Upgrade to remove ads
Care of Patient with Pancreatic Problems:
Terms in this set (30)
Review of the Pancreas:
- Anatomic placement and function
- Pancreas as endocrine gland*
and as exocrine gland - secretes inactive digestive enzymes (lipase, trypsin, elastase) that assist in the breakdown of starches, proteins and fats in the small intestine
- >early activation of these enzymes in the pancreas instead of the small intestines > inflammation > pancreatitis.
- Pancreatic duct obstruction>increased pressure ductal pressure spillage of trypsin into pancreatic tissue autodigestion.
*Disorder - diabetes mellitus for endocrine
Autodigestion in Acute Pancreatitis:
- Blunt Abdominal Trauma
- Operative Manipulation
- Drug Use
- Unknown/ Other Causes
Obstruction which can lead to:
- Direct Toxic Injury to pancreatic cells
- Production and release of pancreatic enzymes--> Trypsin
Trypsin can lead to:
Production and Release of Pancreatic Enzymes can lead to:
Electase: Necrosis of blood vessels and ductal fibers-> Hemorrhage
Phosphotase A: Fat nercosis & cell membrane disruption
Lipase: Fat Necrosis
- Vascular PErmeability
- Smooth Muscle Contraction
Acute Pancreatitis: Pg. 1218-1223
DEFINITION: Acute life-threatening inflammation of the pancreas, mild to necrotizing hemmorhagic pancreatitis (NHP)
PATHOphysiology: Premature activation of excessive pancreatic enzymes that destroys ductal tissue and pancreatic cells>auto-digestion and fibrosis of pancreatic cells.>edema, inflammation to necrotizing hemorrhagic pancreatitis (NHP)>bleeding,
fibrosis, tissue death.
4 major PATHOphysiologic PROCESSES: lipolysis, proteolysis, necrosis of blood vessels and inflammation.
Lipolysis: Lipase>enzymatic fat necrosis of pancreatic cells>releases fatty acid (lipolytic process) which combines with ionized calcium forming a soap-like product>low serum calcium level
Proteolysis: leads to thrombosis and gangrene of the pancreas, localized or entire region
Necrosis of blood vessels: secretion of enzymes kallikrein releases peptides, bradykinin, kallidin w/c result in minor to massive bleeding of the pancreatic tissues that may result to shock and death.
Inflammatory stage: necrotic areas may result to bacterial process to abcess, mild or severe leading to calcification and fibrosis
COMMON CAUSES: biliary tract disease due to gallstones>obstructive pancreatitis; surgery complication from whipple, cholecystectomy, other pancreatic, gastric and duodenal procedures, trauma, alcohol, cigarette smoking, viral infections, drug toxicity, renal disturbances, etc
Other Causes of Acute Pancreatitis:
- The trauma may also occur as a complication of the diagnostic procedure endoscopic retrograde cholangiopancreatography (ERCP), although this rarely occurs.
Other causative factors include:
• Trauma: external (blunt trauma, stab wounds, gunshot wounds [GSWs])
• Pancreatic obstruction: tumors, cysts, or abscesses; abnormal organ structure
• Metabolic disturbances: hyperlipidemia, hyperparathyroidism, or hypercalcemia
• Renal disturbances: failure or transplantation
• Familial, inherited pancreatitis
• Penetrating gastric or duodenal ulcers, resulting in peritonitis
• Viral infections, such as coxsackievirus B and human immune deficiency virus [HIV] infection
• Toxicities of drugs, including opiates, sulfonamides, thiazides, steroids, and oral contraceptives (less common)
• Cigarette smoking
• Cystic fibrosis
• Abdominal surgery
Acute Pancreatitis Manifestations: Pg. 1219-1220
- Severe abdominal pain, nausea, vomiting, weight loss
- Jaundice (swelling of head of pancreas, slow bile flow, calculi, pancreatic pseudocyst)
- Intermittent hyperglycemia to type 1 DM (glucagon released, decreased release of insulin)
- Left lung pleural effusion, atelectasis, pneumonia, ARDS, pulmonary edema
Coagulation defects (necrotic tissues and enzymes into the blood stream)
- Shock from peripheral vasodilation, decreased renal perfusion, hypovolemia, acute renal failure, paralytic ileus
- Elevated temperature, tachycardia, and decreased blood pressure
Acute Pancreatitis- Patient Centered Collaborative Care: Pg. 1218-1223
Collaborative care Assessment: history, physical, psychosocial
Laboratory and diagnostic tests table 59-4, p1221
- Clinical manifestations
Priority nursing interventions for problems:
- Manage acute abdominal pains, provide relief of symptoms, anticipate and treat complications, IV fluids (replace calcium and magnesium), drug therapy, fasting (rest pancreas, reduce pancreatic enzyme secretion), rest, I & O, daily weights, indwelling catheter, NGT (gastric decompression prevents gastric juices from flowing into the duodenum, respiratory treatment, frequent oral and nares hygiene (dry oral mucosa may cause parotitis), lowering client's anxiety level, ICU admission if critically ill. Adequate nutrition to meet metabolic needs*(notes)
Community-Based Care, patient and family teaching
Acute Pancreatitis Assessment:
- Death occurs in a small percentage of patients with acute pancreatitis, but with early diagnosis and treatment, mortality can be reduced.
- It occurs at a higher rate in older adults and in patients with postoperative pancreatitis. The prognosis for recovery is usually good for pancreatitis associated with biliary tract disease and poor if pancreatitis accompanies alcoholism.
- Severe abdominal pain, mid-epigastric area or left upper quadrant.
- Assess intensity and quality of pain. Usually sudden onset and radiates to back, left flank, or left shoulder.
- The pain is described as intense, boring (feeling that it is going through the body), continuous/worsened by lying in the supine position, often finds relief by assuming the fetal position (with the knees drawn up to the chest and the spine flexed) or by sitting upright and bending forward.
- Assess weight loss resulting from nausea and vomiting and weight.
- Gray-blue discoloration of the abdomen and periumbilical area; gray-blue discoloration of the flanks, caused by pancreatic enzyme leakage to cutaneous tissue from the peritoneal cavity;
absent or decreased bowel sounds usually indicate paralytic (adynamic) ileus.
- On light palpation, note abdominal tenderness, rigidity, and guarding as a result of peritonitis.
- A palpable mass may be found if a pancreatic pseudocyst is present. Pancreatic ascites creates a dull sound on percussion.
Vital signs: elevated temperature, tachycardia, and decreased blood pressure
Auscultate the lung fields for adventitious sounds or diminished breath sounds, and observe for dyspnea or orthopnea.
Acute Pancreatitis Diagnostic Studies:
- Contrast-enhanced computed tomography (CT) provides a more reliable image and diagnosis of acute pancreatitis.
- May also be used to rule out pancreatic pseudocyst or ductal calculi.
- Abdominal ultrasound - most sensitive test to diagnose causes of pancreatitis, such as gallstones, can be performed at bedside.
- Abdominal x-ray may reveal gallstones.
- Chest x-ray may show elevation of the left side of the diaphragm or pleural effusion.
- Pancreatic stones are best diagnosed through ERCP (Endoscopic retrograde cholangiopancreatography visualizes the pancreatic and common bile ducts).
Nursing Diagnosis and Collaborative Problems for Patients with Acute Pancreatitis Include:
1. Acute Pain related to pancreatic inflammation and enzyme leakage (NANDA-I)
2. Inadequate nutrition related to the inability to ingest food and absorb nutrients
- Provide supportive care by relieving symptoms, to decrease inflammation, and to anticipate or treat complications.
- As for any patient, continually assess for and support the ABCs (airway, breathing, and circulation).
- In collaboration with the respiratory therapist, if available, provide oxygen and other respiratory support as needed.
- The collaborative plan of care depends on the severity of the illness.
- Abdominal pain is the most common symptom of pancreatitis.
- The main focus of nursing care is aimed at controlling pain by interventions that decrease GI tract activity, thus decreasing pancreatic stimulation.
- Pain assessment to measure the effectiveness of these interventions is an essential part of nursing care.
- If pancreatitis was caused by gallstones, an ERCP with a sphincterotomy (opening of the sphincter of Oddi) may be performed on an urgent or emergent basis.
- If this procedure is not successful, surgery is required. ERCP is described in detail in Chapter 52.
Nutritional Therapy in Acute Pancreatitis:
- Collaborate with the health care provider, dietitian, and pharmacist to plan and implement the most appropriate nutritional intervention.
- NPO on early stages (24-48 hrs)
- Jejunal tube feeding unless paralytic ileus is present may be started.
- Early nutritional intervention enhances immune system functioning and may prevent complications and worsening inflammation.
- Enteral feeding is preferred over total parenteral nutrition (TPN) because it causes fewer episodes of glucose elevation and other complications associated with TPN.
- Be sure that the patient is weighed every day.
- When food is tolerated during the healing phase, the health care provider prescribes small, frequent, moderate- to high-carbohydrate, high-protein, low-fat meals.
- Foods should be bland with little spice.
- GI stimulants such as caffeine-containing foods (tea, coffee, cola, and chocolate), as well as alcohol, should be avoided.
- Monitor the patient beginning to resume oral food intake for nausea, vomiting, and diarrhea.
- If any of these symptoms occur, notify the health care provider immediately.
- To boost caloric intake, supplements may be ordered along with fat-soluble and other vitamin and mineral replacement supplements.
Glutamine, omega-3 fatty acids, fiber, antioxidants, and/or nucleotides may be added to the patient's nutrition plan.
Home Teaching for Acute Pancreatitis:
Patient's and family's knowledge of the disease:
- Regain strength
- Avoid further episodes of pancreatitis and prevent progression to a chronic disease
- Abstain from drinking to prevent further pain attacks and extension of inflammation and pancreatic insufficiency
- Report occurrence of acute abdominal pains
- Signs of biliary tract disease (jaundice, clay-colored stools, or darkened urine)
- Do medical follow-up, if alcoholic - provide information about groups such as Alcoholics Anonymous (AA).
- Family members may attend support groups such as Al-Anon and Alateen.
Acute Pancreatitis Drug Therapy:
- Morphine or hydromorphone (Dilaudid) are typically used; Acute pain 2-3 days to 2 weeks
- (Demerol)usually NOT used in older adults because may cause seizures.
- IV or transdermal fentanyl and epidural analgesia.
- Histamine receptor antagonists (e.g., ranitidine [Zantac])
- Proton pump inhibitors (e.g., omeprazole [Prilosec]) help decrease gastric acid secretion.
- Antibiotics indicated primarily for patients with acute necrotizing pancreatitis.
Acute Pancreatitis Surgical Interventions:
- Surgical intervention usually not indicated
- Gallstones removal if indicated,
- Urgent or emergent ERCP with sphincterotomy (opening sphincter of Oddi).
- If not successful, a laparoscopic (MIS) cholecyctectomy
- Laparoscopic draining of abscess or pseudocyst
Complications of Acute Pancreatitis:
- Pancreatic infection> septic shock
- Acute kidney failure
- Paralytic ileus
- Hypovolemic shock
- Pleural effusion, acute respiratory distress syndrome, pneumonia, atelectasis
- Multi-organ system failure
- Disseminated intravascular coagulation (DIC)
- Type 2 Diabetes mellitus
- Parotitis (inflammation of salivary galnd)
- A patient with acute pancreatitis, monitor for significant changes in vital signs that may indicate the life-threatening complication of shock.
- Hypotension and tachycardia may result from pancreatic hemorrhage, excessive fluid volume shifting, or the toxic effects of abdominal sepsis from enzyme damage.
- Observe the patient for changes in behavior and level of consciousness (LOC) that may be related to alcohol withdrawal, hypoxia, or impending sepsis with shock.
Paralytic (adynamic) ileus: is a common complication of acute pancreatitis and prolonged nasogastric intubation may be necessary.
- Assess frequently for the return of peristalsis by asking the patient if he or she has passed flatus or had a stool.
- The return of bowel sounds is not reliable as an indicator of peristalsis return; passage of flatus or a bowel movement is the most reliable indicator. See the discussion of intestinal obstructions in Chapter 57 on p. 1157.
Monitor respiratory complications:
- Observe respiratory status every 4 to 8 hours or more often as needed, provide oxygen to promote comfort in breathing.
- Pleural effusions increase patient discomfort.
- Assess fluid overload - weight gain, lung crackles, dyspnea and other signs of respiratory failure.
Observe for hypocalcemia by assessing for Chvostek's and Trousseau's signs.
- These tests cause muscle spasms after stimulating the associated nerves. (Chapter 11)
- Progressive destructive disease of pancreas characterized by remissions and exacerbations
Types/Causes chronic calcifying pancreatitis (CCP),
autoimmune pancreatitis; idiopathic and hereditary chronic pancreatitis
- Remissions and exacerbations referred as "flare-ups".
- Inflammation and fibrosis of the tissue contribute to pancreatic insufficiency and diminished function of the organ.
- Biliary tract obstruction (cholecystitis and cholelithiasis)
- Autoimmune pancreatitis is a chronic inflammatory process in which immunoglobulins invade the pancreas;
- Idiopathic and hereditary chronic pancreatitis may be associated with SPINK1 and CFTR gene mutations (Midha et al., 2010).
- The protein encoded by the SPINK1 gene is a trypsin inhibitor.
- The CFTR gene is associated with cystic fibrosis. Research on these gene mutations can help develop targeted drug therapy for treatment of these diseases.
Key Features of Chronic Pancreatitis:
• Intense abdominal pain (major clinical manifestation) that is continuous and burning or gnawing
• Abdominal tenderness
• Possible left upper quadrant mass (if pseudocyst or abscess is present)
• Respiratory compromise manifested by adventitious or diminished breath sounds, dyspnea, or orthopnea
• Steatorrhea; clay-colored stools
• Weight loss
• Dark urine
• Polyuria, polydipsia, polyphagia (diabetes mellitus)
- Abdominal pain is typically described as a continuous burning or gnawing dullness with periods of acute exacerbation (flare-ups). The pain is very intense and relentless. The frequency of acute exacerbations may increase as the pancreatic fibrosis develops.
- Pancreatic insufficiency in chronic pancreatitis causes loss of exocrine function.
Loss of pancreatic endocrine function is responsible for the development of diabetes mellitus
- Abdominal pain is described as continuous burning or gnawing dullness with periods of acute exacerbation (flare-ups).
- The pain is very intense and relentless.
- The frequency of acute exacerbations may increase as the pancreatic fibrosis develops.
- Decreased pancreatic secretions and bicarbonate, reduction in pancreatic enzyme secretion to produce steatorrhea (stools are pale, bulky, and frothy and have an offensive odor) resulting from severe malabsorption of fats.
- The action of colonic bacteria on unabsorbed lipids and proteins is responsible for the extremely foul odor.
- Fat content is visible in the stools.
- Stool fat output may be more than 40 g/day.
- Weight loss and muscle wasting (a decrease in muscle mass) and leads to general debilitation.
- Protein malabsorption results in a "starvation" edema of the feet, legs, and hands caused by decreased levels of circulating albumin.
(peuritic pain, pleural effusions, and pulmonary infiltrates) may be present and ARDS may develop. Pancreatic ascites may decrease diaphragmatic excursion and lung expansion, resulting in impaired ventilation.
In chronic pancreatitis, laboratory findings include normal or moderately elevated serum amylase and lipase levels. Obstruction of the intrahepatic bile duct can cause elevated serum bilirubin and alkaline phosphatase levels. Intermittent elevations in serum glucose levels are common and can be detected by blood glucose monitoring, both fasting and non-fasting.
Chronic Pancreatitis Non-Surgical Management:
Nonsurgical management (*notes on surgical management & slide 8)
- Opioid and non-opioid analgesia
- Enzyme replacement
- Pancreatic-enzyme replacement therapy (PERT), Pancrelipase
- Insulin therapy for diabetic clients (insulin or oral hypoglycemic agents)
- H2 blockers or proton pump inhibitors or neutralizing stomach acid with oral sodium bicarbonate (enhance the effectiveness of PERT)
- Refer to discharge teaching for acute pancreatitis
Nutrition therapy limit food intake to avoid increased pain.
- TPN or total enteral nutrition (TEN), with vitamin and mineral replacement may be ordered, increased number of calories, up to 4000 to 6000 calories/day, to maintain weight. Foods high in carbohydrates and protein assist in healing.
Avoid: high fat (due to
diarrhea) and alcohol.
Surgery - not a primary intervention for treatment of chronic pancreatitis.
- May be indicated for ongoing abdominal pain, incapacitating relapses of pain, or complications such as abscesses and pseudocysts.
- The underlying pathologic changes determine the procedure indicated.
- Using laparoscopy, the surgeon incises and drains an abscess or pseudocyst.
- Laparoscopic cholecystectomy or choledochotomy (incision of the common bile duct) may be indicated if biliary tract disease is an underlying cause of pancreatitis.
- If the pancreatic duct sphincter is fibrotic, the surgeon performs a sphincterotomy (incision of the sphincter) to enlarge it.
- Endoscopic sphincterotomy may be used for patients who are poor surgical candidates.
In some cases laparoscopic distal pancreatectomy may be appropriate for resection of the distal pancreas or pancreas head.
- Endoscopic pancreatic necrosectomy and natural orifice transluminal endoscopic surgery (NOTES) are becoming more common for removing necrosed pancreatic tissue.
- Both procedures are performed through the GI wall without a visible skin incision.
- The NOTES procedure is discussed in Surgical Management on p. 1217 in the Cholecystitis section.
In a few cases, pancreas transplantation may be done. However, this procedure is performed most often for patients with severe, uncontrolled diabetes
Chronic Pancreatitis Patient and Family Teaching:
• Take pancreatic enzymes with meals and snacks and follow with a glass of water.
• Administer enzymes after antacid or H2 blockers. (Decreased pH inactivates drug.)
• Swallow the tablets or capsules without chewing to minimize oral irritation and to allow the drug to be released slowly.
• If you cannot swallow the capsule, pierce the gelatin casing and place contents in applesauce.
• Do not mix enzyme preparations in protein-containing foods.
• Wipe your lips after taking enzymes to avoid skin irritation.
• Do not crush enteric-coated preparations.
• Follow up on all scheduled laboratory testing. (Pancrelipase can cause an increase in uric acid levels.)
- Pancreatic-enzyme replacement therapy (PERT) is the standard of care to prevent malnutrition, malabsorption, and excessive weight loss (Chart 59-3).
- Pancrelipase is usually prescribed in capsule or tablet form and contains varying amounts of amylase, lipase, and protease.
- Teach patients not to chew or crush pancrelipase delayed-release capsules (Creon) or enteric tablets, and teach them to take the medications with all meals and snacks.
- Most serious complication of pancreatitis due to necrosis
- Always fatal if untreated
- High fever - 104 F
- Blood cultures
- Drainage via percutaneous method or laparoscopy to prevent sepsis
- Antibiotic treatment alone does not resolve abscess
- Slide 11 for surgical intervention
- May be palpated as an epigastric mass
- Manifestations epigastric pain,
- Bowel obstruction
- Fistula formation
- Pancreatic ascites
- May spontaneously resolve (6-8 weeks) or rupture
- Carcinoma of the pancreas. A cross-section through the head of the pancreas and adjacent common bile duct showing both an ill-defined mass in the pancreatic substance (arrowheads) and the green discoloration of the duct resulting from total obstruction of bile flow.
- Leading cause of cancer deaths each year in US, usually discovered in the late stages, primary or a result of metastasis, highly metastatic, exact cause unknown. Risk factors - notes.
- Clinical manifestations depend on the site of origin or metastasis.
- Organ enlargement affecting the liver, jaundice, invasion of surrounding organs, venous thromboembolism See Chart 59-5.
(Ignatavicius et al., 2016, p 1227)
• Diabetes mellitus
• Chronic pancreatitis
• High intake of red meat, especially processed meat like steak
• Long-term exposure to chemicals such as gasoline and pesticides
• Older age
• Male gender
• Cigarette smoking
• Family history
• Genetic syndromes
Pancreatic Carcinoma Diagnostics:
- Increased serum amylase, lipase levels, alkaline phosphatase and bilirubin levels, carcinoembryonic antigen (CEA) levels.
- Tumor markers such as CA 19-9 and CA 242 (Pagana & Pagana, 2014).
- Abdominal ultrasound and contrast-enhanced CT .
- Endoscopic ultrasonography - for diagnosis and provide information on tumor type and size (Tonolini et al., 2012).
Contrast harmonic echo-endoscopic ultrasound increases the accuracy of diagnosing solid pancreatic masses (Fusaroli et al., 2010).
- Endoscopic retrograde cholangiopancreatography (ERCP) provides visual diagnostic data.
- Percutaneous transhepatic biliary cholangiogram with placement of a percutaneous transhepatic biliary drain (PTBD).
- No specific blood tests diagnose pancreatic cancer.
- The degree of enzyme elevation depends on the acuteness or chronicity of the pancreatic and biliary damage.
- Abdominal ultrasound and contrast-enhanced CT are the most commonly used imaging techniques for confirming a tumor and can differentiate the tumor from a cyst.
- An alternative to ERCP is a percutaneous transhepatic biliary cholangiogram with placement of a percutaneous transhepatic biliary drain (PTBD).
- This drain decompresses the blocked biliary system by draining bile, either internally, externally, or both.
- Aspiration of pancreatic ascitic fluid by abdominal paracentesis may reveal cancer cells and elevated amylase levels
Pancreatic Cancer Interventions:
- Treatment - only palliative not curative
- Prevent tumor spread thru chemotherapy Ex. of drugs: 5-FU, Gemzar, Xeloda, Taxotere, Tarceva.
- Radiation with radioctive iodine seeds, FUDR
- Growth factor inhibitors, kinase inhibitors, anti-angiogenesis factors
- Reduce pain with opioid analgesics
- Preoperative care
NG tube may be inserted
TPN typically begun
- Operative procedure may include Whipple procedure, biliary stent.
Pancreatic Cancer Interventions Extra Notes:
- The cancers are often metastatic and recur despite treatment. Chemotherapy shrinks tumor.
- Drugs used: 5-Fluorouracil (5-FU), with gemcitabine (Gemzar) for locally advanced, or unresectable, pancreatic cancers.
- Gemcitabine may also be given with capecitabine (Xeloda), docetaxel (Taxotere), and/or erlotinib (Tarceva), a targeted agent for unresectable or metastatic tumors.
- Some patients receive three or four drugs and have had more tumor shrinkage as a result.
- Observe for adverse drug effects, such as fatigue, rash, anorexia, and diarrhea. Chapter 22 discusses nursing implications of chemotherapy in more detail.
- Other targeted therapies being investigated include growth factor inhibitors, anti-angiogenesis factors, and kinase inhibitors (also known as tyrosine kinase inhibitors).
- Kinase inhibitors are a newer group of drugs that focus on cancer cells with little or no effect on healthy cells. Chapter 22 describes general nursing interventions associated with chemotherapy.
- To control pain, the patient takes high doses of opioid analgesics (usually morphine) as prescribed and uses other comfort measures before the pain escalates and peaks.
- Because of the poor prognosis, drug dependency is not a consideration. Chapter 3 describes in detail the care of the patient with chronic cancer pain.
- Intensive external beam radiation therapy to the pancreas may offer pain relief by shrinking tumor cells, alleviating obstruction, and improving food absorption.
- It does not improve survival rates. Implantation of radioactive iodine (125I) seeds, in combination with systemic or intra-arterial administration of floxuridine (FUDR), has also been used.
- The patient may experience discomfort during and after the radiation treatments. Chapter 22 describes radiation therapy in more detail.
- For patients experiencing biliary obstruction who are high surgical risks, biliary stents placed percutaneously (through the skin) can ensure patency to relieve pain.
- These stents are devices made of plastic materials that keep the ducts of the biliary system open. Using another approach, self-expandable stents may be inserted endoscopically to relieve obstruction.
- The surgical procedure for cancer of the pancreas involves resection of the antrum of the stomach, the gallbladder, the duodenum, and varying amounts of the pancreas. Anastomoses are constructed between the stomach, the common bile and pancreatic ducts, and jejunum.
- The three anastomoses that constitute the Whipple procedure:
- Whipple procedure, or radical pancreaticoduodenectomy.
- This surgical procedure involves resection of the proximal pancreas, adjoining duodenum, distal portion of the stomach, and distal portion of the common bile duct.
- The pancreatic duct, common bile ducts, and stomach are anastomosed to the jejunum.
In preparing to care for the patient, which conditions does the nurse recognize as potential complications of acute pancreatitis? (Select all that apply.)
A. Strep throat
B. Pleural effusion
C. Diabetes mellitus
D. Pancreatic infection
E. Acute kidney failure
Answer: B, C, D, E
All, with the exception of strep throat, are potential complications of acute pancreatitis.
A 68-year-old patient presents to the ED the day after Thanksgiving, stating that he has "eaten and drunk quite a bit." He states that about 1 hour ago he experienced a sudden onset of pain in the left upper quadrant that radiates to his left flank. He rates the pain as an 8 on a 0-to-10 scale. The patient is admitted with acute pancreatitis.
Which laboratory finding corroborates the diagnosis of acute pancreatitis?
Serum lipase, 150 U/L
Serum amylase, 200 U/L
Serum glucose, 80 mg/dL
White blood cells (WBCs), 6000 mcL
A serum amylase of 200 U/L is elevated (normal range is approximately 23 to 85 U/L). Lipase normal range is 0-160 U/L; WBC normal range is 4800-10,800 ccm; and glucose normal range is 82-110 mg/dL. Amylase, lipase, WBC, and glucose are often higher than normal in patients with acute pancreatitis.
When the patient is asked about pain, he says that it is intense and continuous. He states that sometimes when he curls up in a fetal position the pain eases.
Which medication does the nurse recognize that will provide the most comprehensive pain relief at this time?
PCA morphine sulfate
IM fentanyl (Sublimaze)
PCA meperidine (Demerol)
Oral hydromorphone (Dilaudid)
Meperidine is not a good choice because it can cause seizures, especially in older adults. While hydromorphone is a good choice with acute pancreatitis pain, IV is the best route. Fentanyl is a good alternative, but the route chosen should be IV or transdermal. Another option is epidural analgesia.
In the care of a patient with acute pancreatitis, which assessment parameter requires immediate nursing intervention?
Heart rate of 105 beats/min
Serum glucose of 136 mg/dL
Blood pressure of 102/76 mm Hg
Respiratory rate of 28 breaths/min
Rationale: The patient with pancreatitis may develop pulmonary complications, pleural effusions, pulmonary infiltrates, and acute respiratory failure or ARDS. Increases in respiratory effort is an important assessment variable in the care of a patient with pancreatitis. Patients may also be hyperglycemic and hypovolemic. Assessing and treating endocrine function of the pancreas and perfusion variables are also important.
THIS SET IS OFTEN IN FOLDERS WITH...
Nursing Care of Patients With Liver, Pan…
Glomerulonephritis & Nephrotic Syndrome
Chp 40 - Iggy - care with hematologic pr…
YOU MIGHT ALSO LIKE...
Chapter 59: Care of Patients with Problems of Bili…
Chapter 59: Care of Patients with Problems of Bili…
Chapter 50 (PrepU), Meg Surg: Biliary Disorders
Meg Surg: Biliary Disorders
OTHER SETS BY THIS CREATOR
Leadership: Chapter 1 Nurse Practice Acts
Cancers of the Male and Female Reproduct…
Gynecological Dysfunction and Sexually T…
Study Guide Exam 6
OTHER QUIZLET SETS
Clin Med: Lower Respiratory Tract Infections