Pancreatitis For PCCN for Progressive Care Certified Nurse (PCCN)

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

Noticing: Assessment & Recognizing Cues:

• Subjective Cues
  • Pain
    • Abd, radiates to back
    • Worse after eating
  • Nausea
• 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)

Interpreting: Analyzing & Planning:

• Labs
  • Amylase
    • ↑500
    • Normalizes quickly
  • Lipase
    • Elevated longer than Amylase
  • C-Reactive Protein
  • ↑ WBC
  • Lactate
• Diagnostics
  • CT SCan
    • Pancreatic Inflammation
    • Obstruction/Stones
  • Ultrasound
    • Large Pancreas
    • Obstruction/Stones
  • CXR
    • Pleural Effusion
      • ARDS

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

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

Linchpins (Key Points):

• Notice
  • Abdominal Pain
    • Worse after eating
    • Cullens/Grey-Turners Sign
• Interpret
  • Enzymes and Imaging
    • Function and Obstruction
• Respond
  • Fluids & NG/J-tube
    • “Shock” and needs nutrition that bypasses the stomach
• Reflect
  • ARDS/Shock watch