UMB NU371 NURS371 NU 371 Evidence-Based Nursing Practice (UMB UMass Boston, Fall 2023) PrepU Pancreatitis with complete solution

UMB NU371 NURS371 NU 371 Evidence-Based Nursing Practice (UMB UMass Boston, Fall 2023) PrepU Pancreatitis with complete solution Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: a) cannot tolerate high-glucose concentration. b) are at risk for gallbladder contraction. c) are at risk for hepatic encephalopathy. d) can digest high-fat foods. - a) cannot tolerate high-glucose concentration. - Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest. A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder? a) Edema and inflammation b) Pleural effusion c) Sepsis d) Disseminated intravascular coagulopathy - a) Edema and inflammation - Mild acute pancreatitis is characterized by edema and inflammation confined to the pancreas. Minimal organ dysfunction is present, and return to normal function usually occurs within 6 months. A health care provider suspects a client may have developed pancreatitis. Which laboratory value will confirm this diagnosis? a) High serum amylase and lipase b) Altered alkaline phosphatase and red blood cell count c) Chymotrypsin level and fibrinogen level d) Change in platelet count and prothrombin level - a) High serum amylase and lipase - Laboratory criteria for the diagnosis of pancreatitis are serum amylase or lipase greater than three times the upper limit of normal. Altered alkaline phosphatase and prothrombin levels may indicate liver disease. Alkaline phosphatase is one kind of enzyme found in the body. It can show signs of liver disease or a bone disorder. The red blood cell count is used to measure the number of oxygen-carrying blood cells in a volume of blood. Chymotrypsin digests proteins in the intestine. Fibrinogen is a soluble protein in the plasma that is broken down to fibrin by the enzyme thrombin to form clots. A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Having more than 450,000 platelets is a condition called thrombocytosis; having less than 150,000 is known as thrombocytopenia. Prothrombin time is a blood test that measures how long it takes blood to clot. A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? a) Monitor pulse oximetry every hour. b) Withhold analgesics unless necessary. c) Instruct the client to cough only when necessary. d) Use incentive spirometry every hour. - d) Use incentive spirometry every hour. - The nurse instructs the client in techniques of coughing and deep breathing and in the use of incentive spirometry to improve respiratory function. The nurse assists the client to perform these activities every hour. Repositioning the client every 2 hours minimizes the risk of atelectasis. The client should be instructed to cough every 2 hours to reduce atelectasis. Monitoring pulse oximetry helps show changes in respiratory status and promotes early intervention, but it would do little to minimize the risk of atelectasis. Withholding analgesics is not an appropriate intervention due to the severe pain associated with pancreatitis. The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion? a) Spray the oropharynx with an anesthetic spray. b) Have the patient maintain a backward tilt head position. c) Allow the patient to sip water as the tube is being inserted. d) Have the patient eat a cracker as the tube is being inserted. - c) Allow the patient to sip water as the tube is being inserted. - During insertion, the patient usually sits upright with a towel or other protective barrier spread in a biblike fashion over the chest. The nostril may be swabbed or the oropharynx sprayed with an anesthetic agent to numb the nasal passage and suppress the gag reflex. The tip of the patient's nose is tilted upward, and the tube is aligned to enter the nostril. When the tube reaches the nasopharynx, the patient is instructed to lower the head slightly and, if able, to begin to swallow as the tube is advanced. The patient may also be encouraged to sip water through a straw to facilitate advancement of the tube if this action is not contraindicated A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is board-like and no bowel sounds are detected. What is the major concern for this patient? a) The patient requires more pain medication. b) The patient is developing a paralytic ileus. c) The patient has developed peritonitis. d) The patient has developed renal failure. - c) The patient has developed peritonitis. - Abdominal guarding is present. A rigid or board-like abdomen may develop and is generally an ominous sign, usually indicating peritonitis (Privette et al., 2011). Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes mellitus. Which of the following explains the cause of this secondary diabetes? a) Dysfunction of the pancreatic islet cells b) Ingestion of foods high in sugar c) Inability for the liver to reabsorb serum glucose d) Renal failure - a) Dysfunction of the pancreatic islet cells - Diabetes mellitus resulting from dysfunction of the pancreatic islet cells is treated with diet, insulin, or oral antidiabetic agents. The hazard of severe hypoglycemia with alcohol consumption is stressed to the client and family. When secondary diabetes develops in a client with chronic pancreatitis, the client experiences in