pancreatitis Flashcards
pancreatitis
inflammatory process of the pancreas
* acute * chronic
functions of the pancreas
- secretes digestive enzymes:
- protease (trypsin) proteins and amino acids
- lipase -fats, glycerol
- amylase-starch
- beta cells secrete insulin for carb metabolism
- alpha cells secrete glucagon for carb metabolism
- lipase & amylase measure protein in blood-elevated levels mean pancreatitis
Etiology of pancreatitis
- alcohol abuse - #1 cause
- biliary tract disease
- infection abscess (acute pancreatitis) antibiotics, insulin, monitor temp
- drug induced - steroids, thiazide diuretics, sulfonamides, nsaids
- post op gi surgery- (trauma)manipulation of the organs during surgery. moving things around
- metabolic disorders: hyperlipidema, hyperparathyroidism, renal failure
- Kaposi sarcoma (HIV pts) pancreatitis is a secondary problem
pathophysiology of pancreatitis
auto-digestion of the pancreas by its enzyme trypsin and other proteolytic enzymes (pancreas eats itself)
diagnostic tests for pancreatitis
*amalyse, lipase: most important
*blood glucose levels - hyperglycemia
*triglycerides levels - hyperlipidemia
*calcium levels - hypocalcemia
*24 hour urine for renal amylase; creatinine clearance (collection)
ERCP - REMAIN NPO UNTIL GAG REFLEX RETURNS (ENDOSCOPIC RETROGRADE PANCREATONOMY)SCOPE THE GALL BLADDER AND PANCREAS;CONSENT, PATIENT NEEDS TO UNDERSTAND THE PROCEDURE, REINFORCEMENT; NPO 6-8HRS; NOT AT BEDSIDE; AFTER SURGERY ALL ORDERS NEED TO BE REDONE; ORDERS CANNOT CARRY THROUGH. THEY EXPIRE
CLINICAL MANIFESTATIONS OF PANCREATITIS
- SUDDEN ONSET, CONTINUOUS, SEVERE LUQ PAIN RADIATES TO MED-EPIGASTRIC & BACK AREA
- PAIN IS AGGRAVATED BY EATING; LYING IN A RECUMBENT POSITION & NOT RELIEVED WITH VOMITING. FLEXION OF THE SPINE MAY RELIEVE PAIN
- MAY HAVE A LOW GRADE FEVER
- ABDOMINAL TENDERNESS & MAY BE JAUNDICED
- LUNGS MAY HAVE CRACKLES (PANCREAS IS UNDER LUNGS AND SEEPS INTO PLEURAL SPACE)
- BOWEL SOUNDS MAY BE DECREASED OR ABSENT IF ILLEUS HAS OCCURRED (NO CONTRACTION OF BOWEL - PERISTALSIS STOPS
- STEATORRHEA - FOUL SMELLING, FROTHY STOOLS (LOT OF FAT, INABILITY TO BREAK DOWN FAT, FLOAT, FOUL SMELLING & FROTHY)
CLASSIC MANIFESTATIONS ASSOCIATES W/PANCREATITIS
- GREY TURNER SPOTS - (FLANK AREA) PANCREATITIS ECOMONIC AREA IN FLANK-VERY LARGE-REPRESENTS BLOOD THAT IS COMING OUT BECAUSE PANCREAS IS EATING ITSELF (INTERNAL BLEEDING)
- CULLEN SIGN - PERIUMBILICAL AREA
*****VERY IMPORTANT SLIDE
COMPLICATIONS OF PANCREATITIS
*HYPOVOLEMIC SHOCK DUE TO HEMORRHAGE & FLUID SHIFTS FROM PROTEIN LEAKAGE INTO THE RETRO-PERITONEAL SPACES
*PSEUDOCYST IF RUPTURES LEADS TO PERITONITIS
*ABSCESS - INFECTION; SURGICAL EMERGENCY (NEEDS TO BE DRAINED)
*SYSTEMIC COMPLICATIONS:
PLEURAL EFFUSION
ATELECTASIS
PNEUMONIA
*TET ANY (TWITCHING, LOCK JAW) LOW CALCIUM LEVELS; PREDISPOSED MUSCLE IRRITABILITY
PHARMACOLOGICAL MANAGEMENT OF PANCREATITIS
- # 1 PAIN MANAGEMENT (CHRONIC & ACUTE) *RELIEF OF PAIN - DEMEROL CAUSES LESS SPASMS OF THE SPHINCTER OF ODDI; MSO4 HAS LONGER HALF LIFE(USED MOST OFTEN) IV PUSH; SMALLER PT 4 MG, BIGGER 6-8 MG; I PUSH SLOWLY (S/E: RESP RATE, BP > 100 SYSTOLE; VOMIT-ORDER ANTI EMETIC (ZOLFRAN)IV PUSH, 4 MG (NORMAL DOSE) STAY W/PATIENT, GIVE LITTLE BIT AT A TIME, INCREASE FLUIDS, IF PATIENT TOLERATING WELL, GIVE A LITTLE MORE; THROUGH SALINE LOCK & FLUSH TO AVOID OCCLUSION; LEAVE IV GOING AND PUT IN ANOTHER PORT*ASTISPASMODICS/ANTICHOLENERGICS - USE WITH CAUTION IN PRESENCE OF ILLEUS - BENTYL, PROBANTHINE
*CARBONIC ANHYDRASE INHIBITOR - DIAMOX REDUCES HCO3
*ANTACIDS
*HISTAMINE 2 ANTAGONIST
*CALCIUM GLUCONATE FOR HYPOCALCEMIA
*GLUCAGON DECREASES INFLAMMATION/AMALYSE
*INSULIN
PANCREATIN - VIOKASE (CHRONIC PANCREATITIS) CHO, FAT & PROTEIN ENZYMES CANNOT TAKE CARE OF
THERAPEUTIC MANAGEMENT OF PANCREATITIS
- PAIN MANAGEMENT
- AGGRESSIVE FLUID REPLACEMENT - LACTATED RINGERS (LOTS OF ELECTROLYTES)
- D IV’S BECAUSE BLOOD GLUCOSE LEVELS HIGH
- NPO W/ NG TUBE TO SUPPRESS PANCREATIC ENZYMES SECRETION & REST PANCREAS
- IF SHOCK PRESENT - PLASMA EXPANDERS (MIGHT NEED ALBUMIN, NS BOLUS-SALT IN SOLUTION EXPANDS PLASMA)
- PERITONEAL LAVAGE OR DIALYSIS TO REMOVE EXUDATE FROM PERITONEAL CAVITY
SURGICAL MANAGEMENT OF PANCREATITIS
- ERCP DONE IN PRESENCE OF GALLSTONES
- PERCUTANEOUS DRAINAGE OF PSEUDOCYST/ABSCESS
- WHIPPLE PROCEDURE - HEAD OF PANCREAS OR PART OF PANCREAS THAT HAS A TUMOR WILL BE REMOVED (DIABETES, HYPOVALEMIC SHOCK, SEPTIC, VERY SICK AFTER WHIPPLE NEEDS INTENSIVE CARE, NOT A CURE, WILL STILL DIE
NUTRITIONAL MANAGEMENT OF ACUTE PANCREATITIS
- NPO
- TPN
- PROGRESS TO SMALL FREQUENT FEEDINGS- HIGH CARB & PROTEIN; LOW FAT
- NO STIMULANTS (COFFEE, ALCOHOL)
- SUPPLEMENTAL FAT SOLUBLE VITAMINS
ASSESSMENT MONITORING FOR PANCREATITIS
- ELECTROLYTE IMBALANCE DUE TO VOMITING AND GASTRIC SUCTIONING SODIUM, CHLORIDE, K (PT ON NG TUBE)
- MONITOR GLUCOSE LEVELS
- OBSERVE FOR TETANY DUE TO HYPOCALCEMIA-JERKING, MUSCLE TWITCHING/NUMBNESS AROUND LIPS/FINGERS
- ASSESS FOR CHVOSTECK (TWITCH) & TROUSEEAU SIGN(BLOOD PRESSURE CUFF)
- RESPIRATORY INFECTION/FAILURE
NURSING INTERVENTIONS FOR PANCREATITIS
- RELIEF OF PAIN - DEMEROL, ANTICHOLENERGIC/ANTISPASMOTICS (SLOWS DOWN PERISTALSIS (BLADDER CONTRACTIONS, GI FUNCTION-SLOWS BLADDER ACTIVITY
- MAINTAIN BODY POSITION SIDE LYING 45 DEGREE ANGLE W/TRUNK FLEXED & KNEES UP TO ABDOMIN (FETAL)
- GOOD ORAL HYGIENE - NPO & DRY MOUTH FROM ANTICHOLENERGICS
- ADMINISTER IV FLUID THERAPY OR TPN
- WOUND CARE AFTER PANCREATIC SURGERY W/MEASURES TO PREVENT SKIN IRRITATION
NURSING DIAGNOSIS
- IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS…..
- FLUID VOLUME DEFICIT
- INEFFECTIVE BREATHING PATTERNS
- ACUTE PAIN
- RISK FOR INFECTION
- IMPAIRED GAS EXCHANGE
