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NURSING 241 (Fall 2018) > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

The nurse teaches a client with chronic pancreatitis about measures to prevent exacerbation of the disease, which information would the nurse include? Select all that apply.
A. Eat bland foods
B. Avoid alcohol ingestion
C. Avoid caffeinated drinks
D. Eat small meals and snacks high in calories
E. Eat high-fat, low-protein, high carbohydrate meals

A

Answer: B, C, D

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2
Q

In a healthy pancreas it has an endocrine/exocrine function. What does each one do?

A

Endocrine: Secretion of insulin to regulate blood glucose
Exocrine: Secretion of digestive enzymes to allow absorption of nutrients in the duodenum
*

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3
Q

In acute pancreatitis, pancreatic enzymes digest the _____ instead of _____ in the duodenum.

A

Pancreas, Nutrients

*The pancreas eats itself

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4
Q

What are 5 local results of “autodigestion”?

A
  • Edema
  • Inflammation
  • Bleeding d/t digestion of vessel walls
  • Cyst in pancreas/abdomen
  • Abscess from cyst
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5
Q

What are 4 systemic results of “autodigestion”?

A
  • Vasodilation and fluid shifting: ascitess and hypotension/shock
  • Multiple organ failure: poor organ perfusion
  • ARDS (acute respiratory distress syndrome)
  • Renal failure
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6
Q

Acute pancreatitis can range from mild to fatal. It all depends on how much of the pancreas has been “eaten”. What is sign in mild and fatal pancreatitis?

A

Mild: Confined to pancreas
Severe (Fatal): Also systemic complications
*It can get that severe that it leads to necrotizing with death of pancreatic tissue

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7
Q

T or F ; Acute pancreatitis is reversible

A

True!

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8
Q

What are the 4 most common causes of acute pancreatitis?

A
  • Alcohol abuse
  • Duodenitis: inflammation of the duodenum
  • PUD (Peptic ulcer disease)
  • Gallstones
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9
Q

What are the 2 risk factors for acute pancreatitis?

A
  • Alcoholism
  • Gallstones
    30% of patients have no known cause
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10
Q

With acute pancreatitis, what is most commonly seen when it comes to the assessment of pain?

A
  • Abrupt onset, continuous severe epigastric abdominal pain, may radiate to back
  • Relieved by sitting up and leaning forward
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11
Q

What most commonly causes pain to start with acute pancreatitis?

A

Starts after fatty meal or increased alcohol intake

*Need opioids to relieve pain

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12
Q

With acute pancreatitis, what is most commonly seen during the GI assessment?

A
  • Nausea, vomiting
  • Abdominal distention and rigidity
  • Decreased bowel sounds
  • Ascites
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13
Q

What are some integumentary S&S that you would see during an assessment for acute pancreatitis?

A
  • Mild jaundice
  • Turner’s sign
  • Cullen’s sign
  • Hypotension
  • Elevated temperature
  • Cold clammy skin
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14
Q

_____ sign appears as a blue discoloration/bruising on the flanks, and is a sign of retroperitoneal hemorrhage, or bleeding behind the peritoneum.

A

Turner’s sign

*Takes 24 to 48 hrs to develop, and can predict a severe attack of acute pancreatitis

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15
Q

______ sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus

A

Cullen’s sign

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16
Q

What are the 5 diagnostic studies for acute pancreatitis?

A
  • Amylase (30-170)
  • Lipase (14 - 280)
  • WBC (elevated)
  • Blood glucose (elevated d/t insulin supply being affected)
  • US/CT
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17
Q

What is a normal amylase and lipase level?

A

Amylase: 30-170 u/L
Lipase: 14-280 u/L

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18
Q

What is the nursing care for pain control for acute pancreatitis?

A
  • Opioid analgesics such as morphine or hydromorphone

- Regular dosing

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19
Q

How would an NG tube be used for pain control for acute pancreatitis?

A

It removes the stimulus of pain by removing gastric secretions
- Remember to do frequent oral hygiene, maintain patency and suction

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20
Q

What is the nursing care to improve breathing patterns for acute pancreatitis?
*Pt may be hypoxic

A
  • Semi fowler’s position
  • Check pulse Ox
  • Auscultate lungs
  • Frequent position changes
21
Q

What 4 medications are commonly used in the nursing care for acute pancreatitis?

A
  • Antibiotics
  • Morphine or hydromorphone (Dilaudid)
  • Ranitidine (Zantac)
  • Omeprazole (Prilosec)
22
Q

What do Zantac and Prilosec do in the body?

A

Decrease pH in the stomach

23
Q

What is the nursing care for fluid and electrolyte balance?

A
  • I&O, daily weight
  • Abdominal girth
  • Hypovolemia (decreased blood volume)
  • IV fluids/TPN/Enteral feedings
  • Monitor electrolyte levels (Fluid and electrolyte shifts)
24
Q

What is the nursing care for nutrition?

A
  • Antiemetics as needed
  • Daily weights, I&O
  • Monitor bowel sounds
  • Blood glucose checks q 4-6 hrs
  • Administer TPN/jejunal enteral feeding
  • High carbohydrate/low fat diet when client resumes eating
  • *IF ENCEPHALOPATHY—RESTRICT PROTEIN
25
Q

A _____ tube empties into the jejunum and so it avoids the duodenum and pancreatic enzyme release

A

Jejunal tube

26
Q

What are 3 advantages of a jejunal feeding?

A

Maintains bowel function

  • Supports immune function
  • Fewer complications than TPN
27
Q

What is the nursing care for an enteral tube feeding?

A
  • Correct formula and rate
  • Verify placement by xray
  • Check blood glucose q 4 to 6 hrs
  • Chick site for irritation
  • Secure tube per policy
28
Q

What is the nursing care for the patient that is at risk for aspiration d/t acute pancreatitis?

A

HOB elevated 30 degrees

  • Turn off feeding when HOB is lowered
  • Check residual q 4 hrs: may not be able to do this d/t small diameter of tube
29
Q

What are some complications that come with enteral therapy?

A
  • Diarrhea
  • Tube displacement
  • Tube obstruction (Check if tube may be used for med administration because it clogs easily d/t small diameter)
  • Hyperglycemia
30
Q

What are the 4 focuses for treatment of acute pancreatitis?

A
  • Pain management
  • IVF to maintain vascular volume
  • Elimination of PO intake (decreased pancreatic enzyme secretion)
  • Antibiotics (prevent or treat abscess formation)
31
Q

What is the cycle of chronic pancreatitis?

A

Chronic inflammation of pancreas -> Fibrosis of pancreas -> Obstruction of ducts and decreased endocrine function

32
Q

T or F ; Chronic pancreatitis is irreversible and causes physical changes to pancreas

A

TRUE

33
Q

What are the 3 risk factors of chronic pancreatitis?

A
  • Alcohol abuse: should not drink alcohol at all
  • Duct obstruction
  • Dyslipidemia (abnormally elevated cholesterol or fats)
34
Q

What are the 3 risk factors of chronic pancreatitis?

A
  • Alcohol abuse
  • Cystic fibrosis
  • Thiazide diuretics
35
Q

Surgery is the most common medical treatment for acute pancreatitis. Why would surgery be done?

A
  • To improve drainage of enzymes
  • To relieve pain
  • To decrease frequency of attacks
  • Will require multiple procedures!
36
Q

What is the assessment of pain that occurs with chronic pancreatitis?

A
  • Recurrent, epigastric/LUQ abdominal pain
  • Lasts days to weeks (Flares up)
  • Need opioids to relieve pain
37
Q

What is the assessment of GI problems that occurs with chronic pancreatitis?

A
  • Anorexia, nausea, vomiting
  • Weight loss (Eat and eat but cannot absorb nutrients)
  • Constipation
  • Steatorrhea
  • Eating can make chronic pancreatitis worse
38
Q

The excretion of abnormal quantities of fat with the feces owing to reduced absorption of fat by the intestine

A

Steatorrhea

39
Q

What are 5 complications that can occur with chronic pancreatitis?

A

Malabsorption/malnutrition

  • Diabetes mellitus (Make sure to draw a fasting glucose to make sure it is accurate)
  • Pancreatic pseudocyst or abscess
  • Stricture of common bile duct (May require stents to keep open)
  • Opioid addiction
40
Q

What are the 3 diagnostic studies for chronic pancreatitis?

A
  • ERCP: looks at the duct
  • MRI and CT: abscess or cyst present?
  • Fecal fat content
41
Q

What is the nursing care to monitor the pain of chronic pancreatitis?

A
  • Opioids: stool softeners should be used for constipation

- Higher doses to manage chronic pain

42
Q

What is the nursing care to manage nutrition?

A
  • Pancrealipase to help digest fat/proteins
  • Fat soluble vitamin replacement
  • CC diet if DM develops
43
Q

How does Pancrelipase work?

A

Increased digestion of carbs, fats, and proteins in the GI

44
Q

What are the side effects of Pancrelipase?

A

Diarrhea
stomach cramping
nausea

45
Q

What are the nursing actions for Pancrelipase?

A
  • Give after antacids/at least 1 hr in between
  • Give with food
  • Swallow tablets whole
  • Have clients rinse mouth and wipe lips after taking as this drug can breakdown the oral mucosa
  • Can open capsule and sprinkle on non protein foods
46
Q

How do you evaluate the effectiveness of Pancrelipase?

A
  • Check for less fatty stools

- Weight

47
Q

What are 4 areas for client education of chronic pancreatitis?

A
  • DM management if needed
  • Pain medication
  • Pancrelipase therapy
  • No alcohol
48
Q 
The nurse is caring for a client with a history of alcoholism. Which findings would indicate that the client has possible developed chronic pancreatitis? Select all that apply. 
A. Steady weight gain
B. Flank pain on right side only
C. Fatty stools
D. Excessive hunger
E. Nausea and vomiting
A

Answer: C, E

49
Q

When BK asks how acute pancreatitis develops, what is the nurse’s best response?
A. This happens when the pancreas is damaged by eating spicy foods combined with alcohol
B. Tumors of the pancreas or bowel cause this
C. Gallstones or alcohol use cause pancreatic enzymes to digest the pancreas
D. People with poorly controlled diabetes develop acute pancreatitis

A

Answer: C

NURSING 241 (Fall 2018) (10 decks)

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