pleural effusion, atelectasis, pneumonia, ARDS, ▪ Could eventually have: multi-organ and system failure respiratory distress and oliguria o Cardiovascular ▪ Hypotension ▪ Tetany d/t low calcium ( sign of severe disease)
o Trypsin can activate prothrombin and plasminogen → increase risk for emboli o Patients with severe disease are at risk for Abdominal compartment syndrome- r/t intraabdominal hypertension and edema • Lab results for pancreatitis: o Serum amylase ↑ - usually elevated early and remains elevated 24-72 hours . o Serum lipase ↑ - Results will confirm diagnosis because amylase can be affected by other diseases o Urinary amylase ↑ o Blood glucose ↑ o Serum calcium ↓ o Serum triglycerides ↑ o ESR elevated ↑ • Collaborative Care Acute pancreatitis o Goals ▪ Relief of pain ▪ Prevention/alleviation of shock ▪ Reduction of pancreatic secretions ▪ Correction of fluid and electrolyte imbalances ▪ Prevention/treatment of infection ▪ Removal of precipitating factors o Care focuses on: ▪ Aggressive hydration (IV Fluids) ▪ Pain management – morphine maybe used , antispasmodics ▪ Management of metabolic complications – supplemental oxygen, placed on PPIs, H2 blocker and receive pancreatic enzymes to help with digestion ▪ Minimize pancreatic stimulation • NPO,NGT, medications to decrease gastric secretions, may need parenteral nutrition ( ↓ risk for infection) . • Once feeding is resumed- assess for intolerance to foods, increasing abdominal girth – all signs of pancreas being irritated. Diet usually high carbohydrates ▪ Monitor blood sugar closely ▪ Abstain from alcohol
• Nursing management: o Goals: ▪ Relief of pain ▪ Normal fluid and electrolyte balance ▪ Minimal to no complications ▪ No recurrent attacks o Acute Interventions ▪ Monitor vitals ▪ √ response to IV fluids ▪ Monitor electrolytes, I&O ( remember what's lost with GI secretions), blood glucose , CBC, ▪ Assess mental status ▪ Assess respiratory function! ▪ Assess pain levels ▪ Oral care for the patient who is NPO or has NGT (assess for patency and blockage) ▪ Abdominal assessment – risk for paralytic ileus ▪ Assess renal status • Discharge Instructions o Physical therapy maybe needed o Abstain from alcohol – may need counseling o Dietary teaching – restrict fats, carbohydrate high diet ( less stressful to pancreas) – avoid crash diets- o Patient should be aware of symptoms of infection, diabetes, steatorrhea, • Chronic pancreatitis : Continuous prolonged inflammatory and fibrosing process of the pancreas. o Causes : ▪ Alcohol abuse ,obstruction by gallstones, tumor, pseudocysts, trauma and systemic diseases ( SLE, cystic fibrosis) ▪ It may follow acute pancreatitis. o Symptoms ▪ Abdominal pain ▪ Pancreatic insufficiency • Collaborative care o If there is an acute episode – care is the same o Want to prevent further attacks o Relief of pain o Diet , pancreatic enzymes, & control of blood sugar – ways to control pancreatic insufficiency.
o No consumption of alcohol and caffeine beverages. o May need endoscopic procedures ▪ Choledochojejunostomy ▪
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- Fall '16
- Denise Cauble