Pancreatitis
The nurse recognizes that teaching a patient following a laparoscopic cholecystectomy has been effective when the patient makes which statement? a. "I can take a shower and walk around the house tomorrow." b. "I need to limit my activities and not return to work for 4 weeks." c. "I can expect yellowish drainage from the incision for a few days." d. "I will follow a low-fat diet for life because I do not have a gallbladder."
"I can take a shower and walk around the house tomorrow."
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 not need to monitor my blood glucose levels when I am home"
"I shouldn't eat any salty foods or foods with high amounts of sodium"
The nurse has taught the client about an upcoming ERCP procedure. The nurse determines that the client needs further information if the client makes which statement? a. "I know I might sign the consent form" b. "I hope the throat spray keeps me from gagging" c. "I'm glad I don't have to lie still for this procedure" d. "I'm glad some intravenous medication will be given to relax me"
"I'm glad I don't have to lie still for this procedure"
Nursing assessment
- Abdominal pain, including a sudden onset at a mid-epigastric or LUQ location with radiation to the back - Pain aggravated by a fatty meal, alcohol or lying in a recumbent position - Abdominal tenderness and guarding - N&V - Weight loss - Absent or decreased bowel sounds - Elevated WBC, glucose, bilirubin, alkaline phosphatase, and urinary amylase levels - Elevated lipase and amylase levels - Decreased calcium, magnesium levels - Cullen's sign - Turner's sign
What are causes of pancreatitis?
- Trauma - Use of alcohol - Biliary tract disease - Viral/bacterial disease - Hyperlipidemia - Hypercalcemia - Cholelithiasis - Hyperparathyroidism - Ischemic vascular disease - Peptic ulcer disease
Nursing interventions
- Withhold food and fluid during the acute period and maintain hydration with IVF - Administer parenteral nutrition for severe nutritional depletion - Administer supplement preparations and vitamins/minerals to increase caloric intake - An NG may be inserted if the pt is vomiting or has a biliary obstruction/paralytic ileus - Administer opiates for pain - Administer H2-recepter antagonists or PPI's to decrease hydrochloric acid production and prevent activation of pancreatic enzymes - Instruct the client in avoidance of alcohol - Instruct the client to notify HCP if acute abdominal pain, jaundice, clay-colored stools, or dark-colored urine develops
In reviewing the medical record for a patient admitted with acute pancreatitis, the nurse sees that the patient has a positive Cullen's sign. Indicate the area in the accompanying figure where the nurse will assess for this change. a. 1 b. 2 c. 3 d. 4
3
During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first? a. A 58-yr-old patient who has compensated cirrhosis and reports anorexia b. A 40-yr-old patient with chronic pancreatitis who has gnawing abdominal pain c. A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C) d. A 36-yr-old patient recovering from a laparoscopic cholecystectomy who has severe shoulder pain
A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C)
What manifestations are associated with acute pancreatitis?
Abdominal pain in the LUQ, N&V, low-grade fever, elevated WBC count, hypotension, tachycardia, jaundice
A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte levels are normal. d. Abdominal pain is decreased.
Abdominal pain is decreased
Which enzyme is responsible for autodigestion of the pancreas and leads to bleeding in a patient with acute pancreatitis?
Activated trypsin
A patient reports severe pain in the abdomen. The patient's body temperature is 100. The laboratory reports show a white blood cell (WBC) count of 13,000, lipase of 180, and amylase of 150. Which condition would the nurse suspect? a. Hepatitis b. Cholelithiasis c. Liver cirrhosis d. Acute pancreatitis
Acute pancreatitis
A patient reports severe, piercing pain in the abdomen, accompanied by shortness of breath. The laboratory reports demonstrate elevated serum amylase, triglycerides, and lipase levels, as well as hyperglycemia. Which condition would the nurse suspect? a. Cirrhosis b. Cholescystitis c. Hepatic cancer d. Acute pancreatitis
Acute pancreatitis
Which interventions would the nurse implement for a patient with acute pancreatitis who is restless and reports abdominal pain? SATA a. Massage the patient's abdomen b. Administer IV morphine c. Encourage the patient to go for a walk d. Instruct the patient to drink more water e. Encourage the patient to change positions frequently
Administer IV morphine Encourage the patient to change positions frequently
Which prescribed treatment would the nurse expect to administer to a patient with pancreatitis who has a BP of 80/70 mm Hg? a. Albumin b. Octreotide c. Cyclosporine d. Acetazolamide
Albumin
What risk factor will the nurse specifically ask about when a patient is being admitted with acute pancreatitis? a. Diabetes b. Alcohol use c. High-protein diet d. Cigarette smoking
Alcohol use
Which client problem has priority for the client diagnosed with acute pancreatitis? a. Risk for fluid volume deficit b. Alteration in comfort c. Imbalanced nutrition: less than body requirements d. Knowledge deficit
Alteration in comfort
A patient with acute pancreatitis has hypovolemic shock. Which order will the nurse implement first? a. Start 1000mL of normal saline at 500 mL/hr b. Obtain blood cultures before starting IV antibiotics c. Draw blood for hematology and coagulation factors d. Apply high-flow oxygen (100%) with a non-rebreather mask
Apply high-flow oxygen (100%) with a non-rebreather mask
The client diagnosed with acute pancreatitis is complaining of severe abdominal pain. Which interventions should the nurse implement? SATA a. Ask the client to rate the pain on a scale of 1-10 pain scale b. Determine when the client received the last dose of medication c. Administer Hydrocodone, a narcotic pain medication d. Assist the client to a semi-fowlers position e. Apply oxygen at 4 L/min via nasal cannula
Ask the client to rate the pain on a scale of 1-10 pain scale Determine when the client received the last dose of medication Assist the client to a semi-fowlers position
The client is immediate postprocedure (ERCP). Which intervention should the nurse implement? a. Assess for rectal bleeding b. Increase fluid intake c. Assess gag reflex d. Keep in supine position
Assess gag reflex
Trypsinogen is converted to trypsin leading to destruction of the ductal tissue and pancreatic cells. This then leads to what?
Autodigestion and fibrosis of the pancreas
Which finding for a patient with pancreatitis is termed Grey Turner's sign?
Bluish discoloration of the flank area
Which medication would the nurse anticipate will be prescribed for a patient with pancreatitis who reports tingling around the lips? a. Insulin b. Vitamin K c. Cholestyramine d. Calcium gluconate
Calcium gluconate
The client diagnosed with acute pancreatitis is placed on total parenteral nutrition (TPN). Which intervention should the nurse implement? a. Monitor blood glucose levels daily b. Assess the peripheral intravenous site c. Check the client's complete blood count d. Change the tubing with every new bag of TPN
Change the tubing with every new bag of TPN
When taking the blood pressure (BP) on the right arm of a patient who has severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patient's blood pressure. c. Check the calcium level in the chart. d. Notify the health care provider immediately
Check the calcium level in the chart
Which information about diet would the nurse provide for a patient who is diagnosed with acute pancreatitis? SATA a. Limit fluid intake b. Consume a low-fat diet c. Avoid consuming alcohol d. Consume a low-carb diet e. Consume a high-carb diet
Consume a low-fat diet Avoid consuming alcohol Consume a high-carb diet
Which laboratory finding indicates resolution of a patient's acute pancreatitis? a. Increasing hemoglobin level b. Falling serum bilirubin level c. Decreasing serum amylase level d. Increasing serum alkaline phosphatase level
Decreasing serum amylase level
The BP of a patient with pancreatitis dropped from 125/80 mm Hg to 90/60 mm Hg. The nurse administers isotonic fluids without an increase in the patient's BP. Which medication would the nurse anticipate will be prescribed by the health care provider? a. Morphine b. Dopamine c. Omeprazole d. Pancrelipase
Dopamine
An increase in capillary permeability results in leaking of fluid into the interstitium and can lead to what?
Edema, hypovolemia, hemorrhage, pancreatic and adipose tissue necrosis
Which physiologic condition is consistent with mild pancreatitis?
Edematous pancreas
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
Increased serum amylase
What medications can cause pancreatitis?
Glucocorticoids, sulfonamides, tetracyclines, NSAIDS, furosemide, hydrochlorothiazide, estrogen
A client admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assess by the nurse. Which assessment findings would be consistent with acute pancreatitis? SATA a. Diarrhea b. Black, tarry stools c. Hyperactive bowel sounds d. Gray-blue color at the flank e. Abdominal guarding and tenderness f. LUQ pain with radiation to the back
Gray-blue color at the flank Abdominal guarding and tenderness LUQ pain with radiation to the back
Which clinical findings would be consistent with a patient developing a pancreatic abscess? SATA a. High fever b. Steatorrhea c. Leukocytosis d. Chvostek's sign e. Abdominal pain
High fever Leukocytosis Abdominal pain
A patient with pancreatitis is irritable, has jerking movements, and reports a loss of sensation in the fingers. Which laboratory test results would the nurse expect? SATA a. Hypocalcemia b. Hypoglycemia c. Hyponatremia d. Hypomagnesemia e. Increased serum AFP
Hypocalcemia Hypomagnesemia
Which statements of the student nurse indicate effective learning about providing care to a patient with acute pancreatitis? SATA a. I should encourage the patient to tolerate pain b. I should encourage the patient to limit fluid intake c. I should monitor the patients blood glucose levels d. I should check for spider angioma on the patient's skin e. I should check the patient's body temperature for fever
I should monitor the patients blood glucose levels I should check the patient's body temperature for fever
Which laboratory finding would indicate a patient's worsening pancreatic function? a. Increased levels of sodium b. Increased levels of calcium c. Increased levels of potassium d. Increased levels of triglycerides
Increased levels of triglycerides
A patient with pancreatitis has a nasogastric tube connected to low intermittent gastric suction. Which intervention would the nurse expect to be prescribed? a. Infusion of calcium gluconate b. Administration of dicyclomine c. Infusion of lactated Ringer's solution d. Administration of oral pancreatic enzymes
Infusion of lactated ringers solution
A patient is admitted with tetany. Which laboratory value should the nurse plan to monitor? a. Total protein b. Blood glucose c. Ionized calcium d. Serum phosphate
Ionized calcium
A patient is admitted with severe acute pancreatitis. Which clinical manifestations would the nurse expect? SATA a. Jaundice b. Spider angiomas c. Exocrine function d. Thrombocytopenia e. Pancreatic necrosis
Jaundice Exocrine function Pancreatic necrosis
Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis? a. Lipase b. Calcium c. Bilirubin d. Potassium
Lipase
The client is diagnosed with acute pancreatitis. Which health-care provider's admitting order should the nurse question? a. Bedrest with bathroom privileges b. Initiate IV therapy of D5W at 125 mL/hr c. Weigh the client daily d. Low-fat, low-carbohydrate diet
Low-fat, low-carbohydrate diet
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? SATA a. Maintain NPO status b. Encourage coughing and deep breathing c. Give small, frequent high-calorie feedings d. Maintain the client in a supine and flat position e. Give hydromorphone IV for pain f. Maintain IVF at 10 mL/hr to keep the vein open
Maintain NPO status Encourage coughing and deep breathing Give hydromorphone IV for pain
The nurse is planning care for a patient with acute severe pancreatitis. What is the highest priority patient outcome? a. Having fluid and electrolyte balance b. Maintaining normal respiratory function c. Expressing satisfaction with pain control d. Developing no ongoing pancreatic disease
Maintaining normal respiratory function
The nurse is developing a plan of care for a patient with acute pancreatitis. Which nursing actions would be included in the plan of care? SATA a. Monitor electrolyte levels b. Assess respiratory function c. Provide psychologic support d. Prepare the patient for surgery e. Observe for muscular twitching
Monitor electrolyte levels Assess respiratory function Provide psychologic support Observe for muscular twitching
A patient with severe acute pancreatitis has abdominal distention, frequent belching, and excessive flatulence. Which drug in the patient's medication orders would the nurse hold until the health care provider is contacted? SATA a. Mylanta b. Morphine c. Omeprazole d. Dycyclomine e. Acetazolamide
Morphine Dycyclomine
Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient who has acute pancreatitis? a. Nausea and vomiting b. Hypotonic bowel sounds c. Muscle twitching and finger numbness d. Upper abdominal tenderness and guarding
Muscle twitching and finger numbness
Which intervention would the nurse expect to include in the plan of care for a patient with acute pancreatitis who has recurrent vomiting? a. Immediate enteral feeding to prevent malnutrition b. Nasogastric (NG) suction and NPO status c. Initiate early prophylactic therapy to prevent infection d. Administer Acetaminophen every four hours for pain relief
Nasogastric (NG) suction and NPO status
What treatment measure is used in managing 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)
Nasogastric (NG) suction to prevent gastric contents from entering the duodenum
Which assessment finding is of most concern for a patient with acute pancreatitis? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass
Palpable abdominal mass
A patient reports severe abdominal pain, nausea, and vomiting. The nurse palpates a mass in a patient's upper abdomen. Laboratory reports show the white blood cell (WBC) count as 12,000. The nurse would anticipate that the patient will be treated for which condition? a. Pseudocyst b. Cullens signs c. Spider angioma d. Pancreatic abscess
Pancreatic abscess
Which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis? a. Tetany b. Pseudocyst c. Pleural effusion d. Pancreatic abscess
Pancreatic abscess
Which condition is associated with the accumulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates? a. Biliary sludge b. Biliary atresia c. Pancreatic abscess d. Pancreatic pseudocyst
Pancreatic pseudocyst
The client diagnosed with acute pancreatitis is in pain. Which position should the nurse assist the client to assume to help decrease the pain? a. Recommend lying in the prone position with legs extended b. Maintain a tripod position over the bedside table c. Place in side-lying position with knees flexed d. Encourage a supine position with a pillow under the knees
Place in side-lying position with knees flexed
A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which prescribed action should the nurse take first? a. Place the patient on NPO status. b. Administer sedative medications. c. Ensure the consent form is signed. d. Teach the patient about the procedure.
Place the patient on NPO status
A patient with acute pancreatitis has a nursing diagnosis of acute pain resulting from 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 for pain relief d. Ambulate the patient every 3 to 4 hours to increase circulation and decrease abdominal congestion
Position the patient on the side with the head of the bed elevated 45 degrees for pain relief
Which action would the nurse perform immediately for a patient with acute pancreatitis who develops acute respiratory distress syndrome (ARDS)? a. Infuse NS b. Give chest compressions c. Provide ventilatory support d. Schedule a portable chest x-ray
Provide ventilatory support
When the increase in capillary permeability happens and the fluid leaks into the interstitial space, third spacing of fluids happens and leads to what?
SIRS
The third day after an alcohol-dependent patient was admitted to the hospital for acute pancreatitis, the nurse determines that the patient is experiencing alcohol withdrawal delirium. What are the signs of withdrawal delirium on which the nurse bases this judgement? SATA a. Apathy b. Seizures c. Disorientation d. Severe depression e. Cardiovascular collapse f. Visual and auditory hallucinations
Seizures Disorientation Visual and auditory hallucinations
The primary diagnostic tests for acute pancreatitis are?
Serum amylase and serum lipase
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 d. Severe left upper quadrant (LUQ) or midepigastric pain
Severe left upper quadrant (LUQ) or midepigastric pain
Which additional information should the nurse consider when reviewing the laboratory results for a patient's total calcium level? a. The blood glucose b. The serum albumin c. The phosphate level d. The magnesium level
The serum albumin
