Complex Care: Acute Pancreatitis
How long it is recommended for a patient with Acute Pancreatitist go without food intake
48-72 hours
Which condition has the signs and symptoms of ABDOMINAL PAIN SUDDEN ONSET at the mid-epigastric or left upper quadrant with radiation to the back. Pain may increase with meals due to stimulation, N/V, weight loss, Cullen's Signs, Turner Signs, fever, jaundice and hypovolemic shock
Acute Pancreatitis
Which condition presents with the laboratory results of elevated serum amylase, bilirubin, lipase, WBC, glycouse, AP, ALT, AST and decrease serum values for calcium, magensium and potassium
Acute Pancreatitis
A client is admitted to the hospital for acute pancreatitis. The nurse obtains the client's vital signs, performs a physical assessment, and reviews the client's health history. What is the priority intervention by the nurse? A. Reduce environmental stimuli. B. Institute constant observation of the client. C. Continue to monitor the client's vital signs. D. Assess the client for alcohol withdrawal symptoms.
D. Assess the client for alcohol withdrawal symptoms.
Which elements are released by the Pancreas when eating
Protein, Amylase & Lipase Fat
Acute Pancreatitis Medication Management IV Fluids-->NG Tube-->H2 Receptor Blockers or PPI-->Pain Control Opiates "Morphine"-->Nutrition 1st Choice Enteral Feeding & 2nd Choice Parenteral Feeding (TPN)-->NPO-->Fluid/Electrolyte Balance & Antiemetic Agents
Acute Pancreatitis Medication Management IV Fluids-->NG Tube-->H2 Receptor Blockers or PPI-->Pain Control Opiates "Morphine"-->Nutrition 1st Choice Enteral Feeding & 2nd Choice Parenteral Feeding-->NPO-->Fluid/Electrolyte Balance & Antiemetic Agents
What is the common cause of Acute Pancreatitis
Alcoholism
Which elements is the hallmark of Acute Pancreatitis
Hypocalcemia <9.0mg/dL (normal range: 9.0-10.5mg/dL)
Why is fluids the highest NURSING PRIORITY for Acute Pancreatitis
Hypovolemic Shock
What is the imaging GOLD Standard for Acute Pancreatitis
CT Scan with Contrast
What are the most common signs and symptoms of Acute Pancriatitis
Epigastric or RUQ abdominal pain
What condition results in the blockages of the Pancreas
Gallstones
Why does internal bleeding happen during Acute Pancreatitis
Third Spacing & Capillary Fluid Filling
What would a nurse isolate a patient with Acute Pancreatitis, especially with the smell of food
To prevent stimulation of the Pancreatic Enzymes that could excerbate their condition
When a nursing is assessing a patient for Acute Pancreatitis, what is the name of "brushing of the flank"
Turners
What is the normal range for Lipase
0-160units/L
What condition is inflammation and autodigestion of the pancreases due to ALCOHOL, biliary tract disease, viral or bacterial diseaes, hyperlipidemia, hypercalemia, cholelithiasis, hyperparahyrodism, ischemic vascular disease and peptic ulcer disease
Acute Pancreatitis
Which condition has the complications of ARDS, Sepsis, Multi-Organ Failure, Hypovolemic Shock, Pancreatic Abscesss and Renal Failure
Acute Pancreatitis
Acute Pancreatitis Nursing Interventions: IV Fluids-->Monitor I/O's-->NPO-->Alternative Nutrition (e.g. Enteral first choice & Parenteral 2nd choice)-->NG Tube placement IF PARALYTIC ILLEUS-->PAIN Managment-->Diet (e.g. low fat, avoid ETOH, avoid caffine)-->monitor/teach complications-->Notify acute abdominal pain, jaundice, dark urine, low BP & tachycardia
Acute Pancreatitis Nursing Interventions: IV Fluids-->Monitor I/O's-->NPO-->Alternative Nutrition (e.g. Enteral first choice & Parenteral 2nd choice)-->NG Tube placement IF PARALYTIC ILLEUS-->PAIN Managment-->Diet (e.g. low fat, avoid ETOH, avoid caffine)-->monitor/teach complications-->Notify acute abdominal pain, jaundice, dark urine, low BP & tachycardia
What medication administration decrease gastrointestinal activity and the secretion of pancreatic enzymes
Analgesics, histamine-receptor antagonists, and proton pump inhibitors
If a older patient has Acute Pancreatitis, what are the potential secondary effects
Atelectasis & Pneumonia
A client who is obese and has a history of alcohol abuse is admitted to the hospital with the diagnosis of acute pancreatitis. Which is the initial priority expected client outcome in response to therapy at this time? A. Report decreased pain B. Insert nasogastric (NG) tube quickly C.Join Alcoholics Anonymous D. Lose four pounds (1.8 kilograms) a week
A. Report decreased pain Pain relief is the priority. Severe pain is associated with acute pancreatitis caused by inflammation of the pancreas, peritoneal irritation, and biliary tract obstruction. Although inserting the NG tube quickly is appropriate, it is not priority, and some clients do not need an NG tube; the NG tube is inserted to allow the pancreas to rest, decreasing pain. Losing weight and joining Alcoholics Anonymous are later goals.
A client is admitted to the hospital with slight jaundice and reports of pain on the left side and back. A diagnosis of acute pancreatitis is made. Which common response to acute pancreatitis should the nurse monitor in the client? A. Crackles B. Hypovolemia C. Gastric reflux D. Jugular vein distention
B. Hypovolemia
Which medication should the nurse question when it is prescribed for a client with acute pancreatitis? A. Ranitidine B. Cimetidine C. Meperidine D. Promethazine
C. Meperidine Meperidine should be avoided because accumulation of its metabolites can cause central nervous system irritability and even tonic-clonic seizures (grand mal seizures). Ranitidine is useful in reducing gastric acid stimulation of pancreatic enzymes. Cimetidine is useful in reducing gastric acid stimulation of pancreatic enzymes. Promethazine is useful as an antiemetic for clients with pancreatitis. STUDY TIP: The old standbys of enough sleep and adequate nutritional intake also help keep excessive stress at bay. Although nursing students learn about the body's energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage.
A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis. The physiologic alteration that occurs in acute pancreatitis is A. uncontrolled hypoglycemia caused by an increased release of insulin. B. loss of storage capacity for senescent red blood cells. C. premature activation of inactive digestive enzymes, resulting in autodigestion. D. release of glycogen into the serum, resulting in hyperglycemia.
C. premature activation of inactive digestive enzymes, resulting in autodigestion.
When a nursing is assessing a patient for Acute Pancreatitis, what is the name of "brushing around the umbilicus"
Cullens
A client is admitted to the hospital for medical management of acute pancreatitis. Which nursing action is most likely to reduce the pancreatic and gastric secretions of a client with pancreatitis? A. Encouraging clear liquids B. Obtaining a prescription for morphine C. Assisting the client into a semi-Fowler position D. Administering prescribed anticholinergic medication
D. Administering prescribed anticholinergic medication Anticholinergic drugs block the neural impulses that stimulate pancreatic and gastric secretions; they inhibit the action of acetylcholine at postganglionic cholinergic nerve fibers. Oral fluids stimulate pancreatic secretion and are contraindicated. Morphine sulfate is an analgesic and therefore does not decrease gastric secretions; in the past morphine sulfate was contraindicated for pain control with pancreatitis because it can precipitate spasms of the smooth musculature of the pancreatic ducts and the sphincter of Oddi. However, recent research indicates that it is the drug of choice over meperidine hydrochloride because the metabolites of meperidine hydrochloride can cause central nervous system irritation and seizures. The semi-Fowler position decreases pressure against the diaphragm; it will not decrease pancreatic secretions. STUDY TIP: Enhance your time-management abilities by designing a study program that best suits your needs and current daily routines by considering issues such as the following: (1) amount of time needed; (2) amount of time available; (3) "best" time to study; (4) time for emergencies and relaxation.
What is the normal range for Amylase
25-125units/L
The nurse is teaching a client who is being discharged home after hospitalization for acute pancreatitis. Which statement by the client indicates a need for further teaching? A. "I may have caffeine and chocolate in moderation." B. "I may need to take fat-soluble vitamins and other supplements." C. "I should avoid alcohol even after symptoms resolve." D. "I will consume a diet high in carbohydrates and protein and low in fats."
A. "I may have caffeine and chocolate in moderation."
Acute Pancreatitis Nursing Priorities Fluids (Isotonic)-->Pain Managment-->Nutrition-->Infection
Acute Pancreatitis Nursing Priorities Fluids (Isotonic)-->Pain Managment-->Nutrition-->Infection
What condition results in the pre-mature activation of enzymes "autodigestion" within the Pancreas
Alcoholism
A client is admitted with a diagnosis of acute pancreatitis. The medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolytes, and decreasing anxiety. Which interventions should the nurse implement? Select all that apply. A. Provide a low-fat diet B. Administer analgesics C. Teach relaxation exercises D. Encourage walking in the hall E. Monitor cardiac rate and rhythm F. Observe for signs of hypercalcemia
B. Administer analgesics , C. Teach relaxation exercises & E. Monitor cardiac rate and rhythm
Which of the following lab results would be most indicative of pancreatitis? A. Glucose 115, sodium 137, amylase 100 B. Lipase 250, amylase 350, glucose 218, total calcium 4.2 C. Amylase 325, total calcium 9.2, potassium 4.1 D. Sodium 162, amylase 120, lipase 101
B. Lipase 250, amylase 350, glucose 218, total calcium 4.2
Why does a patient have hyperglycemic condition with Acute Pancreatitis
Breakdown of the Endrocrine component of Insulin
A client with a long history of alcohol abuse develops acute pancreatitis. What should be done to best prevent stimulation of the pancreas? A. Maintain the gastric pH at a level less than 3.5 B. Encourage the resumption of activities of daily living. C. Administer the histamine H2-receptor antagonist as prescribed. D. Ensure that the nasogastric tube remains in the fundus of the stomach
C. Administer the histamine H2-receptor antagonist as prescribed. The histamine H2-receptor antagonist medication inhibits histamine at H2 receptor sites in parietal cells, thus decreasing gastric secretion and preventing pancreatic stimulation. A lower pH will stimulate pancreatic secretion, which contains bicarbonate ions that neutralize the acid. The client should rest to decrease stimulation of the pancreas. The tube should be positioned nearer the pylorus for removal of gastric contents.
A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis. Based on the diagnosis, the patient A. is at risk for hypovolemic shock from plasma volume depletion. B. requires observation for hypothermia C. should be started on enteral feedings after the PEG tube is placed. D. is placed on a fluid restriction to avoid the fluid sequestration.
A. is at risk for hypovolemic shock from plasma volume depletion.
For Acute Pancreatitis, the laboratory results of Serum Amylase and Lipase will increase or decrease
Increase
True or False: If the Pancreatic Enzymes are not able to get out "blockage" (e.g .Gallstones) or pre-mature activation of the enzymes (e.g. Alcoholism), the enzymes cannot get out of the Pancreas, therefore, this results in breakdown of the enzymes inside the Pancreas that leads to inflammation
True
