The document presents a case study of a 63-year-old woman, B.K., admitted to the hospital with symptoms of acute pancreatitis. Her initial workup found elevated amylase and lipase levels and imaging showed a moderately severe pancreatitis. She developed a pleural effusion that required a thoracentesis. After several days, B.K. exhibited signs of alcohol withdrawal. She eventually admitted to daily heavy alcohol use, revealing it as the likely cause of her pancreatitis.
The document presents a case study of a 63-year-old woman, B.K., admitted to the hospital with symptoms of acute pancreatitis. Her initial workup found elevated amylase and lipase levels and imaging showed a moderately severe pancreatitis. She developed a pleural effusion that required a thoracentesis. After several days, B.K. exhibited signs of alcohol withdrawal. She eventually admitted to daily heavy alcohol use, revealing it as the likely cause of her pancreatitis.
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Presentation I made after analyzing a case study involving pancreatitis.
The document presents a case study of a 63-year-old woman, B.K., admitted to the hospital with symptoms of acute pancreatitis. Her initial workup found elevated amylase and lipase levels and imaging showed a moderately severe pancreatitis. She developed a pleural effusion that required a thoracentesis. After several days, B.K. exhibited signs of alcohol withdrawal. She eventually admitted to daily heavy alcohol use, revealing it as the likely cause of her pancreatitis.
The document presents a case study of a 63-year-old woman, B.K., admitted to the hospital with symptoms of acute pancreatitis. Her initial workup found elevated amylase and lipase levels and imaging showed a moderately severe pancreatitis. She developed a pleural effusion that required a thoracentesis. After several days, B.K. exhibited signs of alcohol withdrawal. She eventually admitted to daily heavy alcohol use, revealing it as the likely cause of her pancreatitis.
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A PRESENTATI ON BY
HENRY R. CHOUI NARD
Case Study 51 Pancreatitis Epidemiology 40 cases per year per 100,000 adults US has the highest rates of pancreatitis African Americans 3 times more likely Common causes Alcohol use Biliary tract malfunctions Cholelithiasis (Gallbladder stones) Pathophysiology Endocrine and Exocrine functions Digestive enzymes Amylase Tripsin Lipase
Premature Activation Autodigestion
Assessment Abdominal pain that radiates to the back Tenderness and Guarding Pain worsens after eating Diagnostics Blood tests Stool tests CT Scan Ultrasound Interventions Fasting slowly advancing diet Pain Management IV fluids Surgery http://daveproject.org/transgastric-endoscopic- necrosectomy-for-walled-off-pancreatic- necrosis/2009-10-28/ Enzyme replacement therapy Case Study B.K. is a 63-year-old woman who is admitted to the medical-surgical unit from the ED with nausea and vomiting and epigastric and LUQ abdominal pain that is sever, sharp, and boring and radiates through her mid-back. The pain started 24hrs ago and awoke her in the middle of the night. B.K. is retired and smokes half-pack of cigarettes daily. She is anxious and demanding when she arrives on the unit. B.K. denies using alcohol. VS are 100/70, 97bpm, 30, 100.2F, 88% Room Air, 92% 2L NC. Hasnt been to a physician in years. Case Study Continued ED nurse giving you the report states the admitting diagnosis is acute pancreatitis of unknown etiology.
What do you think might be the cause? Case Update CT scanner is down but an ultrasound was performed. no cholelithiasis, gallbladder wall thickening, or choledocholithiasis was seen. Pancreas was not well visualized due to overlying bowel gas. Urine was dark in color
How does this information change your thoughts about the cause? Case Study Progress B.K. is restless, lying on her right side, diaphoretic with poor skin turgor, tachycardic, tachypnea, absent breath sounds LLL, N/V with dry heaves, hypoactive bowel sounds, distended/firm abdomen that is tender with guarding noted.
Of these assessment findings, what do you think points towards the diagnosis of acute pancreatitis? Laboratory Test Results BUN 24mg/dL WBC 17,500/mm 3 Total bilirubin 2.0 mg/dL Creatinine 1.4 mg/dL Amylase 2,000 u/L Lipase 3,000 u/L Albumin 3.0 g/dL
Which values are important with this case? Chest X-ray Report The admission Chest X-ray reports reads, small pleural effusion in the LLL
What are some ways that you as a nurse could improve her condition? NPO Woes B.K. complains of thirst and demands something to drink, her orders indicate NPO, except sips and chips
How do you handle her request? Why is she NPO?
Silent Night But Wait! B.K. eventually falls asleep peacefully. Suddenly several hours later her pulse oximeter alarm goes off. It reads 87% and she is moaning softly.
What will you do!?
Respiratory Assessment Lungs sounds absent in the LLL and very diminished in the RLL. You percuss a dull thud over the LML and LLL up to the scapula tip. You also hear resonance over the entire right lung and LUL.
What do these finding suggest? What will most likely be ordered to verify your findings?
Another Chest X-ray A STAT CXR shows significant pleural effusion developing in the LLL with extension into the RLL.
As a nurse, what are you responsible for with a thoracentesis? What caused this effusion to happen in the first place? Things Begin to Look Better The physician removed 200ml of slightly cloudy serous fluid and the antibiotics were adjusted. B.K. is on 3L NC with unlabored and regular respirations; 96% CT scanner is working and it shows a moderately severe pancreatitis, but no local fluid collection or pseudocysts. No ileus or evidence of neoplasia was noted Her laboratory values are decreasing towards normal levels. Physician writes an order to advance B.K. diet to full liquids.
If she cannot tolerate this diet, what physiologic need should be addressed at 72hrs? And on the Third Day B.K. becomes agitated with tremors, some disorientation, and auditory hallucinations. Her pulse and BP are elevated, although her pain has not increased. She has had no visitors since her admission.
What is B.K. most likely experiencing? What actions will you take? The Real Truth Revealed The physician orders scheduled Librium and a social services consult to evaluate and treat possible alcohol abuse. 3 days later she is lucid, tolerating clear liquids, and her pain is controlled w/ PO pain medications. She eventually admits to drinking 3-4 scotch-on-the-rocks daily and is estranged from her family due to her drinking. Her discharge is ordered for this evening if she tolerates a low-fat/low-cholesterol diet, which she does.
Why a low-fat/low-cholesterol diet? What will you include in her discharge teaching? Research Opportunities Pancreatitis is very well known and documented disease. Mortality rates are high, how do we improve? There is no reliable screening test for the early detection of pancreatic cancer. We need to invest in the development of an effective screening test. Sources Cited Acute Pancreatitis . (n.d.). Acute Pancreatitis. Retrieved February 24, 2014, from http://emedicine.medscape.com/article/181364-overview#a0156 Clinic, M. (n.d.). Pancreatitis. Diagnosis at Mayo Clinic. Retrieved February 26, 2014, from http://www.mayoclinic.org/diseases- conditions/pancreatitis/basics/tests-diagnosis/con-20028421 Harding, M., & Snyder, J. S. (2013). Case Study 51. Winningham's critical thinking cases in nursing: medical-surgical, pediatric, maternity, and psychiatric (5th ed., pp. 229 - 233). St. Louis, Mo.: Elsevier/Mosby. Hopkins, J. (2012, November 12). Basics of Pancreatic Cancer. Johns Hopkins Medicine. Retrieved February 26, 2014, from http://pathology.jhu.edu/pc/basicintro.php?area=ba Transgastric Endoscopic Necrosectomy for Walled-Off Pancreatic Necrosis. (n.d.). DAVE Project Gastroenterology RSS. Retrieved March 4, 2014, from http://daveproject.org/transgastric-endoscopic-necrosectomy-for- walled-off-pancreatic-necrosis/2009-10-28/
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