Pancreatitis

Question 1

the following flashcards are based on the in class lecture recording about pancreatitis

Question 2

what is pancreatitis?

Answer 2

acute inflammation of pancreas

Question 3

what is the function of the pancreatitis ?

Answer 3

secretion of the insulin
malnutrition - help with absorption

Question 4

remember patients with pancreatitis can have insulin issues and results in them getting what?

Answer 4

secondary diabetes
- hyperglycemia

Question 5

what is the patho behind acute pancreatitis ?

Answer 5

spillage of pancreatic enzymes into surrounding pancreatic issue causing auto digestion and severe pain ( pretty much eating your own pancreas )

Question 6

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?

Answer 6

atelectatisis
pneumonia

Question 7

what is the most common cause for pancreatitis?

Answer 7

alcohol use
gallbladder disease
drug reactions
hypertriglyceridemia

Question 8

what are the clinical manifestation for a patient with acute pancreatitis ?

Answer 8

left upper quadrant or mid-epigastric pain
that can radiate to back

Question 9

why is eating worse for patients with pancreatitis ? like why do you think eating worsens the pain for these patients?

Answer 9

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

Question 10

patients in pain will usually throw up, however with pancreatitis, what happens ?

Answer 10

your pain will not be relieved with vomiting

Question 11

when doing an abdominal assessment what are the 3 things you will find with patients with pancreatitis?

( these are your basic ones )

Answer 11

abdominal ( rebound ) tenderness

muscle guarding

decreased or absent bowel sounds

Question 12

why might we hear crackles in the lungs for a patient who has pancreatitis ?

Answer 12

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

Question 13

what are the 2 abdominal skin discoloration signs?

Answer 13

grey turners spots/sign
Cullens sign

Question 14

what is grey turners sign mean?

Answer 14

ecchymosis left flank
( because bleeding of the pancreas, so we are seeing the bruising on the left flank/back)

Question 15

what is Cullens sign?

Answer 15

periumbilical ecchymosis

Question 16

what are the 3 complication we are going to talk about when it comes to pancreatitis?

Answer 16

pseudocyst
pancreatic abscess
systemic complications

Question 17

what is psydocyst and why is it a complication for pancreatitis? (2 things here)

Answer 17

fluid, pancreatic enzyme, debris and exudates surrounded by wall

it can cause additional pain and may perforate and cause peritonitis

Question 18

how can we detect a pseudocyst?

how can we treat a pseudocyst? (2)

Answer 18

detect by imaging or palpable mass

resolves on its own or surgery

Question 19

what is a pancreatic abscess?

what is our main concern with this ?

treatment?

Answer 19

an infected pseudocyst

development of sepsis if it perforates

need prompt surgical drainage

Question 20

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

Answer 20

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 )

Question 21

why are we concerned for hypocalcemia ?

Answer 21

the laryn spams, we are concerned for their breathing cause of the tetany

Question 22

what are the 2 main labs we are going to check for diagnostic studies for pancreatitis?

Answer 22

increase
amylase & lipase

Question 23

most of the time, patients who have pancreatitis, we want them to be on what? and why?

Answer 23

NPO
because remember those enzymes are going to be activated from the food and having to digest it

Question 24

what is the way we are going to make sure these patients are receiving their food and why ?

Answer 24

TPN

the reason is because enteral foods are still going to cause the pancreas to work and secrete those enzymes and cause more inflammation

Question 25

we are also concerned for these patients developing septic shock, so what are we going to look for (4)

Answer 25

fever hypotension dic tachycardia

Question 26

how do we treat with sepsis shock ?

Answer 26

fluid bolus and go from there

Question 27

if a patient is going into septic shock and we treat them with fluid and nothing happens, what is our next step?

Answer 27

vasopressors like dopamine

Question 28

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?

Answer 28

we are not stimulating the pancreas so its causing more of a problem

Question 29

why do we give antibiotics to these patients?

Answer 29

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

Question 30

what type of medication will be use to help with pain?

Answer 30

iv morphine

Question 31

we are also going to be monitoring oxygenation status for pancreatitis, can you tell me why this might be the case?

Answer 31

again, painful to breathe, so we must know if they are breathing properly

Question 32

if patients have gallstones that are causing the pancreatitis, what can we do ?

Answer 32

remove the gallstones or the gallbladder in general

Question 33

what other medication just than just morphine can we give patients who are in pain with pancreatitis?

Answer 33

antispasmodics to help with the spams the pancreas may be causing

Question 34

what is a medication that we can use to help patients decrease their pancreatic secretions when they have pancreatitis?

Answer 34

carbonic anhydrase inhibitor

Question 35

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?

Answer 35

small, frequent high carbohydrate meals and fat soluble vitamins

Question 36

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?

Answer 36

proton pump inhibitors no blood in stools

Question 37

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

Question 38

why are patients restlessness, anxious ?

Answer 38

because pain to breathe, hypoxic because of the lack of oxygen reaching in the body

Question 39

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

Question 40

what are their labs going to look like? (3)

Answer 40

increase amylase/lipase hyperglycemia hypocalcemia

Question 41

more than likely we are going to need to give them ___for their hyperglycemia

Answer 41

insulin

Question 42

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

Question 43

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

Question 44

Acute care Monitoring vital signs Hypotension, fever, tachypnea Monitor response to IV fluids Closely monitor fluid and electrolyte balance Assess respiratory function

Question 45

Acute care Monitor fluid and electrolyte balance Chloride, sodium, and potassium Hypocalcemia Tetany Calcium gluconate to treat Hypomagnesemia

Question 46

TEST QUESTION THE FIRST THING YOU ARE GOING TO DO WHEN A PATIENT IS NOT HAVING GOOD OXYGENATION STATUS IS WHAT?

Answer 46

MANAGE THEIR PAIN

Question 47

how do we treat hypocalcemia ? emergency medication

Answer 47

calcium gluconate

Question 48

what do we see if a patient has low magnesium? (4)

Answer 48

hyper-reflexes increase rr diarrhea hypertension

Question 49

what might be a position of comfort for a patient who is having pancreatitis that we can encourage patient to do ? (2)

Answer 49

flex truck and draw knees ( curling up like a ball ) side lying with hob at 45 degrees

Question 50

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

Question 51

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)

Question 52

what is chronic pancreatitis?

Answer 52

continuous, prolonged inflammatory and fibrosing process of the pancreas

Question 53

she just says its low grade persistent pancreatitis