Pancreatitis, TPN, NG and enteral tube therapy

Question 1

Side of the pancreas that is responsible for hormones that regulate body system.

Answer 1

Endocrine

Question 2

Side of the pancreas making digestive enzymes and that plays a role in pancreatitis.

Answer 2

Exocrine

Question 3

What makes stool brown?

How can stool become clay coloured?

Answer 3

Bile

If a stone blocks the common bile duct, stool will become clay-coloured

Question 4

How does pancreatitis occur?

Answer 4

An obstructoin blocks the common bile duct - cyst, gallstone, tumour, etc. - and blocks the pancreatic enzymes - start to autodigest the pancreas and get excruciating pain.

Question 5

What are the main triggers of acute pancreatitis?

Answer 5

Alcohol abuse and gallstones

Question 6

Acute pancreatitis

• ________ of the pancreas
• varies from mild ______ to severe _______ necrosis
• occurs most often in ______-age; and this gender is more greatly affected
• most common cause is _________ and ___ disease

Answer 6

inflammation
edema, hemorrhagic
middle-age
men > women
alcoholism, GB

Question 7

How are stones removed from the common bile duct?

Answer 7

Surgical removal or blasted out

Question 8

What is the mortality rate of acute pancreatitis?

What surgery and what test may predispose someone to develop pancreatitis?

Answer 8

10%

GI surgery or ERCP - endoscope retrograde cholangiography

Question 9

What drugs would be stopped if someone developed acute pancreatitis?

Answer 9

Oral contraceptives, thiazide diuretics and corticosteroids

Question 10

Self-digestion of the pancreas by its own proteolytic enzymes, principally _______, causes acute pancreatisis

Answer 10

Trypsin

Question 11

80% of patients with acute pancretitis have biliary tract disease, however, only 5% of patients with _____ develop pancreatitis

Answer 11

gallstones

Question 12

What are the classic symptoms of acute pancreatitis?

Answer 12

Pain that buckles you over

Nausea and vomitting - doesn’t improve after vomiting

Question 13

Clinical manifestation of acute pancreatitis
Pain:
- located at the ______, radiates (often to the left ______ or ____), sudden onset, severe, deep, piercing, increases with ______, increases in _______ position, not relieved with ______.

Answer 13

LUQ, shoulder, back

eating, recumbent (on back with knees bent), vomiting

Question 14

What are the classical clinical manifestations of acute pancreatitis?

Answer 14

Epigastric/back pain

Nausea and vomiting

Question 15

In acute pancreatitis, we will see no motility in the ______.
If pancreatitis is prolonged, we will start seeing these signs.

Answer 15

ileus
grey turner sign
cullen’s sign

Question 16

hemorrhagic patches on the skin around the umbilicus.

Answer 16

cullen’s sign

Question 17

bruising of the skin of the loin in acute hemorrhagic pancreatitis,

Answer 17

Grey turner sign

Question 18

Acute pancreatitis is the unique occasion when _______ is most effective.

Answer 18

demerol

Question 19

How is pain relief accomplished for acute pancreatitis?

Answer 19

Morphine and demerol

Question 20

Interprofessional care for acute pancreatitis

• pain relief - with what?
• diet?
• transfusion?
• purpose of bed rest?

Answer 20

pain relief with morphine and demerol

• client is NPO to minimize pancreatic enzyme secretion
• client is fed through enteral feeding or TPN
• NG tube is used to suction
• albumin is tranfused if shock is present
• will give calcium gluconate by IV if tetany is present

Client is on bed rest to decrease metabolic rate and enzymatic secretion

Question 21

cramps, convulsions, twitching of the muscles, and sharp flexion of the wrist and ankle joints. A manifestation of abnormal calcium metabolism.

Answer 21

tetany

Question 22

Usually we give patients an isotonic solution - normal saline; or dextrose if we want a hypotonic solution. However, there is a solution that can legit do both, what is it?

Answer 22

Lactated ringers

Question 23

Drug that decreases pancreatic activity/acidity in stomach/intestine; one of the most common medications given in acute care
What other drugs are given to pancreatitis patients that also decrease pancreatic activity?

Answer 23

Pantoprazole

Zantac and tagamet (oral)

Question 24

Diagnosis of Pancreatitis:

• Hx and characteristics of ________ pain
• Serum _______ and _______ levels (__x higher than normal)
• Urinary _______ elevated; stools ____ and _____ odour

Answer 24

abdominal
amylase, lipase - 3x higher
amylase
pale, foul

Question 25

Why would stools be pale in pancreatitis?

Why the foul odour?

Answer 25

Pale if the obstruction occurs for long enough (no bile)

Foul odour if fat is not being broken down

Question 26

What is steatorrhea and what are the four F’s?

Answer 26

Medical term for fatty stool

- Foul smelling, fatty, floats, frothy

Question 27

What do we do to minimize the foul odour that the patient may be experiencing from pancreatitis?

Answer 27

Charcoal or odour antagonizers

Question 28

What would bloodword indicate for a pancreatitis patient?

Answer 28

Serum amylase and lipase 3x elevated
Elevated WBCs
tetany (hypocalcemia)
hyperglycemia
Elevated serum bilirubin
Dehydration leading to elevated Hematocrit
(in the case of hemorrhagic necrosis - can get decreased Hb)

Question 29

What is a paracentesis?

Answer 29

Abdominal tap - done at bedside, sterile procedure with large needles to remove fluid

Question 30

This is done to relieve a pleural effusion.

Answer 30

Thoracentesis

Question 31

What tests/procedures are done to aid in the diagnosis of pancreatitis?

Answer 31

Ultrasound, X-ray, Computed tomography

MRCP (magnetic resonance cholangiopancreatography), paracentesis

Question 32

Nursing interventions - pancreatitis
Relieving pain:
- Give pain meds ____ pain is severe
- Assess _______ of pain medication
- Comfortable _______, frequent change in position
- Side lying with HOB elevated ___ degrees

Answer 32

before
effectiveness
positioning
45

Question 33

Nursing interventions - pancreatitis
Relieving N&V:
- person will be \_\_\_\_\_
- NG tube for \_\_\_\_\_\_
- \_\_\_\_ fluids
- Frequent \_\_\_\_\_ and \_\_\_\_\_\_ care

Answer 33

NPO
suctioning
IV
oral and nasal care

Question 34

When meds are due at 8, when can we give them?

Answer 34

Anywhere from 7:30 to 8:30

Question 35

Nursing interventions - pancreatitis
Prevent infection:
- Monitor \_\_\_\_\_\_
- Preventing pneumonia?
- Immobility - risk for?

Answer 35

vitals
Turning, DB and C, Semi-fowler’s
Monitor skin frequently and provide good skin care

Question 36

Progressive destruction of pancreas with fibrotic replacement, strictures and calcifications of pancreatic tissue

Answer 36

Chronic pancreatitis

Question 37

Describe the typical patient who has chronic pancreatitis.

Answer 37

Not a surgical candidate - e.g. poor heart
Often abused alcohol
Malabsorption - often very skinny
Often diabetic (since the pancreas cannot produce insulin correctly)

Question 38

What is the most important symptom to remember for chronic pancreatitis?

Answer 38

They will have steatorrhea

Question 39

How is chronic pancreatitis managed?

Answer 39

Diet - low fat, high carb, no alcohol
Pancreatic enzyme replacement (viokase and Cotazym)
Diabetes control

Question 40

How is chronic pancreatitis diagnosed?

Answer 40

ERCP
CT
MRI
US
leukocytosis
increased ESR
Secretin stimulation test

Question 41

test for pancreatic function. Given Secretin hormone and then volume and
bicarbonate concentrations are measured of pancreatic secretions.

Answer 41

Secretin stimulation test

Question 42

A reduction in these concentration is usually diagnostic of chronic pancreatitis (secretin stimulation test).

Answer 42

Amylase and bicarbonate