Pancreatitis

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client?

Administering morphine I.V. as ordered Explanation: The nurse should address the client's pain issues first by administering morphine I.V. as ordered. Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues.

A client has been hospitalized with pancreatitis for 3 days. The nurse assesses the client and documents the accompanying results. The nurse realizes these findings are a manifestation of what sign?

Cullen's sign Explanation: Cullen's sign is evidenced by discoloration at the periumbilical area. This sign may indicate an underlying subcutaneous intraperitoneal hemorrhage. Chvostek's sign is a facial nerve spasm and Trousseau's sign is a carpopedal spasm; both signs occur with hypocalcemia. Broca's area, not sign, is an area within the brain that controls the motor functions involved in speech.

When the nurse is caring for a patient with acute pancreatitis, what intervention can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions?

Frequent changes of positions Explanation: Frequent changes of position are necessary to prevent atelectasis and pooling of respiratory secretions.

The nurse is caring for a client with chronic pancreatitis. Which symptom would indicate the client has developed secondary diabetes?

Increased appetite and thirst Explanation: When secondary diabetes develops in a client with chronic pancreatitis, the client experiences increased appetite, thirst, and urination. Vomiting, diarrhea, low blood pressure and pulse, and constipation do not indicate the development of secondary diabetes.

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 Explanation: Enteral or parenteral nutrition may be prescribed. In addition to administering enteral or parenteral nutrition, the nurse monitors the serum glucose concentration every 4 to 6 hours.

When teaching a client about chronic pancreatitis, which of these does the nurse relate is the long term result of this condition?

Progressive destruction of the organ Explanation: The chief distinction between acute and chronic pancreatitis is the irreversibility of pancreatic function with chronic pancreatitis. Chronic pancreatitis is characterized by progressive destruction of the exocrine pancreas, by fibrosis, and, in the later stages, by destruction of the endocrine pancreas. While the most common cause of chronic pancreatitis is alcohol abuse, it is not the consequence.

The nurse recognizes which intervention is essential to reduce the pain of acute pancreatitis?

Withholding food and fluid Explanation: Withholding food and fluid prevents premature activation of pancreatic enzymes and autodigestion. Pain medication will mask pain, but not treat the underlying problem of preventing autodigestion, as will intravenous fluids.

Which individual likely faces the highest risk of developing chronic pancreatitis?

A woman who has 6 to 8 alcoholic beverages each evening Explanation: By far, the most common cause of chronic pancreatitis is long-term alcohol use disorder. The other cited factors are not noted to contribute significantly to the pathogenesis of chronic pancreatitis.

A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder?

Edema and inflammation Explanation: Mild acute pancreatitis is characterized by edema and inflammation confined to the pancreas. Minimal organ dysfunction is present, and return to normal function usually occurs within 6 months.

The nurse is assessing a client with acute pancreatitis who denies use of alcohol. When teaching the client about additional causes of acute pancreatitis, the nurse includes which of these in the discussion? Select all that apply.

Gallstones Increased cholesterol Abdominal trauma Explanation: Acute pancreatitis is associated with alcohol abuse, gallstones, hyperlipidemia, hypercalcemia, infections (particularly viral), abdominal and surgical trauma, and drugs such as thiazide diuretics.

Which condition is most likely to have a nursing diagnosis of fluid volume deficit?

Pancreatitis Explanation: Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. Appendicitis, cholecystitis, and gastric ulcer are less likely to exhibit fluid volume deficit.

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. Explanation: Abdominal guarding is present. A rigid or board-like abdomen may develop and is generally an ominous sign, usually indicating peritonitis

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason?

To reduce gastric and pancreatic secretions Explanation: Anticholinergic medications reduce gastric and pancreatic secretion.

When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize that the pathogenesis begins with an inflammatory process whereby:

Activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue. Explanation: Acute pancreatitis is associated with the escape of activated pancreatic enzymes into the pancreas and surrounding tissues. These enzymes cause fat necrosis, or autodigestion, of the pancreas. Alcohol is known to be a potent stimulator of pancreatic secretions, and it also is known to cause partial obstruction of the sphincter of the pancreatic duct, rather than bowel obstruction. The pancreas is irreversibly damaged and will not recover to normal functioning results from chronic pancreatitis. Acute pancreatitis also is associated with viral infections. The pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction occurring with cancer of the pancreas. Presence of stones in the common bile duct with jaundice is primarily a result of gallstones.

While on tour, a 32-year-old musician has presented to the emergency department of a hospital after a concert reporting severe and sudden abdominal pain. The client admits to a history of copious alcohol use in recent years, and the client's vital signs include temperature 38.8°C (101.8°F), blood pressure 89/48 mm Hg and heart rate 116 beats/min. Blood work indicates that serum levels of C-reactive protein, amylase, and lipase are all elevated. Which diagnosis does the care team suspect first?

Acute pancreatitis Explanation: Alcohol use, fever, hypotension and tachycardia are often associated with pancreatitis, as are elevated serum amylase and lipase levels. These enzymes would be unlikely to rise in cases of hepatitis, cholecystitis, or cirrhosis. The precise mechanisms whereby alcohol exerts its action are largely unknown. The capacity for oxidative and nonoxidative metabolism of ethanol by the pancreas and the harmful byproducts that result have been related to the disease process. Hepatitis C has an incubation period. Most adults who acquire the infection usually are asymptomatic. Jaundice is uncommon. Direct measurement of hepatitis C virus in the serum remains the most accurate test for infection. Cirrhosis represents the end stage of chronic liver disease. The end result is liver failure that affects many organs. The client usually presents with anemia, thrombocytopenia, endocrine disorders, skin lesions, azotemia and acute kidney injury, and hepatic encephalopathy.

Which of these substances should the nurse teach the client with pancreatitis to absolutely avoid?

Alcohol Explanation: Clients with chronic pancreatitis must be told alcohol is forbidden as it frequently precipitates attacks.

The client has right upper quadrant pain caused by acute choledocholithiasis. The health care provider suspects the common bile duct is obstructed, based on which flowing lab value?

Bilirubin 15 mg/dL (256.56 µmol/L) (high) Explanation: Choledocholithiasis, stones in the common duct, usually originate in the gallbladder but can form spontaneously in the common duct. Bilirubinuria and an elevated serum bilirubin are present if the common duct is obstructed. With acute cholecystitis, approximately 75% of clients have vomiting. Ascites is common with late-stage liver failure rather than duct obstructions. Bleeding is associated with liver failure due to deficiency of clotting factors and acute pancreatitis due to activated enzymes, causing fat necrosis and hemorrhage from the necrotic vessels.

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find?

Correct response: Elevated urine amylase levels Explanation: Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low.

When evaluating a client for complications of acute pancreatitis, the nurse should observe for

Decreased urine output. Explanation: Acute pancreatitis can cause decreased urine output, which results from the renal failure that sometimes accompanies this condition. Intracranial pressure neither increases nor decreases in a client with pancreatitis. Tachycardia, not bradycardia, usually is associated with pulmonary or hypovolemic complications of pancreatitis. Hypotension can be caused by a hypovolemic complication, but hypertension usually isn't related to acute pancreatitis.

A 70-year-old client is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which gerontologic consideration associated with the pancreas?

Decreases in the physiologic function of major organs Explanation: Acute pancreatitis affects people of all ages, but the mortality rate associated with acute pancreatitis increases with advancing age. The pattern of complications changes with age. Younger clients tend to develop local complications; the incidence of multiple organ failure increases with age, possibly as a result of progressive decreases in physiologic function of major organs with increasing age.

A nursing student has learned about many collaborative interventions to achieve pain relief for clients with acute pancreatitis. Which of the following are appropriate? Choose all that apply.

Encourage bed rest to decrease the client's metabolic rate. Teach the client about the correlation between alcohol intake and pain. Withhold oral feedings to limit the release of secretin. Explanation: The acutely ill client is maintained on bed rest to decrease the metabolic rate and reduce the secretion of pancreatic and gastric enzymes. The nurse also assesses the home situation and reinforces instructions about fluid and nutrition intake and avoidance of alcohol. Oral feedings are withheld to decrease the secretion of secretin; therefore, having sips of clear liquids is not an appropriate intervention.

Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels?

Frequent vomiting, leading to loss of fluid volume Explanation: Fluid and electrolyte disturbances are common complications because of nausea, vomiting, movement of fluid from the vascular compartment to the peritoneal cavity, diaphoresis, fever, and the use of gastric suction. The nurse assesses the client's fluid and electrolyte status by noting skin turgor and moistness of mucous membranes. The nurse weighs the client daily and carefully measures fluid intake and output, including urine output, nasogastric secretions, and diarrhea

The nurse is caring for a client with right upper quadrant pain secondary to acute choledocholithiasis. If the common bile duct becomes obstructed, which manifestation will the nurse expect?

Hyperbilirubinemia Explanation: Choledocholithiasis, stones in the common duct, usually originate in the gallbladder but can form spontaneously in the common duct. Bilirubinuria and an elevated serum bilirubin (hyperbilirubinemia) are present if the common duct is obstructed. With acute cholecystitis, approximately 75% of clients have vomiting. Ascites is common with late-stage liver failure rather than duct obstructions. Bleeding is associated with liver failure due to deficiency of clotting factors, and is also associated with acute pancreatitis due to activated enzymes causing fat necrosis and hemorrhage from the necrotic vessels.

A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority?

Impaired nutrition: less than body requirements Explanation: While each diagnosis may be applicable to this client, the priority nursing diagnosis is impaired nutrition: less than body requirements. The physician, nurse, and dietitian emphasize to the client and family the importance of avoiding alcohol and foods that have produced abdominal pain and discomfort in the past. Oral food or fluid intake is not permitted during the acute phase.

The nurse is caring for a client with severe acute pancreatitis. Which interventions should the nurse prioritize? Select all that apply.

Keep client NPO. Infuse intravenous fluids. Maintain nasogastric tube. Explanation: Treatment for severe acute pancreatitis includes withholding oral foods and fluids, and restoration of lost plasma volume with intravenous fluids. Meperidine rather than morphine usually is given for pain relief because it causes fewer spasms of the sphincter of the pancreatic duct. Gastric suction via nasogastric tube is used to treat bowel distention and prevent the secretion of pancreatic enzymes. Antidiarrheal medications are not indicated in acute pancreatitis.

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm the diagnosis of acute pancreatitis?

Pain with abdominal distention and hypotension Explanation: Assessment findings associated with pancreatitis include pain with abdominal distention and hypotension. Blood in stools and recent hypertension aren't associated with pancreatitis; fatty diarrhea and hypotension are usually present. Presence of easy bruising and bradycardia aren't found with pancreatitis; the client typically experiences tachycardia, not bradycardia. Adventitious breath sounds and hypertension aren't associated with 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 Explanation: The nurse should place the client with acute pancreatitis in a side-lying position with knees flexed; this position promotes comfort by decreasing pressure on the abdominal muscles. The nurse should administer an analgesic, as needed and ordered, before pain becomes severe, rather than once each shift. Because the client needs a quiet, restful environment during the acute disease stage, the nurse should discourage frequent visits from family and friends. Frequent oral feedings are contraindicated during the acute stage to allow the pancreas to rest.

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client?

Relieving abdominal pain Explanation: The predominant clinical feature of acute pancreatitis is abdominal pain, which usually reaches peak intensity several hours after onset of the illness. Therefore, relieving abdominal pain is the nurse's primary goal. Because acute pancreatitis causes nausea and vomiting, the nurse should try to prevent fluid volume deficit, not overload. The nurse can't help the client achieve adequate nutrition or understand the disease and its treatment until the client is comfortable and no longer in pain.

The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of:

Serum lipase Explanation: In most cases, serum amylase and lipase levels are elevated within 24 hours of the onset of the symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but serum lipase levels may remain elevated for a longer period, often days longer than amylase.