Question

Objective:

1.    Student nurse will obtain pertinent information through questioning and assessment for accurate triage.

2.    Student will work with interdisciplinary team in order to provide best patient 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. Jones presented to urgent care at the persistence of his wife. He has been having severe upper abdominal pain with increasing nausea and vomiting lasting several days. He has been having “anger issues” per wife. He has mild tremors and diaphoresis.

Plan of Care: Patient will be assessed by urgent care, triage RN. RN will utilize the attached Briggs Protocol for best patient care.

           

           

Medication	Drug Classification, expected action, indication for use	Possible Adverse Effects	Medication or Food Interactions	Nursing Considerations	Client Education and Evaluation of Effectiveness
Metformin
Losartan
Tramadol
Folic Acid
Simvastatin
Omeprazole
Pancrelipase

Pre-Simulation Questions: (3-5 full sentences detailing needs of this patient)

1.    In your opinion, is this acute or chronic pancreatitis? What is the difference between these conditions?

2.    What are the anticipated needs of this patient?

3.    What are the key symptoms that led you to this conclusion?

CBC with Differential	What will this tell us?	What is the specific reason for this patient?
Complete Metabolic Panel	What does this contain?	What could they tell us about this patient?
Amylase	Normal Range?	What would elevation tell us?
Lipase	Normal Range?	What would elevation tell us?
Bilirubin	Normal Range?	What would elevation tell us?
Urine Drug Screen	What does this test for?
Serum Alcohol Level	Normal Range?	What would you expect this to be?

Answer 1

1. Mr. Juan has been having severe abdominal pain with increasing nausea and vomiting lasing several days which indicates to be an Acute pancreatitis.

Difference between Acute and Chronic Pancreatitis

Acute Pancreatitis	Chronic Pancreatitis
A sudden attack of pain in the upper abdominal area that can last for hours or days.	Persistent attacks over a period of times, usually more than 6 months.
Pain radiating from the abdomen to the back.	Pain radiating from the abdomen to the back.
Nausea or vomiting, with pain increase following a meal.	Nausea or vomiting, with pain increase following a meal.
Fevers and changes in skin color, often a yellowish appearance in the skin.	Excessive thirst and fatigue. Fevers and changes in skin color, often a yellowish appearance in the skin.
More than 80 percent of the cases of acute pancreatitis are related to biliary stones or alcohol use.	The most common cause of chronic pancreatitis is alcohol. Alcohol consumption has been implicated in approximately 70 percent of cases as a major cause of this disease. Other causes include gallbladder disease, hyperparathyroidism (increased secretion from the parathyroid glands) and trauma to the pancreas. Weight loss, in the later stages of chronic pancreatitis, the longer you live with the disease the less likely you have of eating a normal diet because the pain may be too great to eat normally.

2. Mr. Juan needs to be taken care for aggressive volume repletion, pain control, close monitoring of hemodynamic and volume statuses, attention to nutritional needs, control on hypertension and diabetes and monitoring for complications are essential in patients with acute pancreatitis.

3.  The crucial difference between the types of pancreatitis can be made by the difference in the longevity of the pain. Acute pancreatitis starts with a sudden attack of pain that peters out after a few hours to days while chronic pancreatitis remains persistent for months.