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sav nur 334 final exam week 7 > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

How is acute pancreatitis defined

A

Premature activation of excessive pancreatic enzymes that destroy pancreatic cells, resulting in autodigestion & fibrosis of pancreas.

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2
Q

acute pancreatitis can range from what

A

mild edema to severe hemorrhagic necrosis

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3
Q

what are the 2 most common causes of acute pancreatitis

A

Gallstones and ETOH

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4
Q

What is the best imaging for pancreatitis

A

CT scan

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5
Q

What characteristics does a CT scan show in pancreatitis

A

diameter,
calcifications,
pancreatic cysts
pseudocysts

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6
Q

2 complications of acute pancreatitis

A

Pseudocyst – cavity (filled w/ necrotic products) surrounding outside of pancreas (resolves spontaneously or perforates into peritoneum)

Abscess – large fluid-containing cavity within pancreas (results in extensive necrosis of pancreas); need prompt surgical drainage

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7
Q

Acute pancreatitis interventions to RELIEVE PAIN

A

IV morphine

Assume positions that flex the trunk (less stretch on peritoneum)

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8
Q

Acute pancreatitis interventions to maintain F&E balance

A

Monitor VS frequently (can be labile)

Monitor for fluid imbalances & electrolyte imbalances

Aggressive IV hydration

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9
Q

Acute pancreatitis interventions to rest/suppress pancreatic enzyme stimulation

A

NPO; meticulous oral care

NG to Low Wall Suction

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10
Q

What do we monitor the stool for in acute pancreatitis

A

steatorrhea which means the body has Impaired protein/fat metabolism. Stool will appear oily & float.

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11
Q

What health promotion do we want to encourage

A

stop ETOH intake

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12
Q

Diet teaching when patient is no longer NPO with acute pancreatitis

A

Diet teaching – CHO encouraged (less stimulating to pancreas); fat restriction

Need fluids!!!

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13
Q

Define Chronic Pancreatitis

A

Progressive, destructive – w/ remissions & flares; caused by inflammation & fibrosis of tissue

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14
Q

What are the Clinical Manifestations of Chronic Pancreatitis

A 
Intense abdominal pain (tenderness less than when acute)
	Mass? – suspect pseudocyst or abscess
	Ascites
	Respiratory compromise
	Steatorrhea
	Dark urine
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15
Q

Do we use pain control in Chronic pancreatitis

A

Yes – opioids used;

however, to be used cautiously (some opioids might increase pain by causing spasms).

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16
Q

Describe Steatorrhea

A 
oily
bulky
floats
greasy
malodorous
17
Q

What is Pancreatic-enzyme replacement therapy (PERT):

A

Standard of care to prevent malnutrition, malabsorption, & excessive weight loss.

18
Q

what is contained in pancrelipase

A

amylase
lipase
protease

19
Q

pancrelipase is given during what

A

What is Pancreatic-enzyme replacement therapy (PERT):

20
Q

What needs to be recorded during Pancreatic-enzyme replacement therapy (PERT):

A

Record number & consistency of stools per day to monitor effectiveness of enzyme therapy.

21
Q

What is the Goal of PERT

A

Goal = less frequent & less fatty stools

22
Q

What are the teaching points of PERT enzyme replacement

A

Take pancreatic enzymes before or with meals and snacks.
Sometimes ordered to administer with antacid or H2 blockers; (because a decreased pH inactivates drug).
Tell the patient to swallow the tablets without chewing to minimize oral irritation.
Avoid lip/skin contact with enzymes. (Wipe lips prn after ingesting.)
Mix the powder form in applesauce or fruit juice at patient’s request.
Do not mix enzyme preparations in protein-containing foods.
Do not crush enteric-coated preparations.

23
Q

What are some considerations with patient weight in chronic pancreatitis

A

Weight loss can be significant:

Sometimes a candidate for TPN

If taking PO, may need up to 4000 to 6000 calories/day to maintain weight.

24
Q

What do patients need to avoid to prevent exacerbation of chronic pancreatitis

A

Avoid things that make your symptoms worse, such as drinking caffeinated beverages.

Avoid alcohol ingestion; refer to self-help group for assistance.

Avoid nicotine.

25
Q

How do patients need to manage nutrition to prevent exacerbation of chronic pancreatitis

A

Eat bland, low-fat, high-protein, high carbohydrate meals; avoid gastric stimulants, such as spices.

Eat small meals and snacks high in calories.

26
Q

what do patients need to consider with medications in Prevention of Exacerbation of Chronic Pancreatitis

A

Take the pancreatic enzymes that have been prescribed for you with meals.

27
Q

Should patients exercise heavily to prevent exacerbation of chronic pancreatitis

A

No, they should Rest frequently; restrict your activity to one floor until you regain your strength.

28
Q

T/F Hyperglycemia should be monitored in acute pancreatitis

A

True, due to impact to the exocrine function

29
Q

Why is there low serum calcium in acute pancreatitis

A

Happens with fat necrosis

30
Q

why is there an increase in serum triglycerides in acute pancreatitis

A

due to fat necrosis

31
Q

why is there an increase in amylase and lipase in acute pancreatitis

A

pancreatic cell injury

32
Q

why do we see Hypovolemia/tachycardia in acute pancreatitis

A

Due to plasma vol being lost as inflammatory mediators released into circulation increase vascular permeability and dilate vessels

33
Q

why do we see cullen’s and turner’s sign in acute pancreatitis

A

pancreatic enzyme leakage into cutaneous tissue

34
Q

why do we see paralytic ileus in acute pancreatitis

A

related peritoneal irritaion causes intestinal motility to slow down/stop

35
Q

why do we see jaundice in acute pancreatitis

A

hepatobiliary obstructive process (elevated bilirubin)

36
Q

why do we see low-grade fever/ leukocytosis in acute pancreatitis

A

inflammatory process

37
Q

why do we see N/V in acute pancreatitis

A

associated with any pain originating in viscera

38
Q

why do we see pain in acute pancreatitis

A

due to distention of pancreas, peritoneal irritation and related inflammation

39
Q

Clinical manifestations in acute pancreatitis

A

pain

N/V

low grade fever/ leukocytosis

jaundice

paralytic ileus

cullen’s & turner’s sign

hypovolemia/tachycardia

increase serum amylase & lipase

increase serum triglycerides

decrease in serum calcium

sav nur 334 final exam week 7 (8 decks)

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