Page 193 - Critical Care Notes

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■ Abdominal flat plate radiograph or ultrasound of abdomen, CT, MRI, and
endoscopic cholangiopancreatography
■ Chest x-ray to detect pleural effusions
■ Serum chemistries, including ↓ calcium, ↓ magnesium, ↑ bilirubin, ↑ glu-
cose, ↓ potassium, ↑ liver enzymes, ↓ albumin, and ↑ triglycerides
■ Urinalysis and ↑ urinary amylase (6.5–48.1 Units/hr [SI units] normal)
■ CBC (↑ WBC, hematocrit and hemoglobin may be ↑ or ↓), PT/PTT,
↑ C-reactive protein
■ ABGs to assess for hypoxemia and metabolic acidosis
■ ECG – ST-segment depression and T-wave inversion
Management
■ Administer analgesics; position patient in knee-chest position.
■ Consider prophylactic antibiotics. For necrotizing pancreatitis, administer
imipenem-cilastatin (Primaxin) for its high concentration of the drug in the
pancreas.
■ Assess fluid and electrolyte balance. Note hypokalemia, hypomagnesemia,
or hypocalcemia. Administer IV fluids, crystalloids, and colloids. Monitor
intake and output.
■ Assess nutritional status. Keep patient NPO initially. Consider TPN or
gastric or jejunal enteral feedings. Stress ulcer prophylaxis.
■ Insert NG tube if vomiting, obstruction, or gastric distention is present.
Provide frequent oral care.
■ Assess for metabolic acidosis.
■ Assess neurological status for confusion and lethargy.
■ Assess respiratory status and monitor ABGs or venous oxygen saturation.
Administer O 2 as needed. Prevent ARDS from loss of surfactant.
■ Administer insulin if elevated blood glucose levels exist.
■ Assess abdomen for distention, rigidity, ascites, and increasing pain or rebound
tenderness; auscultate bowel sounds and measure abdominal girth.
■ Administer anticholinergics, pantoprazole (Protonix) or famotidine (Pepcid)
as indicated.
■ Treat fever and monitor WBC count.
■ Assess vital signs. Monitor for cardiac arrhythmias.
■ Prepare patient for surgical débridement or pancreatic resection for necro-
tizing pancreatitis or drainage of pancreatic pseudocyst or abscess or
Whipple’s procedure.
Complications
■ Pancreatic abscess, necrosis or pseudocyst formation, and bowel infarction
■ Acute lung injury (ALI), ARDS, pleural effusion, atelectasis, pneumonia,
pneumonitis, hypoxemia, and respiratory failure
GI