Pancreatitis Flashcards
1
A
Pancreatitis
2
Q
What kind of pancreatitis is this?
- Reversible
- d/t activated pancreatic enzymes auto digesting the pancreas ranging from mild to necrotizing hemorrhagic pancreatitis
A
Acute pancreatitis
3
Q
What kind of pancreatitis is this?
- Irreversible
- Defined as persistent inflammation that causes scarring and damage to the pancreas and surrounding tissue.
A
Chronic pancreatitis
4
Q
Causes of Acute pancreatitis
A
Gallstones, alcohol, infection, tumor, medications, trauma
5
Q
Causes of chronic pancreatitis
A
Repeated episode of pancreatitis, excessive and prolonged consumption of alcohol, cystic fibrosis
6
Q
S/S of Chronic pancreatitis
A
- Chronic epigastric pain / no pain
- Pain ↑ after drinking etoh
- Weight loss
- Jaundice
- DM
- Dark urine
7
Q
S/S of acute pancreatitis
A
- 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
8
Q
bluish discoloration of flank
A
Grey-turners sign
9
Q
bluish discoloration of umbilicus
A
Cullens sign
10
Q
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
A
Chronic pancreatitis
11
Q
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
A
Acute pancreatitis
12
Q
Expected labs for a patient with pancreatitis
A
- 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
13
Q
Risk factors for pancreatitis
A
- Gender: male
- Race: African American
14
Q
What does kind of diet is a patient with pancreatitis put on after dx?
A
- 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
15
Q
A patient with pancreatitis requires gastic decompression, what needs to be done?
A
NG tube
16
Q
Medications used to treat acute Pancreatitis
A
- Opioid analgesics
- Anticholinergics
- Antibiotic
- histamine blocker: cimetidine
- Proton pump inhibitor
- Pancreatic enzymes
17
Q
If pancreatitis is severe how is nutrition provided?
A
enteral or parental nutrition
18
Q
Procedures to treat pancreatitis
A
- Ercp
- Cholecystectomy/sphincterectomy/ endoscopic pancreatic necrosectomy
- Pancreaticjejunostomy
19
Q
How should a patient with pancreatitis be positioned in bed
A
semi-fowlers position or fetal position to relieve ABD pressure
20
Q
Breaks down carbs to glucose
A
Amylase
21
Q
Breaks down proteins
A
Protease
22
Q
Breaks down fat
A
Lipase
23
Q
Medicaition given to acute pancreatitis patients for acute pain
A
Morphine and dilauded
24
Q
Medication given to acute pancreatitis patients for moderate pain
A
Ketorolac or other NSAIDs
25
Medications given to patients with acute pancreatitis to dry up secretions
Anticholinergics
26
Examples of Anticholinergics
Hyoscyamine (levsin)
Scopolamine
27
Medications used to decrease gastric acid secretion in patients with acute pancreatitis
Histamine bockers and Proton pump inhibitors
28
Omeprazole is what kind of medication? what should a patient be monitored for if they are taking it?
Proton pump inhibitor
Hypomagnesemia
29
Example of a histamine
Rnitidine or zantac
30
Is administering pancreatic enzymes and PERT the same thing
No
31
What is PERT
Pancreatic enzyme replacement therapy
32
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)
33
An example of a pancreatic enzyme
Pancrelipase (Ultresa)
34
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
35
What circumstance calls for ABX therapy to be used to treat acute pancreatitis
Necrotic pancreatitis
36
Expected outcomes for acute pancreatitis
Stable VS
Stable weight
Decreasing amylase and lipase levels
Electrolytes WNL
Decreased pain
Decreased liver enzymes
37
Complications associated with Acute pancreatitis
* Necrotizing pancreatits
* Pancreatic hemorrhage
* Pancreatic pseudocyst
* Tetany
* Pleural effusion and atelectasis
* Coagulation deficits
38
# 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
39
Necrotizing pancreatitis can lead to what?
develop sepsis, shock, and multiple-organ failure.
40
# What complication of pancreatitis is this?
* Patients have increased pain
* decreased BP
* tachycardia
* Turner’s and/or Cullen’s signs are present.
Pancreatic hemorrhage
41
encapsulated areas of fluid that contains pancreatic enzymes and tissue. Forms about 4-6 weeks after initial acute episode.
Pancreatic pseudocysts
42
# The following are s/s of what complication of pancreatitis
include chills, fever, N/V, abd. pain.
Pancreatic pseudocysts
43
How are pancreatic pseudocysts treated
* Resolves spontaneously over several weeks.
* Can become abcessed, which would need drained and/or debrided.
44
inflating BP cuff creates a carpal spasm
indicates hypocalcemia
Trousseau sign
45
tapping over facial nerve leads to facial twitching
d/t low calcium
Chvostek sign
46
Tetany is caused by what?
hypomagnesemia and hypocalcemia
47
involuntary muscle contractions and overly stimulated peripheral nerves
Tetany
48
Why does the HCP need to be notified of tetany
Tetany=hypocalcemia
hypocalcemia=cardiacdysrythmias
49
Nursing Dx for acute pancreatitis
* Acute pain
* Ineffective breathing pattern
* Imbalanced nutrition, less that body requirements
50
Expected VS of someone with acute pancreatitis
* Fever and tachycardia
* Tachypnea
* Hypotension
* hypoxemia
51
Pain in a patient with acute pancreatitis
* Pain located in the RUQ or LUQ
* Rebound tenderness
* Muscle guarding/rigid abdominal muscles
52
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
53
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
54
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
55
Patient teaching for acute pancreatitis
Dietary Teaching
No alcohol
No smoking
Disease symptoms, progression, diagnostic procedures, and interventions
56
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
57
Treatment for Chronic pancreatitis
Pain management
IV fluid replacement
Electrolyte management
Nutritional support
Insulin therapy
PERT
Surgery
58
Sx procedures for Chronic hepatitis
Resection
Puestow
59
Treatment of Acute pancreatitis
NPO status
IV fluid-NS or LR
ICU level care, if other organs involved
Treat cause of pancreatitis
60
Nursing dx for Chronic pancreatitis
Acute pain
Imbalanced Nutrition, less than body requirements
Hopelessness
61
Nursing assessment for Chronic Pancreatitis
Vital signs
Monitor lab values
Weight
Pain
Assess abdomen
Assess skin color
Assess stool appearance
62
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.
63
Nursing actions for Chronic pancreatitis
Administer pancreatic enzyme replacement therapy (PERT)
GI Prophylaxis
Provide rest and calm environment
Pain relief measures
Collaborate with dietician
64
Medications for GI prophylasis in patients with chronic pancreatitis
H2 blockers
PPIs
65
Patient teaching for chronic pancreatitis
No alcohol
Do not chew pancreatic enzymes
Limit fat in diet
Avoid food triggers
Support groups
66
what does grey turners sign indicate
acute necritizing pancreatitis
67
what does cullens sign indicate
hemorrhage
