Question

Forty-nine-year-old Frank has been a heavy drinker for the past 25 years. He also has a history of hypertension, hyperlipidemia, and recent upper respiratory viral infection. Frank’s only current medication is Lasix (furosemide) 40 mg od. He presents with severe epigastric pain that radiates to his back and worsens when lying down. His abdomen is distended, and bowel sounds are hypoactive. Frank has a fever and is diaphoretic and hypotensive, and his serum calcium is very low. In your initial post answer the following questions: Frank is being transferred to the ICU. If you were the ICU nurse, what would you have to consider in Frank’s case? What would you expect in the way of treatment modalities for Frank? nutritional status and what test would you labs would you evaluate and why?

Answer 1

As frank is a chronic drinker and symptoms match the diagnosis of Acute pancreatitis, I would consider that frank is suffering from pancreatitis.

Treatment modalities

As management of pancreatitis is directed towards relieving symptoms and preventing or treating complications

- Adequate administration of analgesia

- ill patient is maintained on bed rest to decrease the metabolic rate and reduce the secretion of pancreatic and gastric enzymes

- maintain semifowlers position to decrease pressure on diaphragm by distended abdomen and to increase respiratory expansion.

- patient is at risk for akin breakdown because of poor nutritional status, enforced bed rest and restlessness, so the nurse carefully assess for akin breakdown and infection.

Nutritional status

All oral intake ia withheld, to inhibit stimulation of the pancreas and it's secretion of enzymes.

Parentral nutrition is usually an important part of therapy, particularly in debilitated patients

Note the factors( temperature elevation, nausea, vomiting) that alter patients nutritional requirement.

Lab tests

Serum amylase and lipase levels- In 90% oof cases these levela rise in excess of three times their normal upper limit.

WBC- it is usually elevated

serum bilirubin level- Elevated

xray studies- of abdomen and chest may be obtained to differentiate pancreatitis from other disorders.

Ultrasound and CT scan- Identify an increase in diameter of pancrease and to detect pancreatic cyst, abscess or pseudocyst.

Hematocrit and hemoglobin to monitor patient for bleeding

Calcium levels- to detect hypocalcemia, complication of pancreatitis.