Unit 1 Chapter 54 Gastrointensinal Acute and Chronic Pancreatitis

Question 1

What is Acute Pancreatitis

Answer 1

Abrupt disruption and inflammation in the pancreas to perform duties that is reversible

-cannot excrete pancreatic enzymes to small intestine to absorb nutrients from the food

Duties
-break down fats and proteins through excreated enzymes
-excretion of insulin to control blood sugar

-occurs mainly in adults

Question 2

What is the #1 risk factor of Acute Pancreatitis?

Answer 2

Alcohol abuse or consumption

also ..
* Biliary disease (gallstones)
* Abdominal trauma,
viral infections,
-drugs(opiates, sulfonamides, thiazides, steroids, and
oral contraceptives (less common)
-cystic fibosis
and tumors
-trauma

Question 3

Should you administer fat soluable vitamins to a patient with Acute Pancreatitis
A.No
B.Yes

Answer 3

A.No , due to dysfunction in pancrease to perform its natural function like excreting pancreatic enzymes to break down fats and proteins

Question 4

What diet is best for patients with Acute Pancreatitis?
A. low fat , low protein, low carbs
B. high fat , low protein, low carbs

Answer 4

A. low fat , low protein, low carbs

SMALL FREQUENT MEALS

Question 5

Signs and symptoms of Acute Pancreatitis

Answer 5

SEVERE Abdominal Pain
EPIGASTRIC PAIN
pain that radiates to the back,left flank, or left shoulder.**
LEFT UPPER QUADRANT PAIN
* Abdominal tenderness
*tentany due to hypocalcemia
* Nausea/ vomiting / weight loss
** Jaundice**
* Gray-blue discoloration around umbilical area (Cullen’s sign )
* Gray-blue discoloration on thigh and peritoneal cavity area (Turner’s
sign)
Steathrea (fatty stools)
-weight loss
-acities
-constipation
-diabetes melitis
-hypoxemia
-metabolic acidosis

Question 6

Is the pain worsened or relieved when assuming a supine position for Acute Pancreatitis?

A. relived
B. worsened

Answer 6

PAIN IS worsened by lying in the supine position.

Question 7

What position would you see a patient in during pain in Acute Pancreatitis to relieve their pain?
A. Prone
B.Fetal
C. Supine
D. Sims

Answer 7

B.Fetal

Often the patient finds relief by assuming the fetal position (with the knees drawn up to the chest and the spine flexed) or by siing upright and bending forward.

Question 8

What labs would you suspect to be elevated for Acute Pancreatitis?

Answer 8

Pancreatic enzymes, liver labs, glucose,esr

Question 9

esr normal range

Answer 9

Male: 15 mm/hr
Female: up to 20 mm/hr

Question 10

Amalyse Normal range and function

Answer 10

-digest carbohydrates
elevation in amalyse: lack on energy due to inability to digest carbohydrates

56-190 IU/L

Question 11

Lipase Normal range and function

Answer 11

• digest fat
  elevation in lipase: Fatty stools steatorrhea. 0-110 IU/L

Question 12

Chymotrypsin and Trypsin function

Answer 12

-digest proteins
Elevation: poor wound healing

Question 13

Endocrine dysfuction

Answer 13

elevation
-increased glucose

Question 14

Your patient with Acute Pancreatitis, is displaying polyuria and is complaining of being hungry all the time which lab value will indicate the patients current condition?

A. Glucose 190ml
B. Lipase 100
C. Amalyse 70
D. Troponin 0.1

Answer 14

A. Glucose 190ml

Polyuria, polydipsia, polyphagia (diabetes mellitus)

Question 15

Emergency Medical Management of Acute Pancreatitis

Answer 15

NPO(NOTHING BY MOUTH)
PAIN MANAGEMENT
IV HYDRATION

Question 16

What is the medication of choice for a patient experiencing SEVERE abdominal pain with Acute Pancreatitis?
A. Allopurinol
B. Morphine
C. Acetaminophen
D. Ketorolac

Answer 16

B. Morphine

Question 17

Are patients with Acute Pancreatitis at risk for Hemrohhage

Answer 17

Monitor and record vital signs frequently to assess for elevated temperature, tachycardia, and decreased blood pressure, or assign and closely supervise this activity. Auscultate the lung fields for adventitious sounds or diminished breath sounds and observe for dyspnea or orthopnea.

-For the patient with acute pancreatitis, monitor for significant changes in vital signs that may indicate the life-threatening complication of shock. Hypotension and tachycardia may result from pancreatic hemorrhage,

Question 18

Maintenance Interventions for Patients with Acute Pancreatitis

Answer 18

-promote rest due to fatigue from maldigestion of carbs

-Sprinkle pancreatic enzymes on all snacks and food

-monitor for constipation, pancreatic enzymes decrease frequency of fatty stools

Question 19

Complications of Acute Pancreatitis

Answer 19

Hypovolemia – can lead to hypovolemic shock or acute kidney failure
(pre-renal)
* Hemorrhage *
Paralytic ileus – due to hypovolemia causing peristalsis to slow down
to absorb more fluid from stool
Pleural effusion
*respiratory distress syndrome,**
pneumonia
* Multi-system organ failure

*DIC -Disseminated intravascular coagulation (DIC) involves hypercoagulation of the blood, with consumption of clo ing factors and the development of microthrombi.

• Diabetes mellitus

Question 20

Can Acute Pancreatitis Affect all organs in the body?
A. Yes
B. No

Answer 20

A. Yes

REQUIRED MULTIDISCIPLINARY APPROACH
-DIETICIAN
-* Respiratory care
* Nutritional consult

Question 21

What is the lab value that is the indicator for nutritional status?

Answer 21

Albumin (3.5-5)

Question 22

Your patient with a history of alcohol abuse has been admitted and diagnosed with Acute pancreatitis. Which statement from the patient required further teaching?

A. I will drink 1 alcoholic drink a day since I’m used to drinking 4 a day.
B. I will eat small frequent meals
C. I will eat a bland diet
D. The pancreatic enzymes will help decrease my constipation

Answer 22

A. I will drink 1 alcoholic drink a day since I’m used to drinking 4 a day.
-refer to AA
-NO ALCOHOL AT ALL

Question 23

What diagnostic test is best to confirm pancreatic stones?

Answer 23

stones are best diagnosed through ERCP.

Question 24

What is the most common sign of Pancreatitis?
boring

Answer 24

Severe continuous “boring” abdominal pain is the most common symptom of pancreatitis

-The patient often states that the pain had a sudden onset and radiates to the back, left flank, or left shoulder. The pain is described as intense, boring (feeling that it is going through the body), and continuous,

Question 25

Healing Phase Nutrition intervention

Answer 25

When food is tolerated during the healing phase, the primary health care provider prescribes small, frequent, moderate- to high-carbohydrate, high-protein, low-fat meals.

Food should be bland with little spice. GI stimulants such as caffeine-containing food (tea, coffee, cola, and chocolate), as well as alcohol, should be avoided

Monitor the patient beginning to resume oral food intake for nausea, vomiting, and diarrhea. If any of these symptoms occur, notify the primary health care provider immediately.

Question 26

Your patient with Acute Pancreatitis is currently in the healing stage. He has been maintaining his bland diet well. On-shift change, you notice he is vomiting? What is the nurse’s priority intervention?
A. Notify the healthcare provider
B. document this as a normal finding
C. application of O2 surgery
D. increase carb in his diet

Answer 26

A. Notify the healthcare provider

Monitor the patient beginning to resume oral food intake for nausea, vomiting, and diarrhea. If any of these symptoms occur, notify the primary health care provider immediately.

Question 27

Does the patient require follow-up after discharge?

Answer 27

The patient requires medical follow-up with the primary care provider to monitor the disease process.

Question 28

What is Chronic Pancreatitis

Answer 28

Chronic pancreatitis is a progressive, destructive disease of the pancreas that has remissions and exacerbations (“flare-ups”). Inflammation and fibrosis of the tissue contribute to pancreatic insufficiency and diminished function of the organ.

Question 29

Risk factors of Chronic Pancreatitis

Answer 29

The most frequent cause is alcoholism but may also be caused by hereditary pancreatitis or
protein malnutrition

Question 30

Prevention of Exacerbations of Chronic Pancreatitis

Answer 30

Prevention of Exacerbations of Chronic Pancreatitis
* Avoid things that make your symptoms worse, such as drinking caffeinated beverages.
* Avoid alcohol ingestion; refer to a self-help group for assistance.
* Avoid nicotine.
Eat bland, low-fat, high-protein, and moderate-carbohydrate meals; avoid gastric stimulants such as spices.
Eat small meals and snacks high in calories.
* Take the pancreatic enzymes that have been prescribed for you with meals.
* Rest frequently; restrict your activity to one floor until you regain your strength.

Question 31

Enzyme Replacement for the Patient With Chronic Pancreatitis

Answer 31

• Take pancreatic enzymes with meals and snacks and follow with a glass of water.
  Administer enzymes after antacid or H2 blockers. (Decreased pH inactivates drug.)
• Swallow the tablets or capsules without chewing, to minimize oral irritation and allow the drug to be released slowly.
• If you cannot swallow the capsule, pierce the gelatin casing and place contents in applesauce.
• Do not mix enzyme preparations in protein-containing foods.
• Wipe your lips after taking enzymes to avoid skin irritation.
• Do not crush enteric-coated preparations.
• Follow up on all scheduled laboratory testing. (Pancreatic enzyme replacements can cause an increase in uric acid levels.)

Question 32

Signs and Symptoms of Chronic Pancreatitis

Answer 32

• Intense abdominal pain , a major symptom, that is continuous and burning or gnawing
• Abdominal tenderness
• Ascites
• Possible left upper quadrant mass (if pancreatic pseudocyst or abscess is present)
• Respiratory compromise manifesting with adventitious or diminished breath sounds, dyspnea, or orthopnea
• Steatorrhea; clay-colored stools
• Weight loss
• Jaundice
• Dark urine
• Polyuria, polydipsia, polyphagia (diabetes mellitus)

Question 33

Pancreatic Enzyes Patient Teaching

Answer 33

Pancreatic enzymes are usually prescribed in the form of capsules or tablets that contain varying amounts of amylase, lipase, and protease.

Teach patients not to chew or crush pancreatic enzyme replacements that are available as delayed-release capsules or enteric tablets. Teach them to take the enzymes with all meals and snacks (Burchum & Rosenthal, 2019).

The dosage of pancreatic enzymes depends on the severity of the malabsorption. Record the number and consistency of stools per day to monitor the effectiveness of enzyme therapy. If pancreatic enzyme treatment is effective, the stools should become less frequent and less fa y.

Question 34

Should you administer Antaacid before pancreatic enzymes or after?

Answer 34

Antacaids before , the pancreatic enzymes after