Med Surg: Pancreatitis

The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all that apply. 1. Administer antacids as prescribed 2. Encourage coughing and deep breathing 3. Administer anticholinergics as prescribed 4. Give small, frequent high-calorie feedings 5. Maintain the client in a supine and flat position 6. Give meperidine (Demerol) as prescribed for pain.

Ans: 1, 2, 3, 6 The client with acute pancreatitis normally is placed on NPO status to rest the pancreas and suppress gastrointestinal secretions. Because abdominal pain is a prominent symptom pancreatitis, pain medication such as meperidine is prescribed. Some clients experience lessened pain by assuming positions that flex the trunk, with the knees drawn up to the chest. A side-lying position with the head elevated 45 degrees decreases tension on the abdomen and may help ease the pain. The client is susceptible to respiratory infections because the retroperitoneal fluid raises the diaphragm, which causes the client to take shallow, guarded abdominal breaths. Therefore measures such as turning, coughing, and deep breathing are instituted. Antacids and anticholinergics may be prescribed to suppress gastrointestinal secretions.

A client has been admitted to the hospital with a diagnosis of acute pancreatitis and the nurse is assessing the client's pain. What type of pain is consistent with this diagnosis? 1. Burning and aching, located in the left lower quadrant and radiating to the hip 2. Severe and unrelenting, located in the epigastric area and radiating to the back 3. Burning and aching, located in the epigastric are and radiating to the umbilicus 4. Severe and unrelenting, located in the left lower quadrant and radiating to the groin

Ans: 2 The pain associated with acute pancreatitis is often severe and unrelenting, is located in the epigastric region, and radiates to the back. The other options are incorrect.

The nurse is instructing a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided (select all that apply)? a. Avoid nicotine b. Eat bland foods c. Observe stools for steatorrhea d. Eat high-fat, low-protein, high-carbohydrate meals e. Take prescribed pancreatic enzymes immediately following meals.

Ans: a, b, c Measures to prevent attacks of pancreatitis are those that decrease the stimulation of the pancreas. Lower fat intake and foods that are less stimulating and irritating (bland) should be encouraged. Higher carbohydrates are less stimulating. Avoid alcohol and nicotine, since both stimulate the pancreas. Monitor for steatorrhea to determine effectiveness of the enzymes and because it may indicate worsening pancreatic function. Pancreatic enzymes should be taken with, not after, meals.

Nursing management of the patient with acute pancreatitis includes (select all that apply) a. checking for signs of hypocalcemia. b. providing a diet low in carbohydrates. c. giving insulin based on a sliding scale. d. observing stools for signs of steatorrhea. e. monitoring for infection, particularly respiratory tract infection.

Ans: a, e

Combined with clinical manifestations, what is the laboratory finding that is most commonly used to diagnose acute pancreatitis? a. Increased serum calcium b. Increased serum amylase c. Increased urinary amylase d. Decreased serum glucose

Ans: b Although serum lipase levels and urinary amylasy levels are increased, an increased serum amylase level is the criterion most commonly used to diagnose acute pancreatitis in the first 24 to 72 hours. Serum calcium levels are decreased.

What is the patient with chronic pancreatitis more likely to have than the patient with acute pancreatitis? a. The need to abstain from alcohol b. Experience acute abdominal pain c. Malabsorption and diabetes mellitus d. Require a high-carbohydrate, high-protein, low-fat diet

Ans: c Chronic damage to the pancreas causes a deficiency of digestive enzymes and insulin resulting in malabsorption and diabetes mellitus. Abstinence from alcohol is necessary in both types of pancreatitis, as is a high-carbohydrate, high protein, and low-fat diet. Although abdominal pain is a major manifestation of chronic pancreatitis, more commonly a constant heavy, gnawing feeling occurs.

What treatment measure is used in the management of the patient with acute pancreatitis? a. Surgery to remove the inflamed pancreas b. Pancreatic enzyme supplements administered with meals c. Nasogastric (NG) suction to prevent gastric contents from entering the duodenum d. Endoscopic pancreatic sphincterotomy using endoscopic retrograde cholangiopancreatography (ERCP)

Ans: c Pancreatic rest and suppression of secretions are promoted by preventing any gastric contents from entering the duodenum, which would stimulate pancreatic activity. Surgery is not indicated for acute pancreatitis but may be used to drain abscesses or cysts. An endoscopic retrograde cholangiopancreatography (ERCP) pancreatic sphincterotomy may be performed when pancreatitis is related to gallstones. Pancreatic enzyme supplements are necessary in chronic pancreatitis if a deficiency in secretion occurs.

A patient with acute pancreatitis has a nursing diagnosis of pain related to distention of the pancreas and peritoneal irritation. In addition to effective use of analgesics, what should the nurse include in this patient's plan of care? a. Provide diversional activities to distract the patient from the pain. b. Provide small, frequent meals to increase the patient's tolerance to food. c. Position the patient on the side with the head of the bed elevated 45 degrees of pain relief. d. Ambulate the patient every 3 to 4 hours to increase circulation and decrease abdominal congestion.

Ans: c Positions that flex the trunk and draw the knees up to the abdomen help to relieve the pain of acute pancreatitis and positioning of the patient on the side with the head elevated decreases abdominal tension. Diversional techniques are not as helpful as positioning in controlling the pain. The patient is usually NPO because food intake increases the pain and inflammation. Bed rest is indicated during the acute attack because of hypovolemia and pain.

The nurse determines that further discharge instruction is needed when the patient with acute pancreatitis makes which statement? a. "I should observe for fat in my stools." b. "I must not use alcohol to prevent future attacks of pancreatitis." c. "I shouldn't eat any salty foods or foods with high amounts of sodium." d. "I will need to continue to monitor my blood glucose levels until my pancreas is healed."

Ans: c Sodium restriction is not indicated for patients recovering from acute pancreatitis but the stools should be observed for steatorrhea, indicating that fat digestion is impaired, and glucose levels may be monitored for indication of impaired B-cell function. Alcohol is a primary cause of pancreatitis and should not be used.

Which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis? a. Tetany b. Pseudocyst c. Plerual effusion d. Pancreatic abscess

Ans: d A pancreatic abscess is a collection of pus that must be drained to prevent infection of adjacent organs and sepsis. Tetany from hupocalcemia is treated with IV calcium gluconate (10%). Although pseudocysts usually resolve spontaneously, they may be treated with surgical, percutaneous catheter, or endoscopic drainage to prevent perforation. Pleural effusion is treated by treating the cause (pancreatitits) and monitoring for respiratory distress and oxygen saturation.

When assessing a patient with acute pancreatitis, the nurse would expect to find: a. hyperactive bowel sounds. b. hypertension and tachycardia. c. a temperature greater than 102 F (38.9 C). d. Severe midepigastric or left upper quadrant (LUQ) pain.

Ans: d the predominant symptom of acute pancreatitis is severe, deep abdominal pain that is usually located in the left upper quadrant (LUQ) but may be in the midepigastrium. Bowel sounds are decreased or absent, temperature is elevated only slightly, and the patient has hypovolemia and may manifest symptoms of shock.