Question

Objectives:

1.    Student nurse will obtain report from Emergency Department nurse.

2.    Student nurse will prioritize tasks in appropriate order for positive patient outcomes.

3.    Student nurse will delegate needed tasks as needed.

4.    Medications given as needed and in a timely manner to prevent adverse outcomes.

Patient Information

NAME: Juan Martinez

AGE: 55

DOB: February 26, 1963

WEIGHT: 180 lbs. (88.6 kg)

HEIGHT: 65 inches (170 cm)

Past Medical and Social History: Juan is a 55 year old of Mexican decent. He was a member of the Army from 1981 through the Gulf War in 1994. He grew up in Texas before joining the Army. He obtained a back injury while serving in Kuwait. When he left the Army he relocated in Minnesota and is currently married. Juan is currently a mechanic. He has a BMI of approximately 30. Wife states he drinks about “a six pack” a night and more on the weekends.

He has been in and out of treatment for alcoholism. He is “borderline diabetic”, hypertensive, and hypercholesteremic.

Situation: Mr. Martinez was driven to the Emergency Room (ER) by his wife after being triaged at Urgent Care. Urgent care nurse called to give report to ER Charge nurse stating patient is having severe upper abdominal pain with possible Delirium Tremens (DTs). Patient had CT scan completed before transfer to floor.

Plan of Care: Doctor to assess patient. Orders listed below. Patient admitted to Medical-Surgical unit with diagnosis of Pancreatitis.

Provider Orders:

            Insert NG tube per protocol once on floor

            IV catheter placement – Flush IV Q shift

            Medications as follows:

                        Ondansetron

                        Midazolam

                        Dilaudid IVP

            Strict Inputs and Outputs (I&O)     

            Finger Stick Blood Glucose Q4hours

            NPO except for ice chips

            MINDS Protocol

            Ambulate as Tolerated

Vitamin Bag running at 200 mL/hr (Contains 100 mg Thiamine, 1 mg Folic Acid, 10 mL MVI (Multivitamin) in normal saline)

           

Questions: (Please answer with 3-5 sentences with reference).

1.    What is purpose of CT scan in this patient? What would be found on a positive CT scan? Name two other diagnostic tools (besides laboratory values) that could also be used.

2.    Why is a Vitamin Bag ordered for this patient?

3.    What is the purpose of the nasogastric tube in pancreatitis?

           

Answer 1

1. PURPOSE OF CT SCAN:-
- CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs.
- CT scans are more detailed than standard X-rays.
- useful in diagnosis of pancreatitis and pancreatic cancer.

TWO OTHER DIAGNOSTIC TOOLS-
(a) Blood amylase or lipase level
(b) Trans abdominal ultrasound

2. VITAMINS IN PANCREATITIS:-
(a) Vitamin B Complex:- the entire complex helps relieve stress on the pancreas.
-vitamins B-3 and B-5 in particular are important for fat and carbohydrate metabolism.
(b) Vitamin C :- Free radical scavenger.
-best to use a buffered form of vitamin C.
(c) All vitamins are helpful.

3. PURPOSE OF NASOGASTRIC TUBE IN PANCREATITIS:-
- If food is given parentral then due to lack of the stimulatory effects of oral feeding results in gastro-intestinal atrophy with decreased villous thickness in the intestinal tract, which leads to bacterial translocation across the gut barrier, sepsis, and organ failure.
- so nasogastric tube is preferred.