ADH Pancreas
A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct?
"Maintain a high-carbohydrate, low-fat diet."
diagnostics for pancreatitis
Computed tomography with contrast
When reviewing the history of a client with pancreatic cancer, the nurse would identify which of the following as a possible risk factor?
History of pancreatitis
A nurse is planning care for a client who will be arriving to the unit postoperatively from bariatric surgery. In an effort to decrease the risk of venous thromboembolism (VTE), which health care provider orders does the nurse anticipate?
Mechanical compression and prophylactic anticoagulation
abdominal pain assessment
P- comes on when recumbent Q- deep piercing twisting pain R- LUQ or mid epigastric that radiates to back, pt may flex spine to get relief, aggravated by eating/alcohol, unrelieved by vomiting, aggravated by supine or walking, relieved by sitting up and leaning forward S- severe T- sudden onset
Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit?
Pancreatitis
When caring for a client with acute pancreatitis, the nurse should use which comfort measure?
Positioning the client on the side with the knees flexed
A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk?
Reposition the client every 2 hours.
A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is board-like and no bowel sounds are detected. What is the major concern for this patient?
The patient has developed peritonitis.
Lab tests for pancreatitis
WBC count- increased serum glucose- increased (from insulin) Liver enzymes- increased bilirubin- increased blood amylase- increased (elevated for 2-3 days) PLT- decreased (-ases are high)
client education
abstain from alchol, avoid high fat foods or heavy meals to prevent acute incidents
client education for pancreatitis
abstain from alcohol avoid high fat foods or heavy meals to prevent acute cases
Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients:
cannot tolerate high-glucose concentration.
a nurse is completing an admission assessment of a client with pancreatitis, what is an expected finding?
epigastric pain radiating to left shoulder
A client with suspected biliary obstruction due to gallstones reports changes to the color of his stools. Which stool color does the nurse recognize as common to biliary obstruction?
gray
expected findings
jaundice. decreased bowel sounds, fruity breath, ascites, tetany, bluish gray discoloration, ecchymoses on flanks, trousseau sign (hand spasm when blood pressure cuff is inflated), chvostek sign (facial twitch)
patient/nursing care pancreatitis
no alcohol/smokingmonitor hydration position client for comfort (fetal, side-lying/leaning forward) monitor blood glucose pain management NPO until pain free diet is bland/high protein/low fat/mall freq meals NO STIMULANTS LIKE CAFFEINE
a nurse is preparing to admin pancrealipase to a pt with pancreaitis. which of the following actions should the nurse take?
offer a glass of water following med admin
medications for pancreatitis
opioid analgesics imipenem/antibiotic ranitidine/histamine receptor antagonists omeprazole pancrelipase
Health promotion for pancreatitis
low fat diet avoid alcohol
A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test?
Serum amylase
diagnostics
Serum amylase (25-125 U/L) more than 200 U/L for 24-72 hours starts to rise 2-6 hr after onset pain. Peaks at 24 hrs. Return to normal at 72 hr Serum lipase (3-19 U/dL) used with amylase, rises later than amylase (48 hrs) return to normal 8-14 days Increased WBC, glucose, lipid, low calcium
Medications for pancreatitis
pancreatic enzymes: pancrelipase proton pump inhibitors: Omeprazole antibiotics: imipenem opioid analgesics
Lab tests
Blood amylase- increased within first 24 hr, elevated for 2-3 days, can indicate abcess lipase- increases slowly and remains longer than amylase (((increase in enzymes indicate pancreatic cell injury))) WBC count- increased due to infection Platelets- decreased Blood calcium/magnesium- decreased due to fat necrosis blood liver enzymes/bilirubin- increased serum glucose- increased due to insulin production
nursing care for pancreatitis
rest pancreas= NPO, bland high protein/low fat diet, no stimulants, no alcohol, limit stress, manage pain, small freq. meals, antiemetic administered) position client of comfort (fetal/side lying bed elevated, sitting up/leaning forward) administer analgesics moinotr blood glucose provide insulin monitor hydration status (I&O, orthostatic BP, lab values0, admin IV fluids/electrolyte replacement
A nurse prepares nutrition education for a client who will undergo bariatric surgery. What nutrition suggestion best indicates a beneficial effect on the number and quality of bowel movements the client may have after surgery?
Avoid high-fat foods
What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct?
ERCP
A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder?
Edema and inflammation
A critical care nurse is caring for a client with acute pancreatitis. One potentially severe complication involves the respiratory system. Which of the following would be an appropriate intervention to prevent complications associated with the respiratory system?
Maintain the client in a semi-Fowler's position.
Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because they
cannot tolerate a high glucose concentration.
a nurse is assessing a client who has pancreaittis, what is a manifestation?
gray blue discoloration of umbilicus ksin
a nurse is completing nutrition teaching on a pt with pancreatitis. what indicates understanding of teaching?
i plan to eat small frequent meals, i will use skim milk while cooking, i will eat easy to digest food with limited spice
A nurse is reveiwing the admission lab results of a client who has acute pancreatitis, an expected finding is
increased blood glucose level
expected findings for pancreatitis
onset of severe/boring pain/epigastric/radiating to back/left flank/left shoulder Pain worse when lying down pain relieved by fetal position/sitting upright leaning forward weight loss N/V tetany(hypocalcemia) ascites fruity breath jaundice absent bowel sounds warm/moist skin bluish gray periumbilical discoloration
Which symptoms will a nurse observe most commonly in clients with pancreatitis?
severe, radiating abdominal pain
Pain with pancreatitis
sudden, onset, severe boring pain knifelike pain epigastric, radiating to back, left flank, left shoulder pain worse when lying down pain relieved when fetal or sitting upright bending over
A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:
yellow sclerae.
main cause of pancreatitis
chronic alcohol use secondary cause is by cholelithiasis
Pancreatitis risk factors
cig smoking viral infection trauma kidney failure ulcers med toxicity hyperlipidemia old age alcohol use ERCP hypercalcemia genetics biliary tract disease
acute pancreatitis
reversible, bowel sounds decreased, low grade fever, leukocytosis, hypotension, tachycardia, cyanosis, shock, turner's/cullen;s sign abdominal wall discolored treatment: surgery, monitor for signs/symptoms, promote rest, antibiotics, pain management, TPN/fluids, manage electrolyte imbalance, support resp fucntion (elevate HOB, oxygen, monitor for pleural effsuion, incentive spirometer), suppress pancreatic enzymes (NG suction/NPO/Antacids/H2 antagonists) goal: relief of pain, prevent shock, support resp function, maintain fluid balance complications: Pulmonary: related to release of noxious cytokines that damage surfactant and lung parenchyma Cardiovascular: related to fluid loss, myocardial depression, electrolyte imbalance Electrolyte imbalance: hypocalcemia
Clinical manifestations of common bile duct obstruction include all of the following except:
Light-colored urine
A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN?
Measure blood glucose concentration every 4 to 6 hours
risk factors of pancreatitis
cig smoking, viral infection, trauma, gastro surgery, kidney failure, older age, alcohol use, ERCP, biliary tract disease/gallstones can cause blockage where common bile duct and pancreatic duct meet, med toxicity, ulcer, hypercalcemia, hyperlipidemia
Chronic pancreatitis
progressive destruction of pancreas and long term inflammation. Can go undetected b/c classic diagnostic findings are not always present in early stages. Increase risk of malignancy. Progressive loss of pancreatic function, fibrotic tissue replaces pancreas tissue Etiology: follow bouts of acute pancreatitis, caused by malnutrition, biliary disease, chronic alc use Manifestations: abdominal pain (heavy/gnawing/burning/cramp), constipation, malabsorption with weight loss, steatorrhea (fatty/foul smelling stool/frothy urine/stool), diabetes Diagnostic: ERCP, Lab test (serum amylase/lipase, increased serum bilirubin, increased alkaline phosphatase, mild leukocytosis, elevated sedimentation rate Goals of nursing care: pain relief, prevent acute exacerbations, control of pancreatic exocrine/endocrine insufficiency, low-fat high carb diet, avoid crash diet and binging Home/Ambulatory Care: focus on chronic care and health promotion, dietary control (no alc, avoid caffeine, low fat high carb diet, avoid crash diets, smoking cesssation), control of diabetes, taking pancreatic enzymes correctly, patient and family teaching disease progression. High risk for pancreatic cancer
complications
hypovolemia: up to 6L fluid can third spaced /monitor electrolytes and for hypotension and shock infection: leakage of fluid out of damaged pancreatic duct, manifests as fever/nausea/vomiting/jaundice nurisng action= monitor for rupture, hemorrhage, monitor skin for breakdown type 1 diabetes: destruction of beta cells, nursing action is to monitor blood glucose/give insulin, pt should adhere to long term diabetes management atelectasis; more common in older adutls, causesd by pancreatic ascities/splinting of chest due to pain upon coughing. nursing action is to monitor for hypoxia and give ventilation coagulation defects: organ failure: inflamamion, caused by necrosizing hemorrhagic pancreatitis, admin treatments
