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. He is suffering from acute pancreatitis and its complications
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?
Sample Answer
Acute Pancreatitis
As an ICU nurse, I would consider Frank’s diagnosis of acute pancreatitis and his symptoms to formulate an effective nursing intervention plan.
Nursing Diagnosis
From the observed symptoms, it appears that Frank is suffering from acute pain. Frank is therefore displaying numerous symptoms of acute pain, such as reporting such pain and displaying autonomic responses pain. This pain may be related to chemical contamination of peritoneal surfaces by autodigestion of the pancreas or pancreatic exudate (Johnstone, 2018). The acute pain that the patient is experiencing may also be a result of obstruction of pancreatic, biliary ducts. The acute pain that Frank displays may also be a result of the extension of inflammation to the retroperitoneal nerve plexus (Garber et al., 2018). As an ICU nurse, the desired outcome for the patient includes the patient reporting that the pain is controlled or relieved, demonstrating the utilization of different methods that provide pain relief, and following the prescribed therapeutic regimen (Johnstone, 2018).
Nursing interventions
The nursing interventions that would be ideal for Frank, who has been diagnosed with acute pancreatitis and is suffering from acute pain, would include conducting a pain evaluation of the patient. The ICU nurse would have to ask the patient to highlight the specific location of his pain and rate the intensity on a scale of 0 to 10. The nurse would also ask the patient what relieves or aggravates the pain. According to Nikkola et al. (2017), severe pain is there for one of the most significant symptoms of patients suffering from pancreatitis. Pain in the right upper quadrant of the patient, therefore, highlights the involvement of the head of the pancreas. On the other hand, pain in the left upper quadrant highlights the involvement of the pancreatic tail. For patients experiencing localized pain, the development of abscesses and pseudocysts is suspected (Nikkola et al., 2017).
The second nursing intervention that an ICU nurse would have to provide to Frank, who is suffering from acute pancreatitis, is allowing the patient to remain on bed rest. The nurse would therefore assist the patient in lying in their most comfortable position. This would help to decrease gastrointestinal is stimulation and the patient’s metabolic rate and thereby reduce the patient’s pancreatic activity and pain (Johnstone, 2018). The ICU nurse could also help the patient to sit in an upright position and flex their knees while leaning forward. Such a posture would help the patient to reduce abdominal tension and pressure and provide some pain relief for the patient (Garber et al., 2018). An ICU nurse could provide different comfort measures to the patient, such as quiet diversional activities, and encourage different relaxation techniques such as visualization and guided imagery. These techniques could help the patient to relax and to effectively cope with acute pain as a result of pancreatitis (Nikkola et al., 2017). Keeping the ICU environment free of food odors could also play a huge role in controlling the patient’s pain. According to Garber et al. (2018), sensory stimulation such as food odors can result in activation of enzymes in the pancreas increase the pain in a patient.
Treatment modalities
The treatment modalities for the patient with acute pancreatitis would entail narcotic analgesics such as pentazocine (Talwin) to relieve the patient’s pain. The administration of sedatives such as diazepam (Valium) would also be considered for the patient to reduce ductal spasms, enzyme secretions, and metabolic needs and promote rest (Nikkola et al., 2017). Finally, the administration of antacids and Cimetidine would also help to neutralize gastric acids and control the production of pancreatic enzymes and therefore reduce pain (Garber et al., 2018).
References
- Garber, A., Frakes, C., Arora, Z., & Chahal, P. (2018). Mechanisms and Management of Acute Pancreatitis. Gastroenterology Research and Practice, 1–8. https://doi.org/10.1155/2018/6218798.
- Johnstone C (2018). Pathophysiology and nursing management of acute pancreatitis. Nursing Standard. https://doi.org/ 10.7748/ns.2018.e11179.
- Nikkola, J., Laukkarinen, J., Huhtala, H., & Sand, J. (2017). The Intensity of Brief Interventions in Patients with Acute Alcoholic Pancreatitis Should be Increased, Especially in Young Patients with Heavy Alcohol Consumption. Alcohol and Alcoholism, 52(4), 453–459. https://doi.org/10.1093/alcalc/agx023
