Nokea
A patient with chronic pancreatitis had a pancreaticojejunostomy created 3 months ago for relief of pain and to restore drainage of pancreatic secretions. The patient has come to the office for a routine postsurgical appointment. The patient is frustrated that the pain has not decreased. What is the most appropriate initial response by the nurse?
- A. The majority of patients who have a pancreaticojejunostomy have their normal digestion restored but do not achieve pain relief.
- B. Pain relief occurs by 6 months in most patients who undergo this procedure, but some people experience a recurrence of their pain.
- C. Your physician will likely want to discuss the removal of your gallbladder to achieve pain relief.
- D. You are probably not appropriately taking the medications for your pancreatitis and pain, so we will need to discuss your medication regimen in detail.
Correct Answer: B
Rationale: Pain relief from a pancreaticojejunostomy often occurs by 6 months in more than 85% of the patients who undergo this procedure, but pain returns in a substantial number of patients as the disease progresses. This patient had surgery 3 months ago; the patient has 3 months before optimal benefits of the procedure may be experienced. There is no obvious indication for gallbladder removal and nonadherence is not the most likely factor underlying the pain.
You may also like to solve these questions
A patient has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize which of the following topics?
- A. Management of fluid balance in the home setting
- B. The need for blood glucose monitoring for the next week
- C. Signs and symptoms of intra-abdominal complications
- D. Appropriate use of prescribed pancreatic enzymes
Correct Answer: C
Rationale: Because of the early discharge following laparoscopic cholecystectomy, the patient needs thorough education in the signs and symptoms of complications. Fluid balance is not typically a problem in the recovery period after laparoscopic cholecystectomy. There is no need for blood glucose monitoring or pancreatic enzymes.
A nurse is assessing a patient who has been diagnosed with cholecystitis, and is experiencing localized abdominal pain. When assessing the characteristics of the patients pain, the nurse should anticipate that it may radiate to what region?
- A. Left upper chest
- B. Inguinal region
- C. Neck or jaw
- D. Right shoulder
Correct Answer: D
Rationale: The patient may have biliary colic with excruciating upper right abdominal pain that radiates to the back or right shoulder. Pain from cholecystitis does not typically radiate to the left upper chest, inguinal area, neck, or jaw.
A patient has a recent diagnosis of chronic pancreatitis and is undergoing diagnostic testing to determine pancreatic islet cell function. The nurse should anticipate what diagnostic test?
- A. Glucose tolerance test
- B. ERCP
- C. Pancreatic biopsy
- D. Abdominal ultrasonography
Correct Answer: A
Rationale: A glucose tolerance test evaluates pancreatic islet cell function and provides necessary information for making decisions about surgical resection of the pancreas. This specific clinical information is not provided by ERCP, biopsy, or ultrasound.
A patient is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication?
- A. Sudden increase in random blood glucose readings
- B. Increased abdominal girth accompanied by decreased level of consciousness
- C. Fever, increased heart rate and decreased blood pressure
- D. Abdominal pain unresponsive to analgesics
Correct Answer: C
Rationale: Pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis because of resulting hemorrhage, septic shock, and multiple organ dysfunction syndrome (MODS). Signs of shock would include hypotension, tachycardia and fever. Each of the other listed changes in status warrants intervention, but none is clearly suggestive of an onset of pancreatic necrosis.
A nurse is creating a care plan for a patient with acute pancreatitis. The care plan includes reduced activity. What rationale for this intervention should be cited in the care plan?
- A. Bed rest reduces the patients metabolism and reduces the risk of metabolic acidosis.
- B. Reduced activity protects the physical integrity of pancreatic cells.
- C. Bed rest lowers the metabolic rate and reduces enzyme production.
- D. Inactivity reduces caloric need and gastrointestinal motility.
Correct Answer: C
Rationale: The acutely ill patient is maintained on bed rest to decrease the metabolic rate and reduce the secretion of pancreatic and gastric enzymes. Staying in bed does not release energy from the body to fight the disease.