Pancreatitis
What causes of pancreatitis have a better outcome of recovery?
Bonus 100: what causes of pancreatitis have a worse outcome of recovery?
Prognosis is good with biliary tract disease
Bonus 100: poor when alcoholism
What kidney complication happens with pancreatitis?
bonus 100: what substance causes it?
Acute tubular necrosis: lining of tubules doesnt have enough pressure to filter fluids. The volume going through the tubules is toxic to the endothelial cells on tubules. The endothelial cells slough off and causes a blockage. Fix by increasing fluids to flush out endothelial cells.
Bonus: antibiotics are hard on kidneys
Which client is most at risk for the development of gallstones?
A. 22-year-old woman who is 1 month postpartum
B. 65-year-old woman after a liquid protein diet
C. 70-year-old man with peptic ulcer disease
D. 33-year-old man with type 2 diabetes
ANS: B
Liquid protein diets increase susceptibility to gallstones by releasing cholesterol from tissues, which is then excreted as crystals in the bile.
1. A nurse is caring for a patient with acute pancreatitis. Which laboratory finding is most indicative of this condition?
A) Decreased serum calcium
B) Increased serum lipase
C) Decreased serum bilirubin
D) Increased blood urea nitrogen (BUN)
B) Increased serum lipase
Rationale: Serum lipase and amylase are elevated in acute pancreatitis due to pancreatic inflammation.
With severe pancreatitis, how long has organ failure lasted?
over 48 hours
How do you minimize pancreatic stimulation to prevent irritation to the pancreas? Name three interventions
NPO, NG tube to intermittent suction (esp with frequent vomiting, or paralytic ileus), Antacids, proton pump inhibitor (pantoprazole), anticholinergics, Nutritional support (hypermetabolic and hypercatabolic) consider if oral nutrition is unlikely to resume within 5 days, Enteral nutrition via nasojejunal tube, TPN
the client is dx with acute pancreatitis. which health care providers admitting order should the nurse question?
1. bedrest with bathroom privleges.
2. initiate iv therapy of D5W at 125 mL/hr
3. weigh client daily
4. low fat, low carb diet
low fat, low carb diet: the client will be NPO, which will decrease stimulation of the pancreatic enzymes, resulting in decreased autodigestion of the pancreas, therefore decreasing pain
2. A patient with chronic pancreatitis is being discharged. What dietary instruction should the nurse provide?
A) High-fat, low-protein diet
B) Low-fat, high-protein diet
C) High-carbohydrate, high-fat diet
D) Low-protein, low-carbohydrate diet
B) Low-fat, high-protein diet
Rationale: A low-fat diet reduces pancreatic stimulation, while high-protein intake supports tissue repair.
Name five labs that diagnose pancreatitis and which direction those levels will go in.
Serum Lipase, Serum Amylase, Isoamylase P (pancreatic), Blood and urine glucose , WBC’s, Serum bilirubin (direct) are all increased
Name five postsurgical interventions for pancreatic surgery
Monitoring glucose, total abstinence from alcohol, spicy foods and heavy meals, diet restrictions, mod to high protein, low fat, mod to high carbs, small and frequent meals. AVOID crash dieting and ETOH, recurrence of symptoms Steatorrhea, pain, use of Pancreatic Enzymes
the client dx with acute pancreatitis is in pain. which position should the nurse assist the client to assume to help decrease the pain?
1. recommend lying in the prone position with legs extended
2. maintain a tripod position over the bedside table
3. place in side lying position with knees flexed
4. encourage a supine position with a pillow under the knees
place in side lying position with knees flexed: this fetal position decreases pain caused by the stretching of the peritoneum as a result of edema
A nurse is monitoring a patient with severe acute pancreatitis. The presence of Cullen's sign indicates:
A) Peritonitis
B) Retroperitoneal hemorrhage
C) Bowel obstruction
D) Hepatic failure
B) Retroperitoneal hemorrhage
Rationale: Cullen's sign (periumbilical bruising) is associated with internal bleeding.
What integumentary symptoms will you find with pancreatitis?
Cullen sign: grey-blue around epigastric
Grey-turner: grey-blue around flank, lower black
Cold, pale, mottled skin
What are the three risk factors of cholecystitis?
female forty fat
the client dx with acute pancreatitis is being discharged home. which statement by the client indicates the teaching has been effective?
1. i should decrease my intake of coffee, tea, and cola
2. i will eat a low fat diet and avoid spicy foods
3. i will check my amylase and lipase levels daily
4. i will return to work tomorrow but take it easy
i will eat a low fat diet and avoid spicy foods: high fat and spicy foods stimulate gastric and pancreatic secretions and may precipitate an acute pancreatic attack
the nurse is administering a pancreatic enzyme to the client dx with chronic pancreatitis. which statement best explains the rationale for administering this med?
1. it is an exogenous source of protease, amylase, and lipase
2. this enzyme increases the number of bowel movements
3. this medication breaks down in the stomach to help with digestion
4. pancreatic enzymes help break down fat in the small intestine
it is an exogenous source of protease, amylase, and lipase: pancreatic enzymes enhance the digestion of starches (carbohydrates) in the gastrointestinal tract by supplying an exogenous (outside) source of the pancreatic enzymes protease, amylase and lipase
Name the five nursing diagnoses in order of priority with pancreatitis.
Fvd: treat heme instability
Pain
Altered nutrition
Ineffective breathing r/t pain
Anxiety, coping, powerlessness
What are two findings of SIRS?
Core temp greater than 38 C
(100.9 F) or less than 36 (96.8 F)
HR greater than 90 bpm
RR greater than 20 bpm, or PaCO2 less than 32mmHg
WBC greater than 12000 or less than 4,000mm3 , or greater than 10% immature (band)]
Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient with acute pancreatitis?
a. Nausea and vomiting
b. Hypotonic bowel sounds
c. Abdominal tenderness and guarding
d. Muscle twitching and finger numbness
D: Muscle twitching and finger numbness indicate hypocalcemia
the client with an acute exacerbation of chronic pancreatitis has a nasogastric tube. which interventions should the nurse implement? select all that apply
1. monitor the clients bowel sounds
2. monitor the clients food intake
3. assess the clients intravenous site
4. provide oral and nasal care
5. monitor the clients blood glucose
monitor the clients bowel sounds, assess the clients intravenous site, provide oral and nasal care, provide oral and nasal care, monitor the clients blood glucose: the return of bowel sounds indicates the return of peristalsis, and the nasogastric suction is usually discontinued within 24 to 48 hrs thereafter. the nurse should assess for signs of infection or infiltration. fasting and the ng tube increase the clients risk for mucous membrane irritation and brk dwn. blood glucose levels are monitored because clients with chronic pancreatitis can develop diabetes mellitus