Pancreatitis Cabrillo College胰腺炎国立大学.pptVIP

* * Crystalloids – NS Colloids – albumin if 3rd spacing continues Blood – to replace losses in hemorrhagic pancreatitis * Alert to signs of pleural effusion, usually left side – crackles, wheezes, diminished breath sounds Bilateral atelectasis- diminished breath sounds Signs of hypoxia-increased restlessness, increased HR/Resp rate * * * Cerebral perfusion Hypovolemic or septic shock Early ETOH withdrawal * How would you communicate? This means that he is very sick…that his pancreas is inflamed and bleeding and that tissue is dying. The DPAHC will let the health care team know what to do if he should get worse … does he want heroic means, like CPR, breathing tubes, etc. The nurse asks if they know how to get in touch with his ex-wife and children * Prepare them for his confusion and erratic behavior Explain his tubes, IV’s, etc. Reinforce that he is gravely ill; listen, keep them informed and respond honestly. Refer to social service and chaplaincy services to evaluate and support family friends Deternine code status/complete DPAHC * * Know purpose, location, drainage expectations and dangers of each tube placed. * Patients will need pain management and wound care, but the pain r/t pancreatitis should be eliminated Medications will depend on how much damage occurred or how much of the pancreas was removed. Signs that pancreatic enzymes and bile salts are needed include steatorrhea and diarrhea. Teaching for discharge includes dietary modifications, alcohol programs, meeting nutritional needs If post op, care of drains and wounds will be necessary with return demonstrations by patient and caregiver S/S hyperglycemia Notify MD for S/S of recurrence Steatorrhea/Severe epigastric or back pain/Persistent gastritis, nausea, vomiting/Weight loss/? temps/ss hyperglycemia * * * 75% of pancreatic cancers involve the head of the pancreas, 25% involve the body and tail of pancreas, so jaundice d/t blocking of the ampulla of vater may be the earliest sign * 90% die within f