Chapter 46 MANAGEMENT OF CLIENTS WITH EXOCRINE PANCREATIC AND BILIARY DISORDERS

UNDERSTANDING PATHOPHYSIOLOGY 1. Clients with pancreatic disorders may have problems with ______ and_____________. 2. True or False _____ In the United states, alcohol abuse is the number-one cause of acute pancreatitis. _____ Inflammation of the gallbladder may be acute or chronic. 3. Biliary pancreatitis occurs when: (Select all that apply) a. Edema or an obstruction blocks the ampulla of vater. b. There is reflux of bile into pancreatic ducts. c. There is direct injury to the acinar cells. d. There is blockage of spleen vats. 4. List seven risk factors for pancreatitis. a. b. c. d. e. f. g. 5. A cholecystectomy is the removal of gallbladder. 6. __________appears only when common duct obstruction is present. 7. List three types of gallstones and provide a brief description of each. a. b. c. 8. Clinical signs of acute pancreatitis are a result of _____________ of the pancreas. APPLYING SKILLS 9. Turners sign is ___________________. 10. Cullens sign is ___________________. 11. A client admitted to the clinic with a confirmed case of pancreatitis will show elevation of which of the following in the lab results? (Select all that apply.) 1. Amylase 2. Glucose 3. Potassium 4. Trypsin 12. Signs of shock in clients with acute pancreatitis can result from: (Select all that apply) 1. Hypovolemia 2. Vasodilating effect of kinin enzymes 3. Development of congestive heart failure 4. Increase in tubular necrosis

13. What symptoms would the nurse expect to see in a client with acute pancreatitis? (Select all that apply.) 1. Diarrhea 2. Jaundice 3. Abdominal pain 4. Abdominal distention What conditions would be consistent with acute pancreatitis? 1. Leukopenia 2. Thrombocytopenia 3. Hyperkalemia 4. Hyperglycemia What complication must the nurse watch for in a client with acute pancreatitis? (Select all that apply.) 1. Altered fluid volume 2. Duodenal ulcer 3. Cirrhosis 4. Respiratory problems The most specific and characteristic manifestation of cholelithiasis is ___________. Assessment of the client with cholelithiasis becomes important because the manifestations are similar to and need to be distinguished from ___________.

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BEST PRACTICES 18. The overall management of a client with acute pancreatitis requires: (Select all that apply.) 1. Managing the pain 2. Correcting hypovolemia 3. Restoring electrolyte balance 4. Elevating the hemoglobin margins 19. Dietary instructions for a client with pancreatitis being discharged from a clinic should include: (Select all that apply.) 1. Eating frequent meals high in protein 2. Following a low-fat diet 3. Ensuring moderate to high carbohydrate intake 4. Avoiding alcohol 20. The nurse must evaluate the client with pancreatitis for the development of: 1. Diabetes mellitus 2. Hepatitis 3. Cholelithiasis 4. Irritable bowel syndrome 21. Complications associated with cholecystectomy include: (Select all that apply.) 1. Hemorrhage 2. Pneumonia 3. Thrombophlebitis 4. Urinary retention and ileus 22. True or False ______ Nonsurgical intervention for the cholelithiasis client is the most common intervention in the U.S. to treat gallstones.

______ Assessment following the cholecystectomy includes monitoring breath and bowel sounds, vital signs, hemorrhage, and respiratory problems. ______ After laparoscopic cholecystectomy, referred pain to the shoulder is a common occurrence of pain. 23. ____________ has been contraindicated in patients with pancreatitis because it causes spasms of the sphincter of Oddi. Current evidence suggests that it may be a viable alternative for pain management. 24. When extreme hyperglycemia is present in clients with acute pancreatitis, which of the following medications will be ordered? 1. Oral agents 2. Insulin 3. Narcotic 4. Muscle relaxants 25. In the treatment of acute pancreatitis, ____________ must be administered intravenously if there is evidence of hypocalcemia with tetany. 26. Pancreatic enzyme replacements should be taken: 1. Three times per day 2. With each meal 3. In the morning and at bedtime 4. Every 4 hours