Question

Brief Patient History:
Mr. C is a 38-year-old Hispanic male admitted to the intensive care unit from the emergency department (ED) in hypovolemic shock. Mr. C was initially diaphoretic, unresponsive, and pale with a blood pressure of 70 systolic. After fluid resuscitation in the ED, his blood pressure increased to 90 systolic and responsiveness was restored. Mr. C is a migrant worker from Mexico who speaks limited English and is married with four children. All family members live in Mexico, except his uncle. Mr. C?s uncle verbalizes that his nephew has been complaining of severe abdominal pain for the past few days, with frequent episodes of nausea and vomiting.

Clinical Assessment:
Mr. C is in a fetal position, complaining of nausea and intolerable knifelike abdominal pain, radiating to his back. A physical examination reveals that Mr. C is restless, obeys commands, and moves all extremities. Bilateral breath sounds are diminished with bibasilar crackles, S1 S2 without murmur, and capillary refill greater than 3 seconds, and peripheral pulses are 1+. Abdomen is distended and tenderness and guarding, hypoactive bowel sounds, and tympany are noted. Trousseau?s sign (carpopedal spasm with inflation of blood pressure cuff) and Chvostek?s sign (muscle spasm of the face with tap on facial nerve) are present. Skin is cool, pale, and dry. IV fluids are Ringer solution at 200 mL/hr and Foley catheter draining amber urine at 20 mL/hr.

Diagnostic Procedures:
Mr. C?s vital signs include blood pressure of 92/68 mm Hg, pulse of 122 beats/min that is thready and weak, respiratory rate of 26 breaths/min, temperature of 100.8° F, and SpO₂ of 92% on O₂ at 4 L per nasal cannula. His arterial blood gasses are: pH of 7.48, PaO₂ of 80 mm Hg, PaCO₂ of 48 mm Hg, HCO₃ level of 38 mEq/L. He has an O₂ saturation of 95% on an FIO₂ of 36%.

Diagnostic values for Mr. C are as follows:
WBC, 19,600 units/L; hematocrit (Hct), 48.3%; hemoglobin (Hgb), 11.6 g/dL;
blood urea nitrogen (BUN), 18 mg/dL; serum creatinine, 1.2 mg/dL; serum glucose, 220 mg/dL; serum amylase, 280 Somogyi units/mL; serum lipase, 13.5 Somogyi units/mL; serum sodium, 140 mEq/L; serum potassium, 2.9 mEq/L; serum calcium, 5.8 mg/dL; serum albumin, 2.8 mg/dL; serum magnesium, 0.9 mg/dL; serum C-reactive protein, 140 mg/dL; and serum lactate, 3 mmol/L.

Medical Diagnosis
Acute Pancreatitis/Ranson criteria of 4

1. What major outcomes do you expect to achieve for this patient? (7 major outcomes)

2. What problems or risks must be managed to achieve these outcomes? (Hint: 6 potential problems in the form of nursing diagnoses and identify how you would address the nursing diagnosis)

3. What interventions must be initiated to monitor, prevent, manage, and eliminate the problems and risks identified? (6 answers)

4. What interventions should be initiated to promote optimal functioning, safety, and well being of the patient?

5. What possible learning needs would you anticipate for this patient?

6. What cultural and age-related factors may have a bearing on the patient's plan of care?

Answer 1

1.The major outcomes which hast be achieved fir this patient are

• To reduce infection
• To relieve fever
• To increase the blood pressure to normotension
• To relieve from pain
• To relieve nausea and vomiting
• To have normal GFR rate

2.

• Infection related to pathogenic invasion as evidenced by increased lactate level,WBC count, temperature
• Impaired thermoregulation related to infection as evidenced by increased body temperature
• Impaired cardiac output related to reduced blood volume as evidenced by decreased blood pressure
• Acute pain related to inflammatory process as evidenced by increased pancreatic enzymes,disyended abdomen, tenderness
• Fluid volume deficit related to low blood volume as evidenced by vomiting,edema, electrolyte imbalance
• Impaired urine output related to decrease renal function as evidenced by loe GFR rate

3.The intervention needed are

• Administer antibiotics (to control infection) antipyretics (to reduce fever) analgesics (to manage pain) proton pump inhibitors, antiemetics (to control nausea and vomiting)
• Administer intravenous fluid to increased fluid volume
• Monitor intake and output to prevent any renal complications
• Replace calcium supplements to control probls associated die to hypocalcemia
• Aseptic techniques to prevent cross infection or contamination
• Assess neurological status,vitals every 15minutes untill atuent gains normalcy or out of danger zone
• Monitor the abdominal girth

4.To increase optimal safety and intervention are

• Monitor the patient (vitals, intake and output, neurological status)
• To ensure the patient is improving and not detoriating with the treatment provided
• Medication and IVF to treat the underlying problems
• Screening the patient in advance for complications and consequences and providing appropriate preventative care.