NU371 PrepU: Pancreatitis

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? a) Weight loss b) Diarrhea c) Fatigue d) Hypertension

a) Weight loss - 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.

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? a) Dysfunction of the pancreatic islet cells b) Ingestion of foods high in sugar c) Inability for the liver to reabsorb serum glucose d) Renal failure

a) Dysfunction of the pancreatic islet cells - 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.

Given the fact that acute pancreatitis can result in severe, life-threatening complications, the nurse should be assessing the client for which complication? a) Cerebral hemorrhage b) Acute tubular necrosis c) Bilateral pneumothorax d) Complete heart block

b) Acute tubular necrosis - 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.

When assessing the client with acute pancreatitis, which of these diagnostic tests—consistent with the disease— does the nurse anticipate will be altered? a) The transaminases b) Creatine kinase c) Amylase and lipase d) Glucose values

c) Amylase and lipase - Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis.

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? a) The patient requires more pain medication. b) The patient is developing a paralytic ileus. c) The patient has developed peritonitis. d) The patient has developed renal failure.

c) The patient has developed peritonitis. - 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).

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? a) To decrease metabolism b) To depress the central nervous system and increase the pain threshold c) To reduce gastric and pancreatic secretions d) To relieve nausea and vomiting

c) To reduce gastric and pancreatic secretions - Anticholinergic medications reduce gastric and pancreatic secretion.

What concepts does the nurse understand about gerontologic considerations related to acute pancreatitis? Select all that apply. a) As the client ages, there is an increased risk for the development of acute pancreatitis. b) As the client ages, there is an increased mortality rate for acute pancreatitis. c) As the client ages, there is an increased risk for the development of multiple organ dysfunction syndrome. d) As the client ages, the pattern of complications related to acute pancreatitis changes. e) As the client ages, the size of the pancreas decreases, increasing the risk of developing acute pancreatitis.

a) As the client ages, there is an increased risk for the development of acute pancreatitis. b) As the client ages, there is an increased mortality rate for acute pancreatitis. c) As the client ages, there is an increased risk for the development of multiple organ dysfunction syndrome. - Gerontologic considerations must be remembered when caring for older adult clients with acute pancreatitis. Clients of all ages may develop acute pancreatitis; however, mortality rate for acute pancreatitis increases as the client ages. Additionally, as the client ages, the pattern of complications related to acute pancreatitis changes and the risk of developing multiple organ dysfunction syndrome (MODS) increases with age. The size of the pancreas does not decrease as the client ages.

A client with a history of chronic pancreatitis asks about potential long-term complications. Which response by the nurse would be most accurate? a) Clients can develop signs of diabetes and malabsorption. b) Chronic pancreatitis can lead to liver failure and cirrhosis. c) Long-term effects are similar to those seen in cholelithiasis. d) Clients with chronic pancreatitis develop portal hypertension.

a) Clients can develop signs of diabetes and malabsorption. - 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.

The nurse is caring for a client with suspected chronic pancreatitis. Which diagnostic test or imaging does the nurse recognize as the most useful in diagnosing this condition? a) ERCP b) MRI c) CT d) Ultrasound

a) ERCP - The ERCP is the most useful study in the diagnosis of chronic pancreatitis. The other answer choices may be used; however, these are not the most useful in the diagnosis of chronic pancreatitis.

A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder? a) Edema and inflammation b) Pleural effusion c) Sepsis d) Disseminated intravascular coagulopathy

a) Edema and inflammation - 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.

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? a) Frequent changes of positions b) Placing the patient in the prone position c) Perform chest physiotherapy d) Suction the patient every 4 hours

a) Frequent changes of positions - Frequent changes of position are necessary to prevent atelectasis and pooling of respiratory secretions.

A health care provider suspects a client may have developed pancreatitis. Which laboratory value will confirm this diagnosis? a) High serum amylase and lipase b) Altered alkaline phosphatase and red blood cell count c) Chymotrypsin level and fibrinogen level d) Change in platelet count and prothrombin level

a) High serum amylase and lipase - 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 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? a) Muscle twitching and finger numbness b) Paralytic ileus and abdominal distention c) Hypotension d) Elevated blood glucose concentration

a) Muscle twitching and finger numbness - 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.

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? a) Pancreatitis can elevate the diaphragm and alter the breathing pattern. b) Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation. c) Pancreatitis can atrophy the diaphragm and alter the breathing pattern. d) Pancreatitis causes alterations to hemoglobin, impairing oxygenation.

a) Pancreatitis can elevate the diaphragm and alter the breathing pattern. - 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.

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? a) Providing intensive insulin therapy b) Allowing a clear liquid diet during the acute phase c) Administering oral analgesics around the clock d) Maintaining a high-Fowler's position

a) Providing intensive insulin therapy - 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.

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? a) Relieving abdominal pain b) Preventing fluid volume overload c) Maintaining adequate nutritional status d) Teaching about the disease and its treatment

a) Relieving abdominal pain - 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.

When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize that the pathogenesis begins with an inflammatory process whereby: a) activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue. b) the pancreas is irreversibly damaged and will not recover to normal functioning (chronic). c) the pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction. d) stones will develop in the common bile duct, resulting in acute jaundice.

a) activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue. - 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.

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: a) cannot tolerate high-glucose concentration. b) are at risk for gallbladder contraction. c) are at risk for hepatic encephalopathy. d) can digest high-fat foods.

a) cannot tolerate high-glucose concentration. - 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 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? a) pancreatitis b) appendicitis c)Crohn disease d) ulcerative colitis

a) pancreatitis - ]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.

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? a) Increased serum calcium levels b) Elevated urine amylase levels c) Decreased liver enzyme levels d) Decreased white blood cell count

b) Elevated urine amylase levels - 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.

When caring for the client with acute pancreatitis, which alterations does the nurse recognize is consistent with the disease? a) Hypertension b) Hyperglycemia c) Leukopenia d) Polyuria

b) Hyperglycemia - 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.

Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? a) Shock b) Pancreatic necrosis c) MODS d) Tetany

b) Pancreatic necrosis - 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? a) Appendicitis b) Pancreatitis c) Cholecystitis d) Peptic ulcer

b) Pancreatitis - 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.

When teaching a client about chronic pancreatitis, which of these does the nurse relate is the long term result of this condition? a) Alcohol abuse b) Progressive destruction of the organ c) Easily cured with antibiotic therapy d) Weight gain

b) Progressive destruction of the organ - 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.

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? a) Serum calcium b) Serum lipase c) Serum bilirubin d) Serum amylase

b) Serum lipase - 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.

When caring for a client with acute pancreatitis, the nurse should use which comfort measure? a) administering an analgesic once per shift, as ordered, to prevent drug addiction b) positioning the client on the side with the knees flexed c) encouraging frequent visits from family and friends d) administering frequent oral feedings

b) positioning the client on the side with the knees flexed - 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 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? a) Placing the client in a semi-Fowler's position b) Maintaining nothing-by-mouth (NPO) status c) Administering morphine I.V. as ordered d) Providing mouth care

c) Administering morphine I.V. as ordered - 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.

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? a) Spray the oropharynx with an anesthetic spray. b) Have the patient maintain a backward tilt head position. c) Allow the patient to sip water as the tube is being inserted. d) Have the patient eat a cracker as the tube is being inserted.

c) Allow the patient to sip water as the tube is being inserted. - 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

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? a) Albumin 2.0 g/dL (20 g/L) (low) b) Amylase 150 units/L (2.50 µkat/L) (high) c) Bilirubin 15 mg/dL (256.56 µmol/L) (high) d) Serum calcium level 7 mg/dL (1.75 mmol/L) (low)

c) Bilirubin 15 mg/dL (256.56 µmol/L) (high) - 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.

A client with persistent, recurring episodes of epigastric and upper left quadrant pain and anorexia, nausea, vomiting, constipation, and flatulence has been diagnosed with chronic pancreatitis. What is the cause of the symptoms of chronic pancreatitis? a) Destruction of the common bile duct b) Destruction of the endocrine pancreas c) Destruction of both the endocrine and exocrine pancreas d) Blockage of the common bile duct

c) Destruction of both the endocrine and exocrine pancreas - Chronic pancreatitis is characterized by progressive destruction of the exocrine pancreas, fibrosis, and, in the later stages, by destruction of the endocrine pancreas. Blockage of the bile duct would cause acute pancreatitis.

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? a) Ascites b) Vomiting c) Hyperbilirubinemia d) Hemorrhage

c) Hyperbilirubinemia - 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 client is admitted to the health care center with hyperglycemia, a 15-pound weight loss, and reports of vague upper and midabdominal pain that increases in intensity at night. The client' health history indicates alcoholism, smoking of a pack of cigarettes daily, and diabetes for the past 20 years. Upon examination the nurse finds swelling in the feet and abdominal ascites. Based on the clinical manifestations, which condition is the most likely diagnosis? a) Pancreatic pseudocysts b) Acute pancreatitis with edema c) Pancreatic carcinoma d) Cholecystitis

c) Pancreatic carcinoma - Pain, jaundice, and weight loss are considered classic signs of pancreatic carcinoma. Other signs include rapid, profound, and progressive weight loss as well as vague upper or midabdominal pain or discomfort unrelated to any gastrointestinal function that is often difficult to describe. It is often more severe at night and is accentuated when lying supine. The formation of ascites is common. An important sign is the onset of symptoms of insulin deficiency: glucosuria, hyperglycemia, and abnormal glucose tolerance. Therefore, diabetes may be an early sign of carcinoma of the pancreas.

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? a) Serum calcium b) Serum bilirubin c) Serum amylase d) Serum potassium

c) Serum amylase - 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.

A client has been admitted to the emergency department with severe mid-epigastric, upper quadrant abdominal pain. Based on the signs and symptoms and laboratory data documented in the chart, the nurse would anticipate preparing for which diagnosis? a) peptic ulcer b) Crohn's disease c) pancreatitis d) irritable bowel syndrome

c) pancreatitis - The assessment findings combined with the laboratory results suggest pancreatitis. The pancreas is situated behind the stomach in the upper quadrant. Signs and symptoms of pancreatitis include severe mid-epigastric, upper quadrant abdominal pain, fever, nausea, and vomiting. Inflammation of the pancreas results in leukocytosis. Injured ?-cells are unable to produce insulin, leading to hyperglycemia, which may be as high as 500 to 900 mg/dl (27.75 to 49.95 mmol/L). Lipase and amylase levels become elevated as the pancreatic enzymes leak from injured pancreatic cells. Calcium becomes trapped as fat necrosis occurs, leading to hypocalcemia. Peptic ulcer, Crohn's disease, and irritable bowel syndrome do not cause amylase or lipase levels to increase.

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? a) Monitor pulse oximetry every hour. b) Withhold oral feedings for the client. c) Instruct the client to avoid coughing. d) Reposition the client every 2 hours.

d) Reposition the client every 2 hours. - 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 client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? a) Monitor pulse oximetry every hour. b) Withhold analgesics unless necessary. c) Instruct the client to cough only when necessary. d) Use incentive spirometry every hour.

d) Use incentive spirometry every hour. - 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.