Pancreatitis, TPN, NG and enteral tube therapy Flashcards
Side of the pancreas that is responsible for hormones that regulate body system.
Endocrine
Side of the pancreas making digestive enzymes and that plays a role in pancreatitis.
Exocrine
What makes stool brown?
How can stool become clay coloured?
Bile
If a stone blocks the common bile duct, stool will become clay-coloured
How does pancreatitis occur?
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.
What are the main triggers of acute pancreatitis?
Alcohol abuse and gallstones
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
inflammation edema, hemorrhagic middle-age men > women alcoholism, GB
How are stones removed from the common bile duct?
Surgical removal or blasted out
What is the mortality rate of acute pancreatitis?
What surgery and what test may predispose someone to develop pancreatitis?
10%
GI surgery or ERCP - endoscope retrograde cholangiography
What drugs would be stopped if someone developed acute pancreatitis?
Oral contraceptives, thiazide diuretics and corticosteroids
Self-digestion of the pancreas by its own proteolytic enzymes, principally _______, causes acute pancreatisis
Trypsin
80% of patients with acute pancretitis have biliary tract disease, however, only 5% of patients with _____ develop pancreatitis
gallstones
What are the classic symptoms of acute pancreatitis?
Pain that buckles you over
Nausea and vomitting - doesn’t improve after vomiting
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 ______.
LUQ, shoulder, back
eating, recumbent (on back with knees bent), vomiting
What are the classical clinical manifestations of acute pancreatitis?
Epigastric/back pain
Nausea and vomiting
In acute pancreatitis, we will see no motility in the ______.
If pancreatitis is prolonged, we will start seeing these signs.
ileus
grey turner sign
cullen’s sign
hemorrhagic patches on the skin around the umbilicus.
cullen’s sign
bruising of the skin of the loin in acute hemorrhagic pancreatitis,
Grey turner sign
Acute pancreatitis is the unique occasion when _______ is most effective.
demerol
How is pain relief accomplished for acute pancreatitis?
Morphine and demerol
Interprofessional care for acute pancreatitis
- pain relief - with what?
- diet?
- transfusion?
- purpose of bed rest?
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
cramps, convulsions, twitching of the muscles, and sharp flexion of the wrist and ankle joints. A manifestation of abnormal calcium metabolism.
tetany
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?
Lactated ringers
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?
Pantoprazole
Zantac and tagamet (oral)
Diagnosis of Pancreatitis:
- Hx and characteristics of ________ pain
- Serum _______ and _______ levels (__x higher than normal)
- Urinary _______ elevated; stools ____ and _____ odour
abdominal
amylase, lipase - 3x higher
amylase
pale, foul
Why would stools be pale in pancreatitis?
Why the foul odour?
Pale if the obstruction occurs for long enough (no bile)
Foul odour if fat is not being broken down
What is steatorrhea and what are the four F’s?
Medical term for fatty stool
- Foul smelling, fatty, floats, frothy
What do we do to minimize the foul odour that the patient may be experiencing from pancreatitis?
Charcoal or odour antagonizers
What would bloodword indicate for a pancreatitis patient?
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)
What is a paracentesis?
Abdominal tap - done at bedside, sterile procedure with large needles to remove fluid
This is done to relieve a pleural effusion.
Thoracentesis
What tests/procedures are done to aid in the diagnosis of pancreatitis?
Ultrasound, X-ray, Computed tomography
MRCP (magnetic resonance cholangiopancreatography), paracentesis
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
before
effectiveness
positioning
45
Nursing interventions - pancreatitis Relieving N&V: - person will be \_\_\_\_\_ - NG tube for \_\_\_\_\_\_ - \_\_\_\_ fluids - Frequent \_\_\_\_\_ and \_\_\_\_\_\_ care
NPO
suctioning
IV
oral and nasal care
When meds are due at 8, when can we give them?
Anywhere from 7:30 to 8:30
Nursing interventions - pancreatitis Prevent infection: - Monitor \_\_\_\_\_\_ - Preventing pneumonia? - Immobility - risk for?
vitals
Turning, DB and C, Semi-fowler’s
Monitor skin frequently and provide good skin care
Progressive destruction of pancreas with fibrotic replacement, strictures and calcifications of pancreatic tissue
Chronic pancreatitis
Describe the typical patient who has chronic pancreatitis.
Not a surgical candidate - e.g. poor heart
Often abused alcohol
Malabsorption - often very skinny
Often diabetic (since the pancreas cannot produce insulin correctly)
What is the most important symptom to remember for chronic pancreatitis?
They will have steatorrhea
How is chronic pancreatitis managed?
Diet - low fat, high carb, no alcohol
Pancreatic enzyme replacement (viokase and Cotazym)
Diabetes control
How is chronic pancreatitis diagnosed?
ERCP CT MRI US leukocytosis increased ESR Secretin stimulation test
test for pancreatic function. Given Secretin hormone and then volume and
bicarbonate concentrations are measured of pancreatic secretions.
Secretin stimulation test
A reduction in these concentration is usually diagnostic of chronic pancreatitis (secretin stimulation test).
Amylase and bicarbonate
