Pancreatitis

• What are the risk factors for acute pancreatitis?

  Alcohol use, Gall Bladder disease

  Age > 55
• What are labs seen in the patient with acute pancreatitis?

  • Hypocalcemia
  • Increased:
  • Amylase/Lipase
  • Triglycerides
  • WBC
  • glucose
  • LFTs
  • BUN
• What are the symptoms of acute pancreatitis?

  • Mid epigastric pain, sharp, constant that radiates to back & L shoulder
  • onset after alcohol or large meal
  • Nausea, Vomiting w/ distention
  • Hypoactive/Absent bowel sounds
  • Hypocalcemia Signs = Chvostek & Trouseau's
  • Tachypnea, Tachycardia
  • Fever
  • Hypertensive or Hypotensive
• What are risk factors of chronic pancreatitis?

  Alcohol, smoking & pancreatic necrosis
• What are symptoms of chronic pancreatitis?

  Recurring abdominal pain and vomiting; wt loss; steatorrhea, Diabetes Sx 
• What do the labs look like in a patient with chronic pancreatitis?

  • Increased amylase & lipase 
  • hypocalcemia 
• What are some nursing considerations for the patient experiencing fluid volume deficit in acute pancreatitis?

  • Rehydration ~ aggressive (5 – 10 ml/kg ~ 2.5 - 4L avg) within first 24H if no renal or heart problems  
  • Monitor Fluid balance= I&O, daily weights, VS , CVP Monitoring (N = 2 – 8)
  • Antiemetics, NGT if needed (for comfort/rest) 
  • Glucose control ~ FBS monitoring  
  • Monitor labs for renal d/t impact of hypovolemia on organ function and electrolytes lost by vomiting, malnutrition  
• How does CVP monitoring help in the treatment of fluid volume deficit in acute pancreatitis?

  helps monitor for hypovolemic shock from third spacing
• How does the nurse manage pain during acute pancreatitis?

  • NPO [dec intake = dec pancreatic stimulation]; bed rest in fowler’s or knee-chest position 
  • Meds: opiates, histamine blocker or PPI 
• What are the complications of pancreatitis?

  • Necrotizing pancreatitis  ~ more likely to DIE 
  • Associated hemorrhage, septic shock, and MODS 
  • Requires surgical drainage or resection and Abx 
  • Respiratory distress/failure  
  • Atelectasis, pleural effusion, ARDS
• What are nursing dx to consider in the treatment of chronic pancreatitis?

  • Pain management
  • Nutrition
  • Fall precautions d/t osteoporosis
• How does the nurse manage care for a patient experiencing nutrition less than body requirements in acute pancreatitis?

  Diet: low fat, low protein, moderate carbs  

  • Frequent small meals --> (less pancreatic stimulation) 
  • Started when Sx decrease (pain & N/V)  
  • Enteral feedings if NPO >/= 72H 
  • TPN if enteral feedings are not tolerated within 5 days of admission  
  • Provide insulin --> helps them utilize carbs
• What condition is a patient likely to have 2 fold increase risk of within 5 years of an acute pancreatic episode?

  Diabetes
• What type of nutritional guidelines should a patient with chronic pancreatitis follow?

  • Bland diet, low fat, moderate protein & carb  
  • Insulin for carb utilization 
  • Vitamins ~ fat-soluble (KADE) replacement 
  • PPIs or H2RAs ~ help w/ gastric acid excretion 
  • Pancreatic enzyme replacement  
  • Encourage alcohol abstinence ~ prevention of acute attack  
• Why are PPIs or H2RAs given to chronic pancreatitis patients?

  • helps w/ gastric acid excretion 
  • Gastric acids can inactivate pancreatic enzyme replacement med as well as contribute to pancreatitis  
• What medication is given for chronic pancreatitis?

  Pancreatic enzymes: Pancrelipase

  • A: increases digestion of fats, carbs & proteins
  • S: abdominal cramps, diarrhea, nausea
• What are some teaching and nursing considerations when giving pancrelipase?

  • pork based = contraindicated in allergy/faiths
  • Give with meals or snacks = immediately or concurrent
  • Swallow whole; do not chew or crush
  • Powder form = can sprinkle on apple sauce if needed --> do not get on hands or inhale
  • Give concurrently w/ H2RAs to prevent activation of gastric acid
• How do you evaluate that pancrelipase has been effective?

  steatorrhea decreases and weight increases