c. Positions that flex the trunk and draw the knees up to the abdomen help relieve the pain of acute pancreatitis. Positioning the patient on the side with the head elevated decreases abdominal tension. Diversional techniques are not as helpful as positioning in controlling the pain. The patient is usually NPO because food intake increases the pain and inflammation. Bed rest is indicated during the acute attack because of hypovolemia and pain.

a, b, c. Measures to prevent attacks of pancreatitis are those that decrease the stimulation of the pancreas. Lower fat intake and foods that are less stimulating and irritating (bland) should be encouraged. High carbohydrates are less stimulating. Avoid alcohol and nicotine, since both stimulate the pancreas. Monitor for steatorrhea to determine the effectiveness of the enzymes and because it may indicate worsening pancreatic function. Pancreatic enzymes should be taken with, not after, meals.

b. Although serum lipase levels and urinary amylase levels are increased, an increased serum amylase level is the criterion most commonly used to diagnose acute pancreatitis in the first 24 to 72 hours.
Serum calcium levels are decreased and serum glucose is increased.

c. Pancreatic rest and suppression of secretions are promoted by preventing any gastric contents from entering the duodenum, which would stimulate pancreatic activity.

Surgery is not indicated for acute pancreatitis but may be used to drain abscesses or cysts. Pancreatic enzyme supplements are necessary in chronic pancreatitis if a deficiency in secretion occurs, but not for acute pancreatitis. An endoscopic retrograde cholangiopancreatography (ERCP) pancreatic sphincterotomy may be done when pancreatitis is related to gallstones.

c. Sodium restriction is not indicated for patients recovering from acute pancreatitis, but fat is restricted. The stools should be observed for steatorrhea, indicating that fat digestion is impaired. Alcohol is a primary cause of pancreatitis and should not be used. Glucose levels are monitored for chronic pancreatitis.

c. Chronic damage to the pancreas causes a deficiency of digestive enzymes and insulin resulting in malabsorption and diabetes. Abstinence from alcohol is necessary in both types of pancreatitis, as is a high carbohydrate, high-protein, and low-fat diet. Although abdominal pain is a major manifestation of chronic pancreatitis, more commonly a constant heavy, gnawing feeling occurs.

d. A pancreatic abscess, usually from an infected pseudocyst, is a collection of pus that must be drained to prevent infection of adjacent organs and sepsis. Tetany from hypocalcemia is treated with IV calcium gluconate (10%). Although pseudocysts usually resolve spontaneously, they may be treated with surgical, percutaneous catheter, or endoscopic drainage to prevent perforation.

Pleural effusion is treated by treating the cause (pancreatitis) and monitoring for respiratory distress and oxygen saturation.

d. The predominant symptom of acute pancreatitis is severe, deep abdominal pain that is usually located in the left upper quadrant (LUQ) but may be in the midepigastrium. Bowel sounds are decreased or absent, the patient is hypotensive and may manifest symptoms of shock, and there is only a low-grade fever.