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    A 45-year-old male presents to the emergency department with severe abdominal pain rated 7-9 out of 10, nausea, vomiting, chills and a low grade fever. His lab work and imaging show elevated pancreatic enzymes consistent with acute pancreatitis. He is diagnosed with acute pancreatitis and admitted to the hospital. After 6 days of treatment including nothing by mouth, total parenteral nutrition, pain medications and monitoring, his symptoms resolve and he is discharged to a rehabilitation facility.

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    NGN Presentation

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    api-718934821
    42 views15 pages
    A 45-year-old male presents to the emergency department with severe abdominal pain rated 7-9 out of 10, nausea, vomiting, chills and a low grade fever. His lab work and imaging show elevated pancreatic enzymes consistent with acute pancreatitis. He is diagnosed with acute pancreatitis and admitted to the hospital. After 6 days of treatment including nothing by mouth, total parenteral nutrition, pain medications and monitoring, his symptoms resolve and he is discharged to a rehabilitation facility.

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    A 45-year-old male presents to the emergency department with severe abdominal pain rated 7-9 out of 10, nausea, vomiting, chills and a low grade fever. His lab work and imaging show elevated pancreatic enzymes consistent with acute pancreatitis. He is diagnosed with acute pancreatitis and admitted to the hospital. After 6 days of treatment including nothing by mouth, total parenteral nutrition, pain medications and monitoring, his symptoms resolve and he is discharged to a rehabilitation facility.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    42 views15 pages

    NGN Presentation

    Uploaded by

    api-718934821
    A 45-year-old male presents to the emergency department with severe abdominal pain rated 7-9 out of 10, nausea, vomiting, chills and a low grade fever. His lab work and imaging show elevated pancreatic enzymes consistent with acute pancreatitis. He is diagnosed with acute pancreatitis and admitted to the hospital. After 6 days of treatment including nothing by mouth, total parenteral nutrition, pain medications and monitoring, his symptoms resolve and he is discharged to a rehabilitation facility.

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    NGN Case Study:

    Pancreatitis
    Lauryn McClellan, Katie Barben, Mercedes Banuelos,
    Kylie Lemmon
    Background

    A 45-year-old male, Frank Gallagher, presents to the ED with severe abdominal pain.
    He states his pain level as a 7/10 yesterday afternoon which elevated to a 9/10 after
    dinner last night and breakfast this morning. Along with pain, he reports nausea and
    vomiting after having his nightly 3 beers (which follows 2 beers during the day). He
    states his pain does not subside with TUMS. He states he started to get chills and
    develop a low-grade fever this morning and finally decided it was time to come to the
    ED.

    NGN Case Study: Pancreatitis 2


    Highlight Text
    Select the rows in the background that indicate the client may be
    experiencing a complication:

    A 45-year-old male, Frank Gallagher, presents to the ED with severe


    abdominal pain. He states his pain level as a 7/10 yesterday
    afternoon which elevated to a 9/10 after dinner last night and
    breakfast this morning. Along with pain, he reports
    nausea and vomiting after having his nightly 3 beers (which follows
    2 beers during the day). He states his pain does not subside with
    TUMS. He states he started to get chills and develop a low-grade
    fever this morning and finally decided it was time to come to the ED.

    NGN Case Study: Pancreatitis 3


    Answer to highlight Text
    Select the rows in the background that indicate the client may be
    experiencing a complication:

    A 45-year-old male, Frank Gallagher, presents to the ED with severe


    abdominal pain. He states his pain level as a 7/10 yesterday
    afternoon which elevated to a 9/10 after dinner last night and
    breakfast this morning. Along with pain, he reports
    nausea and vomiting after having his nightly 3 beers (which follows
    2 beers during the day). He states his pain does not subside with
    TUMS. He states he started to get chills and develop a low-grade
    fever this morning and finally decided it was time to come to the ED.

    NGN Case Study: Pancreatitis 4


    Vital Signs
    Vital signs 09:45 am

    Heart rate 110

    Respiratory rate 30

    Blood pressure 108/74

    Oxygen saturation 98%

    Temperature 101.3

    NGN Case Study: Pancreatitis 5


    Diagnostic Findings
    Labs Value
    • Glucose • 174
    • Amylase • 312
    • Lipase • 486
    • WBC • 15,000
    • Ca • 7.9
    • AST • 160
    • ALT • 150
    • CRP • 190
    • Bilirubin • 1.22
    • Triglycerides • 187
    • BUN • 10

    NGN Case Study: Pancreatitis 6


    Initial Assessment
    Objective Subjective
    • Rigid-board like abdomen • Sudden severe pain in mid-epigastric
    • Steatorrhea LUQ
    • Temperature 101.3 • N/V
    • Heart rate 110 • Abdominal guarding
    • Respiratory rate 30 • Bluish discoloration at the flanks
    • Hyperglycemia (Grey-turner sign)
    • Elevated pancreatic enzymes • Jaundice
    • Diaphoretic • Foul smelling stool

    NGN Case Study: Pancreatitis 7


    Diagnostic Tests
    Frank Gallagher is suspected to have pancreatitis based on
    elevated pancreatic enzymes and physical signs and
    symptoms. The provider ordered an Abdominal ultrasound and
    an Abdominal CT. The results of the radiologic imaging came
    back consistent with pancreatitis.
    Frank was diagnosed with acute pancreatitis and admitted to
    a med-surg unit.

    NGN Case Study: Pancreatitis 8


    PRESENTATION TITLE
    Question #2: Drag n Drop
    • The nurse knows that (1) is the priority concern for the client. (2) is
    the most effective medical treatment option. NG to low cont. Suction,
    Pancreatic enzymes, Pantoprazole, Morphine, and D5W infusion are
    prescribed, and the nurse should administer (3) first. The nurse will
    question the healthcare provider as to why (4) has been prescribed.
    • Answer options:
    • Pancreatic Rest, Fluid management, Electrolyte replacement,
    Strict NPO, Clear liquid diet, NG to low cont. suction, Morphine,
    Pantoprazole, pancreatic enzymes, D5W.

    NGN Case Study: Pancreatitis 10


    Answer to question #2: Drag n Drop
    The nurse knows that (Pancreatic Rest) is the priority concern for the
    client. (Strict NPO) is the most effective medical treatment option. NG to
    low cont. Suction, Pancreatic enzymes, Pantoprazole, Morphine,
    and D5W infusion are prescribed, and the nurse should administer (NG to
    low cont. suction) first. The nurse will question the healthcare provider
    as to why (D5W) has been prescribed.
    Rationale:
    • We would question the HCP if D5W is prescribed because the patient is
    hyperglycemic. The nurse would expect insulin to be prescribed instead. The nurses
    first priority is to rest the pancreas this is accomplished via Strict NPO, NGT to low
    cont. Suction, and TPN. After these are addressed, the nurse could expect to
    manage fluids, replace electrolytes, address pain control, manage/prevent systemic
    complications, and finally address the underlying issue.

    NGN Case Study: Pancreatitis 11


    Treatment
    Rest pancreas while addressing nutrition!
    • NGT to low suction
    • STRICT NPO
    • TPN (or jejunal feeding) or TEN
    • Fluid management & electrolyte replacement
    • Pain control = IV narcotics (morphine, fentanyl)
    • Prevent systemic complications
    • Address Alcohol Use
    • Adress the underlying issue. Potential ERCP? Surgery?

    NGN Case Study: Pancreatitis 12


    Summary of patient info

    Frank Gallagher was treated for acute pancreatitis, monitored for


    complications, and given supportive treatment. He is now tolerating a
    regular diet. His symptoms resolved and he is now being discharged to a
    rehab facility. He stayed in the hospital for 6 days.

    NGN Case Study: Pancreatitis 13


    Discharge teaching
    Look at him! He's beautiful and ready to go to rehab!
    Alcohol rehabilitation
    Abstinence from alcohol is the top priority!
    The nurse provides teaching to Frank
    about recognition of early symptoms that may
    indicate recurrence, when to contact the
    physician, lifestyle changes, abstinence from
    alcohol, and to take prescribed pancreatic
    enzyme with or immediately after meals and
    swallow them whole.

    PRESENTATION TITLE 14
    THE END

    NGN Case Study: Pancreatitis 15

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