Pancreatitis For PCCN for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
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
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.
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System