PCCN MASTER
You receive a 42 year old male patient from the Emergency Department who is
being admitted with suspected acute pancreatitis. You know the blood test most
specific to acute pancreatitis is:
A. Serum ammonia level.
B. Urine amylase Level.
C. Serum lipase Level.
D. Serum amylase level. - ANSWERS-C. Serum lipase level.
Amylase will rise first but Lipase is MORE SPECIFIC to pancreatitis. Therefore,
serum amylase is considered an early marker but serum lipase is a confirmatory
marker when elevated 3 times normal. Urine amylase will often rise with
pancreatitis but again, serum lipase is more specific to pancreatitis.
You receive a 42 year old male patient from the Emergency Department who is
being admitted with acute pancreatitis. His blood pressure is 92/70, heart rate
100, respiratory rate 16, temperature 37.2 C. He is experiencing pain of 8/10 and
continues to have nausea. Priority initial interventions in treating acute
pancreatitis include all of the following EXCEPT:A. Pain management.B. NPO
status to decrease pancreatic activity.C. Cardiac monitoring.D. Fluid resuscitation.
- ANSWERS-C. Initial priorities are aimed at decreasing the release of pancreatic
enzymes by placing the patient on NPO status. Pain management is a priority to
not only provide comfort but also assure the patient is able to participate in deep
breathing activities to prevent pulmonary complications often associated with
,pancreatitis. Fluid resuscitation is needed secondary to third space shifting of
fluids and the associated hypovolemic state.
Your 78 year old male patient with acute pancreatitis is ordered fluid resuscitation
with 0.9% Normal Saline at 250cc per hour over 4 hours. This patient has a history
of a significant myocardial infarction in the past. Over the next 4 hours your
clinical assessment priority will be:
A. Assessment of pain to assure he does not become overstressed and increase
his myocardial demand.
B. Monitor weight for signs of fluid overload.
C. Assessment of lung sounds for signs of pulmonary edema.
D. Assessment of extremities for signs of increasing peripheral edema. -
ANSWERS-C. With a past cardiac history of significant myocardial infarction the
addition of large volumes of fluid can result in fluid overload and pulmonary
edema if the patient has a reduced ejection fraction. Fluid resuscitation is
important but large volumes of fluid in the cardiac patient require careful,
frequent assessments. Many patients with acute pancreatitis already have edema
secondary to the third spacing of fluids during the acute phase of pancreatitis.
Therefore, peripheral edema and weight gain may be related to third spacing of
fluid and not increased circulating volume. All patients with pancreatitis require
careful pain management with the primary goal of assuring good respiratory
effort to avoid pulmonary complications. Patients with pancreatitis often take
small breaths due to the pain they are experiencing.
Nutrition support is important in the patient with acute pancreatitis. You
anticipate once the nausea and vomiting has subsided nutrition will be provided
in the following manner:
A. Soft, low fat diet.
,B. Continuous tube feedings with a nasojejunal tube.
C. Total parental nutrition with no lipids.
D. Clear liquid diet. - ANSWERS-A. Soft, low fat diet.
The newest literature supports feeding the patient as early as possible to prevent
an empty bowel and the complications associated with lack of nutrition in the gut.
Oral feedings are preferred over tube feedings or TPN if the patient is able to
tolerate. Soft diet is recommended over clear liquids.
When caring for a patient with acute pancreatitis who is hypotensive the nurse
knows the primary intervention is going to be:
A. Vasopressors to counteract the effects of alpha blockage.
B. Inotropes to increase cardiac output.
C. Aggressive fluid resuscitation.
D. Emergent surgery. - ANSWERS-C. Aggressive fluid resuscitation.
In acute pancreatitis hypoalbuminemia is often present which leads to a decrease
in oncotic pressure. In conjunction with severe inflammation this can lead to large
amounts of fluid leaking into the peritoneal or even retroperitoneal space.
Aggressive fluid administration to maintain adequate preload is a priority
treatment consideration. Cardiac output is adversely affected in acute
pancreatitis due to a deficit in preload and not due to a contractility problem.
Vasopressors may be needed if fluid resuscitation is not effective in achieving an
adequate mean arterial pressure. However, fluid should be used first because the
physiological alterations in acute pancreatitis result in a reduction of
preload.Pancreatitis is managed medically except in rare cases of necrotizing
pancreatitis.
, The most common causes of acute pancreatitis are:
A. Cholelithiasis and heavy alcohol use.
B. Hepatitis and stress ulcers.
C. Stress ulcers and cholelithiasis.
D. Heavy alcohol use and hepatitis. - ANSWERS-A. Cholelithiasis and heavy alcohol
use.
Pancreatitis occurs when pancreatic enzymes are activated while still in the
pancreas and the enzymes autodigest the pancreas. This occurs as a result of an
obstruction. Gallstones and heavy alcohol intake are the two most common
causes. Gallstones located in the distal common bile duct can block the pancreatic
duct. This can lead to a reflux of bile into the pancreas. When gallstones are the
etiology the serum alanine aminotransferase (ALT) is elevated. Alcohol use is the
most common cause of pancreatitis. Alcohol can increase the protein content of
pancreatic fluid and therefore predispose the patient to blockages within the
ducts. Alcohol may also cause spasm of the sphincter of Oddi which increases
pressure within the ducts.
A patient with hepatic failure demonstrates deterioration in handwriting and
when asked on exam to hold his arm and hand out like a stop sign, involuntary
flapping of the hand (asterixis) is observed. These symptoms are most likely due
to:
A. Intracranial hemorrhage.
B. Sub clinical seizure.
C. Alcohol withdrawal.
You receive a 42 year old male patient from the Emergency Department who is
being admitted with suspected acute pancreatitis. You know the blood test most
specific to acute pancreatitis is:
A. Serum ammonia level.
B. Urine amylase Level.
C. Serum lipase Level.
D. Serum amylase level. - ANSWERS-C. Serum lipase level.
Amylase will rise first but Lipase is MORE SPECIFIC to pancreatitis. Therefore,
serum amylase is considered an early marker but serum lipase is a confirmatory
marker when elevated 3 times normal. Urine amylase will often rise with
pancreatitis but again, serum lipase is more specific to pancreatitis.
You receive a 42 year old male patient from the Emergency Department who is
being admitted with acute pancreatitis. His blood pressure is 92/70, heart rate
100, respiratory rate 16, temperature 37.2 C. He is experiencing pain of 8/10 and
continues to have nausea. Priority initial interventions in treating acute
pancreatitis include all of the following EXCEPT:A. Pain management.B. NPO
status to decrease pancreatic activity.C. Cardiac monitoring.D. Fluid resuscitation.
- ANSWERS-C. Initial priorities are aimed at decreasing the release of pancreatic
enzymes by placing the patient on NPO status. Pain management is a priority to
not only provide comfort but also assure the patient is able to participate in deep
breathing activities to prevent pulmonary complications often associated with
,pancreatitis. Fluid resuscitation is needed secondary to third space shifting of
fluids and the associated hypovolemic state.
Your 78 year old male patient with acute pancreatitis is ordered fluid resuscitation
with 0.9% Normal Saline at 250cc per hour over 4 hours. This patient has a history
of a significant myocardial infarction in the past. Over the next 4 hours your
clinical assessment priority will be:
A. Assessment of pain to assure he does not become overstressed and increase
his myocardial demand.
B. Monitor weight for signs of fluid overload.
C. Assessment of lung sounds for signs of pulmonary edema.
D. Assessment of extremities for signs of increasing peripheral edema. -
ANSWERS-C. With a past cardiac history of significant myocardial infarction the
addition of large volumes of fluid can result in fluid overload and pulmonary
edema if the patient has a reduced ejection fraction. Fluid resuscitation is
important but large volumes of fluid in the cardiac patient require careful,
frequent assessments. Many patients with acute pancreatitis already have edema
secondary to the third spacing of fluids during the acute phase of pancreatitis.
Therefore, peripheral edema and weight gain may be related to third spacing of
fluid and not increased circulating volume. All patients with pancreatitis require
careful pain management with the primary goal of assuring good respiratory
effort to avoid pulmonary complications. Patients with pancreatitis often take
small breaths due to the pain they are experiencing.
Nutrition support is important in the patient with acute pancreatitis. You
anticipate once the nausea and vomiting has subsided nutrition will be provided
in the following manner:
A. Soft, low fat diet.
,B. Continuous tube feedings with a nasojejunal tube.
C. Total parental nutrition with no lipids.
D. Clear liquid diet. - ANSWERS-A. Soft, low fat diet.
The newest literature supports feeding the patient as early as possible to prevent
an empty bowel and the complications associated with lack of nutrition in the gut.
Oral feedings are preferred over tube feedings or TPN if the patient is able to
tolerate. Soft diet is recommended over clear liquids.
When caring for a patient with acute pancreatitis who is hypotensive the nurse
knows the primary intervention is going to be:
A. Vasopressors to counteract the effects of alpha blockage.
B. Inotropes to increase cardiac output.
C. Aggressive fluid resuscitation.
D. Emergent surgery. - ANSWERS-C. Aggressive fluid resuscitation.
In acute pancreatitis hypoalbuminemia is often present which leads to a decrease
in oncotic pressure. In conjunction with severe inflammation this can lead to large
amounts of fluid leaking into the peritoneal or even retroperitoneal space.
Aggressive fluid administration to maintain adequate preload is a priority
treatment consideration. Cardiac output is adversely affected in acute
pancreatitis due to a deficit in preload and not due to a contractility problem.
Vasopressors may be needed if fluid resuscitation is not effective in achieving an
adequate mean arterial pressure. However, fluid should be used first because the
physiological alterations in acute pancreatitis result in a reduction of
preload.Pancreatitis is managed medically except in rare cases of necrotizing
pancreatitis.
, The most common causes of acute pancreatitis are:
A. Cholelithiasis and heavy alcohol use.
B. Hepatitis and stress ulcers.
C. Stress ulcers and cholelithiasis.
D. Heavy alcohol use and hepatitis. - ANSWERS-A. Cholelithiasis and heavy alcohol
use.
Pancreatitis occurs when pancreatic enzymes are activated while still in the
pancreas and the enzymes autodigest the pancreas. This occurs as a result of an
obstruction. Gallstones and heavy alcohol intake are the two most common
causes. Gallstones located in the distal common bile duct can block the pancreatic
duct. This can lead to a reflux of bile into the pancreas. When gallstones are the
etiology the serum alanine aminotransferase (ALT) is elevated. Alcohol use is the
most common cause of pancreatitis. Alcohol can increase the protein content of
pancreatic fluid and therefore predispose the patient to blockages within the
ducts. Alcohol may also cause spasm of the sphincter of Oddi which increases
pressure within the ducts.
A patient with hepatic failure demonstrates deterioration in handwriting and
when asked on exam to hold his arm and hand out like a stop sign, involuntary
flapping of the hand (asterixis) is observed. These symptoms are most likely due
to:
A. Intracranial hemorrhage.
B. Sub clinical seizure.
C. Alcohol withdrawal.
