Pancreatitis Flashcards
What’s the major exocrine function of the pancreas?
Facilitate digestion through the secretion of enzymes and hormones into proximal duodenum
What enzymes/hormones are secreted by the pancreas?
Secretin, Cholecytokinin-pancreozymin (CCK and PCZ) and protein/fat digestion
What is pancreatitis?
Inflammation of the pancreas from autodigestion
Obstruction of pancreatic duct, hypersection of the exocrine enzymes of the pancreas, which enter the bile duct and reflux into the pancreatic duct causes what?
Pancreatitis
What is the chief complaint in acute pancreatitis?
PAIN
What is autodigestion?
Process where the pancreatic enzymes destroy its own tissue leading to inflammation
What is acute pancreatitis?
Digestion of the pancreas by trypsin, usually from long-term alcohol use or can be from trauma or a viral infection
What’s the nursing assessment for acute pancreatitis?
Severe abd pain, acute and more severe after meals, abd guarding, N/V, hypotension, resp. distress and hypoxia
Serum amylase and lipase, elevated WBC and H/H are what?
Lab studies performed
What diagnostics can be performed?
CT scans or ultrasounds
What is done to establish pancreatic drainage or debride a necrotic pancreas?
Surgical intervention
What type of dressing are ordered for necrotic wounds that are left OPEN?
Wet-to-dry
What postacute management is done for acute pancreatitis?
Antacids and oral feedings (low fat, proteins)
What is Endoscopic Retrograde Cholangipancreatography (ERCP)?
Is to diagnose chronic pancreatitis and to differentiate inflammation and fibrosis from cacrinoma
Nursing measures to reduce pain and discomfort in a pt w/ acute pancreatitis?
Admin Meperidine (Demoral)*, Dilaudid or morphine; NPO TPN instead; NGT suction if needed; bed rest; report sudden increase in pain bc of possible perforation
Nursing measures to improve breathing pattern in a pt w/ acute pancreatitis?
Semi-fowlers; anticholinergic meds; pulse ox; C/DB exercises and useing IS
Nursing measures to improve nutritional status?
Daily weights and nutritional labs (albumin/protein); TPN; diet high in carbs and low in fats/protein; ne heavy meals or alcohol
What should be checked if a pt is on TPN and how often?
Glucose; q6hr
Nursing measures to prevent F/E imbalances?
I/O; wts; monitor for ascities; IVF; blood transfusions; be alert for s/s of shock
What can cause F/E imbalances?
N/V; NGT suction; fever
What are s/s of shock?
Hypotension; tachycardia and pale skin
Nursing measures to prevent pancreaticc necrosis?
Monitor VS; IV’s; and possible ventilatory support
What is the major cause of morbidity and mortality?
Pancreatic necrosis
What are risks from pancreatic necrosis?
Hemorrhage, septic shock, multiple organ failure
Nursing measures to prevent shock and multiple organ failure?
Monitor CV, renal and resp. s/s
Nursing measures to improve skin integrity?
Assess wounds and drain sites; consult w/ ET/WOC nurse; turn q2h; use specialty beds and assess for poor wound healing
What is chronic pancreatitis?
Inflammatory disorder characterized by progressive anatomic and functional destruction of the pancreas
Chronic alcohol abuse, hereditary disorders of the pancreas, cystic fibrosis, hypercalcemia, hyperlipidemia, meds, autoimmune conditions and either unknown are causes of what?
Chronic pancreatitis
Modify behaviors that may exacerbate the natural history of the disease; enable the pancreas to heal itself; determine the cause of the abd pain and alleviate it; detect pancreatic exocrine insufficiency and restore digestion and absorption to normal and diagnose and treat endocrine insufficiency is what?
Th goals of medical treatment for chronic pancreatitis
Pancreatic pseudocyst; abscess; fistula; ascities; fixed obstruction of the intrapancreatic portion of the distal common bile duct; stenosis of the duodenum w/ gastric outlet observation and variceal hemorrhage due to splenic vein thrombosis are all indications of what?
Surgical management
What are pseudocysts?
Encapsulated collections of fluid that may develop w/in the pancreas and in the abd cavity
What is a fistula?
An abnormal connection b/t organs