1. Briefly explain acute pancreatitis and discuss its incidence.

Acute Pancreatitis is described as an inflammatory disease that affects the pancreas.  The pathogenesis and etiology of the disease have been intensely investigated for several years worldwide. As per the incidence, it is a relatively common ailment that affects roughly 300,000 people per year in the US with a mortality rate of 7%. In 80% of the patients, acute pancreatitis is deemed to be mild it resolves itself here with no severe complications. It only has severe complications on about 20% of the patients and poses substantial mortality despite the great interventions (Engel, Williams, Golm, Clay, Machotka, Kaufman & Goldstein, 2010).  Alcoholic pancreatitis incidence is higher in males. Males have got a greater risk of suffering acute pancreatitis in the patients with gallstones. However, more women develop the disease because gallstones occur in women with an increased frequency.

2. Mrs. Miller’s admitting diagnosis is acute pancreatitis. Can a person have chronic pancreatitis? If so, what is the incidence, and how would you define chronic pancreatitis?

Yes, it is true that an individual can have chronic pancreatitis. It is an inflammation of the pancreas which does not heal but gets worse over a given period causing permanent damage.  The disorder is caused by the consumption of alcohol for a more extended period most probably many years. The condition mostly develops in people between 30-40 years of age. The recurrence of acute pancreatitis leads to chronic pancreatitis. The disease primarily occurs in men than women.

3. Discuss the common clinical manifestations of acute pancreatitis.

The most common clinical symptom of acute pancreatitis is abdominal pain. These include; upper abdominal pain, the abdominal pain which extrapolates to the patients back and the abdominal pain which makes the patient feel worse after eating. The other clinical manifestations are; nausea, rapid pulse, fever, vomiting, and tenderness when touching the abdomen.

4. Briefly discuss the diagnostic tests that help confirm the diagnosis of pancreatitis.

The diagnostic tests that are used to diagnose pancreatitis are; Blood test which used to check for the increased levels of pancreatic enzymes. Stool test mostly used in chronic pancreatitis to measure fat levels, which suggests that the digestive system does not absorb nutrients as required. Computerized Tomography, this involves scanning of the pancreases to check for the presence of gallstones and to investigate the extent of inflammation of the pancreas. Endoscopic Ultrasound used to check for any blockages of the pancreas duct and its inflammation. Magnetic resonance Imaging used to look for pancreas, gallbladder and ducts abnormalities. Abdominal Ultrasound used to check pancreatic inflammations and gallstones.

5. Identify the assessment findings in Mrs. Miller’s case that are consistent with acute pancreatitis.

The assessment findings in Mrs. Millers that are consistent with acute pancreatitis include vomiting, nausea, abdominal pain, and rapid pulse. The others are fever signaled by the high temperature and abdomen which is distended and extremely tender on palpation.

6. Mrs. Miller asks, “What is the test I am having done today?” How would the nurse describe a KUB to Mrs. Miller?

The test that Mrs. Miller is to take is called a KUB.  Kidney, Ureter, Bladder is a plain film radiology test that is used to evaluate stone growth interval in patients with stone diseases that have been recognized. The test can also be used in setting the acute stones in the patient. The test is capable of providing a 3D visualization of the kidney stones without exposure to radiations making it a safer method. The test enables the practitioners to carry out an intravenous pyelogram to evaluate the existence of obstruction and hydronephrosis in the patients.

7. 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 at greatest risk.

The two leading causes of pancreatitis include chronic alcohol drinking and gallstones. Gallstones are made up of tiny rocks formed in the gallbladder. The cholesterol and bile materials they are made of joins together to build a mass of solid. Gallstones find their way into the bile duct from the bladder thereby obstructing pancreatic. The blockage leads to a collection of the pancreatic fluid in the pancreatic duct causing the pancreas inflammation. Gallstones are more in women than men (Tenner, Baillie, DeWitt, & Vege, 2013). It affects all the age groups but affects the old age patients on the higher side. The second most common cause is chronic alcohol abuse. Alcohol contains metabolic and toxic elements that affect acinar cells in the pancreas.  Alcohol causes premature enzymes activation, small obstruction of the duct interferes with the normal blood flow in the pancreas. It also leads to abnormalities in the Oddi motility sphincter, activates cholecystokinin and releases secretin which starts up pancreatic secretion. Alcoholic pancreatitis is mostly affecting the population of middle age, with 45-55 years peak incidence.

8. 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.

Ranson Criteria was made initially for alcohol-induced AP. Later it was changed for gallstone- induced AP and was based on using the cut off value of 3. It uses the criteria of age, glucose, WBC, and serum on admission to test the severity of pancreatitis. The criteria are repeated after 48 hours.  Glasgow Imrie was modified from Ransom’s criteria used to test acute pancreatitis. Initially, it was composed of 9 factors which were later reduced to 8 because of its high predictive value. It indicates the severity of pancreatitis by taking three and above positive criteria on blood basis, which is repeated after 48 hours. A score is achieved by assigning a point to each criterion. The variables used are Age, calcium, PaO2, Blood glucose, LDH, Albumin, and WBC.

9. Briefly discuss the treatment options for pancreatitis and explain why Mrs. Miller has an NG tube to low wall suction.

In mild cases, the patients can stay at home as they take pain medication and clear liquids. The treatment of patients suffering from acute pancreatitis is mostly geared towards managing the metabolic complications, pain reduction, decreasing the level of stimulation of the pancreas, supportive care to the patients among others.  In acute cases, patients should be hospitalized and taken through ERCP to remove the stones in the bile duct causing obstructions. X-Ray and other imaging methods can be employed in the treatment of the disease. Amylase and lipase form important tests for patients suffering from pancreatitis. Therefore, the other treatment that doctors concentrate on is to ensure that the level of amylase and lipase are improved to the right level (Carroll, Herrick, Gipson & Lee, 2007).  The work of the NG used by Mrs. Miller is to deliver nutrients via the feeding pump to the patient and also help in removing gastric contents. It drains the stomach hence preventing vomiting, nausea, washing the toxins in the stomach and removal of gastric distention.

10    Discuss the complications that can arise if pancreatitis is not treated.

Pancreatitis can lead to severe complications if not treated. The complications include; Pseudocyst, involves collection and debris in the pancreas in cyst-like pockets, causing internal bleeding and infection (Forsmark, 2007).  Infection, the disease can make the pancreas vulnerable to infections and bacteria. Breathing problems, the chemical change in the body leads to lung malfunctioning and low oxygen level. The other complications include Kidney failure, Diabetes, Malnutrition and pancreas cancer.

11. Evaluate Mrs. Miller’s potassium level. Should the nurse question the health care provider’s prescription for the diuretic spironolactone? Why or why not?

The blood potassium level of the patient is low, as an average person should have a blood potassium level of 3.5- 5.0 milliEquivalents per liter while the patient had 3.2 mEq/L. The nurse should not question the health care provider’s prescription of diuretic spironolactone.  Because it has been administered supplement the potassium level by increasing it in the blood level to normal.

12. 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?

It is not appropriate for the nurse to crush the drug. This is because the drugs physical and chemical property mostly controls its subsequent absorption. If crushed it may also reduce the effectiveness, occluded feeding tube or increased toxicity of the drug. The nurse must first of all check the safe means of administering the drug via NG tube. These include compatibility of the drug, the chemical composition, drug absorption rate as per ASPEN rules, internal diameter and length of the tube, the size of the oral syringe, and composition of the tube among others. These would help in safe drug dosing and intraluminal pressures.

13. Which type of diet will Mrs. Miller advance to when her NPO status is discontinued? What types of liquids are allowed on this diet?

The type of diet that Mrs. Miller should advance to when her NPO status is discontinued should be low-fat foods and carbohydrate-rich drink. The fluids that they should be given should be the fluids that are as clear as possible to prevent any internal complications.

14. Identify the priority nursing diagnosis for Mrs. Miller’s plan of care and two additional nursing diagnoses that the nurse should consider.

The priority diagnosis for Mrs. Miller plan of care is Actual diagnosis. The diagnosis nursing care would help improve Mrs. Miller’s health condition as it makes her oust the fear, panic, and apprehensions she might have. The other nursing diagnoses that the nurse should consider are the wellness and risk diagnoses.  Wellness diagnosis helps to encourage and assure the patient, family and the community of the wellness of the patient. Risk diagnosis enables the nurse to advise both the patient and the family of any risk she would face when they go contrary to medication instructions.

References

Carroll, J. K., Herrick, B., Gipson, T., & Lee, S. P. (2007). Acute pancreatitis: diagnosis, prognosis, and treatment. American family physician, 75(10).

Engel, S. S., Williams‐Herman, D. E., Golm, G. T., Clay, R. J., Machotka, S. V., Kaufman, K. D., & Goldstein, B. J. (2010). Sitagliptin: review of preclinical and clinical data regarding incidence of pancreatitis. International journal of clinical practice, 64(7), 984-990.

Forsmark, C. E. (Ed.). (2007). Pancreatitis and its complications. Springer Science & Business Media.

Tenner, S., Baillie, J., DeWitt, J., & Vege, S. S. (2013). American College of Gastroenterology guideline: management of acute pancreatitis. The American journal of Gastroenterology, 108(9), 1400.

White, R., & Bradnam, V. (2015). Handbook of drug administration via enteral feeding tubes. pharmaceutical press.

 
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