ADVANCED MEDSURG. STUDY GUIDE TEST HEPATIC-
PANCREATIC SYSTEMS AND BURNS 2025
For assistance with your assignment email me:
•Know acute pancreatitis: S/S. ALL THAT APPLY.
“Abdominal pain is the predominant symptom”
-Left upper quadrant pain (epigastric / hypochondriac regions)
-Radiates to the back
- Cullen's sign (bruising of belly button region)
-Gray Turner's sign, caused by seepage of the blood into the flank area
-Flexion of the spine
•Know acute pancreatitis: Nursing management. ALL THAT APPLY.
Supportive Care (treat symptoms)
-Pain management with Morphine combined with antispasmodic medications such as
nitroglycerin and papaverine.
-Fluid hydration with Lactated Ringers
-Dopamine for hypotension
-NPO and NG tube
-Prevent infections (Pancreatic infection is the leading cause of morbidity and mortality in
patients with acute pancreatitis)
•Know acute pancreatitis: Rationale for total parenteral nutrition (TPN).
-Pt’s are NPO and need to give the body nutrition while skipping the GI tract; this will give the
pancreas a break.
-Reducing pancreatic stimulation and enzyme secretion.
•Know pain management of acute pancreatitis.
,-NPO
-IV Morphine is best
-Meperidine is CONTRAINDICATED and can cause seizures.
•Know etiology of acute pancreatitis: Priority assessment for the alcoholic patient.
- WHEN WAS LAST DRINK
- Assess for withdrawal symptoms
•Know pancreatic enzymes used to assess the patient’s response to treatment. TWO
QUESTIONS
-AMYLASE (breaks down carbohydrates/sugars) Amylase levels can return to normal within a
few days even if the pancreatitis persists, so it’s less reliable for long-term monitoring.
-LIPASE (breaks down fat) More specific to the pancreas compared to amylase and remains
elevated longer, making it a better marker for diagnosing and monitoring pancreatitis.
-Amylase/ Lipase GOES DOWN if getting better
-Trypsinogen (breaks down protein) Less commonly used to diagnose pancreatitis.
•Know abdominal complications after surgical management of acute pancreatitis.
-Paralytic ileus, bile duct injuries, hemorrhage, surgical site infection.
•Know S/S of chronic pancreatitis.
-Steatorrhea, fatty-poop “frothy/ slimy poop”
-Weight loss
-Pain
-Dyspepsia
-(same as acute)
•Know liver cirrhosis: Know complications – S/S of increased ammonia levels.
LIVER CIRRHOSIS is chronic inflammation of the liver that leads to irreversible scarring
(onset is slow and progressive).
-Overproduction of aldosterone occurs, causing sodium and water retention and potassium
excretion.
-Increased Ammonia + other toxins leads to hepatic encephalopathy (asterixis, AMS, coma)
-GABA causes depression of the CNS that inhibits neurotransmission and synaptic regulation.
•Know liver cirrhosis: Pharmacological management.
-The use of DIURETIC AGENTS and SODIUM RESTRICTION is successful in 90% of
patients with ascites (related to cirrhosis).
, -ANTACIDS/ H2 ANTAGONISTS/PPI decrease gastric distress and the risk of GI BLEEDS
-VIT. + SUPPS. promote healing and improve nutritional status
-SPIRONOLACTONE (aldosterone-blocking agent) or TRIAMTERENE. Both are potassium
sparing-diuretic, most often the FIRST LINE THERAPY in patients with ascites from cirrhosis.
-FUROSEMIDE (Lasix) should be used CAUTIOUSLY due to potential hyponatremia (sodium
depletion).
Drugs that inhibit bacterial growth:
-Lactulose (to reduce ammonia levels) Lactulose works by acidifying the colon and
promoting the growth of beneficial bacteria, which helps to reduce the production and
absorption of ammonia in the gut.
-Neomycin (used to kill the number of intestinal bacteria that convert protein to ammonia
to reduce ammonia levels)
-Rifaximin (antibiotic for gut microbe)
Other Meds to consider:
-Beta-blockers (prevent bleeding of varices) it is given prophylactically; NOT given
DURING bleeding
-Vitamin K (prevents bleeding in a long time frame; NOT used in acute bleeding)
-Thiamine (alcoholism is leading cause of thiamine deficiency; is needed for metabolism
of glucose)
-Milk Thistle/Silybum marianum (decreases jaundice, antioxidant, and anti
inflammatory)
-Ursodeoxycholic Acid used in primary biliary cirrhosis, increases liver function
•Know management of vitamin K deficiency in end stage liver failure. ALL THAT APPLY.
▪ No rectal temp
▪ Soft bristle toothbrush
▪ Bleeding time (platelet count)
▪ Small needles
•Know liver cirrhosis: Therapeutic procedures – Transjugular intrahepatic portosystemic
shunt (TIPS).
-Transjugular intrahepatic portosystemic shunt (TIPS) is a method of treating ascites in
which a cannula is threaded into the portal vein by the transjugular route.
-To reduce portal hypertension, an expandable stent is inserted to serve as an INTRAHEPATIC
SHUNT between the portal circulation and the hepatic vein.
PANCREATIC SYSTEMS AND BURNS 2025
For assistance with your assignment email me:
•Know acute pancreatitis: S/S. ALL THAT APPLY.
“Abdominal pain is the predominant symptom”
-Left upper quadrant pain (epigastric / hypochondriac regions)
-Radiates to the back
- Cullen's sign (bruising of belly button region)
-Gray Turner's sign, caused by seepage of the blood into the flank area
-Flexion of the spine
•Know acute pancreatitis: Nursing management. ALL THAT APPLY.
Supportive Care (treat symptoms)
-Pain management with Morphine combined with antispasmodic medications such as
nitroglycerin and papaverine.
-Fluid hydration with Lactated Ringers
-Dopamine for hypotension
-NPO and NG tube
-Prevent infections (Pancreatic infection is the leading cause of morbidity and mortality in
patients with acute pancreatitis)
•Know acute pancreatitis: Rationale for total parenteral nutrition (TPN).
-Pt’s are NPO and need to give the body nutrition while skipping the GI tract; this will give the
pancreas a break.
-Reducing pancreatic stimulation and enzyme secretion.
•Know pain management of acute pancreatitis.
,-NPO
-IV Morphine is best
-Meperidine is CONTRAINDICATED and can cause seizures.
•Know etiology of acute pancreatitis: Priority assessment for the alcoholic patient.
- WHEN WAS LAST DRINK
- Assess for withdrawal symptoms
•Know pancreatic enzymes used to assess the patient’s response to treatment. TWO
QUESTIONS
-AMYLASE (breaks down carbohydrates/sugars) Amylase levels can return to normal within a
few days even if the pancreatitis persists, so it’s less reliable for long-term monitoring.
-LIPASE (breaks down fat) More specific to the pancreas compared to amylase and remains
elevated longer, making it a better marker for diagnosing and monitoring pancreatitis.
-Amylase/ Lipase GOES DOWN if getting better
-Trypsinogen (breaks down protein) Less commonly used to diagnose pancreatitis.
•Know abdominal complications after surgical management of acute pancreatitis.
-Paralytic ileus, bile duct injuries, hemorrhage, surgical site infection.
•Know S/S of chronic pancreatitis.
-Steatorrhea, fatty-poop “frothy/ slimy poop”
-Weight loss
-Pain
-Dyspepsia
-(same as acute)
•Know liver cirrhosis: Know complications – S/S of increased ammonia levels.
LIVER CIRRHOSIS is chronic inflammation of the liver that leads to irreversible scarring
(onset is slow and progressive).
-Overproduction of aldosterone occurs, causing sodium and water retention and potassium
excretion.
-Increased Ammonia + other toxins leads to hepatic encephalopathy (asterixis, AMS, coma)
-GABA causes depression of the CNS that inhibits neurotransmission and synaptic regulation.
•Know liver cirrhosis: Pharmacological management.
-The use of DIURETIC AGENTS and SODIUM RESTRICTION is successful in 90% of
patients with ascites (related to cirrhosis).
, -ANTACIDS/ H2 ANTAGONISTS/PPI decrease gastric distress and the risk of GI BLEEDS
-VIT. + SUPPS. promote healing and improve nutritional status
-SPIRONOLACTONE (aldosterone-blocking agent) or TRIAMTERENE. Both are potassium
sparing-diuretic, most often the FIRST LINE THERAPY in patients with ascites from cirrhosis.
-FUROSEMIDE (Lasix) should be used CAUTIOUSLY due to potential hyponatremia (sodium
depletion).
Drugs that inhibit bacterial growth:
-Lactulose (to reduce ammonia levels) Lactulose works by acidifying the colon and
promoting the growth of beneficial bacteria, which helps to reduce the production and
absorption of ammonia in the gut.
-Neomycin (used to kill the number of intestinal bacteria that convert protein to ammonia
to reduce ammonia levels)
-Rifaximin (antibiotic for gut microbe)
Other Meds to consider:
-Beta-blockers (prevent bleeding of varices) it is given prophylactically; NOT given
DURING bleeding
-Vitamin K (prevents bleeding in a long time frame; NOT used in acute bleeding)
-Thiamine (alcoholism is leading cause of thiamine deficiency; is needed for metabolism
of glucose)
-Milk Thistle/Silybum marianum (decreases jaundice, antioxidant, and anti
inflammatory)
-Ursodeoxycholic Acid used in primary biliary cirrhosis, increases liver function
•Know management of vitamin K deficiency in end stage liver failure. ALL THAT APPLY.
▪ No rectal temp
▪ Soft bristle toothbrush
▪ Bleeding time (platelet count)
▪ Small needles
•Know liver cirrhosis: Therapeutic procedures – Transjugular intrahepatic portosystemic
shunt (TIPS).
-Transjugular intrahepatic portosystemic shunt (TIPS) is a method of treating ascites in
which a cannula is threaded into the portal vein by the transjugular route.
-To reduce portal hypertension, an expandable stent is inserted to serve as an INTRAHEPATIC
SHUNT between the portal circulation and the hepatic vein.
