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Pancreatitis
Incidence & Risk Factors
Major- Biliary stones, Alcohol use/abuse Minor- Age: 55 to 65 yrs. for biliary pancreatitis 45- 55 yrs. For alcohol-related Female for biliary tract pancreatitis; Male-for alcohol-related pancreatitis. Trauma, Infectious disease, drug toxicities, chronic diseases( inflammatory diseases).
Pancreatitis Assessment
Pain: Steady & severe in nature; located in the epigastric or umbilical region; may radiate to the back. Worsened by lying supine; may be lessened by flexed knee, curved-back position. Vomiting Varies in severity, but is usually protracted, worsened by ingestion of food or fluid. Does not relieve the pain. Usually accompanied by nausea.
Cholelithiasis
Definition, Incidence, Predisposing Factors
Also known as stones in the gallbladder It is the most common disorder of the biliary system and it has been estimated that 8-10% of all adults in the U.S. have this condition. Predisposing factors includes: gender, age, estrogen RX or BCPs, sedentary lifestyle, family history and obesity. Cholecystitis- inflammation of the gallbladder.
Cholelithiasis Interventions
Provide relief from vomiting. NGT-reduces distention & eliminates gastric juices that stimulate cholecystokinin. Maintain fluid and electrolyte balance. Monitor drug therapy. Administer broad spectrum Abx. Chenodeoxycholic acid- bile acid dissolves cholesterol calculi (60% of the stone). NTG & papaverine to reduce spasms of duct. Synthetic narcotics (Demerol, methadone) MSO4 may cause spasms of Oddi and increase spasms.
Cholecystitis Assessment
Epigastric pain- after eating Pain- localized in RUQ because of somatic sensory nerves. Murphys sign- cant take a deep inspiration when assessors fingers are pressed below hepatic margin. Pain begins 2 to 4 hours after eating fried or fatty foods and persist more than 4 to 6 hours. Nausea, vomiting, anorexia Low-grade fever Jaundice Weight loss
Cholecystitis Implementation
Position in low-to semi fowlers position to facilitate bile drainage. Maintain skin integrity. Prevent respiratory complications: TCDB, use of IS. IF NGT is inserted-to relieve distention and increase peristalsis. If t-tube inserted-measure amt. & color. Clamp tube before eating. As t-tube clamp-observe for abdominal discomfort and distention. Unclamp if any N/V. Provide low-fat high carb. and high protein. Maintain for at least 2 to 3 months postoperatively.