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. four risk factors associated with pancreatitis

• severe alcohol consumption
• history of smoking.
• obesity.
• high lipase level.

2. treatment prescribed by the physician:

1. pain medications (acetaminophen, ibuprofen)
2. NPO
3. I V administration
4. O2 administration

3. lab values:

here there is an abnormal elevation in serum amylase 188U/L (normal range is 30 to 110 U/L)

and an abnormal elevation of serum Lipase 400U/L(normal range is 0 to 160 U/L)

4. complications:

local-

• acute fluid collection
• pancreatic necrosis
• pseudocyst

systemic-

• ARDS
• shock
• DIC