+Leukocyte esterase = WBCs present. +Nitrites = bacterial conversion → accurate for UTI. Specific gravity 1.035 = concentrated. Cloudy = infection (WBCs). Normal urine is clear & colorless.

Support autonomy & dignity: involve client in toileting schedule, respectful communication, offer assistive devices. Never recommend isolation or "minimize discussion."

EPO thickens blood → hypertension (160/95) is the complication to report. Rising Hgb is expected. Goal ~10–11, not normal.

Sudden strong desire then involuntary loss = urge. Leak with cough = stress. Frequency + dysuria = UTI. Nocturia/incomplete emptying = overflow. Only the urge definition is correct.

Edema + crackles + SOB + HTN = overload → give loop diuretic. Don't ↑ fluids, give K⁺, or lay supine.

Big blood-filled cysts → flank pain + hematuria. Distractors: jaundice/clay stools (biliary), petechiae/bleeding gums (platelets), bradycardia/dry skin (thyroid).

45 mcg/kg/min, 59 kg, 2500 mg/250 mL → set pump to 15.9 mL/hr. Convert mcg→mg→mL, cancel units, round to tenth.

Wrong = "I can drink as much as I want if I avoid salt." Right behaviors: daily weight, follow fluid restriction, report swelling/SOB.

Access is clotted → notify provider immediately. Don't reassess later, warm compress, or use the site.

Risks: cystoscopy, short female urethra, wiping back-to-front, diabetes. Not risks: adequate fluids, voiding after sex (both protective).

AKI = sudden, trauma/dehydration/hypotension. CKD = DM/HTN, anemia, poor healing. Pyelonephritis = infection, antibiotics, can → sepsis. Overload/↑K⁺/acidosis/dialysis = AKI & CKD.

Bag below bladder, remove ASAP, no kinks, peri-care each shift. No prophylactic antibiotics, no routine irrigation. Monitoring for fever detects, doesn't prevent.

Crackles = fluid in lungs = breathing problem → diuretic first, before teaching or monitoring.

Severe sharp flank → groin pain + hematuria. Distractors: epigastric→back (pancreatitis), RUQ after burger (gallbladder), central + distension (obstruction).

Signs: cloudy outflow, abdominal pain, ↑WBC, fever, N/V. Straw-colored outflow = normal. Expect tachycardia (not brady). Watch for rigid/board-like abdomen, guarding, rebound.

Liver metabolizes glucose/stores glycogen, converts ammonia→urea, handles proteins/fats/vitamins, makes bile clotting factors (bleeding breaks first). Labs: ALT most liver-specific, AST less so, ALP = biliary obstruction, ↑ammonia → encephalopathy, ↑bilirubin → jaundice, ↓albumin → ascites, ↑INR/PT → bleeding. Biopsy: check INR first (give vitamin K if high), lie on the right side after.

Scar tissue replaces working liver (most commonly from alcohol). Assess jaundice at the sclera. Scarring → portal hypertension → ascites & varices. Ascites: biggest danger is respiratory compromise; treat with spironolactone, sodium restriction, paracentesis (give albumin after), or TIPS. Varices: rupture = massive bleed (first-bleed mortality 10–30%). Bleeding varices → stabilize BP first (fluids, blood, vasopressors), protect airway, then band/ligate via EGD; reverse anticoagulation with vitamin K.

Encephalopathy: ammonia builds → confusion, asterixis (hand flap), fetor hepaticus → treat with lactulose (2–3 soft stools/day; add rifaximin). Hepatitis A & E = fecal-oral, self-limiting (A has a vaccine). B = blood/body fluids/sex/perinatal, vaccine exists, can go chronic. C = blood (IV drug use), no vaccine but antivirals cure ~90%. D = only with B.

Acute failure is often acetaminophen overdose (ceiling ~3–4 g/day; antidote = acetylcysteine, timing-dependent). Case logic: low BP → bleeding or low albumin; confusion → ↑ammonia → lactulose; high INR → bleed risk → vitamin K; give fluids cautiously (ascites risk); monitor LFTs/INR; consult GI for transplant.

Gallstones (cholelithiasis) are often silent until one blocks a duct → cholecystitis. Risk = the F's (female, fat, forty, fertile, estrogen, rapid weight loss/post-bariatric, T2DM). Signs: biliary colic (RUQ → right shoulder, worse after fatty food), positive Murphy's sign, clay-colored stool, then fever/↑WBC/↑bilirubin/jaundice. Dx: ultrasound → HIDA → ERCP (can remove stones but risks pancreatitis). Surgery: laparoscopic cholecystectomy (home in 24 h; expect CO₂ shoulder pain); open approach may have a T-tube. Post-op = low-fat diet.

Auto-digestion by amylase & lipase (top causes gallstones + alcohol, ~80%). Pain: severe, boring, mid-abdomen → back, better leaning forward/fetal, worse lying flat. Labs/signs: ↑amylase lipase, hyperglycemia, hypocalcemia (Chvostek/Trousseau), Cullen's (umbilicus) Grey Turner's (flank) bruising = hemorrhagic. NPO is the top priority (even ice chips stimulate the pancreas): rest it with IV fluids/TPN, NG tube, pain control, antiemetics, H2/PPI, pancrelipase; no alcohol/smoking.

Most UTIs = E. coli from stool. Bladder infection usually no fever; once it hits the kidney → fever, high WBC, flank pain = pyelonephritis.

Cotton is king — breathable underwear lowers UTI risk. Avoid synthetics, hot tubs, wet clothes. Wipe front-to-back. Cranberry (unsweetened) may help bacteria not stick.

#1 sign = gross, painless hematuria (actual blood, not tinge). Risks: smoking, male, older age, occupational dyes. Dx: cystoscopy + biopsy, CT.

Unique treatment: chemo goes into the bladder (intravesical), not IV — IV chemo gets filtered out before it reaches the bladder. Also BCG immunotherapy (held ~2h), radiation, surgery.

After cystectomy → diversion: urostomy tubes or ileal conduit (ureters → piece of ileum → stoma). Watch stoma color: should look like inside of your cheek (pink/moist). Dark red/blue/black/brown = poor perfusion = bad. Protect skin with wafer/barrier; change pouch q3–7 days.

When kidneys fail, you lose: waste removal (ammonia builds → confusion), fluid/electrolyte control (K⁺, Na⁺, Mg²⁺ ↑), vitamin D activation (weak bones), BP control (fluid overload → HTN), erythropoietin (→ anemia → tired), acid-base buffering (→ metabolic acidosis).

Blood flow: artery → glomerulus (capillary bed) → Bowman's capsule → convoluted tubules → Loop of Henle (potassium!) → collecting tubule → renal pelvis → ureter → bladder. Adrenal glands sit on top but aren't part of the kidney.

Renal biopsy: patient prone, ultrasound-guided needle. Watch for bleeding (very vascular) + infection; pressure dressing after.

Glomerulonephritis = inflammation of the glomeruli (primary, or secondary from a systemic infection). Sign: reddish-brown / "Coca-Cola" urine, edema, HTN, N/V. Treat symptoms first, then antibiotics for the cause; sometimes hemodialysis to rest the kidney.

Nephrotic syndrome = the result of badly scarred glomeruli. Classic 4: severe pitting edema, low albumin, foamy (protein) urine, high cholesterol. Treat the symptom (albumin, dialysis) + the cause.

Don't memorize all 5 stages. Memorize the 2 numbers:

Slow it down: control BP (biggest lever), drink water (~2 L unless overloaded), stop smoking, limit alcohol, avoid NSAIDs, finish antibiotics.

Replace what the kidney can't do: calcitriol (activate vit D) + calcium carbonate (bones), epoetin + iron (anemia), loop diuretic / Kayexalate (potassium), phosphate control. Diet: low protein if not dialyzed (protein OK once dialyzed), limit abnormal electrolytes, high complex carb, moderate fat.

Neither replaces the kidney's hormonal jobs (vit D, EPO) — only fluids, electrolytes, acid-base, waste.

Access types: temp central venous catheter (emergent, into right atrium) → AV fistula (vein+artery, needs weeks to mature) → AV graft (synthetic tube). Hold meds before HD (beta blockers etc. get filtered out) unless told otherwise.

Restores hormonal function — EPO, BUN/creatinine, GFR, acid-base all normalize. Donor: living, non-heart-beating, or cadaver; related donor best.

Liver jobs: metabolize glucose/store glycogen, convert ammonia→urea, handle proteins/fats/vitamins, make bile & bilirubin, metabolize drugs, and make clotting factors (bleeding is often the first thing to break).

Liver biopsy: check INR first (give vitamin K if high); afterward lie on right side to tamponade; watch for bleeding.

Cirrhosis = scar tissue replaces working liver. Most common cause = alcohol; also hepatitis, fatty liver (metabolic syndrome/steatohepatitis), biliary obstruction. Compensated (looks well, vague symptoms) vs decompensated (jaundice, portal HTN, hepatorenal syndrome).

Ascites: pressure + low albumin push fluid into the abdomen. Biggest danger = respiratory compromise (fluid pushes on lungs). Treat: spironolactone (blocks aldosterone), sodium restriction (not fluid restriction), paracentesis (drain — give albumin after), or TIPS shunt.

Esophageal varices: varicose veins in the esophagus from the backed-up pressure. Rupture = massive bleed, first-bleed mortality 10–30%.

Late sign. Ammonia builds up → toxic to brain → confusion, sleep changes, asterixis (hand flap), coma, seizures. Musty "fetor hepaticus" breath.

General care: high-carb, high-cal, moderate fat/protein, rest the liver, small frequent meals, no alcohol, vaccinate at-risk, hand hygiene, safe injection, purified water when traveling.

Acute cause = often acetaminophen overdose. Chronic = untreated cirrhosis/hepatitis.

Case study logic: Low BP → bleeding OR low albumin. Confusion → high ammonia → lactulose. High INR → bleed risk → vitamin K. Give fluids cautiously (ascites risk). Monitor LFTs + INR; consult GI/liver for possible transplant.

Cholelithiasis = gallstones (often silent). Problem starts when a stone blocks the duct → cholecystitis (inflamed gallbladder).

Risk = the 5 F's vibe: female, estrogen/oral contraceptives, obesity/high cholesterol, type 2 diabetes, rapid weight loss (classic after bariatric surgery), older age, Crohn's, Native/Mexican American, multiple pregnancies.

Ultrasound (first, best/simplest) → HIDA scan (flow through biliary tree) → ERCP (most invasive: camera to biliary tree, can remove stones — but risks pancreatitis).

Cholecystectomy: usually laparoscopic (home within 24h). Open approach if very inflamed/leaking → longer stay, may have a T-tube (drains bile ~2–4 wks while it heals).

Auto-digestion: pancreatic enzymes (amylase & lipase) activate too early and eat the pancreas → inflammation, necrosis, hemorrhage. Top causes = gallstones + alcohol (~80%). Also ERCP, high triglycerides, smoking, trauma, valproic acid.

Wagner used the last ~30 min of Wk 10 L2 to start upper GI / enteral nutrition (EGD, NG/G/J/GJ tubes, checking residuals, aspiration precautions). He said clearly this is for a future exam, not Exam 4. Skip if you're short on time.

One handy definition if you want it: Enteral = feeds through the GI tract (tube feeding). Parenteral = TPN + lipids via IV, bypassing the gut.

Possible answers raised: skin integrity, psychosocial factors, find the underlying cause, check on them more often, toileting schedule.

Options debated: (a) administer prescribed antibiotic, (b) educate on fluid intake since it's only "suspected."

Possible answer raised: "breathing fast."

All possible answers:

• Pre-renal = before the kidney (dehydration, blood loss, cardiac failure, sepsis, hypotension).
• Intra-renal = inside the kidney (pyelonephritis, nephrotic, glomerulonephritis, nephrotoxic drugs, contrast dye, NSAIDs).
• Post-renal = after the kidney / obstruction (kidney stones, BPH, cancer, urethral stricture).

Possible answers raised: bleeding; low albumin.

Possible answers raised: give meds, suction, intubation, transfusion, cauterize, fluids/blood products, vasopressors.

Possible answers raised: "if the stomach isn't working" (a good point, Wagner said, but not his target).

Module topics: urinary diagnostics, incontinence, UTI, bladder cancer + diversion, renal diagnostics, pyelonephritis, glomerulonephritis, nephrotic syndrome, AKI, CKD, renal replacement therapies, PKD, renal calculi.

Factors affecting urinary elimination: poor abdominal/pelvic tone, acute & chronic disorders, spinal cord injury, older age, diet, immobility, psychological factors, pain, medications.

Types: Stress · Urge · Overflow · Reflex/Neurogenic · Functional · Transient.

Treatment: Stress → Kegels. Urge → pharmacotherapy. Overflow → often men w/ BPH; treat BPH, encourage complete emptying. Neurogenic → intermittent cath, bladder training. Functional → bladder training.

Reflex/Neurogenic bladder: from neuro disorders; spastic (empties on reflex, more common) or flaccid (fills + overflow). Tx: pharmacotherapy, bladder training, intermittent self-cath.

Types: urethritis (often STI) · cystitis (bladder) · pyelonephritis (kidney, complication of cystitis).

Risk factors: female anatomy, indwelling catheter (CAUTI), retention, stool incontinence, intercourse, pregnancy, synthetic underwear, hot tubs/wet clothing, neurogenic bladder, diabetes.

Manifestations: urgency/frequency, burning, suprapubic discomfort, cloudy/foul/blood-tinged urine; fever + flank pain = pyelonephritis; older adults → confusion, falls, fatigue, anorexia.

Diagnostics: urinalysis (clean catch), urine C&S, CT (pyelo).

CAUTI prevention: aseptic insertion, prevent backflow, bag below bladder, peri-hygiene, assess need daily, sterile closed system, drain before half full.

Teaching: antibiotics + antipyretics/analgesics, warm sitz baths, 3 L fluid/day, void q3–4h, void after intercourse, cranberry juice, wipe front-to-back, avoid bubble baths/perfumes/wet suits/tight synthetic clothing.

Begins in cells lining the bladder; invasive or non-invasive. Risk: cigarette smoking (2× risk), male, older adults, occupational dyes/nitrates/rubber. #1 sign = gross, painless hematuria.

Diagnostics: cystoscopy with biopsy, CT.

Management: intravesical chemo, intravesical immunotherapy BCG (instilled, retained 2 h), systemic chemo, radiation, surgical excision (partial/total cystectomy).

Ileal conduit care: stoma & skin care, change pouch, measure I&O.

Kidney roles: fluid/electrolyte balance (esp. K⁺), waste removal, vitamin D activation (calcitriol), BP control, RBC production (erythropoietin), acid-base balance.

Kidneys balance pH by reabsorbing bicarbonate & secreting H⁺. Renal failure → metabolic acidosis (can't remove acids / hold bicarb).

Serum: BUN 8–20 (↑ with injury, dehydration, bleeding, hypotension); Creatinine 0.6–1.2 (better marker); GFR >90.

Biopsy: for cancer, unexplained AKI, transplant rejection → monitor renal function, assess for hemorrhage, analgesia.

Pyelonephritis: cystitis S/S + fever, chills, flank pain, N/V; may → sepsis, CKD, HTN. Tx: antibiotics, analgesia, 2 L fluids/day.

Glomerulonephritis: facial/hand/eye/foot edema, anorexia, N, dysuria/oliguria, fatigue, HTN, FVE, cola-colored urine. Mgmt: monitor renal fxn/BP/resp/fluids, antibiotics, possible protein/K⁺ restriction, maybe hemodialysis.

Intrinsic glomerular damage. Manifestations: severe edema (pitting/periorbital), low albumin, proteinuria (foamy urine), hyperlipidemia. Tx: symptom management + treat underlying cause.

Phases: Onset (hrs–days) → Oliguria (100–400 mL/24h, 1–3 wk) → Diuresis (large output, 2–6 wk) → Recovery (up to a year).

Types: Prerenal (↓ blood flow/volume depletion — early fluid restoration can reverse) · Intrarenal (direct damage) · Postrenal (bilateral obstruction).

Manifestations: HTN, FVO, dysrhythmia, crackles/dyspnea, lethargy/twitching/seizures, dry skin; ↑BUN/creatinine, hyperkalemia, hyperphosphatemia, hypocalcemia, ↓Hct, metabolic acidosis.

Management: correct cause, monitor VS/labs/ECG, strict I&O, daily weights, manage FVE/FVD, diuretics, catheter for retention, restrict fluids PRN, BP mgmt, limit protein/K⁺/Na⁺/phosphate/Mg.

Risks: AKI, diabetes, chronic glomerulonephritis, nephrotoxins, HTN (esp. Black clients), autoimmune (SLE), PKD, pyelonephritis, renal artery stenosis, recurrent infections.

Prevention: 2 L water/day, stop smoking, limit alcohol, manage weight/DM/HTN, adhere to meds, finish antibiotics, limit OTC NSAIDs.

Manifestations (mostly fluid overload): lethargy/confusion/seizures; JVD, edema, HTN, HF, peaked T-waves; uremic breath, Kussmaul breathing, crackles, pink frothy sputum; N/V; anemia & bruising; osteodystrophy; dry itchy pale-yellow skin, uremic frost; immunosuppression, poor wound healing.

Labs: hematuria/proteinuria, ↓ specific gravity, chronically ↑BUN/creatinine, ↓Na (dilutional) & ↓Ca, ↑K/phosphorus/Mg, ↓Hgb/Hct (low EPO).

Management: daily weight, review nephrotoxic meds, diet (limit protein, Na, K, Mg, phosphate; high complex carb, moderate fat), fluid restriction, monitor for infection. Pharmacotherapy: calcitriol, calcium carbonate, K⁺-lowering drug, ferrous sulfate, epoetin alfa, loop diuretic.

Dialysate instilled via peritoneal catheter → dwell → drain → exchange. Advantages: fewer side effects, continuous/natural, better for older adults heart failure, fewer diet restrictions, home/while sleeping.

Types: CAPD (manual daytime exchanges) · continuous cycle (machine at night).

Nursing: warm dialysate (don't microwave), sterile technique, monitor glucose (dextrose dialysate), outflow bag below client/dialysate bag above; record outflow amount/color/clarity.

Complications: peritonitis (fever, pain, cloudy outflow — surgical asepsis!), site infection, protein loss, ↑ glucose/lipids, catheter blockage/dislodgement.

Shunts blood through dialyzer; 3×/week, 3–4 h. Removes fluid/electrolytes/waste, fixes acid-base — but doesn't replace hormonal function. Needs vascular access (artery + vein needles).

Access nursing: NO BP/IV/blood draws in access arm; palpate thrill, auscultate bruit; assess distal circulation & infection; check for bleeding post-HD; don't sleep on that arm.

HD nursing: hold most meds until after, pre/post weights, monitor BP (hypotension common), assess access, watch complications.

Complications: clotting/infection of fistula, disequilibrium syndrome (rapid fluid/BUN loss → cerebral edema; early N/V + HA, late ↓LOC/seizures → slow exchange rate), hypovolemia, anemia.

Transplant: for ESKD; donors living/non-heart-beating/cadaver; living related + tissue match = best graft survival; lifelong immunosuppression to prevent rejection.

Case study labs: Peritonitis → ↑CRP, WBC, neutrophils. ESKD → ↑BUN/creatinine/K⁺/phosphorus, ↓Hgb (low EPO).

Autosomal dominant; fluid-filled cysts replace nephrons → enlargement → kidney failure. Most have HTN (cysts compress blood flow).

Manifestations: abd/flank pain (dull = enlargement/infection, sharp = ruptured cyst/stone), HTN, enlarged girth, constipation, bloody/cloudy urine, stones, hyponatremia, progressive failure.

Management: BP control = highest priority, pain mgmt (no NSAIDs), infection & constipation prevention, monitor labs, daily BP/weight, low-Na diet.

Urolithiasis; most stones calcium phosphate/oxalate; most pass without surgery. Risks: stasis, retention, dehydration.

Manifestations: severe renal colic (worse as stone moves), frequency/dysuria, diaphoresis, pallor, N/V, tachycardia, ↑BP, oliguria/anuria if obstructing, hematuria.

Diagnostics: UA, KUB x-ray, ultrasound, CT, cystoscopy.

Management: opioids/NSAIDs (ketorolac)/antiemetics, strain all urine + save stone, ↑ intake to 3 L/day, moist heat, IV fluids, ambulation.

ESWL lithotripsy: moderate sedation + ECG; post: strain urine, expect bruising & hematuria. Complications: urosepsis, obstruction, hydronephrosis.

Diet: Calcium phosphate → limit animal protein & Na. Calcium oxalate → avoid spinach, black tea, cocoa/chocolate, beets, strawberries.

Module topics: cirrhosis, viral hepatitis, liver failure, cholelithiasis, cholecystitis, pancreatitis.

Functions of the liver: glucose metabolism & glycogen storage, ammonia → urea conversion, protein & fat metabolism, vitamin/iron storage (fat-soluble vitamins + B12), bile formation, bilirubin excretion, drug metabolism, clotting-factor production.

Hepatic serum studies (LFTs): ↑ALT (most liver-specific) AST in liver injury; ↑ALP = biliary obstruction; prolonged INR = poor synthetic function; ↑ammonia → hepatic encephalopathy; ↑bilirubin = jaundice; ↓albumin → ascites.

Liver biopsy: monitor INR, assess for hemorrhage, position on the right side after to apply pressure.

Irreversible scarring; functional tissue replaced by fibrosis. Types: alcoholic (most common), post-necrotic (viral hep B/C or toxins), biliary (chronic bile-duct obstruction, least common).

Risk factors: alcohol use disorder, chronic viral hepatitis, autoimmune hepatitis, steatohepatitis (fatty liver), hepatotoxic drugs/toxins, chronic biliary obstruction.

Manifestations: portal HTN, ascites, varices, jaundice, splenomegaly, cognitive changes, petechiae, spider angiomas, palmar erythema, fetor hepaticus; ↑AST/ALT/ALP, ↑bilirubin, ↑ammonia, ↓albumin, prolonged PT/INR, ↓RBC/Hgb/Hct/platelets.

Jaundice: yellowing of skin/sclera/mucous membranes; damaged liver can't process bilirubin (normal 0.3–1.0 mg/dL).

Portal hypertension: ↑ pressure in the portal venous system from obstructed blood flow through the damaged liver — drives ascites & varices.

Ascites: fluid in the peritoneal cavity from portal HTN + hypoalbuminemia (albumin 3.5–5.2 g/dL). Nursing priority = respiratory status. Mgmt: diuretics, strict Na restriction, paracentesis, TIPS shunt.

Enlarged esophageal veins from portal HTN; may rupture → life-threatening hemorrhage. Manifestations: hematemesis, melena, deterioration, hemorrhagic shock. Screen with endoscopy; treat with endoscopic ligation/banding.

Nursing: frequent VS, supplemental O₂, IV fluids/electrolytes/blood products, prevent aspiration, vasoactive drugs, prep for EGD/surgery. Bleeding risk ties to ↓ prothrombin & ↓ vitamin K storage.

A — fecal-oral (contaminated food/water, shellfish); mild, full recovery; supportive care. E — fecal-oral, like A, poor-sanitation regions.

B — blood/body fluids, perinatal, sex; often silent; vaccine-preventable; no cure; risk of chronic hep, cirrhosis, liver cancer. D — only as coinfection with HBV.

C — blood/body fluids (IV drug use, needles, tattoos); often silent; direct-acting antivirals cure >90%; untreated → chronic liver disease, liver cancer.

Nursing: high-carb/high-cal, moderate-fat/protein, small frequent meals (hepatic rest); avoid alcohol; CDC vaccination & infection-control; hand hygiene; safe injection; purified water when traveling.

Hepatic failure: acute (sudden — infection, drug overdose, injury) vs chronic (gradual — cirrhosis/hepatitis). Tx: remove blood toxins, dietary changes, manage complications, possible liver transplant.

Case: 45 y/o male, acetaminophen overdose (suicide attempt) → N/V, abdominal pain, confusion; ↓BP, ↑HR/RR; ↑AST/ALT/bilirubin, prolonged INR. Recognize acetaminophen as the classic hepatotoxic overdose (antidote = acetylcysteine).

Cholelithiasis = stones; cholecystitis = gallbladder inflammation, usually from stones obstructing ducts.

Risk factors — the 5 F's: Female, Fat (obesity), Forty+, Fertile (estrogen/OCPs/multiple pregnancies), Family history; also T2DM, Crohn, rapid weight loss, Native/Mexican American ethnicity.

Manifestations: RUQ pain radiating to right shoulder, worse after fatty foods; Murphy's sign; rebound tenderness, dyspepsia, belching; fever, leukocytosis; ↑bilirubin, jaundice, clay-colored stools, dark urine.

Diagnostics: ultrasound, HIDA scan, ERCP (NPO 6–8 h before, moderate sedation, withhold fluids until gag reflex returns; risk of pancreatitis). Mgmt: laparoscopic cholecystectomy (home in 24 h); open approach may need a T-tube (removed in 2–4 wks) & JP drain.

Pancreatitis: autodigestion by prematurely activated enzymes → inflammation, necrosis, hemorrhage. Acute: 80% from gallstones or alcohol. Chronic: progressive fibrosis → diabetes + malabsorption.

Manifestations: sudden severe boring epigastric pain radiating to back/left flank/shoulder, worse lying down, eased by fetal position or leaning forward; N/V, weight loss, hypocalcemia, hyperglycemia, ↓ bowel sounds. Hemorrhagic signs: Cullen's (periumbilical) Grey Turner's (flank) bruising.

Labs/Procedures: ↑amylase & lipase; ERCP/sphincterotomy for gallstone cause; cholecystectomy if from stones.

Pharm: IV opioids, ketorolac, IV fluids, antiemetics, H2 blockers/PPIs, pancrelipase, insulin. Nursing: NPO then gradual bland low-fat/high-protein small meals, avoid caffeine/alcohol/smoking, NGT to rest pancreas, monitor glucose/electrolytes/amylase/lipase, I&O, daily weight, dietitian consult.