Question

A 63-year-old woman who is admitted to the ICU from the ED with nausea, vomiting, and abdominal pain. The pain is located in the epigastric and LUQ regions

Admission Lab Results

• Lipase 789 U/L
• Amylase 575 U/L
• ALP 139 U/L
• AST 436 U/L
• Total protein 4.6 g/dl
• Albumin 2.2 g/dl
• BUN 32 mg/dl
• Creatinine 1.4 mg/dl
• Glucose 203 ml/dl
• Calcium 7.2 mg/dl
• Potassium 3.2 mg/dl
• WBC 17,500 mm³

1. Which SPECIFIC labs results assist in confirming a diagnosis of pancreatitis? Why are these labs significant?

2. Which NONSPECIFIC lab results are important to monitor in acute pancreatitis? Why are these labs significant?

3. What do the BUN and Creatinine tell you about Mrs. Smith’s kidney function and volume status?

Mrs. Smith’s orders state "Strict NPO." However, she calls out and DEMANDS a drink of water.

4. Using therapeutic communication, how would you reply to Mrs. Smith’s request?

5. List the nursing diagnoses with “related to” (at least 4) and outcomes appropriate for a patient with acute pancreatitis?

Answer 1

1. Let me answer the first 4 questions(as HOMEWORKLIB RULES guidelines)
2. Which SPECIFIC labs results assist in confirming a diagnosis of pancreatitis? Why are these labs significant?
3. Lipase and Amylase are the specific lab results that assist in confirming Pancreatitis. Elevated lipase levels are more specific to the pancreas than elevated amylase levels.
4. Pancreatic lipase and amylase are secreted into the duodenum through the duct system of the pancreas. Its concentration in serum is normally very low. In pancreatitis, the pancreas may begin to autolyse and release pancreatic enzymes including pancreatic lipase and amylase to blood. Thus, through measurement of serum concentration of pancreatic lipase and amylase, acute pancreatitis can be diagnosed

2. Which NONSPECIFIC lab results are important to monitor in acute pancreatitis? Why are these labs significant?
3. Glucose 203 ml/dl
4. Potassium 3.2 mg/dl
5. WBC 17,500 mm³
6. ALP 139 U/L
7. AST 436 U/L

• Increased blood sugar levels: Pancreatitis damages the cells that produce insulin and glucagon, which are the hormones that control the amount of sugar in your blood. This can lead to an increase in blood sugar levels.
• Elevated liver enzymes: Elevated liver enzymes in the setting of acute pancreatitis point toward choledocholithiasis as the cause
• Hypokalemia: Patients with pancreatitis are at risk for hypokalemia (potassium [is less than] 3.5 mEq/L) due to prolonged vomiting or the loss of potassium in the protein-rich fluid that leaks into the peritoneal cavity.
• Increased WBC count: This indicate the presence of severe infection in the body.

3. What do the BUN and Creatinine tell you about Mrs. Smith’s kidney function and volume status?
4. BUN 32 mg/dl
5. Creatinine 1.4 mg/dl
6. BUN and Serum creatinine are in normal range, but the serum creatinine level is near to the maximum allowed value (1.5 mg/dl). So the nurse need to keep an eye on the kidney functioning and urine output of the client.

   Mrs. Smith’s orders state "Strict NPO." However, she calls out and DEMANDS a drink of water.

4. Using therapeutic communication, how would you reply to Mrs. Smith’s request?
5. This NPO is offered because of the concern that food intake will stimulate pancreatic enzyme release in an already inflamed/injured pancreas.
6. Explain the situation to the client citing the lab investigations and USG investigations if done. Explain how to manage the condition, and if she takes fluids by mouth, how the condition may worsen.
7. Also brief her, how long the NPO may probably continue, and once her condition progresses, she will be allowed to sip in clear fluids slowly.