Question

2. Joe Harrison, a 62-year-old bank executive, presents to the emergency room with severe abdominal pain. He describes the pain as excruciating, and indicates it is located in the mid igastrium with radiation into his back. The patient states he has not eaten anything in the past 24 hours, but 2 days ago attended a wedding dinner and consumed a large meal and about 4 to 5 admitted with a diagnosis of rule-out pancreatitis. Learning Objectives 4 a. Blood and urine samples are sent to the lab, and the results indicate that the serum alcoholic beverages. Mr. Harrison admits to being a "social drinker," ingesting 2 to 3 alcoholic beverages several days a week. Based on his clinical presentation and history, Mr. Harrison is amylase and lipase are markedly elevated. How do these findings correlate to the diagnosis of acute pancreatitis? nurse notes that Mr. Harrison's stool is pale and bulky, while his urine is a dark tea color. Correlate these findings to the pathophysiology of acute pancreatitis b. The Mr. Harrison's WBC is 18,500, and his serum glucose is 325. His LDH is 300 IUL and the AST is 120 U/ml Based on the Criteria for Predicting the Severity of Pancreatitis, what is Mr. Harrison's mortality risk? c. Mr. Harrison develops hypocalcemia secondary to the acute pancreatitis. What n d. interventions should the nurse implement related to this complication?

Answer 1

a. ANS: When the results of the serum amylase and lipase are elevated, it means that they have interfered with the pancreatic function of the body the change. Acute pancreas also has a bad effect on the stool and urine which changes its color all through due to the disorder .the mortality risk of Harrison is he is likely to suffer from diabetes. When Harrison develops hypocalcaemia, this is highly relate to the pancreatic disorders.

b. ANS: The nurse notes that Mr. Harrison’s stool is pale and bulky because absence of bile derived pigments. While his urine is a dark tea color generally the dark colour urine results from urinary excretion of the conjugated bilirubin. All these are explained by biliary obstructions. Acute pancreatitis is usually caused by gallstone getting stuck in bile duct on its way from gallbladder into small intestine. Since bile duct shares same opening with pancreatic duct, sudden obstruction of pancreatic opening will cause pancreatic juices to back up into pancreas leading to auto digestion and hence inflammation of pancreas.

c. ANS: Mr. Harrison’s had 50% mortality

Explanation: The Ransons criteria assess based on age in years > 55 years, white blood cell count > 16000 /mcL,blood glucose > 11 mmol/L (>200 mg/dL), serum AST > 250 IU/L,serum LDH > 350 IU/

Each has one point and from patient data Mr. Harrison has 5 points

The method for finding mortality is based on Number of criteria and this correlate to approximate mortality (%): If

1.0 to 2 = 0%

2.3 to 4 = 15%

3.5 to 6 = 50%

4.>6 = 100%.

So 5 points correlate to 50 % mortality

d. ANS: Nursing interventions:

1. Vitamin D supplementation

Explanation: Vitamin D is promotes absorption of calcium hence increasing calcium levels in blood

2. Calcium administration diluted in D5W

Explanation: Calcium can be administered in case of emergencies e.g calcium gluconate

3. ECG to check for long QT syndrome

Explanation: Hypoglycaemia interferes with heart contractions hence need to check for long QT syndrome

4. Magnesium administration

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