Pancreatitis For PCCN for Progressive Care Certified Nurse (PCCN)
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Outline
Pancreatitis
Definition/Etiology:
- Definition
- Inflammation of the pancreas – 10% mortality rate
- Can lead to ARDS
- Acute
- Single episode characterized by abdominal pain and elevated levels of enzymes (amylase, lipase) with inflammation of the pancreas, which returns to normal after resolution of the episode.
- Chronic
- Leads to permanent damage
- Etiology
- Alcoholism
- Obstruction
- Gallstones
- Tumors
Pathophysiology:
- Pathophysiology
- Inflammation
- Local → Systemic
- Can cause shock
- System inflammation – attacks epithelium of vascular system
- Attacks lungs = ARDS (Fatal)
- Enzymes and Pancreas are activated while still inside
- Auto digestion begins
- Pancreas eats itself
- Local → Systemic
- Inflammation
Noticing: Assessment & Recognizing Cues:
- Subjective Cues
- Pain
- Abd, radiates to back
- Worse after eating
- Nausea
- Pain
- Objective Cues
- Vitals
- ↑Temp, ↑ HR, ↓ BP
- “Shocky”
- Abdomen
- Distended
- Decreased/absent bowel sounds
- Vomiting
- Grey-Turner’s sign
- Flank ecchymosis
- Cullen’s Sign – Necrotizing Pancreatitis
- Bruising around umbilicus
- Lungs
- Diminished or Wet (ARDS)
- ↑Temp, ↑ HR, ↓ BP
- Vitals
Interpreting: Analyzing & Planning:
- Labs
- Amylase
- ↑500
- Normalizes quickly
- Lipase
- Elevated longer than Amylase
- C-Reactive Protein
- ↑ WBC
- Lactate
- Amylase
- Diagnostics
- CT SCan
- Pancreatic Inflammation
- Obstruction/Stones
- Ultrasound
- Large Pancreas
- Obstruction/Stones
- CXR
- Pleural Effusion
- ARDS
- Pleural Effusion
- CT SCan
Responding: Patient Interventions & Taking Action:
- Pharmacological Interventions
- IV Antibiotics
- Fluids
- Treat gastric acids
- H2 receptors, PPIs and antacids
- Insulin – poor pancreatic function
- Non-Pharmacological Interventions
- “Gut resting’
- Nothing by mouth because eating stimulates enzyme release
- NG tube
- Decreased gastric distention
- J tube possible
- Feeding tube to duodenum
- Bypasses pancreas
- Inhibit stimulation of pancreatic enzymes and to decrease metabolic stress
- “Gut resting’
Reflecting: Evaluating Patient Outcomes:
- Monitor for complications
- Respiratory Compromise (ARDS)
- Respiratory failure in the setting of sepsis, which leads to increased VQ mismatch, decreased surfactant and stiff lungs. (REVIEW LESSON)
- Administer oxygen, support ventilator, monitor for deterioration
- Hypovolemia 2nd Shock
- Massive third-spacing of fluids may result in fluid collections, necrosis, pseudocysts, abscesses, fistulas, intestinal obstruction
- Accurate intake and output, monitor for infection, administer antibiotics
- Respiratory Compromise (ARDS)
Linchpins (Key Points):
- Notice
- Abdominal Pain
- Worse after eating
- Cullens/Grey-Turners Sign
- Abdominal Pain
- Interpret
- Enzymes and Imaging
- Function and Obstruction
- Enzymes and Imaging
- Respond
- Fluids & NG/J-tube
- “Shock” and needs nutrition that bypasses the stomach
- Fluids & NG/J-tube
- Reflect
- ARDS/Shock watch
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Transcript
References
- AACN, & Hartjes, T. (2023). AACN Core Curriculum for Progressive and Critical Care Nursing (8th ed.). Elsevier Health Sciences (US).
- Dennison, R. D., & Farrell, K. (2015]). Pass PCCN!. Elsevier Health Sciences (US).
- Kupchik, N. (2017). Ace The Pccn®!: You can do it!: Practice question review book. Nicole Kupchik Consulting, Inc.
- Stone, L. M. (2018). Certification and Core Review for High Acuity, Progressive, and Critical Care Nursing (7th ed.). Elsevier Health Sciences (US).
- Trivium Test Prep. (2019). Pccn review book 2019-2020: Pccn Study Guide and Practice Test Questions for the Progressive Care Certified Nurse Exam.
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