Chapter 44: Assessment and Management of Patients with Biliary Disorders
A client has a nasogastric (NG) tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment? "The tube helps control fluid and electrolyte imbalance." "The tube provides relief from nausea and vomiting." "The tube allows the gastrointestinal tract to rest." "The tube allows toxins to be removed."
"The tube allows the gastrointestinal tract to rest." Explanation: Postoperative management of clients who have undergone a pancreatectomy or a pancreaticoduodenectomy is similar to the management of clients after extensive gastrointestinal or biliary surgery. An NG tube with suction and parenteral nutrition allow the gastrointestinal tract to rest while promoting adequate nutrition.
A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood glucose level does the nurse recognize as inadequate to sustain normal brain function? 30 mg/dL 50 mg/dL 70 mg/dL 90 mg/dL
30 mg/dL Explanation: Hyperinsulinism is caused by overproduction of insulin by the pancreatic islets. Occasionally, tumors of nonpancreatic origin produce an insulin-like material that can cause severe hypoglycemia and may be responsible for seizures coinciding with blood glucose levels that are too low to sustain normal brain function (i.e., lower than 30 mg/dL [1.6 mmol/L]) (Goldman & Schafer, 2012; McPherson & Pincus, 2011).
Pharmacologic therapy frequently is used to dissolve small gallstones. It takes about how many months of medication with UDCA or CDCA for stones to dissolve? 1 to 2 3 to 5 6 to 12 13 to 18
6 to 12 Explanation: Ursodeoxycholic acid (UDCA [URSO, Actigall]) and chenodeoxycholic acid (chenodiol or CDCA [Chenix]) have been used to dissolve small, radiolucent gallstones composed primarily of cholesterol. Six to 12 months of therapy are required in many clients to dissolve stones, and monitoring of the client for recurrence of symptoms or occurrence of side effects (e.g., GI symptoms, pruritus, headache) is required during this time.
Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? 1 to 4 months 4 to 6 months 6 to 12 months Over 1 year
6 to 12 months Explanation: Six to 12 months of therapy with UDCA is recommended in clients to dissolve the stones.
A client is instructed to follow a low-fat diet after an inflammatory attack of the gallbladder. Which vitamins or other acids will the nurse recommend the client supplement due to the client's dietary restrictions? Select all that apply. A D K Essential fatty acids Folic acid
A D K Essential fatty acids Explanation: A low-fat diet should be supplemented with vitamins A, D, K, and essential fatty acids. These vitamins are fat-soluble and will need to be administered if the client does not have adequate fat intake. Folic acid is not a fat-soluble vitamin.
The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired? Carbohydrate digestion Protein synthesis Fat digestion Protein digestion
Carbohydrate digestion Explanation: Amylase is a pancreatic enzyme involved in the breakdown and digestion of carbohydrates. Trypsin aids in the digestion of proteins. Lipase aids in the digestion of fats.
Which is a clinical manifestation of cholelithiasis? Epigastric distress before a meal Clay-colored stools Abdominal pain in the upper left quadrant Nonpalpable abdominal mass
Clay-colored stools Explanation: The client with gallstones has clay-colored stools and excruciating upper right quadrant pain that radiates to the back or right shoulder. The excretion of bile pigments by the kidneys makes urine very dark. The feces, no longer colored with bile pigments, are grayish (like putty) or clay colored. The client develops a fever and may have a palpable abdominal mass.
Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? Hot roast beef sandwich with gravy Mashed potatoes White rice Vanilla pudding
Hot roast beef sandwich with gravy Explanation: The diet immediately after an episode of acute cholecystitis is initially limited to low-fat liquids. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, bread, and coffee or tea may be added as tolerated. The client should avoid fried foods such as roast beef because fatty foods may bring on an episode of cholecystitis.
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? Disturbed body image Impaired nutrition: less than body requirements Nausea Anxiety
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.
A critical care nurse is caring for a client with acute pancreatitis. One potentially severe complication involves the respiratory system. Which of the following would be an appropriate intervention to prevent complications associated with the respiratory system? Maintain the client in a semi-Fowler's position. Administer enteral or parenteral nutrition. Carry out wound care as prescribed. Withhold oral feedings.
Maintain the client in a semi-Fowler's position. Explanation: The nurse maintains the client in the semi-Fowler's position to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion. Respiratory distress and hypoxia are common, and the client may develop diffuse pulmonary infiltrates, dyspnea, tachypnea, and abnormal blood gas values. The client who has undergone surgery may have multiple drains or an open surgical incision and is at risk for skin breakdown and infection. Oral food or fluid intake is not permitted; therefore, enteral or parenteral feedings may be prescribed.
The nurse is preparing a teaching tool on pancreatic cancer. Which risk factor(s) will the nurse include in this tool? Select all that apply. Obesity Diabetes Aspirin use Alcohol intake Cigarette smoking
Obesity Diabetes Alcohol intake Cigarette smoking Explanation: The incidence of pancreatic cancer increases with age, peaking in the seventh and eighth decades for both men and women. Risk factors for the development of pancreatic cancer include obesity and diabetes. The risk of pancreatic cancer is greater in those with a history of increased pack years of cigarette smoking and in those with high alcohol intake. Aspirin use is not an identified risk factor for the development of pancreatic cancer.
Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? Shock MODS Tetany Pancreatic necrosis
Pancreatic necrosis Explanation: 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.
Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? Appendicitis Pancreatitis Cholecystitis Peptic ulcer
Pancreatitis Explanation: Hypotension is typical and reflects hypovolemia and shock caused by the loss of large amounts of protein-rich fluid into the tissues and peritoneal cavity. The other conditions are less likely to exhibit fluid volume deficit.
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 can elevate the diaphragm and alter the breathing pattern. Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation. Pancreatitis can atrophy the diaphragm and alter the breathing pattern. Pancreatitis causes alterations to hemoglobin, impairing oxygenation.
Pancreatitis can elevate the diaphragm and alter the breathing pattern. Explanation: 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.
The nurse is caring for a client with symptoms of gallbladder disease. Which diagnostic test will the nurse anticipate preparing the client for to confirm the diagnosis? Ultrasound Abdominal x-ray Cholescintigraphy Oral cholecystography
Ultrasound Explanation: Ultrasonography is the diagnostic procedure of choice because it is rapid and accurate and can be used for clients with liver dysfunction and jaundice. Ultrasonography can detect calculi in the gallbladder or a dilated common bile duct with 90% accuracy. An abdominal x-ray may be obtained to exclude other causes of symptoms; however, only 10% to 15% of gallstones are calcified sufficiently to be visible on such x-ray studies. Cholescintigraphy is used successfully in the diagnosis of acute cholecystitis or blockage of a bile duct. Cholescintigraphy, however, is more expensive than ultrasonography, takes longer to perform, and exposes the client to radiation. It is often used when ultrasonography is not conclusive, such as in acalculous cholecystitis. Oral cholecystography is used if ultrasound equipment is not available or if the ultrasound results are inconclusive.
The digestion of carbohydrates is aided by lipase. amylase. trypsin. secretin.
amylase. Explanation: Amylase is secreted by the exocrine pancreas. Lipase aids in the digestion of fats. Trypsin aids in the digestion of proteins. Secretin is the major stimulus for increased bicarbonate secretion from the pancreas.
The nurse is assessing a client admited with suspected pancreatitis. Which question will the nurse prioritize when assessing this client? "How many meals do you eat every day?" "How much alcohol do you consume in a day?" "When was the last time you took acetaminophen?" "How often and how long do you exercise each day?
"How much alcohol do you consume in a day?" Explanation: Chronic pancreatitis is an inflammatory disorder characterized by progressive destruction of the pancreas. Alcohol consumption in Western societies is the major cause of chronic pancreatitis. Excessive and prolonged consumption of alcohol accounts for approximately 70% to 80% of all cases of chronic pancreatitis. The incidence of pancreatitis is 50 times greater in people with alcoholism than in those who do not abuse alcohol. The type of food (like fried or heavily processed foods) rather than the number of meals eaten each day may contribute to pancreatitis and subsequent flare-ups of the condition. The prescibed use of acetaminophen is not a typical risk factor in pancreatitis and is rare with cases of overdose. The amount and/or lack of exercise is not directly linked to pancreatitis. Risk factors do include obesity.
A client with calculi in the gallbladder is said to have Cholecystitis Cholelithiasis Choledocholithiasis Choledochotomy
Cholelithiasis Explanation: Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile; they vary greatly in size, shape, and composition. Cholecystitis is acute inflammation of the gallbladder. Choledocholithiasis is a gallstone in the common bile duct. Choledochotomy is an incision into the common bile duct.
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 Placing the patient in the prone position Perform chest physiotherapy Suction the patient every 4 hours
Frequent changes of positions Explanation: Frequent changes of position are necessary to prevent atelectasis and pooling of respiratory secretions.
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 requires more pain medication. The patient is developing a paralytic ileus. The patient has developed peritonitis. The patient has developed renal failure.
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 (Privette et al., 2011).
A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder? Edema and inflammation Pleural effusion Sepsis Disseminated intravascular coagulopathy
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.
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? Placing the client in a semi-Fowler's position Maintaining nothing-by-mouth (NPO) status Administering pain medication as ordered Providing mouth care
Administering pain medication as ordered Explanation: The nurse should address the client's pain issues first by administering pain medication 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 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? Increased serum calcium levels Elevated urine amylase levels Decreased liver enzyme levels Decreased white blood cell count
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.
From the following profiles of clients, which client would be most likely to undergo the diagnostic test of cholecystography? Steven, suspected of having a tumor in the colon Andrew, suspected of having esophageal abnormalities Mark, suspected of having stones in the gallbladder Sandra, suspected of having lesions in the liver
Mark, suspected of having stones in the gallbladder Explanation: Cholecystography will be most appropriate for Mark because the test is used to detect stones in the gallbladder. Most likely, Andrew would require barium swallow test to detect any abnormalities in the esophagus. Steven would need a barium enema for to identify a tumor in the colon. Sandra would undergo a radionuclide image test for her lesions in the liver.
The nurse instructs a client on care at home after a laparoscopic cholecystectomy. Which client statement indicates that teaching has been effective? "I can take a shower in a week." "I can drive after 2 weeks." "I should wash the site with mild soap and water." "I should remain on bed rest for several days."
"I should wash the site with mild soap and water." Explanation: After a laparoscopic cholecystectomy, the client should be instructed about pain management, activity and exercise, wound care, nutrition, and follow-up care. The client should be directed to wash the puncture site with mild soap and water when caring for the wound. When resuming activity, the client should be instructed to drive after 3 or 4 days, take a shower or bath after 1 or 2 days, and begin light exercise such as walking immediately.
A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client? "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use." "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated."
"This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." Explanation: If pain occurs in the right shoulder or scapular area (from migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure), the nurse may recommend using a heating pad for 15 to 20 minutes hourly, sitting up in a bed or chair, or walking.
A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? Acute pain related to biliary spasms Deficient knowledge related to prevention of disease recurrence Anxiety related to unknown outcome of hospitalization Imbalanced nutrition: Less than body requirements related to biliary inflammation
Acute pain related to biliary spasms Explanation: The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.
A client recovering from a laparoscopic cholecystectomy reports severe right shoulder pain 24 hours after the procedure. Which education will the nurse provide to the client? Seek medical attention. Position on the left side of the body. Increase the dose of pain medication. Apply a heating pad for 15 to 20 minutes.
Apply a heating pad for 15 to 20 minutes. Explanation: Due to the short length of hospital stay with uncomplicated laparoscopic cholecystectomies, it is important to provide client education about managing postoperative pain and reporting signs and symptoms of intra-abdominal complications. Pain in the right shoulder or scapular area from the migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure may occur. In this case, a heating pad should be applied for 15 to 20 minutes each hour. There is no reason for the client to seek immediate medical attention. Lying on the left side of the body will not relieve the discomfort. The client should be instructed to take pain medication as prescribed.
A client with acute pancreatitis is prescribed hydromorphone 2 mg intranvenously every 4 hours as needed for severe pain. Which assessment will the nurse prioritize for this client? Heart sounds Bowel sounds Bleeding tendency Development of nausea
Bowel sounds Explanation: Adequate administration of analgesia is essential during the course of acute pancreatitis to provide sufficient pain relief and to minimize restlessness, which may further stimulate pancreatic secretion. Pain relief may require parenteral opioids such as morphine, fentanyl, or hydromorphone. Gastrointestinal paralysis and ileus are common problems in early acute pancreatitis that can be potentiated and aggravated by the use of high-dose opioids. Although opioids can affect heart rate, assessing the effect on heart sounds would not be the priority over assessing for bowel sounds in acute pancreatitis. Bleeding tendency would be a priority if the client is taking nonsteroidal anti-inflammatory drugs. Nausea is not identified as a potential adverse effect when a client with acute pancreatitis receives opioids for pain management.
A nurse is reviewing the health care provider orders for a client admitted with acute pancreatitis. The health care provider has ordered intravenous calcium chloride infusions for the client. What does the nurse understand is the reason for this order? Calcium binds to fatty acids when auto digestion of the pancreas occurs. Calcium is unable to form when pancreatic enzymes are elevated. Calcium binds to proteins in the blood when pancreatic enzymes are released. Calcium is unable to enter the blood when auto digestion of the pancreas occurs.
Calcium binds to fatty acids when auto digestion of the pancreas occurs. Explanation: Hypocalcemia is a potential problem with acute pancreatitis because calcium binds to fatty acids when auto digestion of the pancreas occurs.
A nurse is caring for a client who was admitted with pain, tenderness, and rigidity of the upper right abdomen, suggesting a gall bladder issue. The client has also been experiencing nausea and vomiting for the past 3 days. The admitting service is planning for tests to be conducted in the morning.
Cholesterol is elevated in biliary obstruction. It is used to visualize calculi in the gallbladder The radioactive dye allows for visualization of the biliary tract Explanation: Laboratory assessments such as cholesterol levels are used to identify the high levels of cholesterol that contribute to the cholesterol stones. Acidosis (low pH) is not used to diagnosis gall bladder conditions but to identify acid-base imbalances. Potassium is an electrolyte and is not elevated or decreased with the presence of gallstones. An ultrasound or sonography is a high-frequency sound used to produce images of the soft tissue of the gallbladder. Ultrasound can identify a mass, but it does not provide the information needed to determine whether the mass is benign or malignant. The ultrasound does not require sedation; the client is usually awake during the procedure. Cholescintigraphy has been used successfully to diagnosis acute cholecystitis or blockage of a bile duct. In this procedure, a radioactive agent is administered intravenously and then the biliary tract is scanned and images of the gallbladder and biliary tract are obtained. This procedure is more expensive, takes longer to perform and exposes the client to radiation. This procedure does not involve x-rays or high-frequency sound.
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 Increases in the bicarbonate output by the kidneys Increases in the rate of pancreatic secretion Development of local complications
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.
When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.) Encouraging bed rest to decrease the metabolic rate Assisting the patient into the prone position Withholding oral feedings to limit the release of secretin Administering parenteral opioid analgesics as ordered Administering prophylactic antibiotics
Encouraging bed rest to decrease the metabolic rate Withholding oral feedings to limit the release of secretin Administering parenteral opioid analgesics as ordered Explanation: The current recommendation for pain management is the use of opioids, with assessment for their effectiveness and altering therapy if pain is not controlled or increased (Marx, 2009). Nonpharmacologic interventions such as proper positioning (not prone), music, distraction, and imagery may be effective in reducing pain when used along with medications. In addition, oral feedings are withheld to decrease the secretion of secretin.
A client with suspected biliary obstruction due to gallstones reports changes to the color of his stools. Which stool color does the nurse recognize as common to biliary obstruction? Gray Black Red Green
Gray Explanation: A gray-white stool color is common with a biliary obstruction because the stool is no longer colored with bile pigments.
A nurse is providing preoperative teaching to a client undergoing a cholecystectomy. Which topic should the nurse include in her teaching plan? Increase respiratory effectiveness. Eliminate the need for nasogastric intubation. Improve nutritional status during recovery. Decrease the amount of postoperative analgesia needed.
Increase respiratory effectiveness. Explanation: The nurse must teach the client about using an incentive spirometer to promote lung expansion. The high abdominal incision used in a cholecystectomy interferes with respirations postoperatively, increasing the risk of atelectasis. The client will need to use incentive spirometry to promote lung expansion, increase alveolar inflation, and strengthen respiratory muscles. Most clients don't have a nasogastric tube in place after a cholecystectomy. It isn't appropriate to teach improved nutritional status before surgery. It isn't important for the client to be aware of how to decrease the amount of postoperative analgesia, because this is the responsibility of the health care team.
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 Measure abdominal girth every shift Monitor for reports of nausea and vomiting Measure blood glucose concentration every 4 to 6 hours
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.
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 Presence of blood in the client's stool and recent hypertension Presence of easy bruising and bradycardia Adventitious breath sounds and hypertension
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.
Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis? Providing intensive insulin therapy Allowing a clear liquid diet during the acute phase Administering oral analgesics around the clock Maintaining a high-Fowler's position
Providing intensive insulin therapy Explanation: Intensive insulin therapy (continuous infusion) in the critically ill client has undergone much study and has shown promise in terms of positive client outcomes when compared with intermittent insulin dosing. Glycemic control with normal or near normal blood glucose levels improves client outcomes. Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration, even with insulin coverage. Clients with pancreatitis should not be given high-fat foods because they are difficult to digest. The current recommendation for pain management in this population is parenteral opioids. The nurse should maintain the client in a semi-Fowler's position to reduce pressure on the diaphragm.
The nurse is caring for a client with acute pancreatitis. Which prescription will the nurse question before implementing? Apply oxygen at 2 liters via nasal cannula. Give intravenous morphine sulfate 2 mg every 4 hours PRN. Obtain an arterial blood gas analysis now and every hour. Regular insulin infusion for blood glucose level greater than 126 mg/dL.
Regular insulin infusion for blood glucose level greater than 126 mg/dL. Explanation: The client with acute pancreatitis is acutely ill and monitored in the intensive care unit. Insulin may be required if hyperglycemia occurs; however, best practice recommendations include targeting a blood glucose level of 140 to 200 mg/dL. Clinicians are also advised to avoid glucose targets less than 140 mg/dL because adverse effects are likely to increase with lower blood glucose targets. Respiratory care may include the use of humidified oxygen. Opioids are used to treat the pain associated with acute pancreatitis. The client's arterial blood gas will be monitored while in the intensive care unit.
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? Monitor pulse oximetry every hour. Withhold oral feedings for the client. Instruct the client to avoid coughing. Reposition the client every 2 hours.
Reposition the client every 2 hours. Explanation: 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 nurse is teaching a client about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the client correctly identifies which condition as a cause of acute pancreatitis? Fibrosis and atrophy of the pancreatic gland Calcification of the pancreatic duct, leading to its blockage Self-digestion of the pancreas by its own proteolytic enzymes Use of loop diuretics to increase the incidence of pancreatitis
Self-digestion of the pancreas by its own proteolytic enzymes Explanation: Self-digestion of the pancreas by its own proteolytic enzymes, principally trypsin, causes acute pancreatitis. Of clients with acute pancreatitis, 80% had undiagnosed chronic pancreatitis. Gallstones enter the common bile duct and lodge at the ampulla of Vater, obstructing the flow of pancreatic juice or causing a reflux of bile from the common bile duct into the pancreatic duct, thus activating the powerful enzymes within the pancreas. Normally, these remain in an inactive form until the pancreatic secretions reach the lumen of the duodenum. Activation of the enzymes can lead to vasodilation, increased vascular permeability, necrosis, erosion, and hemorrhage.
The nurse should assess for an important early indicator of acute pancreatitis. What prolonged and elevated level would the nurse determine is an early indicator? Serum calcium Serum lipase Serum bilirubin Serum amylase
Serum lipase Explanation: Serum amylase and lipase levels are used in making the diagnosis of acute pancreatitis, although their elevation can be attributed to many other causes (Feldman et al., 2010). 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.
A client is demonstrating symptoms of pancreatic cancer. Which diagnostic test will the nurse expect to be prescribed to prepare the client for surgery? Spiral computed tomography (CT) scan Endoscopic ultrasound Percutaneous transhepatic cholangiography Endoscopic retrograde cholangiopancreatogram
Spiral computed tomography (CT) scan Explanation: Spiral (helical) computed tomography (CT) is more than 85% to 90% accurate in the diagnosis and staging of pancreatic cancer and currently is the most useful preoperative imaging technique. Endoscopic ultrasound is useful to identify small tumors and perform fine-needle biopsy of primary tumors or lymph nodes. Percutaneous transhepatic cholangiography may be used to identify obstructions of the biliary tract by a pancreatic tumor. Endoscopic retrograde cholangiopancreatogram (ERCP) may also be used in the diagnosis of pancreatic carcinoma. Cells obtained during ERCP are sent to the laboratory for analysis.
A client with acute pancreatitis reports muscle cramping in the lower extremities. What pathophysiology concept represents the reason the client is reporting this? Tetany related to hypocalcemia Muscle spasm related to hypokalemia Muscle pain related to referred pain manifestations Tetany related to hypercalcemia
Tetany related to hypocalcemia Explanation: A client with acute pancreatitis who reports muscle cramping or pain should be suspected of having hypocalcemia and tetany of the muscles. Hypocalcemia may occur in acute pancreatitis because, when auto digestion of the pancreas occurs, calcium binds to fatty acids and calcium is decreased in the blood. This is a potentially life-threatening complication of pancreatitis and needs to be immediately addressed.
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 decrease metabolism To depress the central nervous system and increase the pain threshold To reduce gastric and pancreatic secretions To relieve nausea and vomiting
To reduce gastric and pancreatic secretions Explanation: Anticholinergic medications reduce gastric and pancreatic secretion.
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? Monitor pulse oximetry every hour. Withhold analgesics unless necessary. Instruct the client to cough only when necessary. Use incentive spirometry every hour.
Use incentive spirometry every hour. Explanation: 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 nurse knows that the client with cholelithiasis can have a nutritional deficiency. The obstruction of bile flow due to cholelithiasis can interfere with the absorption of Vitamin A Vitamin B6 Vitamin B12 Vitamin C
Vitamin A Explanation: Obstruction of bile flow interferes with absorption of the fat-soluble vitamins A, D, E, and K. Clients may exhibit deficiencies of these vitamins if biliary obstruction has been prolonged. Vitamins B6, B12, and C are not fat soluble.
The nurse is caring for a client experiencing pain related to chronic pancreatitis. When developing a care plan for alternative strategies to opoid usage, which approaches will the nurse include? Select all that apply. Vitamin E Amitriptyline Tetracycline Methylprednisolone Ibuprofen
Vitamin E Amitriptyline Ibuprofen Explanation: In chronic pancreatitis, management of abdominal pain and discomfort is similar to that of acute pancreatitis; however, the focus is usually on the use of nonopioid methods to manage pain. Adjunct means of pain modulation include the use of antioxidants such as Vitamin E, antidepressants such as amitriptyline, avoiding alcohol, smoking cessation, and the use of nonopioid analgesics like ibuprofen. Tetracycline is an antibiotic and has been implicated as a caustive agent of acute pancreatitis. Methylprednisolone is a steroid and may induce acute pancreatitis in some clients.
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 Fatigue Hypertension
Weight loss Explanation: 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.
Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: cannot tolerate high-glucose concentration. are at risk for gallbladder contraction. are at risk for hepatic encephalopathy. can digest high-fat foods.
cannot tolerate high-glucose concentration. Explanation: 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.
A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: yellow sclerae. light amber urine. circumoral pallor. black, tarry stools.
yellow sclerae. Explanation: Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.