Pancreatitis Flashcards
Pancreatitis
What kind of pancreatitis is this?
- Reversible
- d/t activated pancreatic enzymes auto digesting the pancreas ranging from mild to necrotizing hemorrhagic pancreatitis
Acute pancreatitis
What kind of pancreatitis is this?
- Irreversible
- Defined as persistent inflammation that causes scarring and damage to the pancreas and surrounding tissue.
Chronic pancreatitis
Causes of Acute pancreatitis
Gallstones, alcohol, infection, tumor, medications, trauma
Causes of chronic pancreatitis
Repeated episode of pancreatitis, excessive and prolonged consumption of alcohol, cystic fibrosis
S/S of Chronic pancreatitis
- Chronic epigastric pain / no pain
- Pain ↑ after drinking etoh
- Weight loss
- Jaundice
- DM
- Dark urine
S/S of acute pancreatitis
- 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
bluish discoloration of flank
Grey-turners sign
bluish discoloration of umbilicus
Cullens sign
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
Chronic pancreatitis
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
Acute pancreatitis
Expected labs for a patient with pancreatitis
- 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
Risk factors for pancreatitis
- Gender: male
- Race: African American
What does kind of diet is a patient with pancreatitis put on after dx?
- 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
A patient with pancreatitis requires gastic decompression, what needs to be done?
NG tube
Medications used to treat acute Pancreatitis
- Opioid analgesics
- Anticholinergics
- Antibiotic
- histamine blocker: cimetidine
- Proton pump inhibitor
- Pancreatic enzymes
If pancreatitis is severe how is nutrition provided?
enteral or parental nutrition
Procedures to treat pancreatitis
- Ercp
- Cholecystectomy/sphincterectomy/ endoscopic pancreatic necrosectomy
- Pancreaticjejunostomy
How should a patient with pancreatitis be positioned in bed
semi-fowlers position or fetal position to relieve ABD pressure
Breaks down carbs to glucose
Amylase
Breaks down proteins
Protease
Breaks down fat
Lipase
Medicaition given to acute pancreatitis patients for acute pain
Morphine and dilauded
Medication given to acute pancreatitis patients for moderate pain
Ketorolac or other NSAIDs
Medications given to patients with acute pancreatitis to dry up secretions
Anticholinergics
Examples of Anticholinergics
Hyoscyamine (levsin)
Scopolamine
Medications used to decrease gastric acid secretion in patients with acute pancreatitis
Histamine bockers and Proton pump inhibitors
Omeprazole is what kind of medication? what should a patient be monitored for if they are taking it?
Proton pump inhibitor
Hypomagnesemia
Example of a histamine
Rnitidine or zantac
Is administering pancreatic enzymes and PERT the same thing
No
What is PERT
Pancreatic enzyme replacement therapy
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
Pancrelipase (Ultresa)
An example of a pancreatic enzyme
Pancrelipase (Ultresa)
Teaching points for Pancrelipase (Ultresa)
- 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
What circumstance calls for ABX therapy to be used to treat acute pancreatitis
Necrotic pancreatitis
Expected outcomes for acute pancreatitis
Stable VS
Stable weight
Decreasing amylase and lipase levels
Electrolytes WNL
Decreased pain
Decreased liver enzymes
Complications associated with Acute pancreatitis
- Necrotizing pancreatits
- Pancreatic hemorrhage
- Pancreatic pseudocyst
- Tetany
- Pleural effusion and atelectasis
- Coagulation deficits
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.
Necrotizing pancreatitis
Necrotizing pancreatitis can lead to what?
develop sepsis, shock, and multiple-organ failure.
What complication of pancreatitis is this?
- Patients have increased pain
- decreased BP
- tachycardia
- Turner’s and/or Cullen’s signs are present.
Pancreatic hemorrhage
encapsulated areas of fluid that contains pancreatic enzymes and tissue. Forms about 4-6 weeks after initial acute episode.
Pancreatic pseudocysts
The following are s/s of what complication of pancreatitis
include chills, fever, N/V, abd. pain.
Pancreatic pseudocysts
How are pancreatic pseudocysts treated
- Resolves spontaneously over several weeks.
- Can become abcessed, which would need drained and/or debrided.
inflating BP cuff creates a carpal spasm
indicates hypocalcemia
Trousseau sign
tapping over facial nerve leads to facial twitching
d/t low calcium
Chvostek sign
Tetany is caused by what?
hypomagnesemia and hypocalcemia
involuntary muscle contractions and overly stimulated peripheral nerves
Tetany
Why does the HCP need to be notified of tetany
Tetany=hypocalcemia
hypocalcemia=cardiacdysrythmias
Nursing Dx for acute pancreatitis
- Acute pain
- Ineffective breathing pattern
- Imbalanced nutrition, less that body requirements
Expected VS of someone with acute pancreatitis
- Fever and tachycardia
- Tachypnea
- Hypotension
- hypoxemia
Pain in a patient with acute pancreatitis
- Pain located in the RUQ or LUQ
- Rebound tenderness
- Muscle guarding/rigid abdominal muscles
Why would a patient with acute pancreatitis have an elevated glucose level
Glucose elevations due to the digestion of the pancreas, which leads to decreased production and availability of insulin
Nursing assessment for Acute pancreatitis
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
Nursing actions for acute pancreatitis
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
Patient teaching for acute pancreatitis
Dietary Teaching
No alcohol
No smoking
Disease symptoms, progression, diagnostic procedures, and interventions
Dietary teaching for a patient with pancreatic cancer
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
Treatment for Chronic pancreatitis
Pain management
IV fluid replacement
Electrolyte management
Nutritional support
Insulin therapy
PERT
Surgery
Sx procedures for Chronic hepatitis
Resection
Puestow
Treatment of Acute pancreatitis
NPO status
IV fluid-NS or LR
ICU level care, if other organs involved
Treat cause of pancreatitis
Nursing dx for Chronic pancreatitis
Acute pain
Imbalanced Nutrition, less than body requirements
Hopelessness
Nursing assessment for Chronic Pancreatitis
Vital signs
Monitor lab values
Weight
Pain
Assess abdomen
Assess skin color
Assess stool appearance
Pain management in patients with Chronic pancreatitis
Pain may be managed with the administration of opioids initially and then with non-opioids when the pain is less intense.
Nursing actions for Chronic pancreatitis
Administer pancreatic enzyme replacement therapy (PERT)
GI Prophylaxis
Provide rest and calm environment
Pain relief measures
Collaborate with dietician
Medications for GI prophylasis in patients with chronic pancreatitis
H2 blockers
PPIs
Patient teaching for chronic pancreatitis
No alcohol
Do not chew pancreatic enzymes
Limit fat in diet
Avoid food triggers
Support groups
what does grey turners sign indicate
acute necritizing pancreatitis
what does cullens sign indicate
hemorrhage
