N212: Health Differences Across the Life Span 2

Health Differences Across the Lifespan 2 Study Guide

Chapter Four: Metabolic Disorders 4.1 Metabolic Disorders in Response to Obstruction

©2017 Achieve Test Prep Page 87 of 140 Pancreatitis Pancreatitis is when pancreatic enzymes are activated in the pancreas rather than the duodenum, causing tissue damage and autodigestion of the pancreas. It can be mild, sever, or fulminant. Some causes include alcoholism, hyperparathyroidism, and blunt trauma to the abdomen. Pancreatitis may also be drug induced through steroid use, thiazide diuretics, and oral contraceptives. Enzymes break down pancreatic tissue, causing inflammation and edema, damage to blood vessels, hemorrhage, and necrosis of pancreatic tissue. Leakage of enzymes into the blood stream can cause further systemic complications and possibly death. Signs and symptoms include abrupt onset of pain in epigastric area that radiates to the shoulder, temporarily associated with ingestion of alcohol or fatty foods. Substernal area pain may also be felt in the back and flank. Aching, burning, stabbing, pressing pain, abdominal tenderness, distention, tachycardia, nausea, vomiting, jaundice, and steatorrhea are all symptoms. The patient may use the knee-chest position, fetal position, or leaning forward position for comfort. Fulminant disease can progress to hypovolemic shock, ascites, jaundice, and renal failure. Alcohol abusers may have hypomagnesemia and hypoalbuminemia. Blood chemistry shows an increase in amylase, lipase, LD, glucose, AST, and lipid levels with a decrease in calcium and potassium levels. Leukocytosis, hyperglycemia (as high as 500-900 mg/dL), and elevated C-reactive protein indicates the severity of disease. Cullen’s sign is a bluish discoloration of the periumbilical skin caused by intraperitoneal hemorrhage. It may be caused by pancreatitis or ectopic pregnancy. Grey Turner’s is a bluish discoloration over the flank area and represents an accumulation of blood in that area. Treatment: bland, low-fat, high-protein diet with restricted caffeine, alcohol, and gas-forming foods (may require TPN); bed rest (quiet, restful environment) and IV fluids to replace electrolytes; give digestants including Pancrelipase (Viokase, Cotazym) with or before meals; digestants should be taken whole, do not break, crush, or chew (enteric coated); also available as a powder to mix with pureed fruit; NPO status with NGT, if there is vomiting, implement IV hydration; possible peritoneal lavage to remove toxic exudate from abdominal cavity; monitor VS, daily weights, hourly urine output, bowel sounds, and stool; provide diet instruction of several small meals, no alcohol allowed; maintain bedrest during acute phase and increase as tolerated Medications: Opioids and antiemetics; gastric protection with IV H2 blocker ranitidine (Zantac) or proton pump inhibitors such as pantoprazole (Protonix); antispasmodics such as dicyclomine (Bentyl); electrolyte replacement and insulin as required to regulate serum glucose levels and antibiotics as ordered for infection

Made with FlippingBook Online newsletter