NU371 Week 6 PrepU: Pancreatitis
A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct? "Maintain a high-fat diet and drink at least 3 L of fluid a day." "Maintain a high-carbohydrate, low-fat diet." "Maintain a high-sodium, high-calorie diet." "Maintain a high-fat, high-carbohydrate diet."
"Maintain a high-carbohydrate, low-fat diet." o A client with a history of pancreatitis should avoid foods and beverages that stimulate the pancreas, such as fatty foods, caffeine, and gas-forming foods; should avoid eating large meals; and should eat plenty of carbohydrates, which are easily metabolized. Therefore, the only correct instruction is to maintain a high-carbohydrate, low-fat diet. An increased sodium or fluid intake isn't necessary because chronic pancreatitis isn't associated with hyponatremia or fluid loss.
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 Placing the client in a semi-Fowler's position Maintaining nothing-by-mouth (NPO) status Providing mouth care
Administering morphine I.V. as ordered o 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 Chvostek's sign Broca's sign Trousseau's sign
Cullen's sign o 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 teaching a client about chronic pancreatitis, which of these does the nurse relate is the long term result of this condition? Alcohol abuse Weight gain Progressive destruction of the organ Easily cured with antibiotic therapy
Progressive destruction of the organ o 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.
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. Monitor pulse oximetry every hour. Instruct the client to avoid coughing. Withhold oral feedings for the client.
Reposition the client every 2 hours. o Repositioning the client every 2 hours minimizes the risk of atelectasis in a client who is being treated for pancreatitis. The client should be instructed to cough every 2 hours to reduce atelectasis. Monitoring the pulse oximetry helps show changes in respiratory status and promote early intervention, but it would do little to minimize the risk of atelectasis. Withholding oral feedings limits the reflux of bile and duodenal contents into the pancreatic duct.
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 renal failure. The patient requires more pain medication. The patient is developing a paralytic ileus. The patient has developed peritonitis.
The patient has developed peritonitis. o 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 relieve nausea and vomiting To reduce gastric and pancreatic secretions To decrease metabolism To depress the central nervous system and increase the pain threshold
To reduce gastric and pancreatic secretions o Anticholinergic medications reduce gastric and pancreatic secretion.
What is a major concern for the nurse when caring for a patient with chronic pancreatitis? Mental status changes Nausea Pain Weight loss
Weight loss o Weight loss is a major problem in chronic pancreatitis. More than 80% of patients experience significant weight loss, which is usually caused by decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack (Bope & Kellerman, 2011).
When assessing the client with acute pancreatitis, which of these diagnostic tests—consistent with the disease— does the nurse anticipate will be altered? The transaminases Amylase and lipase Glucose values Creatine kinase
Amylase and lipase o Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis.
Given the fact that acute pancreatitis can result in severe, life-threatening complications, the nurse should be assessing the client for which complication? Complete heart block Acute tubular necrosis Cerebral hemorrhage Bilateral pneumothorax
Acute tubular necrosis o Complications of acute pancreatitis include the systemic inflammatory response, acute respiratory distress syndrome, acute tubular necrosis, and organ failure. Cerebral hemorrhage, bilateral pneumothorax, and complete heart block are not associated with the complications of acute pancreatitis.
Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes mellitus. Which of the following explains the cause of this secondary diabetes? Ingestion of foods high in sugar Inability for the liver to reabsorb serum glucose Dysfunction of the pancreatic islet cells Renal failure
Dysfunction of the pancreatic islet cells o Diabetes mellitus resulting from dysfunction of the pancreatic islet cells is treated with diet, insulin, or oral antidiabetic agents. The hazard of severe hypoglycemia with alcohol consumption is stressed to the client and family. When secondary diabetes develops in a client with chronic pancreatitis, the client experiences increased appetite, thirst, and urination. A standard treatment with pancreatitis is to make the client NPO. The dysfunction is related to the pancreas, not the liver.
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? Elevated urine amylase levels Decreased white blood cell count Increased serum calcium levels Decreased liver enzyme levels
Elevated urine amylase levels o 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.
Which condition is most likely to have a nursing diagnosis of fluid volume deficit? Pancreatitis Cholecystitis Appendicitis Gastric ulcer
Pancreatitis o 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.
When caring for a client with acute pancreatitis, the nurse should use which comfort measure? Encouraging frequent visits from family and friends Administering frequent oral feedings Positioning the client on the side with the knees flexed Administering an analgesic once per shift, as ordered, to prevent drug addiction
Positioning the client on the side with the knees flexed o 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 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 calcium Serum bilirubin Serum potassium Serum amylase
Serum amylase o Serum amylase and lipase concentrations are used to make the diagnosis of acute pancreatitis. Serum amylase and lipase concentrations are elevated within 24 hours of the onset of symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but the serum lipase concentration may remain elevated for a longer period, often days longer than amylase. Urinary amylase concentrations also become elevated and remain elevated longer than serum amylase concentrations.
Which of these substances should the nurse teach the client with pancreatitis to absolutely avoid? Fatty foods Alcohol Opioid analgesics Concentrated sweets
Alcohol o Clients with chronic pancreatitis must be told alcohol is forbidden as it frequently precipitates attacks.
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 Suction the patient every 4 hours Placing the patient in the prone position Perform chest physiotherapy
Frequent changes of positions o Frequent changes of position are necessary to prevent atelectasis and pooling of respiratory secretions.
When teaching the client about the cause of acute pancreatitis, which of these points should be included in the teaching session? The pancreas has developed inflammation due to ingestion of acetaminophen. Pancreatic enzymes are activated before leaving the pancreas, causing injury. The only way to get pancreatitis is from alcohol abuse. An infection of the pancreas has occurred.
Pancreatic enzymes are activated before leaving the pancreas, causing injury. o The pathogenesis of acute pancreatitis involves the autodigestion of pancreatic tissue by prematurely activated pancreatic enzymes. Trypsin is activated, then can activate a variety of digestive enzymes that cause pancreatic injury, resulting in an intense local inflammatory and systemic inflammatory response syndrome.
The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status? To aid opening up of pancreatic duct To drain the pancreatic bed To avoid inflammation of the pancreas To prevent the occurrence of fibrosis
To avoid inflammation of the pancreas o Pancreatic secretion is increased by food and fluid intake and may cause inflammation of the pancreas.
Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: can digest high-fat foods. cannot tolerate high-glucose concentration. are at risk for gallbladder contraction. are at risk for hepatic encephalopathy.
cannot tolerate high-glucose concentration. o Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.
The oncology nurse is teaching a group of nursing students about risk factors for pancreatic cancer. Which factors does the nurse include in the teaching session? Select all that apply. Hypertension Chronic pancreatitis Cigarette smoking Age over 50 years Colon cancer
Chronic pancreatitis Cigarette smoking Age over 50 years o The cause of pancreatic cancer is unknown. However, age, smoking, and chronic pancreatitis have been found to be risks. Pancreatic cancer rarely occurs in people younger than 50 years of age, and the risk increases with age.
Which individual likely faces the highest risk of developing chronic pancreatitis? A woman who has 6 to 8 alcoholic beverages each evening A woman who takes 2 acetaminophen tablets 5 to 6 times a day An obese man who has a high-fat diet and has a sedentary lifestyle A man who has become profoundly ill during a tropical vacation
A woman who has 6 to 8 alcoholic beverages each evening o 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.
When caring for the client with acute pancreatitis, which alterations does the nurse recognize is consistent with the disease? Hypertension Hyperglycemia Polyuria Leukopenia
Hyperglycemia o Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis. The white blood cell count may be increased, and hyperglycemia and an elevated serum bilirubin level may be present.
A central venous catheter is inserted for a client being treated for acute pancreatitis. Which of the following would the nurse need to monitor closely? Urine volume Lung sounds Serum electrolyte values Pressure measurements
Pressure measurements o When the physician inserts a central venous catheter in a client who is being treated for acute pancreatitis, the nurse monitors pressure measurements. The nurse should also monitor serum electrolyte values, urine volume, and lung sounds even if a central venous catheter has not been inserted.
The nurse identifies a potential collaborative problem of electrolyte imbalance for a client with severe acute pancreatitis. Which assessment finding alerts the nurse to an electrolyte imbalance associated with acute pancreatitis? Elevated blood glucose concentration Muscle twitching and finger numbness Hypotension Paralytic ileus and abdominal distention
Muscle twitching and finger numbness o Muscle twitching and finger numbness indicate hypocalcemia, a potential complication of acute pancreatitis. Calcium may be prescribed to prevent or treat tetany, which may result from calcium losses into retroperitoneal (peripancreatic) exudate. The other data indicate other complications of acute pancreatitis but are not indicators of electrolyte imbalance.
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? Use incentive spirometry every hour. Instruct the client to cough only when necessary. Monitor pulse oximetry every hour. Withhold analgesics unless necessary.
Use incentive spirometry every hour. o The nurse instructs the client in techniques of coughing and deep breathing and in the use of incentive spirometry to improve respiratory function. The nurse assists the client to perform these activities every hour. Repositioning the client every 2 hours minimizes the risk of atelectasis. The client should be instructed to cough every 2 hours to reduce atelectasis. Monitoring pulse oximetry helps show changes in respiratory status and promotes early intervention, but it would do little to minimize the risk of atelectasis. Withholding analgesics is not an appropriate intervention due to the severe pain associated with pancreatitis.
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? Albumin 2.0 g/dL (20 g/L) (low) Amylase 150 units/L (2.50 µkat/L) (high) Serum calcium level 7 mg/dL (1.75 mmol/L) (low) Bilirubin 15 mg/dL (256.56 µmol/L) (high)
Bilirubin 15 mg/dL (256.56 µmol/L) (high) o 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.
Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? Tetany Shock Pancreatic necrosis MODS
Pancreatic necrosis o Pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis. Shock and multiple organ failure may occur with acute pancreatitis. Tetany is not a major cause of morbidity and mortality in clients with acute pancreatitis.
The nursing student has just reviewed material in the course textbook regarding pancreatitis. The student knows that a major symptom of pancreatitis that causes the client to seek medical care is: Jaundice Mental agitation Fever Severe abdominal pain
Severe abdominal pain o The pain of acute pancreatitis is often very severe, necessitating the liberal use of analgesics. Jaundice is indicative of a bile duct obstruction. Fever and mental agitation are not indicative of pancreatitis.
Which of the following symptoms would indicate that a client with chronic pancreatitis has developed secondary diabetes? Decreased urination and constipation Vomiting and diarrhea Increased appetite and thirst Low blood pressure and pulse
Increased appetite and thirst o 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.
Which nursing action is most appropriate for a client hospitalized with acute pancreatitis? keeping the client supine to increase comfort limiting I.V. fluids, as ordered, to decrease cardiac workload administering oral pain medications, as ordered, to relieve severe pain withholding all oral intake, as ordered, to decrease pancreatic secretions
withholding all oral intake, as ordered, to decrease pancreatic secretions o The nurse should withhold all oral intake to suppress pancreatic secretions, which may worsen pancreatitis. Typically, this client requires a nasogastric tube to decompress the stomach and GI tract. Although pancreatitis may cause considerable pain, it's treated with I.M. meperidine or morphine, not oral pain medicines. Pancreatitis places the client at risk for fluid volume deficit from fluid loss caused by increased capillary permeability. Therefore, this client needs fluid resuscitation, not fluid restriction. A client with pancreatitis is most comfortable lying on the side with knees flexed.
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? Presence of blood in the client's stool and recent hypertension Adventitious breath sounds and hypertension Pain with abdominal distention and hypotension Presence of easy bruising and bradycardia
Pain with abdominal distention and hypotension o 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.
The nurse is caring for a client with acute pancreatitis who is admitted to the intensive care unit to monitor for pulmonary complications. What is the nurse's understanding of the pathophysiology of pulmonary complications related to pancreatitis? Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation. Pancreatitis can elevate the diaphragm and alter the breathing pattern. Pancreatitis causes alterations to hemoglobin, impairing oxygenation. Pancreatitis can atrophy the diaphragm and alter the breathing pattern.
Pancreatitis can elevate the diaphragm and alter the breathing pattern. o Aggressive pulmonary care is required for clients with acute pancreatitis. Pancreatitis can elevate the diaphragm and alter the breathing pattern of clients. Pancreatitis can cause retention of pulmonary secretions but does not thicken the secretions. Acute pancreatitis does not alter the hemoglobin.
A client with a history of chronic pancreatitis asks about potential long-term complications. Which response by the nurse would be most accurate? Chronic pancreatitis can lead to liver failure and cirrhosis. Clients with chronic pancreatitis develop portal hypertension. Clients can develop signs of diabetes and malabsorption. Long-term effects are similar to those seen in cholelithiasis.
Clients can develop signs of diabetes and malabsorption. o Chronic hepatitis is manifested by episodes that are similar to those of acute pancreatitis. As the disease progresses, the endocrine and exocrine pancreatic functions become deficient and the client develops signs of diabetes and malabsorption syndrome. Cholelithiasis may cause liver disorder. Chronic pancreatitis is irreversibility of pancreatic function, not liver function.
When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize that the pathogenesis begins with an inflammatory process whereby: stones will develop in the common bile duct, resulting in acute jaundice. the pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction. activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue. the pancreas is irreversibly damaged and will not recover to normal functioning (chronic).
activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue. o 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 male musician has presented to the emergency department of a hospital after a concert complaining of severe and sudden abdominal pain. He admits to a history of copious alcohol use in recent years, and his vital signs include temperature 38.8°C (101.8°F), blood pressure 89/48 mm Hg and heart rate 116 beats per minute. Blood work indicates that his serum levels of C-reactive protein, amylase, and lipase are all elevated. Which diagnosis would the care team suspect first? Hepatitis C Cholecystitis Liver cirrhosis Acute pancreatitis
Acute pancreatitis o 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 HCV 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 clients usually have anemia, thrombocytopenia, endocrine disorders, skin lesions, azotemia and renal failure, and hepatic encephalopathy.
The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion? Have the patient eat a cracker as the tube is being inserted. Spray the oropharynx with an anesthetic spray. Allow the patient to sip water as the tube is being inserted. Have the patient maintain a backward tilt head position.
Allow the patient to sip water as the tube is being inserted. o During insertion, the patient usually sits upright with a towel or other protective barrier spread in a biblike fashion over the chest. The nostril may be swabbed or the oropharynx sprayed with an anesthetic agent to numb the nasal passage and suppress the gag reflex. The tip of the patient's nose is tilted upward, and the tube is aligned to enter the nostril. When the tube reaches the nasopharynx, the patient is instructed to lower the head slightly and, if able, to begin to swallow as the tube is advanced. The patient may also be encouraged to sip water through a straw to facilitate advancement of the tube if this action is not contraindicated.
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? Development of local complications Decreases in the physiologic function of major organs Increases in the bicarbonate output by the kidneys Increases in the rate of pancreatic secretion
Decreases in the physiologic function of major organs o 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.
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? Acetone in the urine Frequent vomiting, leading to loss of fluid volume Dry mouth, which makes the client thirsty High glucose concentration in the blood
Frequent vomiting, leading to loss of fluid volume o 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.
A health care provider suspects a client may have developed pancreatitis. Which laboratory value will confirm this diagnosis? Altered alkaline phosphatase and red blood cell count Chymotrypsin level and fibrinogen level High serum amylase and lipase Change in platelet count and prothrombin level
High serum amylase and lipase o Laboratory criteria for the diagnosis of pancreatitis are serum amylase or lipase greater than three times the upper limit of normal. Altered alkaline phosphatase and prothrombin levels may indicate liver disease. Alkaline phosphatase is one kind of enzyme found in the body. It can show signs of liver disease or a bone disorder. The red blood cell count is used to measure the number of oxygen-carrying blood cells in a volume of blood. Chymotrypsin digests proteins in the intestine. Fibrinogen is a soluble protein in the plasma that is broken down to fibrin by the enzyme thrombin to form clots. A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Having more than 450,000 platelets is a condition called thrombocytosis; having less than 150,000 is known as thrombocytopenia. Prothrombin time is a blood test that measures how long it takes blood to clot.
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 Vomiting Ascites Hemorrhage
Hyperbilirubinemia o 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? Nausea Disturbed body image Anxiety Impaired nutrition: less than body requirements
Impaired nutrition: less than body requirements o 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.
A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instructions would be most appropriate? Maintain a high-fat, high-carbohydrate diet. Maintain a high-carbohydrate, low-fat diet. Maintain a low-carbohydrate, low-fat diet. Maintain a high-fat, low-carbohydrate diet.
Maintain a high-carbohydrate, low-fat diet. o A client with a history of pancreatitis should avoid foods and beverages that stimulate the pancreas, such as fatty foods, caffeine, and gas-forming foods; should avoid eating large meals; and should eat plenty of carbohydrates, which are easily metabolized. Therefore, the only correct instruction is to maintain a high-carbohydrate, low-fat diet. An increased sodium or fluid intake is not necessary because chronic pancreatitis is not associated with hyponatremia or fluid loss.
A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN? Auscultate the abdomen for bowel sounds every 4 hours Monitor for reports of nausea and vomiting Measure blood glucose concentration every 4 to 6 hours Measure abdominal girth every shift
Measure blood glucose concentration every 4 to 6 hours o 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.
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? Maintaining adequate nutritional status Relieving abdominal pain Preventing fluid volume overload Teaching about the disease and its treatment
Relieving abdominal pain o 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.
A client has sustained a lung injury while hospitalized for the treatment of acute pancreatitis. The nurse anticipates that proliferation of cells will result from: Type I pneumocytes Type II alveolar cells Alveolar macrophages Type I alveolar cells
Type II alveolar cells o Type II alveolar cells are the progenitor cells for type I cells. Following lung injury, they proliferate and restore both type I and type II alveolar cells. Type I alveolar cells are not capable of regeneration. Type I alveolar cells are also known as type I pneumocytes. The alveolar macrophages, which are present in both the connective tissue of the septum and the air spaces of the alveolus, are responsible for the removal of offending substances from the alveoli.
A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis? Weight loss Diarrhea Hypertension Fatigue
Weight loss o Weight loss is most common in the client with chronic pancreatitis due to decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack. The other answer choices are not the most common complications related to chronic pancreatitis.
A parent brings a 10-year-old child to the emergency room with reports of abdominal pain. The nurse performing a physical assessment notes the following symptoms: upper right quadrant pain that radiates to the back; fever; nausea; and abdominal distention. Which disease would the nurse suspect? ulcerative colitis pancreatitis Crohn disease appendicitis
pancreatitis o The child admitted with the suspicion of pancreatitis typically reports acute onset of persistent abdominal pain. It can be mid-epigastric or periumbilical with radiation to the back or the chest. Nausea and vomiting, fever, tachycardia, hypotension, and jaundice may be present. Abdominal signs such as abdominal distention, decreased bowel sounds, rebound tenderness, and guarding also may be noted. Appendicitis pain and tenderness would be localized to the right lower quadrant. Crohn disease is a chronic bowel disorder causing frequent, recurring diarrhea. Ulcerative colitis is a chronic bowel disease affecting the large intestine and the rectum.
