[Verified Answer]: CASE STUDY: GENDER AGE Female 88 SETTING ☐…

CASE STUDY: GENDER AGE Female 88 SETTING ☐ Hospital ETHNICITY ☐ White American CULTURAL CONSIDERATIONS ASE STUDY 3 Mrs. Miller PREEXISTING CONDITIONS ☐ Heart failure (HF); hypothyroidism; gastroesophageal reflux disease (GERD); allergy to penicillin (PCN) COEXISTING CONDITION COMMUNICATION DISABILITY SOCIOECONOMIC SPIRITUAL/RELIGIOUS PHARMACOLOGIC ☐ Potassium chloride (KCI); LEGAL pantoprazole sodium (Protonix); levothyroxine sodium (Synthroid); spironolactone (Aldactone); metoclopramide (Reglan); morphine sulfate (MS Contin) ETHICAL ALTERNATIVE THERAPY PRIORITIZATION DELEGATION THE ENDOCRINE/METABOLIC SYSTEM Level of difficulty: Difficult Overview: This case discusses the diagnostic characteristics and treatment of acute pancreatitis. Use of the Ranson and Glasgow criteria assessment tools to determine disease severity is explained. Potential complications of acute pancreatitis are considered. The nurse educates the client about a scheduled diagnostic procedure to help reduce the client’s anxiety. Safe administration of a medication via a nasogastric tube is ensured. 105 DIFFICULT 106 Part 8 THE ENDOCRINE/METABOLIC SYSTEM Client Profile Case Study Mrs. Miller is an 88-year-old woman who presented with complaints of nausea, vomiting, and abdominal pain. Her vital signs on admission are temperature 99.6°F (37.6°C), blood pressure 113/82, pulse 84, and respiratory rate 20. Her laboratory tests reveal white blood cell count (WBC) 13,000/mm3, potassium (K†) 3.2 mEq/L, lipase 449 units/L, amylase 306 units/L, total bilirubin 3.4 mg/dL, direct bilirubin 2.2 mg/dL, aspartate aminotransferase (AST) 142 U/L, and alanine aminotrans- ferase (ALT) 390 U/L. Physical examination reveals a distended abdomen that is very tender on palpation. Bowel sounds are present in all four quadrants, but hypoactive. Mrs. Miller is admitted with a diagnosis of acute pancreatitis. She will be kept nothing by mouth (NPO). Intravenous (IV) fluid of D51/2 NS with 40 mEq of potassium chloride (KCl) per liter at 100 mL per hour is prescribed. The health care provider prescribes continued administration of her preadmission medica- tions, that is, pantoprazole sodium and levothyroxine sodium (in IV form because the client is NPO) and spironolactone (available in oral form), and adds the pre- scription of IV metoclopramide and morphine sulfate. A nasogastric (NG) tube is inserted and attached to low wall suction. Mrs. Miller’s NG tube is draining yellow-brown drainage. Her pain is being man- aged effectively with IV morphine 4 mg every four hours. Mrs. Miller is anxious and has many questions for the nurse: “What is the test I am having done today? What is pancreatitis? Will I need to have surgery? Why did they put this tube in my nose? When will I be able to eat real food?” Questions 1. Briefly explain acute pancreatitis and discuss its incidence. 2. Mrs. Miller’s admitting diagnosis is acute pancreatitis. Can a person have chronic pancreati- tis? If so, what is the incidence, and how would you define chronic pancreatitis? 3. Discuss the common clinical manifestations of acute pancreatitis. 4. Briefly discuss the diagnostic tests that help confirm the diagnosis of pancreatitis. 5. Identify the assessment findings in Mrs. Miller’s case that are consistent with acute pancreatitis. 6. Identify the possible causes of acute pancreatitis. Discuss the physiology of the two major causes of acute pancreatitis in the United States, and note which individuals are ar risk. 7. The severity of an acute pancreatitis episode can be assessed using two tools: (1) Ranson/Imrie criteria. and (2) modified Glasgow criteria. Describe each of these tools. 8. Briefly discuss the treatment options for pancreatitis, and explain why Mrs. Miller has an NG tube to low wall suction. 9. Discuss the complications that can arise if pancreatitis is not treated. 10. Evaluate Mrs. Miller’s potassium level. Should the nurse question the health care provider’s prescrip- tion for the diuretic spironolactone? Why or why not? 11. Because Mrs. Miller is NPO, the nurse must administer the oral spironolactone via the NG tube. Is it appropriate to crush this medication? Why or why not? What intervention should the nurse take following administration of the medication to facilitate absorption? 12. Which type of diet will Mrs. Miller advance to when her NPO status is discontinued? What types of liquids are allowed on this diet? 13. Identify the priority nursing diagnosis for Mrs. Miller’s plan of care and two additional nursing diagnoses that the nurse should consider.