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NUR 213 > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

Disease characterized by inflammation of the pancreas and is classified as acute or chronic.

A

Pancreatitis

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2
Q

What kind of pancreatitis is this?

  • Reversible
  • d/t activated pancreatic enzymes auto digesting the pancreas ranging from mild to necrotizing hemorrhagic pancreatitis
A

Acute pancreatitis

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3
Q

What kind of pancreatitis is this?

  • Irreversible
  • Defined as persistent inflammation that causes scarring and damage to the pancreas and surrounding tissue.
A

Chronic pancreatitis

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4
Q

Causes of Acute pancreatitis

A

Gallstones, alcohol, infection, tumor, medications, trauma

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5
Q

Causes of chronic pancreatitis

A

Repeated episode of pancreatitis, excessive and prolonged consumption of alcohol, cystic fibrosis

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6
Q

S/S of Chronic pancreatitis

A
  • Chronic epigastric pain / no pain
  • Pain ↑ after drinking etoh
  • Weight loss
  • Jaundice
  • DM
  • Dark urine
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7
Q

S/S of acute pancreatitis

A
  • Sudden severe pain ( LUQ )
  • N/v
  • ↑ HR and ↓ BP
  • ↑ glucose
  • confusion and agitation
  • ABD guarding / rigid board like ABD
  • Grey- turner’s sign
  • Cullens sign
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8
Q

bluish discoloration of flank

A

Grey-turners sign

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9
Q

bluish discoloration of umbilicus

A

Cullens sign

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10
Q

The following are S/S of what kind of pancreatitis?

  • Chronic epigastric pain / no pain
  • Pain ↑ after drinking etoh
  • Weight loss
  • Jaundice
  • DM
  • Dark urine
A

Chronic pancreatitis

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11
Q

All of the following are S/S of what kind of pancreatitis

Sudden severe pain ( LUQ )
N/v
↑ HR and ↓ BP
↑ glucose
Mental confusion and agitation
ABd guarding / rigid board like ABd
Grey- turner’s sign
Cullens sign

A

Acute pancreatitis

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12
Q

Expected labs for a patient with pancreatitis

A
  • Amylase → rapid increase ↑ d/t pancreatic enzyme
  • AST → elevated ↑ d/t bile flow obstruction
  • Alt → elevated ↑ d/t gallstone pancreatitis
  • Direct bilirubin → elevated ↑ d/t biliary obst
  • Lipase → elevated ↑ d/t pancreatic enzyme
  • WBC → elevated ↑ d/t inflammation
  • Calcium → decreased ↓ d/t fat necrosis, hypoalbunemia, malnutrition, common w/ etoh,
  • Albumin → decreased ↓ d/t poor nutrition
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13
Q

Risk factors for pancreatitis

A
  • Gender: male
  • Race: African American
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14
Q

What does kind of diet is a patient with pancreatitis put on after dx?

A
  • Initially NPO status
  • Carbs-containing foods (stimulate pancreas less)
  • Avoid fatty foods and protein-rich foods (stimulates pancreas more)
  • Small, frequent amounts (fist-sized) initially, advancing as pain subsides
  • Vitamin supplements
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15
Q

A patient with pancreatitis requires gastic decompression, what needs to be done?

A

NG tube

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16
Q

Medications used to treat acute Pancreatitis

A
  • Opioid analgesics
  • Anticholinergics
  • Antibiotic
  • histamine blocker: cimetidine
  • Proton pump inhibitor
  • Pancreatic enzymes
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17
Q

If pancreatitis is severe how is nutrition provided?

A

enteral or parental nutrition

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18
Q

Procedures to treat pancreatitis

A
  • Ercp
  • Cholecystectomy/sphincterectomy/ endoscopic pancreatic necrosectomy
  • Pancreaticjejunostomy
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19
Q

How should a patient with pancreatitis be positioned in bed

A

semi-fowlers position or fetal position to relieve ABD pressure

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20
Q

Breaks down carbs to glucose

A

Amylase

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21
Q

Breaks down proteins

A

Protease

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22
Q

Breaks down fat

A

Lipase

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23
Q

Medicaition given to acute pancreatitis patients for acute pain

A

Morphine and dilauded

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24
Q

Medication given to acute pancreatitis patients for moderate pain

A

Ketorolac or other NSAIDs

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25
Q

Medications given to patients with acute pancreatitis to dry up secretions

A

Anticholinergics

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26
Q

Examples of Anticholinergics

A

Hyoscyamine (levsin)
Scopolamine

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27
Q

Medications used to decrease gastric acid secretion in patients with acute pancreatitis

A

Histamine bockers and Proton pump inhibitors

28
Q

Omeprazole is what kind of medication? what should a patient be monitored for if they are taking it?

A

Proton pump inhibitor
Hypomagnesemia

29
Q

Example of a histamine

A

Rnitidine or zantac

30
Q

Is administering pancreatic enzymes and PERT the same thing

A

No

31
Q

What is PERT

A

Pancreatic enzyme replacement therapy

32
Q

aids in fat and protein digestion. Pt teaching is important! Take with EVERY meals and snacks; open capsule and sprinkle it on non-protein foods; drink full glass of water following med; wipe lips and rinse mouth after taking to prevent skin breakdown or irritation

A

Pancrelipase (Ultresa)

33
Q

An example of a pancreatic enzyme

A

Pancrelipase (Ultresa)

34
Q

Teaching points for Pancrelipase (Ultresa)

A
  • Take with EVERY meals and snacks
  • open capsule and sprinkle it on non-protein foods
  • drink full glass of water following med
  • wipe lips and rinse mouth after taking to prevent skin breakdown or irritation
35
Q

What circumstance calls for ABX therapy to be used to treat acute pancreatitis

A

Necrotic pancreatitis

36
Q

Expected outcomes for acute pancreatitis

A

Stable VS
Stable weight
Decreasing amylase and lipase levels
Electrolytes WNL
Decreased pain
Decreased liver enzymes

37
Q

Complications associated with Acute pancreatitis

A
  • Necrotizing pancreatits
  • Pancreatic hemorrhage
  • Pancreatic pseudocyst
  • Tetany
  • Pleural effusion and atelectasis
  • Coagulation deficits
38
Q

What complication of pancreatitis is this?

present 1 or more weeks after the initial onset of acute pancreatitis and is diagnosed by C T scan, which shows the presence of air and gas surrounding the pancreas.

A

Necrotizing pancreatitis

39
Q

Necrotizing pancreatitis can lead to what?

A

develop sepsis, shock, and multiple-organ failure.

40
Q

What complication of pancreatitis is this?

  • Patients have increased pain
  • decreased BP
  • tachycardia
  • Turner’s and/or Cullen’s signs are present.
A

Pancreatic hemorrhage

41
Q

encapsulated areas of fluid that contains pancreatic enzymes and tissue. Forms about 4-6 weeks after initial acute episode.

A

Pancreatic pseudocysts

42
Q

The following are s/s of what complication of pancreatitis

include chills, fever, N/V, abd. pain.

A

Pancreatic pseudocysts

43
Q

How are pancreatic pseudocysts treated

A
  • Resolves spontaneously over several weeks.
  • Can become abcessed, which would need drained and/or debrided.
44
Q

inflating BP cuff creates a carpal spasm
indicates hypocalcemia

A

Trousseau sign

45
Q

tapping over facial nerve leads to facial twitching
d/t low calcium

A

Chvostek sign

46
Q

Tetany is caused by what?

A

hypomagnesemia and hypocalcemia

47
Q

involuntary muscle contractions and overly stimulated peripheral nerves

A

Tetany

48
Q

Why does the HCP need to be notified of tetany

A

Tetany=hypocalcemia
hypocalcemia=cardiacdysrythmias

49
Q

Nursing Dx for acute pancreatitis

A
  • Acute pain
  • Ineffective breathing pattern
  • Imbalanced nutrition, less that body requirements
50
Q

Expected VS of someone with acute pancreatitis

A
  • Fever and tachycardia
  • Tachypnea
  • Hypotension
  • hypoxemia
51
Q

Pain in a patient with acute pancreatitis

A
  • Pain located in the RUQ or LUQ
  • Rebound tenderness
  • Muscle guarding/rigid abdominal muscles
52
Q

Why would a patient with acute pancreatitis have an elevated glucose level

A

Glucose elevations due to the digestion of the pancreas, which leads to decreased production and availability of insulin

53
Q

Nursing assessment for Acute pancreatitis

A

Vital signs
Oxygen status
Pain location, intensity, duration
Abdominal assessment
Presence of Turner’s and/or Cullen’s signs
Serum lipase and amylase
Serum glucose
Serum calcium, Trousseau sign or Chvostek sign
Stool color
Nutritional intake
Daily weight, monitoring of fluid intake and output

54
Q

Nursing actions for acute pancreatitis

A

Maintain NPO status
NGT to low sxn
Administer ordered meds
Analgesics
Antiemetics
Histamine blockers
Sedatives/Anti-anxieties
Promote bedrest
Semi-fowler’s
Fetal
Encourage coughing & deep breathing

55
Q

Patient teaching for acute pancreatitis

A

Dietary Teaching
No alcohol
No smoking
Disease symptoms, progression, diagnostic procedures, and interventions

56
Q

Dietary teaching for a patient with pancreatic cancer

A

Carbs-containing foods (stimulate pancreas less)
Avoid fatty foods and protein-rich foods (stimulates pancreas more)
Small, frequent amounts (fist-sized) initially, advancing as pain subsides
Vitamin supplements

57
Q

Treatment for Chronic pancreatitis

A

Pain management
IV fluid replacement
Electrolyte management
Nutritional support
Insulin therapy
PERT
Surgery

58
Q

Sx procedures for Chronic hepatitis

A

Resection
Puestow

59
Q

Treatment of Acute pancreatitis

A

NPO status
IV fluid-NS or LR
ICU level care, if other organs involved
Treat cause of pancreatitis

60
Q

Nursing dx for Chronic pancreatitis

A

Acute pain
Imbalanced Nutrition, less than body requirements
Hopelessness

61
Q

Nursing assessment for Chronic Pancreatitis

A

Vital signs
Monitor lab values
Weight
Pain
Assess abdomen
Assess skin color
Assess stool appearance

62
Q

Pain management in patients with Chronic pancreatitis

A

Pain may be managed with the administration of opioids initially and then with non-opioids when the pain is less intense.

63
Q

Nursing actions for Chronic pancreatitis

A

Administer pancreatic enzyme replacement therapy (PERT)
GI Prophylaxis
Provide rest and calm environment
Pain relief measures
Collaborate with dietician

64
Q

Medications for GI prophylasis in patients with chronic pancreatitis

A

H2 blockers
PPIs

65
Q

Patient teaching for chronic pancreatitis

A

No alcohol
Do not chew pancreatic enzymes
Limit fat in diet
Avoid food triggers
Support groups

66
Q

what does grey turners sign indicate

A

acute necritizing pancreatitis

67
Q

what does cullens sign indicate

A

hemorrhage

NUR 213 (29 decks)

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