Complex Transitional Nursing Care (NURB 390)
Exam 3 Study Guide DRAFT
-Production and release of insulin and other hormones (endocrine function)
-Production and release of enzymes that aid in the breakdown of starches, proteins, and fats (exocrine
function) - ANSWER>>What are normal functions of the pancreas?
The digestive enzymes that the pancreas normally releases are typically inactive when released and are
activated in the small intestine. In pancreatitis, inflammation of the pancreas leads to early activation of
enzymes in the pancreas, which causes the pancreas to digest itself. Lipolysis and necrosis may occur as
a result. - ANSWER>>What is the pathophysiology of pancreatitis?
Proteolysis leads to thrombosis and gangrene of pancreas - ANSWER>>What role does proteolysis have in
pancreatitis?
Lipase lowers Ca+ levels, increasing the risk of osteoporosis. - ANSWER>>What role does lipase have in
pancreatitis?
Elastase dissolves elastic fibers and ducts of blood vessels, which may lead to hemorrhage and
hypovolemic shock. - ANSWER>>What role does elastase have in pancreatitis?
-Alcohol use/abuse (especially with chronic pancreatitis)***
-Gallstones
-Trauma
-Pancreatic obstruction (ie. from cysts, tumors, etc.)
-Metabolic problems (ie. HLD, hyperthyroidism)
-Drugs - ANSWER>>What are possible etiologies of pancreatitis?
-Pain occurs in the LUQ, mid-epigastrum
-Pain radiates to back and is sudden, severe, and continuous
,-Pain is aggravated by eating - ANSWER>>What are characteristics of pain caused by pancreatitis?
-Flushing, fever
-Cyanosis, dyspnea
-Ileus (and decreased bowel sounds as a result)
-Crackles
-Pleural effusions
-Gray Turner's sign (flank bruising/bleeding) and Cullen's sign (umbilical bruising) --> signs of
retroperitoneal bleeding
-Shock (hypovolemic or septic) --> decreased BP and increased HR
-Jaundice (r/t bile duct obstruction)
-Hyperglycemia
-Increased vascular permeability --> tachypnea and hypoxia
-Steatorrhea if chronic - ANSWER>>What are other clinical cues for pancreatitis?
-Increased amylase and lipase
-Increased WBCs, ESR, glucose, and lipids
-Increased liver enzymes (alkaline phosphatase) and bilirubin if there's bile duct issues
-Decreased Ca+ - ANSWER>>What labs may indicate acute pancreatitis?
-Trousseau's sign (arm twitching)
-Chvostek's sign (facial twitching)
-Muscle spasms
-Increased deep tendon reflexes - ANSWER>>What are s/s of HYPOcalcemia?
-Ultrasound
-CT with contrast
-ERCP - ANSWER>>What are diagnostics for acute pancreatitis?
,-Morphine
-Put patient side lying with knees flexed
-Increase the HOB - ANSWER>>What are interventions for pain relief with acute pancreatitis?
-Administer IVFs
-Administer albumin
-Give meds to manage hypotension
-Monitor hemodynamics - ANSWER>>What are interventions for preventing and treating shock that may
occur with acute pancreatitis?
-Place patient on NPO status
-Place an NG tube for the patient if an ileus has developed - ANSWER>>How are pancreatic secretions
reduced with acute pancreatitis?
-NPO status, then enteral/parenteral nutrition
-Small and frequent high carb meals
-No alcohol - ANSWER>>What is nutrition like for a patient with acute pancreatitis?
-H2 blockers (ie. Pepcid) or PPIs to reduce stomach acid
-Antibiotics if necrotizing pancreatitis occurs
-Antiemetics (ie. Zofran) for N/V
-Insulin for hyperglycemia - ANSWER>>What are some medications that can be given for patients with
acute pancreatitis?
Ca+ and Mg+ - ANSWER>>What electrolytes should be monitored with acute pancreatitis?
ECRP (upper endoscopy with x-ray) or lap chole possible to drain abscess (accumulation of pus from
necrosis of pancreas), pseudocyst (area filled with necrotic products and fluid that may cause
peritonitis), or contaminated fluid. - ANSWER>>What are procedures that can be done for acute
pancreatitis?
, -ARDS
-Atelectasis
-Pneumonia
-MODS
-Hypovolemic shock
-DIC
-Septic shock - ANSWER>>What are complications of procedures performed for acute pancreatitis?
Alcohol abuse or repeated acute pancreatitis - ANSWER>>What are typical causes of chronic pancreatitis?
-Serum amylase and lipase may or may not be elevated
-Increased bilirubin
-Hyperglycemia
-ERCP, CT/MRI, and ultrasound
-Stool analysis - ANSWER>>What are diagnostics for chronic pancreatitis?
-Nonopioid analgesics
-High carb, high protein, and high cal diet that's low in fat
-Avoid alcohol and nicotine
-Watch for complications (ie. bone issues, diabetes, and pancreatic cancer)
-PERT (gives pancreatic enzymes to prevent malnutrition, malabsorption, and excess weight loss)
-Bile salts (facilitate absorption of fat soluble vitamins)
-Insulin/oral hypoglycemics
-H2 blockers or PPIs
-Surgery - ANSWER>>What are interventions for chronic pancreatitis?
Flail chest is 3+ fractures in adjacent ribs in 2+ places that causes paradoxical chest wall movement. Flail
chest commonly occurs after blunt chest trauma or CPR. - ANSWER>>What is flail chest?
Exam 3 Study Guide DRAFT
-Production and release of insulin and other hormones (endocrine function)
-Production and release of enzymes that aid in the breakdown of starches, proteins, and fats (exocrine
function) - ANSWER>>What are normal functions of the pancreas?
The digestive enzymes that the pancreas normally releases are typically inactive when released and are
activated in the small intestine. In pancreatitis, inflammation of the pancreas leads to early activation of
enzymes in the pancreas, which causes the pancreas to digest itself. Lipolysis and necrosis may occur as
a result. - ANSWER>>What is the pathophysiology of pancreatitis?
Proteolysis leads to thrombosis and gangrene of pancreas - ANSWER>>What role does proteolysis have in
pancreatitis?
Lipase lowers Ca+ levels, increasing the risk of osteoporosis. - ANSWER>>What role does lipase have in
pancreatitis?
Elastase dissolves elastic fibers and ducts of blood vessels, which may lead to hemorrhage and
hypovolemic shock. - ANSWER>>What role does elastase have in pancreatitis?
-Alcohol use/abuse (especially with chronic pancreatitis)***
-Gallstones
-Trauma
-Pancreatic obstruction (ie. from cysts, tumors, etc.)
-Metabolic problems (ie. HLD, hyperthyroidism)
-Drugs - ANSWER>>What are possible etiologies of pancreatitis?
-Pain occurs in the LUQ, mid-epigastrum
-Pain radiates to back and is sudden, severe, and continuous
,-Pain is aggravated by eating - ANSWER>>What are characteristics of pain caused by pancreatitis?
-Flushing, fever
-Cyanosis, dyspnea
-Ileus (and decreased bowel sounds as a result)
-Crackles
-Pleural effusions
-Gray Turner's sign (flank bruising/bleeding) and Cullen's sign (umbilical bruising) --> signs of
retroperitoneal bleeding
-Shock (hypovolemic or septic) --> decreased BP and increased HR
-Jaundice (r/t bile duct obstruction)
-Hyperglycemia
-Increased vascular permeability --> tachypnea and hypoxia
-Steatorrhea if chronic - ANSWER>>What are other clinical cues for pancreatitis?
-Increased amylase and lipase
-Increased WBCs, ESR, glucose, and lipids
-Increased liver enzymes (alkaline phosphatase) and bilirubin if there's bile duct issues
-Decreased Ca+ - ANSWER>>What labs may indicate acute pancreatitis?
-Trousseau's sign (arm twitching)
-Chvostek's sign (facial twitching)
-Muscle spasms
-Increased deep tendon reflexes - ANSWER>>What are s/s of HYPOcalcemia?
-Ultrasound
-CT with contrast
-ERCP - ANSWER>>What are diagnostics for acute pancreatitis?
,-Morphine
-Put patient side lying with knees flexed
-Increase the HOB - ANSWER>>What are interventions for pain relief with acute pancreatitis?
-Administer IVFs
-Administer albumin
-Give meds to manage hypotension
-Monitor hemodynamics - ANSWER>>What are interventions for preventing and treating shock that may
occur with acute pancreatitis?
-Place patient on NPO status
-Place an NG tube for the patient if an ileus has developed - ANSWER>>How are pancreatic secretions
reduced with acute pancreatitis?
-NPO status, then enteral/parenteral nutrition
-Small and frequent high carb meals
-No alcohol - ANSWER>>What is nutrition like for a patient with acute pancreatitis?
-H2 blockers (ie. Pepcid) or PPIs to reduce stomach acid
-Antibiotics if necrotizing pancreatitis occurs
-Antiemetics (ie. Zofran) for N/V
-Insulin for hyperglycemia - ANSWER>>What are some medications that can be given for patients with
acute pancreatitis?
Ca+ and Mg+ - ANSWER>>What electrolytes should be monitored with acute pancreatitis?
ECRP (upper endoscopy with x-ray) or lap chole possible to drain abscess (accumulation of pus from
necrosis of pancreas), pseudocyst (area filled with necrotic products and fluid that may cause
peritonitis), or contaminated fluid. - ANSWER>>What are procedures that can be done for acute
pancreatitis?
, -ARDS
-Atelectasis
-Pneumonia
-MODS
-Hypovolemic shock
-DIC
-Septic shock - ANSWER>>What are complications of procedures performed for acute pancreatitis?
Alcohol abuse or repeated acute pancreatitis - ANSWER>>What are typical causes of chronic pancreatitis?
-Serum amylase and lipase may or may not be elevated
-Increased bilirubin
-Hyperglycemia
-ERCP, CT/MRI, and ultrasound
-Stool analysis - ANSWER>>What are diagnostics for chronic pancreatitis?
-Nonopioid analgesics
-High carb, high protein, and high cal diet that's low in fat
-Avoid alcohol and nicotine
-Watch for complications (ie. bone issues, diabetes, and pancreatic cancer)
-PERT (gives pancreatic enzymes to prevent malnutrition, malabsorption, and excess weight loss)
-Bile salts (facilitate absorption of fat soluble vitamins)
-Insulin/oral hypoglycemics
-H2 blockers or PPIs
-Surgery - ANSWER>>What are interventions for chronic pancreatitis?
Flail chest is 3+ fractures in adjacent ribs in 2+ places that causes paradoxical chest wall movement. Flail
chest commonly occurs after blunt chest trauma or CPR. - ANSWER>>What is flail chest?
