Pancreatitis

Acute pancreatitis

Acute pancreatitis is an inflammatory disorder in which the pancreas destroys itself through autodigestion by its own enzymes. The milder form of acute pancreatitis, interstitial edematous pancreatitis, involves inflammation and edema of pancreatic tissue; it is often self-limiting. Necrotizing pancreatitis is the more severe form, characterized first by inflammation and hemorrhage, then by destruction of pancreatic tissue.

The nurse is caring for a client with acute pancreatitis. Which intervention takes priority when caring for this​ client? Weigh the client daily Administer analgesics as ordered Monitor for malnutrition Provide oral care every 2 hours

Administer analgesics as ordered

What is the effect of alcohol on the pancreas for a client diagnosed with acute​ pancreatitis? Alcohol interacts with​ trypsin, causing rapid digestion of pancreatic tissue and resulting in pancreatic necrosis. Alcohol in the bloodstream softens and destroys the elastin of the blood​ vessels, allowing for fluid shift into the peritoneal space. Alcohol is quickly absorbed into the​ bloodstream, causing toxicity of the pancreatic cells and resulting in decreased production of pancreatic enzymes. Alcohol causes edema in the​ duodenum, which raises the pressure within the pancreas and obstructs the outflow of pancreatic enzymes from the gland.

Alcohol causes edema in the​ duodenum, which raises the pressure within the pancreas and obstructs the outflow of pancreatic enzymes from the gland.

manifestations of chronic pancreatitis

Clinical manifestations of chronic pancreatitis include: may mimic acute pancreatitis, but is slower onset Recurrent episodes of epigastric and left upper abdominal pain that radiates to the back, lasting days to weeks Anorexia Nausea Vomiting Weight loss Flatulence Constipation Steatorrhea (fatty, frothy, foul-smelling stools caused by a decrease in pancreatic enzyme secretion).

A client with acute pancreatitis has a positive Turner sign. Where would the nurse assess the client to identify this positive​ sign? Flank area Right upper quadrant area Epigastric area Periumbilical area

flank pain

A client is newly diagnosed with acute pancreatitis. What medication will the nurse administer to assist in controlling the client​'s ​pain? Acetaminophen​ (Tylenol) Hydromorphone​ (Dilaudid) Ketorolac tromethamine​ (Toradol) Tramadol hydrochloride​ (Ultram)

hydromorphone (dilaudid)

The nurse is caring for a client in the emergency department with suspected acute pancreatitis. Which question would be most appropriate for assessing the​ client's risk factors for this disease​ process? ​"Do you take any​ over-the-counter medications?" ​"How much alcohol do you drink each​ week?" ​"When was your last bowel​ movement?" ​"What does your daily diet usually consist​ of?"

How much alcohol do you drink each week? One of the most common risk factors for acute pancreatitis is heavy alcohol​ intake; therefore, assessing the​ client's alcohol intake or pattern is most appropriate. Nutritional deficiencies are a risk factor for​ chronic, not​ acute, pancreatitis. Medications that are known to cause acute pancreatitis include thiazide​ diuretics, such as​ Lasix, and ACE inhibitors. These medications are​ prescribed, not​ over-the-counter. Changes in bowel patterns can indicate symptoms of other GI disorders and are not specific to risk factors related to acute pancreatitis.

The nurse is caring for a client with chronic pancreatitis. Which finding would the nurse expect during the​ client's pain​ assessment? A. ​Steady, dull abdominal pain that radiates to the back B. ​Intermittent, sharp pains localized to the lower abdomen C. Intermittent pain to midabdomen and midback

Intermittent pain to midabdomen and midback

pancreatitis

Pancreatitis (inflammation of the pancreas)

A client is admitted to a medical unit with the diagnosis of chronic pancreatitis. Which medication that is an exogenous source of pancreatic enzymes will the nurse administer with​ meals? Octreotide​ (Sandostatin) Omeprazole​ (Prilosec) Pancrelipase​ (Lipancreatin) Cimetidine​ (Tagamet)

Pancrelipase​ (Lipancreatin) Pancrelipase​ (Lipancreatin), a pancreatic enzyme​ supplement, enhances the digestion of starches and fats by supplying an exogenous source of the pancreatic enzymes​ protease, amylase, and lipase. This medication is administered with meals to promote nutrition and decreases the number of bowel movements. Cimetidine​ (Tagamet), an H2​ blocker, is used to neutralize gastric secretions. Octreotide​ (Sandostatin), a synthetic​ hormone, suppresses pancreatic enzyme secretion and helps relieve pain in chronic pancreatitis. Omeprazole​ (Prilosec), a proton pump​ inhibitor, is used to neutralize or decrease gastric secretions.

risk factors for chronic pancreatitis

Risk factors for chronic pancreatitis are varied and include: Ethnicity: Hospitalization rates for African Americans are three times higher than those for whites in United States. Gender: Men are affected more commonly than women (6.7 versus 3.2 per 100,000 population).1 Excessive alcohol intake: Risk increases 1.4 times for each 20 grams of alcohol consumed per day. Repeated attacks of acute pancreatitis Hyperlipidemia Hypercalcemia due to hyperparathyroidism Nutritional deficiencies Autoimmune disorders Hypertriglyceridemia Medications, such as estrogens, corticosteroids, and thiazide diuretics6 Cystic fibrosis.7,8

The nurse is caring for a client with a possible diagnosis of pancreatitis. Which laboratory values would the nurse​ monitor? Serum creatinine and BUN levels Serum amylase and lipase levels ​Pancreas-associated antigen CA​ 19-9 Fasting glucose and HbA1c levels

Serum amylase and lipase levels Serum amylase and lipase levels are increased due to the release of enzymes from the pancreas as a result of inflammation.​ Pancreas-associated antigen CA​ 19-9 is a tumor marker for diagnosing pancreatic cancer. Serum creatinine and BUN levels are monitored for clients in kidney failure. Fasting glucose and HbA1c levels are monitored for clients with diabetes mellitus.

The nurse is caring for a client admitted for possible chronic pancreatitis. Which clinical manifestation supports this​ diagnosis? Intermittent lower abdominal pain Diarrhea Weight gain Steatorrhea

Steatorrhea

The nurse is caring for a client who has been diagnosed with​ late-stage chronic pancreatitis. Which client symptom most supports this​ diagnosis? Steatorrhea Severe epigastric pain Severe vomiting Severe nausea

Steatorrhea

Risks for acute pancreatitis:

The most common risk factors for acute pancreatitis are: Heavy alcohol intake Gall bladder attacks: mechanical obstruction, gallstones Genetic predisposition Medications, such as ACE inhibitors and Lasix Pregnancy Infection.5

pancreas

The pancreas serves as both an endocrine and an exocrine gland. As an exocrine gland, the pancreas secretes enzymes into the intestine that assist with digestion, breaking down protein, starches, and fats. The endocrine function is responsible for carbohydrate metabolism and regulation of glucose levels.1 Diseases of the pancreas can affect both the exocrine and endocrine functions.

The nurse is caring for a client experiencing manifestations of acute pancreatitis. Which diagnostic tests will assist in confirming this​ diagnosis? ​(Select all that​ apply.) Ultrasound ​Contrast-enhanced CT scan Magnetic resonance cholangiopancreatography​ (MRCP) Endoscopic retrograde cholangiopancreatography (ERCP) Abdominal​ X-ray

Ultrasound ​Contrast-enhanced CT scan Magnetic resonance cholangiopancreatography​

The nurse is planning care for a client with acute pancreatitis. Which problem is the priority for the nurse to address when caring for this​ client? Fluid volume excess Constipation Activity intolerance Acute pain

acute pain

What are potential systemic complications of acute pancreatitis that manifest within 24 hours of the onset of the​ disorder? ​(Select all that​ apply.) Malabsorption syndrome Acute respiratory distress syndrome​ (ARDS) Hypertension Renal failure Hypovolemic shock

hypovolemic shock and renal failure The clinical manifestations of tachycardia and hypotension that are noted with acute pancreatitis may develop into hypovolemic shock as a result of depletion of intravascular fluid volume. Because of the reduction of circulating blood​ volume, the kidneys will not be adequately​ perfused, which may result in renal failure. Hypertension will not occur as a result of the reduction of blood flow. ARDS is a potential systemic complication that would be noted within 3 to 7 days of the onset of the disorder. Malabsorption syndrome is a potential complication of​ chronic, not​ acute, pancreatitis, because the permanent fibrotic changes and tissue destruction that cause this disorder develop over a prolonged period.

What is the intended action of pancrelipase​ (Lipancreatin) in the treatment of chronic​ pancreatitis? It enhances digestion of​ starches, proteins, and fats. It neutralizes pancreatic secretions. It suppresses pancreatic enzyme secretion and helps to relieve pain. It is the primary analgesic to manage pain

it enhances digestion of starches, proteins, and fats.

Which dietary recommendation is appropriate for a client after an episode of​ pancreatitis? A​ low-fat diet A​ high-protein diet A diet low in dairy products A​ high-carbohydrate diet

low fat diet

manifestations of acute pancreatitis

manifestations of acute pancreatitis include: severe epigastric and abdominal pain Nausea and vomiting Fever Decreased bowel sounds with abdominal distention and rigidity Tachycardia Hypotension Cold, clammy skin Mild jaundice Positive Turner sign (flank ecchymosis) Positive Cullen sign (periumbilical ecchymosis).

The nurse is educating a client about complications associated with chronic pancreatitis. Which potential complications would the nurse include in this​ education? ​(Select all that​ apply.) Peptic ulcer disease Malnutrition Hepatitis Diabetes mellitus Opioid addiction

peptic ulcer disease, malnutrition, diabetes mellitus, opiods