PANCREATITIS

Question 1

Inflammation of the pancreas

Answer 1

Pancreatitis

Question 2

Medical emergency with high mortality rate

Answer 2

Acute Pancreatitis

Question 3

Undetectable in early stage

Answer 3

Chronic Pancreatitis

Question 4

What is the main problem of Acute Pancreatitis?

Answer 4

The main problem in Acute Pancreatitis is AUTODIGESTION OF PANCREAS

Question 5

Digests CHO

Answer 5

Amylase

Question 6

Digests fats

Answer 6

Lipase

Question 7

Digests CHON

Answer 7

Trypsin

Question 8

More common yet milder form

Answer 8

Interstitial Edematous Pancreatitis

Question 9

(-) necrosis but pancreas become enlarged due to inflammatory edema

Answer 9

Interstitial Edematous Pancreatitis

Question 10

Patient at risk for hypovolemic shock, F&E imbalances, and sepsis

Answer 10

Interstitial Edematous Pancreatitis

Question 11

(+) Necrosis within and/or around the pancreas

Answer 11

Necrotizing Pancreatitis

Question 12

More widespread and complete enzymatic digestion of gland

Answer 12

Necrotizing Pancreatitis

Question 13

Acute Pancreatitis causes “I GET SMASHED”

Answer 13

I- idiopathic
G- Gall stones
E- Ethanol (Alcohol)
T- Trauma
S- Steroids
M- Mumps/Malignancy
A- Autoimmune
S- Scorpion stings
H- Hypercalcemia/Hypertriglyceridemia
E- ERCP
D- Drugs

Question 14

Obstruction of the common bile duct

Answer 14

Acute Pancreatitis

Question 15

Acute Pancreatitis Clinical Manifestations

Answer 15

C- Cullen’s sign
H- Hyperglycemia, Hypocalcemia
A- Abdominal Pain (main symptom)
G- Grey-turner’s sign
S- Sympathetic Nervous System Stimulation

Question 16

Medical Management of Acute Pancreatitis

Answer 16

• NPO – to inhibit pancreatic stimulation
• Nasogastric suction if with abdominal distention and paralytic ileus
• Enteral feeding (preferred route to meet nutritional needs)
  -Total Parenteral Nutrition (TPN), if enteral route is not tolerated

Question 17

Pain management for Acute Pancreatitis

Answer 17

• Opiod analgesics, as ordered
• Antibiotics, if with infection only
• Intensive insulin therapy/continuous insulin infusion if with hyperglycemia
• IV calcium gluconate if with tetany

Question 18

What medications do we need to give if hypovolemic shock is present in Acute Pancreatitis?

Answer 18

-Give plasma or plasma volume expanders (e.g dextran or albumin) (the purpose is to increase blood volume)
- Dopamine IV (to increase systemic vascular resistance)
- PLR (fluid of choice to correct electrolyte imbalance

Question 19

Surgical Management of Acute Pancreatitis

Answer 19

• ERCP with/without lap chole if gall stones are the cause
• Laparotomy
• Pancreatic Surgery

Question 20

Performed by making a large incision in the abdomen to gain access to the peritoneal cavity.

Answer 20

Laparotomy

Question 21

Resect or debride an infected, necrotic pancreas

Answer 21

Pancreatic surgery

Question 22

Nursing Management of Acute Pancreatitis (GOAL: Pain Control)

Answer 22

-Assess pain score regularly
Administer opioids, as ordered

-Institute non- pharmacologic pain relief interventions

• Facilitate and maintain NPO
  Institute bed rest - to decrease the metabolic rate and reduce the secretion of pancreatic and gastric enzymes.

-Refer increasing severity of pain to physician ASAP

Question 23

Nursing Management of Acute Pancreatitis (GOAL: Improvement of Breathing Pattern)

Answer 23

• Place in semi- Fowler’s position (to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion)

-Change positions frequently (to prevent atelectasis and pooling of secretions)

-Facilitate DBE and coughing, instruct on use of incentive spirometry

Question 24

Nursing Management of Acute Pancreatitis (GOAL: Improvement of Nutritional Status)

Answer 24

• Monitor daily weights
• Administer enteral/parenteral nutrition, as prescribed
• Monitor blood glucose q4-6H or as ordered
• Facilitate high protein, low fat diet once acute symptoms subside
• Instruct to avoid heavy meals and alcoholic beverages

Question 25

Nursing Management of Acute Pancreatitis (GOAL: Maintaining Skin Integrity)

Answer 25

-Assess surgical wound, drainage sites, and skin for signs of infection, inflammation, and breakdown - Provide wound care as prescribed - Prevent contact of intact skin with drainage - Facilitate turning to sides q2H Use specialty beds as indicated to prevent skin breakdown

Question 26

What is the causes of Chronic Pancreatitis?

Answer 26

-Alcohol Consumption - Smoking

Question 27

Chronic Pancreatitis Clinical Manifestations (PAWIS)

Answer 27

P- Pain (upper abdominal and back) A- Anorexia/ Avoidance behavior W- Weight loss I- Impaired CHON and fat metabolism S- Steatorrhea

Question 28

WHO three-step Ladder for Chronic Pain

Answer 28

Step 1: Non-opiod analgesic + adjuvant Step 2: Weak opiod + non-opiod + Adjuvant Step 3: Strong opioid + non opioid + Adjuvant

Question 29

What is the other alternatives of medical management of Chronic Pancreatitis?

Answer 29

PERT (Pancreatic Enzyme Replacement Therapy)

Question 30

If with malabsorption and steatorrhea what appropriate medical management must be administer?

Answer 30

Pecutaneous Enzyme Replacement Therapy (PERT)

Question 31

Nursing Care for Patients Taking Pancreatic Enzyme Replacement (PERT

Answer 31

- Swallow capsules with cold or room temperature liquid - DO NOT crush or chew capsules - Taken with the first bite of each meal and snack - The only foods that do not require you to take enzymes are fruit juice and fruit (fresh and dried fruit) when eaten alone. - DO NOT stop taking PERT even when symptoms persist

Question 32

Surgical Management of Chronic Pancreatitis

Answer 32

-Roux-en--Y - Whipple Resection

Question 33

Also known as pancreaticoduodenectomy

Answer 33

Whipple Resection

Question 34

Pancreaticojejunostomy with side-to-side anastomosis

Answer 34

Roux-en-Y