Week 6 - Pancreatitis Flashcards
what is the function of the pancreas
- secrete enzymes that aide in digestion and insulin production for glucose regulation
what is pancreatitis
- inflammation of the pancreas
the degree of inflammation during pancreatitis can range from..
- mild edema to severe hemorrhagic necrosis `
what are the most common causes of acute pancreatitis
- alcohol abuse
- gallbladder disease (gallstones)
what are other causes of pancreatitis (10)
- hypertriglyceridema
- trauma
- viral infections
- penetrating duodenal ulcer
- cysts
- abscesses
- CF
- drugs
- metabolic disorders
- vascular disease
what are some meds that can cause pancreatitis (6)
- corticosteroids
- thiazides
- estrogens
- sulphonamides
- HIV meds
- anti-inflammatories
briefly describe the patho of pancreatitis
- autodigestion of the pancreas d/t pancreatic enzymes
- can be life-threatening
what are symptoms of pancreatitis (11)
- abdominal pain
- NV
- low-grade fever
- leukocytosis
- hypotension
- tachy
- jaundice
- flushing
- dyspnea
- abdominal tenderness w guarding
- bruising
where is the abdominal pain located in pancreatitis (3)
- midepigastrium
- LUQ
- radiates to back (d/t retroperitoneal location of pnacreas)
describe the characteristics of pain in pancreatitis (7)
- sudden onset
- severe
- deep
- piercing
- continuous
- aggravated by eating & when pt recumbent
- not relieved by vomitting
where is bruising noted in pancreatitis (2)? what are these called
- flanks = grey turner
- periumbilical area = cullen’s sign
what are 2 complications of pancreatitis
- pseudocyst
- abscess
what is a pancreatic pseudocyst
- cavity continuous with or surrounding the outside of the pancreas
what is the pseudocyst filled w (4)
- necrotic products
- plasma
- pancreatic enzymes
- inflammatory exudates
describe what occurs w a pancreatic pseudocyst
- as pancreatic enzymes escape, the serosal surfaces next to the pancreas become inflamed
= formation of granulation tissue
= encapsulation of exudate
what are symptoms of a pancreatic pseudocyts (5)
- abdominal pain
- palpable epigastric mass
- NVA
describe the resolution of pancreatic pseudocyst
- usually resolve on its own within a few weeks
what is a potential complication of a pancreatic pseudocyst
- may perforate = peritonitis
what is a pancreatic abscess
- large fluid containing cavity within the pancreas d/t extensive necrosis of the pancreas
what are symptoms of a pancreatic abscess (4)
- upper abdominal pain
- abdominal mass
- fever
- leukocytosis
what is treatment for a pancreatic abscess
- must be surgically drained promptly to prevent sepsis
what can a pancreatic abcess lead to (2)
- perforation into adjacent organs
- may become infected
what are the main systemic complications of acute pancreatitis
- pulmonary
- CVS –> hypotension
- ## tetany (d/t hypocalcemia)
what pulmonary complications are associated w pancreatitis (3)
- pleural effusion
- atelectasis
- pneumonia
- risk of intravascular thrombi, PE, disseminated intravascular thrombi
what causes the pulmonary complication
- passage of exudate thru the transdiaphragmatic lymph channels
what causes atelectasis as a comp of pancreatitis
- enzyme induced inflammation of the diaphragm = reduced diaphragm movement
what causes the increased risk of thrombi w pancreatitis
- trypsin activates prothrombin
what is the treatment of pancreatitis (3)
- identify cause
- reduce or supress secretion of enzymes
- decrease pancreatic stimulation
what are the main goals of treatment for pancreatitis (5)
- relief of abdominal pain r/t distension (NG tube)
- prevent or alleviation of shock (fluids)
- reduce pancreatic secretions (NPO)
- fluid and electrolyte balance
- removal of precipitating cause
what does chronic pancreatitis lead to
- fibrosis, strictures, calcifications
- progressively destroyed pancreas
range of severity of pancreatitis ranges from
- milk to severe (necrotizing pancreatitis)
if you have severe pancreatitis, what can this lead to (3)
- perm decrease in endocrine and exocrine function
- increased mortality rate
- self-destructs
what is included in acute intervention of pancreatitis (5)
- monitor VS
- IV fluids (aggressive rehydration d/t emesis & decreased intake)
- assess resp function (pancreatic enzymes move thru lymph channels)
- pain mngmt (thru narcotics and positioning)
- monitor for signs of hypocalcemia (combo of calcium and fatty acids during fat necrosis)
why is pain mngmt imp in pancreatitisa
- pain = restlessness = pancreatic stimulation
a nursing diagnosis r/t pancreatitis is acute pain. what interventions can be done for this
- assess pain
- provide optimal pain relief w prescribed analgesics
- eval effectiveness of pain-control measures
- teach use of nonpharmacological measures
- notify physician if measures successful or not
a nursing diagnosis r/t pancreatitis is deficient fluid volume d/t vomitting. what are some nursing interventions for this (2)
- antiemetic meds
- measure or estimate emesis volume
a nursing diagnosis r/t pancreatitis is deficient fluid vol. what fluid and electrolyte mngmt can be used (3)
- monitor electrollyte lvls
- maintain IV solution w electrolytes at constant flow rsate
- consult physician if S&S of electrolyte or fluid imbalances occur
a nursing diagnosis r/t pancreatitis is imbalanced nutrition. what nursing interventions can be done for this (5)
- monitor lab values
- admin enteral (maybe parental) nutrition for carbs, lipids, and amino acids
- provide oral care before meals to decrase foul taste
- ensure availability of progressive therapeutic diet
- provide needed nourishment
- weight pt at approp intervals
a nursing diagnosis r/t pancreatitis is risk of hypocalcemia. what are some nursing interventions for this (7)
- monitor for S&S of hypocalcemia
- monitor for CNS manifestations of hypocalcemia
- monitor labs
- monitor for electrolyte imbalances associated w hypocalcemia (increased PO4, low mg)
- admin prescribed calcium salt , calcium dilutes in D5W
- monitor pts response to treatment
- consult physician if S&S of fluid or electrolyte imbalance persist or worsen
a potential complication of pancreatitis is hypovolemia/shock. what nursing interventions can be done for this (5)
- monitor circulatory status
- strict NPO status to reduce or stop secretion of pancreatic enzymes
- maintain patency of gastric suction
- monitor electrolyte status
- monitor for renal insufficiency
