Pancreatitis Flashcards
the following flashcards are based on the in class lecture recording about pancreatitis
what is pancreatitis?
acute inflammation of pancreas
what is the function of the pancreatitis ?
secretion of the insulin
malnutrition - help with absorption
remember patients with pancreatitis can have insulin issues and results in them getting what?
secondary diabetes
- hyperglycemia
what is the patho behind acute pancreatitis ?
spillage of pancreatic enzymes into surrounding pancreatic issue causing auto digestion and severe pain ( pretty much eating your own pancreas )
pancreas sits right under your diaphragm in the left upper quadrant. what is crazy about this is that the pain can be so bad, that It can impair patients from breathing properly, so what are we worried about as nurses?
atelectatisis
pneumonia
what is the most common cause for pancreatitis?
alcohol use
gallbladder disease
drug reactions
hypertriglyceridemia
what are the clinical manifestation for a patient with acute pancreatitis ?
left upper quadrant or mid-epigastric pain
that can radiate to back
why is eating worse for patients with pancreatitis ? like why do you think eating worsens the pain for these patients?
remember when you eat, your pancreas becomes activated to help secrete those enzymes, however enzymes are inflamed and infected, so the pain gets worse when you eat
patients in pain will usually throw up, however with pancreatitis, what happens ?
your pain will not be relieved with vomiting
when doing an abdominal assessment what are the 3 things you will find with patients with pancreatitis?
( these are your basic ones )
abdominal ( rebound ) tenderness
muscle guarding
decreased or absent bowel sounds
why might we hear crackles in the lungs for a patient who has pancreatitis ?
because of the fact they are not taking deep breaths from the pain the pancreas is causing them to experience especially after they eat when those enzymes are secreted to help digest the food
what are the 2 abdominal skin discoloration signs?
grey turners spots/sign
Cullens sign
what is grey turners sign mean?
ecchymosis left flank
( because bleeding of the pancreas, so we are seeing the bruising on the left flank/back)
what is Cullens sign?
periumbilical ecchymosis
what are the 3 complication we are going to talk about when it comes to pancreatitis?
pseudocyst
pancreatic abscess
systemic complications
what is psydocyst and why is it a complication for pancreatitis? (2 things here)
fluid, pancreatic enzyme, debris and exudates surrounded by wall
it can cause additional pain and may perforate and cause peritonitis
how can we detect a pseudocyst?
how can we treat a pseudocyst? (2)
detect by imaging or palpable mass
resolves on its own or surgery
what is a pancreatic abscess?
what is our main concern with this ?
treatment?
an infected pseudocyst
development of sepsis if it perforates
need prompt surgical drainage
the following is going to be systemic complications that can occur in patients with acute pancreatitis, your job is going to be to tell me how this occurs in the first place.
Pleural effusion
atelectasis
pneumonia
ards
hypotension
DIC
hypocalcemia : tetany
pleural effusion occurs from the fact that the fluid can shift upwards and cause pain
atelectasis -> pneumonia due to the pain being so bad and the pancreas sits under the diaphragm, so they aren’t going to be taking deep breaths
patient with pancreastisi are at high risk of sepsis, and the number one cause for ards is sepsis. so the development of ards is very scary
hypotension due to the lack of clotting factors and the risk of sepsis occurring
dic due to that sepsis risk
( looking at their level of consciousness )
why are we concerned for hypocalcemia ?
the laryn spams, we are concerned for their breathing cause of the tetany
what are the 2 main labs we are going to check for diagnostic studies for pancreatitis?
increase
amylase & lipase
most of the time, patients who have pancreatitis, we want them to be on what? and why?
NPO
because remember those enzymes are going to be activated from the food and having to digest it
what is the way we are going to make sure these patients are receiving their food and why ?
TPN
the reason is because enteral foods are still going to cause the pancreas to work and secrete those enzymes and cause more inflammation
we are also concerned for these patients developing septic shock, so what are we going to look for (4)
fever
hypotension
dic
tachycardia
how do we treat with sepsis shock ?
fluid bolus and go from there
if a patient is going into septic shock and we treat them with fluid and nothing happens, what is our next step?
vasopressors like dopamine
we need to make sure we are feeding the patient enough so they are able to survive and have the energy they need. however we need to make sure of what?
we are not stimulating the pancreas so its causing more of a problem
why do we give antibiotics to these patients?
because of the risk of infection and how everything is being disrupted and could potential cause septic shock, it would not be good to have a even more severe infection
what type of medication will be use to help with pain?
iv morphine
we are also going to be monitoring oxygenation status for pancreatitis, can you tell me why this might be the case?
again, painful to breathe, so we must know if they are breathing properly
if patients have gallstones that are causing the pancreatitis, what can we do ?
remove the gallstones or the gallbladder in general
what other medication just than just morphine can we give patients who are in pain with pancreatitis?
antispasmodics to help with the spams the pancreas may be causing
what is a medication that we can use to help patients decrease their pancreatic secretions when they have pancreatitis?
carbonic anhydrase inhibitor
usually we want to keep the patient NPO for at least the first 24 hours and typically depending on the severity start off with enteral feedings, but in severe cases go to parenteral.
but typically what is their diet going to look like?
small, frequent high carbohydrate meals and fat soluble vitamins
these patients are very stress, and very sick. so they are at risk for developing stress ulcers, what can help us prevent that?
how can we tell that its working?
proton pump inhibitors
no blood in stools
nursing assessment - subjective notes
Health history
Biliary tract disease
Alcohol use
Abdominal trauma
Duodenal ulcers
Infection
Metabolic disorders
Medications
Thiazides
NSAIDs
Surgery or other treatments
Pancreas, stomach, duodenum, biliary tract
ERCP
Alcohol use
Fatigue
Nausea, vomiting, anorexia
Dyspnea
Pain
why are patients restlessness, anxious ?
because pain to breathe, hypoxic because of the lack of oxygen reaching in the body
nursing assessment - objective
Restlessness, anxiety, low-grade fever
Flushing, diaphoresis
Discoloration of abdomen/flank
Cyanosis
Jaundice
Decreased skin turgor
Dry mucous membranes
Tachypnea
Basilar crackles
Tachycardia
Hypotension
Abdominal distention/tenderness
Diminished bowel sounds
what are their labs going to look like? (3)
increase amylase/lipase
hyperglycemia
hypocalcemia
more than likely we are going to need to give them ___for their hyperglycemia
insulin
acute pancreatitis
clinical problems
Pain
Fluid imbalance
Electrolyte imbalance
Nutritionally compromised
planning
Patient will have
Relief of pain
Normal fluid and electrolyte balance
Minimal to no complications
No recurrent attacks
acute pancreatitis
Health promotion
assessment of patient for predisposing and etiologic factors
Encouragement of early treatment of these factors
Elimination of alcohol intake
Early diagnosis/treatment of biliary tract disease
Acute care
Monitoring vital signs
Hypotension, fever, tachypnea
Monitor response to IV fluids
Closely monitor fluid and electrolyte balance
Assess respiratory function
Acute care
Monitor fluid and electrolyte balance
Chloride, sodium, and potassium
Hypocalcemia
Tetany
Calcium gluconate to treat
Hypomagnesemia
TEST QUESTION
THE FIRST THING YOU ARE GOING TO DO WHEN A PATIENT IS NOT HAVING GOOD OXYGENATION STATUS IS WHAT?
MANAGE THEIR PAIN
how do we treat hypocalcemia ?
emergency medication
calcium gluconate
what do we see if a patient has low magnesium? (4)
hyper-reflexes
increase rr
diarrhea
hypertension
what might be a position of comfort for a patient who is having pancreatitis that we can encourage patient to do ? (2)
flex truck and draw knees
( curling up like a ball )
side lying with hob at 45 degrees
Acute care
Observation for signs of infection
TCDB, semi-Fowler’s position
Observation for paralytic ileus, renal failure, mental changes
Monitor serum glucose
Postop wound care
Ambulatory care
Physical therapy
Counseling regarding abstinence from alcohol and smoking
Ambulatory care
Dietary teaching
Low-fat, high-carbohydrate
No crash diets
Patient/family teaching
Signs of infection, diabetes, steatorrhea
Exogenous enzyme supplementation
Expected outcomes
Have adequate pain control
Maintain adequate fluid and electrolyte balance
Be knowledgeable about treatment plan to restore health
Get help for alcohol use and smoking cessation (if needed)
what is chronic pancreatitis?
continuous, prolonged inflammatory and fibrosing process of the pancreas
she just says its low grade persistent pancreatitis
