Pancreatitis

Question 1

Factors that contrubute to the development of acute pancreaitis

Answer 1

• Biliary tract disease (most common cause in women)
• Alcholism (most common cause in men) 70% of the cases in the US

Question 2

Strategies for prevention of pancreaitis

Answer 2

Abstain from alcohol

Question 3

Assessment of acute pancreaitis

Answer 3

1. N/V
2. Abdominal Pain
3. Restlessness
4. Anxiety
5. Low-grade fever
6. Diaphoresis
7. Severe midepigastric or left upper quadrant pain aggravated by food and alcohol intake and unrelieved by comiting
8. Rigors (episode of shaking or exaggerated shivering)
9. Respiratory Symptoms secondary to shallow breathing

Question 4

Commonly occuring nursing diagnoses for the patient with acute pancreaitis

Answer 4

1. Acute Pain r/t inflammation, edema, peritoneal irritation
2. Ineffective breathing pattern r/t decreased lung expansion and pain
3. Deficient fluid volume r/t excessive gastric losses or maldistribution of volume
4. Imbalance nutrition: less than body requirements r/t neusea, vomiting, anorexia, or alcohol intake

Question 5

Therapeutic nursing inverentions to be implemented in caring for a patient with acute pancreaitis

Answer 5

Assessment:

1. VS
2. Pain

Pain control:

1. Acute pancreatitis IV Morphine Sulfate or other narcotics may be used
2. Antibiotics like ampicillin, ciprofloxacin and metrondiazole may be used to prevent bacterial infection of the inflammed, sometimes necrotic, pancreas
3. Drugs like somatostain may also be used to decrease pancreatic sections
4. Position changes such as side lying position with the head elevated 45 degrees
5. Administer meds routinely as prescribed to prevent severe pain leading to hyperventilation (ineffective breathing)

Fluid and Electrolyte Replacement:

1. Volume replacement with IV fluid
2. LR and albumin
3. NPO with N/G tube during acute attack
4. Oral care to relieve dry mouth, nasal care if NG in place
5. Observe for hyponatremia, hypokalemia, hypocalcemia

Nutrition:

1. Initially NPO to reduce pancreatic secretion with or without NG decompression (this rests the GI system)
2. TPN prn if NPO for prolonged period of time
3. when food allowed, small frequent feedings
4. High carbohydrate and protein, low fat diet
5. Bland foods with no caffeine or alchohol
6. Supplemental fat soluble vitamins

Question 6

Teaching plan for patient with acute pancreatitis

Answer 6

• Signs of diabetes (3 Ps)
• Infection
• Foul smelling frothy stools

Question 7

Foods to be included and excluded in the diet of a patient with acute pancreatitis

Question 8

Potential Complications associated with untreated acute pancreatitis

Answer 8

• Pancreatic Pseudocyst
  
  • Cavity that surrounds the pancreas which fills with necrotic cells and fluid. May perforate and drain causing perionitis
• Pancreatic Abscess
  
  • Large fluid-containing pocket within the pancreas. Can becomes infected or perforation

Question 9

Pancreatitis

Answer 9

• An inflammatory process involving the pancreas
• Severity of disease depends upon the extent of destruction to pancreatic cells
• Patients can recover completely from pancreatitis, have recurrent attacks, or develop chronic pancreatitis

Question 10

Pancrelipase (Pancrease)

Answer 10

Use:

Treatment of pancreatic enzyme insufficiency

Action:

Pancreatic enzyme needed for breakdown of substances released from the pancreas

Side/Adverse Effects:

1. Diarrhea
2. Nausea
3. Vomiting
4. Hyperuremia (high uric acid)

Nursing Implications:

1. Administer immediately before or with meals or snacks
2. Instruct patient not to chew tablets and to swallow them quickly with 8 oz. of water to prevent mouth and throat irriation
3. Instruct patient to notify MD if joint pain, abdominal pain, cramping, or blood in the urine occurs

Question 11

Before ERCP

Answer 11

Do not:

1. Take aspirin or medications containing aspirin
2. Eat or drink 6 hours before test

Inform your doctor if you:

1. Take blood thinners (anticoagulants)
2. Take aspirin or aspirin thinners
3. Have allergies to iodine or medications

• Antibiotics may be administered before ERCP

Question 12

After ERCP

Answer 12

Do Not:

1. Drive
2. Operate machinery
3. Drink alcohol

Question 13

Side Effects after ERCP

Answer 13

1. Bloated
2. Expel gas
3. Bowel irregularity
4. Sore throat

Question 14

Risks of ERCP (complications occur in less than 10% of patients)

Answer 14

1. Pancreatitis
2. Perofration
3. Bleeding
4. Medication Reactions
5. Infection

Question 15

Instructions after ERCP

Answer 15

1. Normal diet after 4-8 hours
2. Follow doctor’s guidelines on foods and liquids

Question 16

Call MD after ERCP

Answer 16

1. Severe abdominal pain
2. Fever greater than 100F
3. Black tarry stools or rectal bleeding
4. Vomiting blood
5. Weakness or dizziness

Question 17

Chronic Pancreatitis

Answer 17

• Prolonged inflammation of pancreas
• fibrosis (hardening) occurs to organ, destroying it

Question 18

Diagnostic Tests for pancreatitis

Answer 18

• Serum amylase
• ERCP
• Lipase

Question 19

Causes of chronic pancreatitis

Answer 19

1. Alcohol abuse in the US
2. Biliary tract disease
3. May follow acute pancreatitis

Question 20

Assessment findings of chronic pancreatitis

Answer 20

1. Abdominal pain recurs at intervals of months or years
2. Attacks become almost constant
3. Pain not relieved with food or antacids
4. Weight loss
5. Mild Jaundice
6. Dark urine
7. Steatorrhea (fat in the feces)
8. DM
9. Frothy urine and stool

Question 21

Diagnostic Tests for chronic pancreatitis

Answer 21

1. Serum amylase and lipase
2. ERCP
3. Abdominal CT

Question 22

Commonly occuring nursing diagnoses for patient with chronic pancreatitis

Answer 22

1. Chronic pain r/t inflammation, edema, peritoneal irritation
2. Ineffective breathing pattern r/t decreased lung expansion and pain
3. Deficient Fluid volume r/t excessive gastric losses or maldistribution of volume
4. Imbalance Nutrition: less than body requirements r/t N/V, anorexia, or alcohol ingestion

Question 23

Nursing interventions for chronic pancreatitis

Answer 23

Assess:

1. VS
2. Pain

Pain Control:

1. Provide ordered analgesics
2. May require large, frequent doses

Teach:

1. Pancreatic enzyme replacement such as pancrease
2. Small, frequent meals
3. Avoid fatty foods, alcohol and caffeine

Prevention of chronic attacks:

1. Avoidance of alchohol
2. Referral to alcohol dependency program
3. Take prescribed medications/enzymes