05.01 Pancreatitis and Large Bowel Obstruction for CCRN Review

Nursing Points

General

1. Pancreatitis
   1. Causes
      1. Obstruction of pancreatic ducts
         1. Gallstones
         2. Infection
      2. Alcoholism
      3. Drug Toxicity
         1. Cyclosporine
         2. Steroids
         3. Thiazides
         4. Tetracyclines
      4. Trauma
   2. Symptoms and Effects
      1. Pancrease–>In pancreatitis is “Eats itself”
      2. Hypocalcemia
         1. Uses calcium–> A damaged pancreas generates free fatty acids which will bind to the calcium salts and deposit them in the retroperitoneum
         2. Hyperosmolar hyperglycemic non-ketoacidosis (HHNK)
            1. Caused by a stress response
            2. Hyperglycemia
            3. Pancreas doesn’t release insulin
         3. Left side atelectasis –> pancreatitis causes a decrease in those diaphragm muscles
         4. Left side pleural effusion –> Leak and disruption of the pancrease
         5. Bilateral Rales
            1. Acute Respiratory Distress Syndrome (ARDS)–> Most common cause of death
         6. Internal bleeding from vessel damage causes
            1. Cullen’s Sign–Black and blue area around bellybutton
            2. Grey-Turners Sign-=Black and blue area in flank area
         7.  Elevated Amylase
   3. Treatment
      1. Morphine for pain

1. Bowel Obstruction
   1. Large Bowel Obstruction
      1. Blockage in colon or rectum
         1. Causes intestinal swelling
         2. Can cut off blood supply to the bowel
      2. Symptoms
         1. Large distention
         2. No vomitting
         3. No diarrhea
2. Small Bowel Obstruction
   1. Blockage in small intestine
      1. Complete or partial
      2. Causes gas and waste buildup
   2. Small distention
      1. Vomiting
      2. Diarrhea