Question

Forty-nine-year-old Frank has been a heavy drinker for the past 25 years. He also has a history of hypertension, hyperlipidemia, and recent upper respiratory viral infection. Frank’s only current medication is Lasix (furosemide) 40 mg od. He presents with severe epigastric pain that radiates to his back and worsens when lying down. His abdomen is distended, and bowel sounds are hypoactive. Frank has a fever and is diaphoretic and hypotensive, and his serum calcium is very low.

In your initial post answer the following questions:

1. Frank is being transferred to the ICU. If you were the ICU nurse, what would you have to consider in Frank’s case?
2. What would you expect in the way of treatment modalities for Frank?

Answer 1

Ans-

In this case,the Frank Having used the only one medication that is furosemide 40mg od. This drug is used in the treatment of hypertension to reduce the preload on heart.it act as a diuretic drug.

Where Frank suffering from various types of heart disease and he is aslo consume alcohol.in this case alcohol is harmful for his health.where diaphoresis means excessive sweating.where the hypoactive bowl sound are occurred during the sleeping time.

The Given symptoms on this case, especially a radiating back pain which worsens on lying down is a clearally indicate that the patient having Pancreatitis. the most common cause of the Pancreatitis is high consumption of alcohol, and Frank being an aloholic for last 25 years. Symptoms include a rapid pulse, fever, nausia, swollen and tender abdomen all because of the inflammation to pancrease.in simple words the Pancreatitis means inflammation to the pancrease.

Pancreatitis occurs when the digestive enzymes produced in your pancreas become activated while inside the pancreas, causing damage to the organ.

Ans-1) Intervention of nurse in ICU-

First intervention in the treatment in the ICU isAssess nutritional status, respiratory status, fluid and electrolye status and assess abdomen for asccites.the ending oral intake, rehydration and prevention or renal and respiratory insufficiency. Investigate pain on 0-10 pain scale and location.

Isolated the pain in RUQ indicates head of pancreas and LUQ is tail of pancreas this the help patient with bed rest and comfort, which decreases the metabolic rate and hence secretions of the GI will reduce the panncreatic activity.

Assess nutrition and breathing pattern. Improve the breathing pattern , by maintaining in semi-Fowler's position and imporve nutrition by giving protein rich diet.

Observe for intractable pain due to complications of biliary tract like pancreatic abscess and pseudocyst.Maintain the gastric suction to stimulate the pancreatic enzyme activity.

Ans-2) tratement modilities for frank-

1)Can be prescribed antacids like the Ranitidine to reduce GI secretion of HCl.

2)Prescribe sedatives drug like barbiturates and antispasmodics like atropine, to reduce metabolic needs and pancreatic enzyme secretions.

3)Narcotic analgesics are may be prescribed if the prolonged pain is occurred.

4)Antibiotics only if there is necrotizing pancreatitis symptoms or signs of infection, no prophylactic antibiotic therapy.

5)To avoid infected necrosis, so inducing antibiotic threapy should be beneficial. Intravenous nutritional support can be resorted to. Hypocallcemia correction with i.v. calcium should be done with utmost care.

6)Hypomagnesaemia is found in alcoholics, so Mg correction should be done before hypocalcemia.

7)Antioxidant therapies-Basic and clinical evidence suggests that the development of both acute pancreatitis (AP) and chronic pancreatitis (CP) can be associated with oxidative stress.thats why antioxidants treatment is used.