Question

Chapter 43 Liver, Biliary Tract, and Pancreas Problems

Acute Pancreatitis

Patient Profile

K.Z. is a 39-year-old man who presents to the emergency department describing severe pain in his abdomen that started after he went to bed last night. He has a history of hypertension. He is currently taking hydrochlorothiazide and lisinopril.

Subjective Data

• Has severe, sharp pain in his abdomen and points to his left upper quadrant 10/10
• Pain got worse after he ate breakfast this morning; he vomited, but the pain did not improve
• Has a 21-pack-year smoking history (½ pack)
• Drinks about two cases of beer a week

Objective Data

Physical Examination

• Temperature 100.9°F, pulse 110, respirations 26, blood pressure 110/62
• Height 5'11", weight 180 lb
• Oxygen saturation 93% on room air
• Diminished breath sounds and crackles in left lower lobe
• Bowel sounds hypoactive in all quadrants
• Abdomen slightly distended with left upper quadrant tenderness and guarding relating to pain

Diagnostic Studies

• Chest radiography: small pleural effusion in left lower lobe
• Lab values
  • Hematocrit: 45%
  • Hemoglobin: 14 g/dL
  • Platelets: 190,000/µL
  • Sodium: 135 mEq/L
  • Potassium: 3.9 mEq/L
  • HCO₃: 25.4 mEq/L
  • Chloride: 99.5 mEq/L
  • Calcium: 7.9 mg/dL
  • Amylase: 188 U/L
  • Lipase: 400 U/L

Case Study Questions

1. Lists four risk factors that may be associated with acute pancreatitis:

1.

2.

3.

4.

2. What would the physician prescribe in treating K.Z.’s acute pancreatitis? List at Least Three:

1.

2.

3.

3. Which lab tests in the scenario above would indicate that K.Z. has acute pancreatitis?

4. List two pertinent local complications of acute pancreatitis and two systemic complications of acute pancreatitis?

Local complications:

1.

2.

Systemic complications:

1.

2.

5. Explain and relate K.Z.’s physical examination findings to his diagnosis of acute pancreatitis: Why would they be abnormal; keeping in mind the disease process?
   • Temperature 100.9°F, pulse 110, respirations 26, blood pressure 110/62
   • Low grade temperature:
   • Pulse:
   • Respirations:
   • Low blood pressure:
   • Oxygen saturation 93% on room air:
   • Diminished breath sounds and crackles in left lower lobe:
   • Bowel sounds hypoactive in all quadrants:
   • Abdomen slightly distended with left upper quadrant tenderness and guarding:

6. What type of diet foods would you instruct K.Z. to avoid in living with Acute Pancreatitis? List at Least three:

1.

2.

3.

7. What would be nursing implementations you as the nurse would take in helping K.Z. manage his acute pancreatitis? List at Least Five:

1.

2.

3.

4.

5.

8. List two prioritized actual nursing diagnoses with all three parts you would include in your care plan for K.Z.:

1.

2.

Reference(s)

Answer 1

1) Risk factors associated with acute pancreatitis

smoking and alcoholism

Dyslipidemia

diabetes mellitus

bacteremia

2)Physician opinion for acute pancreatitis

primary treatment include supportive therapy which may be symptomatic treatment

I V fluid for hydration.

analgesics for severe pain

antibiotics for infection

3) lab test include blood test like amylase and lipase and medical history and physical examination is mandatory

4) acute pancreatitis can leads to local complications like

ascites

pancreatic necrosis

systemic complications like

pulmonary edema

respiratory distress syndrome

DIET

if the patient is having severe pain and nausea keep the patient nill orally for a couple of hours

start a liquid diet once the patient is settle and subside the symptoms

liquid diet like soup and almond milk is preferable

protein rich diet is advisable

5)food to avoid

alcohol

fried and spicy food

fast food

fat meat and diary products.

6)Nursing implimentation include

assessment of nutritional status

assessment of fluid and electrlyte imbalance

assessment of abdomen for ascites

assessment of respiratory status

assessment of pain

7) nursing diagnosis

acute pain related to disease condition as evidenced by verbal communication with patient

imbalanced nutrition less than body requirement related to less intake or due to vomiting