Case study - Acute pancreatitis: Nursing

Nurse Gerdie works on a medical-surgical unit and is caring for Leo a 47-year-old male who was recently admitted for acute pancreatitis secondary to alcohol use. After settling Leo in his room, Nurse Gerdie goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Leo's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes. 

First, Nurse Gerdie recognizes important cues, including Leo’s vital signs, which include blood pressure 145/90 mmHg, heart rate 88 beats per minute, and respirations 18 breaths per minute. Nurse Gerdie notices Leo is diaphoretic, his gown is damp, and he’s lying in the fetal position clutching an empty emesis bag. She also sees that he has IV fluids infusing in his right forearm.  

Nurse Gerdie: Hi Leo, it looks like you're not feeling well. What's your pain level right now? 

Leo: It feels like I can’t lie down on my back or get comfortable at all. And I’m so nauseated.  

Nurse Gerdie: I understand, I’m going to help you feel more comfortable.  
Next, Nurse Gerdie analyzes these cues. She reviews the electronic health record, or EHR, and notes that Leo’s prescriptions include hydromorphone IV every 3 hours as needed, and his last dose was given two and a half hours ago in the emergency department; and ondansetron IV for nausea, but he hasn’t yet received a dose. She recognizes that Leo needs effective pain and nausea management to improve his comfort. 

Now, using the information she's gathered, Nurse Gerdie chooses a priority hypothesis of impaired comfort.  

Then she generates solutions to address Leo’s pain and nausea that will include pharmacologic and nonpharmacologic interventions. Nurse Gerdie establishes the expected outcome that after intervening, Leo will report increased comfort within one hour. 

Nurse Gerdie then takes action to implement these solutions. She recognizes he cannot have his next dose of IV hydromorphone for another 30 minutes, so in the meantime, she administers the prescribed ondansetron according to the principles of safe medication administration.