Pancreatitis Case Study PDF

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Pancreatitis Case Study Adult Health 2020 1. Why is Mrs. S. NPO? ○ To rest the pancreas and suppress gastrointestinal secretions 2. Discuss the importance of maintaining the NG tube to low intermittent suction in this patient ○ Eliminates aspiration risk 3. Which type of NG tube may be inserted and placed to suction? ○ Salem sump 4. Please explain, step by step, how you would educate, prepare, position this patient, & insert the NG tube

Measurement 1. Position the patient sitting upright with their neck straight 2. Don gloves 3. Measure the desired length of the NG tube to be inserted: ● Measured from the bridge of the nose to the ear lobe ● Then down to 5cm below the xiphoid process Insertion of NG tube 1. Lubricate the tip of the NG tube 2. If available, a local anesthetic spray can be used on the back of the throat 3. Insert the NG tube in through a nostril – warn the patient prior 4. Gently advance the NG tube through the nasopharynx ● If resistance is met, rotating the NG tube can help, however, DO NOT force the NG tube ● If the patient is becoming distressed or gagging, pause to allow the patient to relax ● It’s useful to look inside the patient’s mouth intermittently to ensure the NG isn’t coiling in there 5. Continue to advance the NG tube down the esophagus ● Ask the patient to take some sips of their water and swallow ● This can help facilitate the advancement of the NG tube 6. Once you reach the desired insertion length, fix the NG tube to the nose with a dressing Aspiration of NG tube 1. Attempt to aspirate gastric contents: ● If aspiration is successful, test the pH (if pH is 4 the patient will require a chest x-ray 2. Once NG tube is deemed safe for feeding (or other uses), the guidewire can be removed 3. Dispose of used equipment into a clinical waste bin 4. Wash hands

Pancreatitis Case Study Adult Health 2020 To Complete the Procedure 1. Explain to the patient that the procedure is over 2. Reassure that the NG tube will become more comfortable over the next few hours 3. Offer patient paper towels to clean their face and nose 4. Document clearly the procedure of NG tube placement: 5. Inform nursing staff that the NG tube is inserted and safely positioned

5. Which method would you use to confirm the proper placement of the NG tube before using it? ○ Aspiration and test of pH ○ X-ray 6. Name 2 positions that can be encouraged in a patient with pancreatitis to alleviate pain – and why? ○ positions that flex the trunk, with the knees drawn up to the chest ○ A side-lying position with the head elevated 45 degrees decreases tension on the abdomen and may help ease the pain 7. What recommendations in regard to ETOH intake should be given to a patient with acute pancreatitis? ○ Abstinence from alcohol is necessary for pancreatitis, as is a high-carbohydrate, high protein, and low-fat diet. Although abdominal pain is a major manifestation of chronic pancreatitis, more commonly a constant heavy, gnawing feeling occurs. 8. Reviewing Mrs. S’s lab work – which specific findings assist in the diagnosis of acute pancreatitis? Vitals Temperature is high (101F) Pulse is high (118 bpm) Respiration is slightly high (22 breaths per minute) Blood pressure is low (100/68)

Lab work Amylase (580) and Lipase (820) levels are high Amylase normal levels: 23-85 Lipase normal levels: 0-160

BUN is high (31) And calcium is low (6.1) Glucose is high (197)

9. Is Lactated Ringer’s the most appropriate IV solution to be used in a pancreatitis patient? Why or why not?

Pancreatitis Case Study Adult Health 2020 ○ The patient is NPO. Giving them LR will replace the electrolytes they are missing by not eating. 10. Mrs. S. is ordered Fentanyl IV for pain… ○ Which vital signs would be most important to check before administering this medication and why? Which vital sign would be most important after administering Fentanyl? Why? ■ Blood pressure, respiratory rate, pulse rate, and O2 Stat. Fentanyl is an opioid and relaxes the body. This causes vital signs to drop. This is the Fentanyl that you will be administering

How will you remove the top? To open the ampoule, hold it with both hands, with one thumb against the narrow top section. Hold the bottom of the ampoule firmly while pushing the top section away from you with easy, even pressure. Light pressure should cleanly snap the ampoule open while using too much force can cause it to shatter. ● What type of needle will you use to draw up the medication? ○ Filter needle ● How many mls of medication will you draw up for the correct dose? ○ The doctor ordered 50 mcg IV Q3 hours. I will administer 1ml of Fentanyl ● At which rate will you safely administer this medication? 11. Which physician’s orders indicate prophylaxis for deep venous thrombosis (DVT)? ○ SCD’s to bilateral lower extremities 12. Discuss Mrs. S’s calcium level. Is it low or elevated? Why? ○ Her Calcium levels are low. This is caused because the pancreas is no longer functioning properly, causing hypocalcemia. 13. Which neuromuscular s/sx would you monitor based on Mrs. S’s calcium level? ○ Chvostek and Trousseau are signs of hypocalcemia. As well as tingling, numbness, bradycardia, and seizures. 14. Mrs. S. is ordered Protonix, a proton pump inhibitor. Why is this medication routinely prescribed for a patient with acute pancreatitis?

Pancreatitis Case Study Adult Health 2020 ○ Protonix has a pancreatic anti-secretory effect. 15. What dietary recommendations will you include in your plan of care for Mrs. S. when she is no longer NPO? ○ It is important for pancreatitis patients to eat high protein, nutrient-dense diets that include fruits, vegetables, whole grains, low-fat dairy, and other lean protein sources. Abstinence from alcohol and greasy or fried foods is important in helping to prevent malnutrition and pain 16. Please list and prioritize 3 nursing diagnoses that would be applicable to Mrs. S. ○ Acute Pain ■ Position change and round the clock pain medication can help assist with pain. ○ Risk for infection ■ Observe for signs of infection. Such as fever, respiratory distress, and jaundice. ○ Imbalance nutrition ■ Assess abdomen, noting the presence and character of bowel sounds, abdominal distension, and reports of nausea....