucometer