ELSEVIER HESI MED SURG; DISEASE MANAGEMENT 1 - SECONDARY PREVENTION- ACUTE CARE

• Only elevate in the first 24 hours! Gastrointestinal System [Pancreatitis] Description • Nonbacterial inflammation of pancreas • Autodigestion of the pancreas by its own enzymes – primarily Trypsin • Major causes: o Alcohol o Biliary tract disease • Chronic pancreatitis = progressive, destructive disease (permanent) • AVOID ALCOHOL CONSUMPTION Assessment • Acute: o Severe mid-epigastric pain radiatesto back (worse after fatty meal/EtOH consumption) o Abdominal guarding, rigid, board-like = PEROTINITIS o N/V o Turner’ssign (bluish discoloration of flanks) o Cullen’ssign (periumbilical area) o Elevated: ▪ Amylase ▪ Lipase ▪ Triglycerides ▪ Glucose o Low: ▪ Serum calcium (hypocalcemia) • Chronic: o Recurring attacks o Steatorrhea o Ascites/dark urine/jaundice (affectsliver) o Weight loss/muscle wasting o S/S of DM – hyperglycemia 2/2 lack of insulin Interventions • Acute: o NPO o NG tube to suction & TPN o Hydromorphone (Dilaudid) or fentanyl for pain o Antacids, H2 blockers, PPIs o Position of comfort: on side with legs drawn to chest o Teach: ▪ Avoid caffeine,spicey foods, fatty foods, alcohol o Monitor BS/need for temporary insulin o Monitor hypocalcemia (tetany, muscle twitching, cramping, grimacing,seizures, increase DTRs, spasms, Trousseau’s and Chvsteks sign) o Semi-fowlersto decrease pressure off abdomen o Monitor for dysrhythmias • Chronic: o Administer analgesics o Administer pancreatic enzymes (Creon) with meals or snacks ▪ Mix with fruit juice/apple sauce o Monitor s/s of DM HESI Hint • Acute pancreatitis islocated retroperitoneally. Any enlargement of pancreases causes peritoneum to stretch tightly –