Afro acute_and_chronic_pancreatitis

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  • 1. Focus on Pancreatitis (Relates to Chapter 44, “Nursing Management: Liver, Pancreas, and Biliary Tract Problems” in the textbook) Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 2. Acute Pancreatitis • An acute inflammatory process of the pancreas • Degree of inflammation varies from mild edema to severe necrosis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 3. Acute Pancreatitis Etiology and Pathophysiology • Most common in middle-aged men and women • Severity of the disease varies according to the extent of pancreatic destruction • Can be life-threatening • African American rate three times higher than for whites Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 4. Acute Pancreatitis Etiology and Pathophysiology (Cont’d) • Primary etiologic factors are • Biliary tract disease • Most common: Gallbladder disease • Alcoholism Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 5. Acute Pancreatitis Etiology and Pathophysiology (Cont’d) • Less common causes • Trauma (postsurgical, abdominal) • Viral infections (mumps, coxsackievirus HIV) • Penetrating duodenal ulcer • Cysts • Idiopathic Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 6. Acute Pancreatitis Etiology and Pathophysiology • Less common causes (cont’d) • Abscesses • Cystic fibrosis • Kaposi’s sarcoma • Metabolic disorders • Vascular diseases • Postop GI surgery Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 7. Acute Pancreatitis Etiology and Pathophysiology • Less common causes (cont’d) • Drugs • Corticosteroids • Thiazide diuretics • Oral contraceptives • Sulfonamides • NSAIDs Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 8. Acute Pancreatitis Etiology and Pathophysiology • Caused by autodigestion of pancreas • Etiologic factors • Injury to pancreatic cells • Activate pancreatic enzymes Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 9. Acute Pancreatitis Fig. 44-14 Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 10. Acute Pancreatitis Etiology and Pathophysiology • Trypsinogen • Activated to trypsin by enterokinase • Inhibitors usually inactivate trypsin • Enzyme can digest the pancreas and can activate other proteolytic enzymes Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 11. Pancreatitis Etiology and Pathophysiology • Elastase • Activated by trypsin • Plays a major role in autodigestion • Causes hemorrhage by producing dissolution of the elastic fibers of blood vessels Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 12. Acute Pancreatitis Etiology and Pathophysiology • Phospholipase A • Plays a major role in autodigestion • Activated by trypsin and bile acids • Causes fat necrosis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 13. Acute Pancreatitis Etiology and Pathophysiology (Cont’d) Trypsin Edema, necrosis, hemorrhage Elastase Hemorrhage Phospholipase A Fat necrosis Kallikrein Edema, vascular permeability, smooth muscle contraction, shock Lipase Fat necrosis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 14. Acute Pancreatitis Etiology and Pathophysiology (Cont’d) • Alcohol • May stimulate production of digestive enzymes • Increases sensitivity to hormone cholecystokinin • Stimulates production of pancreatic enzymes Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 15. Acute Pancreatitis Etiology and Pathophysiology (Cont’d) • Edematous pancreatitis • Mild and self-limiting • Necrotizing pancreatitis • Degree of necrosis correlates with severity of manifestations Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 16. Acute Pancreatitis Clinical Manifestations • Abdominal pain is predominant symptom • Pain located in the left upper quadrant • Pain may be in the midepigastrium • Commonly radiates to the back Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 17. Acute Pancreatitis Clinical Manifestations • Abdominal pain (cont’d) • Sudden onset • Severe, deep, piercing, steady • Aggravated by eating • Not relieved by vomiting Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 18. Acute Pancreatitis Clinical Manifestations • • • • • • Flushing Cyanosis Dyspnea Edema Nausea/vomiting Bowel sounds decreased or absent Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 19. Acute Pancreatitis Clinical Manifestations (Cont’d) • • • • • • Low-grade fever Leukocytosis Hypotension Tachycardia Jaundice Abdominal tenderness Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 20. Acute Pancreatitis Clinical Manifestations (Cont’d) • Abdominal distention • Abnormal lung sounds • Crackles • Discoloration of abdominal wall Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 21. Acute Pancreatitis Complications • Two significant local complications • Pseudocyst • Abscess Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 22. Acute Pancreatitis Complications (Cont’d) • Pseudocyst • Cavity surrounding outside of pancreas filled with necrotic products and liquid secretions • Abdominal pain • Palpable epigastric mass Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 23. Acute Pancreatitis Complications • Pseudocyst (cont’d) • Nausea, vomiting, and anorexia • Elevated serum amylase • May resolve spontaneously within a few weeks or may perforate, causing peritonitis • Treatment: Internal drainage procedure Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 24. Acute Pancreatitis Complications • Pancreatic abscess • A large fluid-containing cavity within pancreas • Results from extensive necrosis in the pancreas • Upper abdominal pain • Abdominal mass Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 25. Acute Pancreatitis Complications • Pancreatic abscess (cont’d) • High fever • Leukocytosis • Requires surgical drainage Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 26. Acute Pancreatitis Complications • Main systemic complications • Pulmonary • Pleural effusion • Atelectasis • Pneumonia Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 27. Acute Pancreatitis Complications • Systemic complications (cont’d) • Cardiovascular • Hypotension • Tetany (caused by hypocalcemia) Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 28. Acute Pancreatitis Diagnostic Studies • History and physical examination • Laboratory tests • Serum amylase • Serum lipase • 2-hour urinary amylase and renal amylase clearance Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 29. Acute Pancreatitis Diagnostic Studies • Laboratory tests (cont’d) • Blood glucose • Serum calcium • Triglycerides Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 30. Acute Pancreatitis Diagnostic Studies • Flat plate of abdomen • Abdominal/endoscopic ultrasound • Endoscopic retrograde cholangiopancreatography (ERCP) • Chest x-ray Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 31. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 32. Acute Pancreatitis Diagnostic Studies (Cont’d) • CT of pancreas • Magnetic resonance cholangiopancreatography (MRCP) Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 33. Acute Pancreatitis Collaborative Care • Objectives include • Relief of pain • Prevention or alleviation of shock • ↓ of pancreatic secretions • Fluid/electrolyte balance • Removal of the precipitating cause Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 34. Acute Pancreatitis Collaborative Care (Cont’d) • Conservative therapy • Supportive care • Aggressive hydration • Pain management • IV morphine • Combined with antispasmodic agent • Management of metabolic complications • Minimizing stimulation Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 35. Acute Pancreatitis Collaborative Care • Conservative therapy (cont’d) • Shock • Plasma or plasma volume expanders (dextran or albumin) • Fluid/electrolyte imbalance • Lactated Ringer’s solution • Ongoing hypotension • Vasoactive drugs: Dopamine (Intropin) • ↑ Systemic vascular resistance Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 36. Acute Pancreatitis Collaborative Care • Conservative therapy (cont’d) • Suppression of pancreatic enzymes • NPO • NG suction • Prevent infections • Peritoneal lavage or dialysis • Remove kinin and phospholipase A exudate Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 37. Acute Pancreatitis Collaborative Care • Surgical therapy indicated if • Presence of gallstones • Uncertain diagnosis • Unresponsive to conservative therapy • Abscess, pseudocyst, or severe peritonitis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 38. Acute Pancreatitis Collaborative Care • Surgical therapy (cont’d) • ERCP • Endoscopic sphincterotomy • Laparoscopic cholecystectomy Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 39. Acute Pancreatitis Collaborative Care (Cont’d) • Drug therapy • IV morphine • Nitroglycerin or papaverine • Antispasmodics • Carbonic anhydrase inhibitor • Antacids • Histamine (H2) receptor Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 40. Acute Pancreatitis Collaborative Care (Cont’d) • Nutritional therapy • NPO status initially to reduce pancreatic secretion • IV lipids • Monitor triglycerides • Small, frequent feedings • High-carbohydrate, low-fat, high-protein diet • Bland diet Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 41. Acute Pancreatitis Collaborative Care • Nutritional therapy (cont’d) • Supplemental fat-soluble vitamins • Supplemental commercial liquid preparations • Parenteral nutrition • No caffeine or alcohol Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 42. Acute Pancreatitis Nursing Assessment • Health history • Biliary tract disease • Alcohol use • Abdominal trauma • Duodenal ulcers • Infection • Metabolic disorders Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 43. Acute Pancreatitis Nursing Assessment (Cont’d) • Medication usage • • • • • Thiazides, estrogens, corticosteroids, NSAIDs Surgical procedures Nausea/vomiting Dyspnea Severe pain Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 44. Acute Pancreatitis Nursing Assessment (Cont’d) • Physical examination findings • Fever • Jaundice • Discoloration of abdomen/flank • Tachycardia • Hypotension • Abdominal distention/tenderness Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 45. Acute Pancreatitis Nursing Assessment (Cont’d) • Abnormal laboratory findings • ↑ Serum amylase/lipase • Leukocytosis • Hyperglycemia • Hyperlipidemia • Hypocalcemia • Abnormal ultrasound/ CT/ ERCP Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 46. Acute Pancreatitis Nursing Diagnoses • Acute pain • Deficient fluid volume • Imbalanced nutrition: Less than body requirements • Ineffective therapeutic regimen management Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 47. Acute Pancreatitis Planning • Overall goals • Relief of pain • Normal fluid and electrolyte balance • Minimal to no complications • No recurrent attacks Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 48. Acute Pancreatitis Nursing Implementation • Health Promotion • Assessment of predisposing factors • Early diagnosis/treatment of cholelithiasis • Eliminate alcohol intake Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 49. Acute Pancreatitis Nursing Implementation (Cont’d) • Acute Intervention • Monitor vital signs • IV fluids • Observe for side effects of medications • Assess respiratory function • Pain assessment and management • Frequent position changes • Side-lying with HOB elevated 45 degrees • Knees up to abdomen Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 50. Acute Pancreatitis Nursing Implementation • Acute Intervention (cont’d) • Fluid/electrolyte balance • Blood glucose monitoring • Monitor for signs of hypocalcemia • Tetany (jerking, irritability, twitching) • Numbness around lips/fingers • Positive Chvostek or Trousseau sign • Monitor for hypomagnesemia Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 51. Acute Pancreatitis Nursing Implementation • Acute Intervention (cont’d) • NG tube care • Frequent oral/nasal care • Observe for signs of infection • Wound care • Observe for paralytic ileus, renal failure, mental changes Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 52. Acute Pancreatitis Nursing Implementation • Ambulatory and Home Care • Physical therapy • Counseling regarding abstinence from alcohol, caffeine, and smoking • Assessment of narcotic addiction Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 53. Acute Pancreatitis Nursing Implementation • Ambulatory and Home Care (cont’d) • Dietary teaching • High-carbohydrate, low-fat diet • Patient/family teaching • Signs of infection, high blood glucose, steatorrhea • Medications/diet Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 54. Acute Pancreatitis Nursing Implementation • Expected outcomes • Maintains adequate fluid volume • Maintains weight appropriate for height • Food and fluid intake adequate to meet nutritional needs Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 55. Acute Pancreatitis Nursing Implementation • Expected outcomes (cont’d) • Describes therapeutic regimen • Expresses commitment to lifestyle changes Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 56. Chronic Pancreatitis • Continuous, prolonged inflammatory, and fibrosing process of the pancreas • Pancreas becomes destroyed as it is replaced by fibrotic tissue • Strictures and calcifications can also occur Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 57. Chronic Pancreatitis Etiology and Pathophysiology • May follow acute pancreatitis • May occur in absence of any history of acute condition • Two major types • Chronic obstructive pancreatitis • Chronic calcifying pancreatitis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 58. Chronic Pancreatitis Etiology and Pathophysiology (Cont’d) • Chronic obstructive pancreatitis • Associated with biliary disease • Most common cause • Inflammation of the sphincter of Oddi associated with cholelithiasis • Other causes include • Cancer of ampulla of Vater, duodenum, or pancreas Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 59. Chronic Pancreatitis Etiology and Pathophysiology (Cont’d) • Chronic calcifying pancreatitis • Inflammation • Sclerosis • Mainly in the head of the pancreas and around the pancreatic duct Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 60. Chronic Pancreatitis Etiology and Pathophysiology • Chronic calcifying pancreatitis (cont’d) • Most common form of chronic pancreatitis • May be referred to as alcohol-induced pancreatitis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 61. Chronic Pancreatitis Etiology and Pathophysiology • Chronic calcifying pancreatitis (cont’d) • Ducts are obstructed with protein precipitates • Precipitates block the pancreatic duct and eventually calcify Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 62. Chronic Pancreatitis Etiology and Pathophysiology • Chronic calcifying pancreatitis (cont’d) • Calcification is followed by fibrosis and glandular atrophy • Pseudocysts and abscesses commonly develop Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 63. Chronic Pancreatitis Clinical Manifestations • Abdominal pain • Located in the same areas as in acute pancreatitis • Heavy, gnawing feeling; burning and cramp-like • Abdominal tenderness • Malabsorption with weight loss Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 64. Chronic Pancreatitis Clinical Manifestations (Cont’d) • • • • • Constipation Mild jaundice with dark urine Steatorrhea Frothy urine/stool Diabetes mellitus Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 65. Chronic Pancreatitis Clinical Manifestations (Cont’d) • Complications • Pseudocyst formation • Bile duct or duodenal obstruction • Pancreatic ascites • Pleural effusion Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 66. Chronic Pancreatitis Clinical Manifestations • Complications (cont’d) • Splenic vein thrombosis • Pseudoaneurysms • Pancreatic cancer Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 67. Chronic Pancreatitis Diagnostic Studies • Confirming diagnosis can be challenging • Based on signs/symptoms, laboratory studies, and imaging Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 68. Chronic Pancreatitis Diagnostic Studies (Cont’d) • Laboratory tests • Serum amylase/lipase • May be ↑ slightly or not at all • ↑ Serum bilirubin • ↑ Alkaline phosphatase Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 69. Chronic Pancreatitis Diagnostic Studies • Laboratory tests (cont’d) • Mild leukocytosis • Elevated sedimentation rate • ERCP • Visualize pancreatic/common bile duct Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 70. Chronic Pancreatitis Diagnostic Studies • • • • CT MRI MRCP Transabdominal ultrasound Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 71. Chronic Pancreatitis Diagnostic Studies (Cont’d) • Endoscopic ultrasound • Secretin stimulation test • Assess degree of pancreatic function • Not useful in diagnosis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 72. Chronic Pancreatitis Collaborative Care • Prevention of attacks • During acute attack, follow acute therapy • Relief of pain • Control of pancreatic exocrine and endocrine insufficiency Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 73. Chronic Pancreatitis Collaborative Care (Cont’d) • Bland low-fat, high-carbohydrate diet • Bile salts • Help absorption of fat-soluble vitamins • Prevent further fat loss • Control of diabetes • No alcohol Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 74. Chronic Pancreatitis Collaborative Care (Cont’d) • Pancreatic enzyme replacement • Acid-neutralizing and acid-inhibiting drugs Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 75. Chronic Pancreatitis Collaborative Care (Cont’d) • Surgery • Indicated when biliary disease is present or if obstruction or pseudocyst develops • Divert bile flow or relieve ductal obstruction Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 76. Chronic Pancreatitis Nursing Management • Focus is on chronic care and health promotion • Dietary control • No alcohol • Control of diabetes • Taking pancreatic enzymes • Patient and family teaching Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 77. Case Study Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 78. Case Study • 63-year-old female enters the emergency department with nausea, vomiting, epigastric pain, left upper quadrant pain • She claims the pain is severe, sharp, and boring and radiates through to her midback Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 79. Case Study (Cont’d) • Pain began 24 hours ago • She is divorced, retired, and smokes a half-pack of cigarettes a day Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 80. Case Study (Cont’d) • Vital signs • Blood pressure 100/70 mm Hg • Heart rate 97 beats/min • Respiratory rate 30 breaths/min • Temperature 100.2°F • She is diagnosed with acute pancreatitis and admitted to the medical-surgical unit Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 81. Discussion Questions 1. What are the possible causes of pancreatitis? 2. What is her priority of care? Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
  • 82. Discussion Questions (Cont’d) 3. What labs are the most important to monitor in acute pancreatitis? 4. What patient teaching should you do with her? Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.