Nursing Case Study Acute Pancreatitis

HISTORY OF PRESENT ILLNESS: This 46-year-old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis, presents to the emergency room after having had three days of abdominal pain. It initially started three days ago and was a generalized vague abdominal complaint. Earlier this morning, the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o. earlier around

JF’s risk factors include her age (79), hypertension, and previous history of coronary arterial disease (NSTEMI about 10 years ago) (1). JF’s current medications do not contribute to her dyslipidemia (1). She does not have a family history of premature cardiovascular diseases. Secondary prevention of cardiovascular events and all-cause-mortality are the primary outcomes for JF’s lipid-lowering therapy. JF was previously stable on atorvastatin for many years and thus has not had lipid testing in the past year. JF recalls meeting her cholesterol targets previously (LDL ~2.0 mmol/L, HDL ~1.2 mmol/L, TG and TC unknown). The recommended target values for post-MI patients are LDL-C of <2.0 mmol/L, and HDL-C <2.6 mmol/L (1 ,2). However, no clinical studies thus far have directly evaluated the benefits of titrating statin dose to achieve target values. A different fix-dose approach involves giving patients the same doses that were shown to produce clinical benefits in trials regardless of how much LDL-C reduction was achieved (1, 2). Using this approach, lipid measurements are only used to monitor for adherence and safety (in case LDL-C too low) (1). Patients with prior history of CAD are considered high-risk (Framingham risk >20%) regardless of their lipid

This is 51 year old AAF. Patient is here for general physical exam for Medicaid application. Patient states that she has a pancrititis. For that reason, she can only perform vare minimal activities. Patient sates she cannot work for that same reason. Patient denies chest pain, reports SOB with minimal activy, denies N/V/ D, or fever. Patient denies depressive moods.

HISTORY OF PRESENT ILLNESS: This 46-year old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis presents to the emergency room after having had 3 days of abdominal pain. It initially started 3 days ago and was a generalized vague abdominal complaint. Earlier this morning the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o earlier around 6am, but he now

“Each year, acute pancreatitis sends more than 200,000 Americans to the hospital. Many of those who suffer from pancreatic problems are also heavy drinkers” (“Beyond Hangovers: Understanding Alcohol's Impact Your Health” 15). The pancreas is an important organ which aids in digestions and energy conversion. The pancreas directs enzymes to the small intestine to digest nutrients and it also secretes insulin and glucagon. The body’s main source of energy is glucose and insulin allows additional glucose to be stored away in the body properly. Too much alcohol damages cells in the pancreas, causing complications with insulin, leaving the organ open to inflammation. Alcohol causes the pancreas to discharge the enzymes intended for the small intestine back into the pancreas which can lead to inflammation and the swelling of tissues and blood vessels. Pancreatitis is the inflammation which causes the organ to malfunction and if one continues to drink, it can magnify into chronic pancreatitis when the inflammation is constant (“Beyond Hangovers: Understanding Alcohol's Impact Your Health” 15-16). Pancreatitis causing severe abdominal pain, persistent diarrhea, and is not curable. Sixty-percent of circumstances result from alcohol; although, some have been linked to gallstones (Freeman).

MR. David likewise takes atorvastatin (Lipitor); 10 mg every day, for hypercholesterolemia (hoisted LDL cholesterol, low HDL cholesterol, and raised triglycerides). He has endured this medicine and holds fast to the day by day plan. Amid the previous 6 months, he has likewise taken chromium picolinate,

A 14 year old female with no known history of pancreatitis, alcoholism, diabetes, or biliary disease presented for an abdominal sonogram. Her only symptom was generalized upper abdominal pain with no history of nausea, vomiting, weight loss, or appetite changes. Ultrasound images showed a well circumscribed, round, hypoechoic 14-mm lesion within the head of the pancreas and another lesion in the body. Color Doppler analysis showed no internal or peripheral vascularity associated with the lesions. The main pancreatic duct was dilated, measuring at 4 mm. The ultrasound examination was followed by an MRI which demonstrated a 12 mm mass in the pancreatic body that correlated to the

The pain is constant and becomes more severe as the days go on. There are many possible indications as to what causes pancreatitis. Some of these causes include alcoholism, cystic fibrosis, gallstones, trauma, and family history of pancreatitis. When a patient has repeated flare-ups of pancreatitis, it is classified as chronic pancreatitis. As this disease progresses, it usually leads to permanent damage of the pancreas. Pancreatitis is treated in many different ways. Once the underlying cause of the disease is known, treatment may include removal of bile duct obstructions, cholecystectomy, treatment for alcoholism, or pancreas surgery to remove some of the damaged

Patient has a CVD (cardiovascular disease); can be exacerbated by having high cholesterol (could be the cause of his angina). Therefore, atorvastatin 80 mg was initiated for secondary prevention of CV

The doctor may also take a blood test to determine if the jaundice is due to pancreatic cancer or liver disease. (Panno) Once the patient is diagnosed with pancreatic cancer, they can choose from different treatment plans. When determining the person’s treatment plan, they take consider their age and expected lifespan, other serious health conditions, the stage of the cancer, if surgery can remove cancer, likelihood of curing the cancer, and how the person feels about side effects. For many patients, the part that most important is the controlling of pain. Some treatments for the cancer include surgery, radiation therapy, chemotherapy and other drugs. (Treating) Treating pancreatic cancer is very difficult due to the dense outer shell around the pancreatic tumor and nearly impossible to penetrate with cancer-killing drugs. “Wall is so tough that clinical trials with medications that are experimental designed to breach barrier had to be abandoned mainstream, drug so harsh they sicken already ailing patients,” said Doctor Abram Handly-Santana, a researcher who specializes in pancreatic cancer. (Ricks) Even though treating pancreatic cancer is difficult, some doctor decide to perform surgery to determine if the tumor is removeable and to determine the staging of the cancer to prescribe the best treatment. (Panno) The best

Acute pancreatitis is an acute inflammatory process ranging from mild abdominal discomfort to severe disease involving multiple organ systems. Diagnosis is based on the presence of at least two of the following three features: abdominal pain; increased pancreatic amylase, and/or lipase levels to ≥3 times the upper limit of normal; and imaging tests showing characteristic findings of acute pancreatitis. The incidence of acute pancreatitis is known to differ geographically due to differences in alcohol consumption or in the incidence of gallstones disease in different parts of the world. Cholelithiasis is the leading cause of acute pancreatitis

The next step in treating a patient with an acute pancreatic attack is focusing on the patient’s current diet and nutrition status. The patient experiencing an acute pancreatitis will need many diet modifications to limit the amount of stimulation to the stomach. However, the patient’s nutrition status must be closely monitored and the appropriate interventions to maintain the patient 's health must be implemented. Acute pancreatitis is a hypermetabolic and hypercatabolic event. Therefore, treatment and maintenance of an individual with acute pancreatitis is contradicting itself. Interventions for this nursing diagnosis include; assessing bowel sounds, maintaining a NPO status, initiating a parental and/ or enteral

Chronic pancreatitis is a continuous inflammatory disorder that is characterized by permanent damage to pancreatic structure and exocrine function. The condition is usually progressive. Symptoms such as vomiting and discomfort after eating may occur intermittently, sometimes accompanied by depression, loss of appetite, and weight loss. In some cases, signs may be as subtle. Chronic pancreatitis may periodically flare up, resulting in acute pancreatitis(Shell, Pg 4).

Can CT be used to predict the outcome and progression of acute pancreatitis in patients exhibiting early signs and symptoms?

A., Conwell, D. L. and Toskes, P. P. (2010). The management of acute and chronic pancreatitis. Journal of Gastroenterology and Hepatology 6, 1–16.