Pancreatitis Flashcards
Pancreas Physiology: exocrine functions (3)
- highly alkaline secretions: neutralize gastric juices in duodenum
- amylase, lipase, and proteases: digestion
- secretin secreted in duodenum at contact with gastric juices leads to secretions of pancreatic juices
Pancreas Physiology: endocrine functions
insulin, glucagon and somatostatin production
In acute pancreatitis what does the nurse need to assess for in the patient’s history?
assess hx of gallstones and alcohol abuse
S/s mild pancreatitis
confined edema and inflammation, minimal organ dysfunction
s/s severe pancreatitis (6)
widespread enzyme digestion, necrosis, peritonitis, pulmonary insufficiency, GI Bleeding, shock
reflux of bile acids with activation and black flow of pancreatic juices –>
autodigestion with blood vessel damage and loss of blood: increased serum lipase, amylase
Clinical manifestations of acute pancreatitis (6)
- abdominal pain (sudden), back pain, N/V
- low-grade fever, leukocytosis
- hypotension, tachycardia, tachypnea
- muscle guarding, rigid-board like abdomen (peritonitis)
- abdominal distention, decreased bowel sounds
- crackles, pulmonary infiltrates
Why do crackles manifest in acute pancreatitis?
they result from exudate with enzymes collected by the lymphatic system
2 signs and lab results for acute pancreatitis
- grey turner’s sign
- cullen’s sign
- If Cullens and grey turners –> possible peritonitis
- elevated serum amylase and lipase
Clinical manifestations of acute pancreatitis (what can happen in the lungs)
-pleural effusion, atelectasis, PNA
Acute pancreatitis complications: Fat necrosis, hypocalcemia
-lipase released from pancreatic cells start digesting fatty acids, attracting calcium in the process –> fatty acids combine with calcium to produce chalky-white areas called fat saponification
Clinical manifestations of hypocalcemia (3)
- Trousseau sign (carpal spasm)
- Chvostek sign (face twitching)
- lip, finger, extremity numbness
Criteria for predicting severity of pancreatitis: criteria on admission to the hospital (5)
- age > 55
- serum WBC > 16,000 mm
- serum glucose > 200 mg/dL
- serum lactose dehydrogenase > 350 IU/ L
- AST > 250 IU/ L
Criteria for predicting severity of pancreatitis: signs and mortality (4)
two or fewer signs: 1% mortality
3 or four signs: 15% mortality
5 or 6 signs: 40% mortality
6 or more signs: 100% mortality
Acute pancreatitis: diagnostic studies (4)
- Labs: serum amylase and lipase, calcium (decrease), WBC (increase)
- abdominal US, X-ray, CT, MRI
- H/H
- ERCP (if suspicion of gallstone pancreatitis)
Acute pancreatitis goals for collaborative care: decrease inflammation (5)
- effective respiratory function (priority)
- prevention or tx of shock
- relief of pain
- FE balance (monitor calcium –> lip/finger numbness, trousseau, chvostek and magnesium) glucose
- prevent infection (PNA/ peritonitis)/treat cause
acute pancreatitis: conservative treatment (9)
- respiratory care priority: semi-fowlers, pulmonary assessment, oxygen, pulse oximeter, C&DM, IS
- prevention and treatment of hypovolemic/septic shock
- early antimicrobials, prevention of infection (PNA/peritonitis)
- pain management: opioids
- maintenance of fluid balance: IV hydration and albumin
- NPO, preferred enteral feedings, when not possible TPN, PPN
- monitor nutritional status
- NG tube: relief of nausea, vomiting, digestion
- biliary drainage
Acute pancreatitis: conservative treatment (medications) (2)
- H2 receptor blockers (famotidine, ranitidine): decrease pancreatic activity by decrease secretion of gastric acid
- PPIs (pantoprazole-protonix): first line treatment for decrease of acidity from gastric juice and secretion volume; max 8 weeks
adverse effects of protonix (3)
higher risk for PNA, depression in older adults, and kidney failure
Acute pancreatitis: surgical tx (4) and risks (1)
- ERCP plus sphincterotomy if obstruction is present
- possible cholecystectomy
- excision of pseudocysts and abscesses
- partial pancreatectomy, pancreatojejuostomy
-RISK FOR BLEEDING AND PERFORATION
Parenteral nutrition
Central PN (TPN): D20-D50 peripheral PN (PPN): D10-D20
Goal for parenteral nutrition
meet nutritional needs, healing
Parenteral nutrition: intravenous fat emulsions (3)
- concurrent with TPN, slow rate (around 8ml/h)
- rate per order
- new tubing for each infusion
Parenteral nutrition: 2012 research and priority assessment
2012: non critically ill hospitalized patients with average blood glucose levels above 180 mg/dl in response to tpn had a 5.6 fold increase in risk of mortality compared with those whose blood glucose levels remained below 140 mg/dl
- priority assessment: BLOOD GLUCOSE
