Case study - Pancreatitis: Nursing

Nurse. Gerty works on a medical surgical unit and is caring for Leo a 47 year old who was recently admitted for acute pancreatitis.

Secondary to chronic alcohol use in collaboration with a registered nurse, RN Don. Nurse.

Gerty 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 Gerty recognizes important cues including Leo's vital signs which include BP, 1 45/90 millimeters of mercury, heart rate, 88 BPM temperature, 99.2 °F and respirations.

18 breaths per minute. Nurse Gerty notices Leo is diaphoretic, his gown is damp and he's holding an empty emesis bag.

She also sees that he has IV fluids infusing in his right forearm. Hi Leo.

It looks like you're not feeling well. What's your pain level right now?

On the 0 to 10 pain scale, my pain is a six. It feels like I can't lie down on my back or get comfortable at all.

And I'm nauseated. I understand I'm gonna help you feel more comfortable.

Next. Nurse, Gerdy analyzes these cues.

She reviews the electronic health record or E hr and notes that Leo's prescriptions include HYDROmorphone IV every three hours as needed.

And his last dose was given 2.5 hours ago and she sees sublingual Ondansetron as ordered to P RN for nausea, but he hasn't yet received a dose today.

Nurse Gerdy understands that acute pancreatitis refers to the sudden inflammation and destruction of the pancreas, which is a long gland located in the upper abdomen or the epigastric region behind the stomach.

She knows that the pancreas has ace in our cells that produce pancreatic juice which contains digestive enzymes like trypsin, amylase and lipase that's released into the duodenum to help digest food.

Nurse ty recognizes that pancreatitis can be caused by a variety of conditions. And in Leo's case, chronic alcohol use likely injured his acinar cells leading to the release and activation of digestive enzymes within the pancreas causing inflammation and tissue destruction.

A process called autodigestion. Nurse.

Gerdy also realizes that the main symptom of acute pancreatitis is abdominal pain in the left upper quadrant or epigastric region, which can radiate to the back.

But patients can also experience nausea and vomiting due to impaired digestion of foods. She recognizes that Leo needs effective pain and nausea management to improve his comfort.

Now, using the information she's gathered along with Leo's medical history. Nurse reports, her findings to R and Don and together they choose a priority hypothesis of impaired comfort.

Then they generate solutions to address Leo's pain and nausea that will include pharmacologic and nonpharmacologic interventions.

And they established the expected outcome that after intervening Leo will report increased comfort within one hour. Nurse Gerdy then takes action to implement these solutions.

She recognizes Leo cannot have his next dose of IV HYDROmorphone for another 30 minutes. So she gathers supplies and enters Leo's room.

Hi, Leo, I have your nausea medication called Ondansetron that dissolves under your tongue. Ok.

Thank you. That really helped me yesterday.

But what about my pain medicine? You're not due for that yet, but in about 30 minutes, nurse dawn will bring that in for you.

Ok. Good nurse Gerty then administers the Ondansetron according to the principles of safe medication administration.

She also helps Leo change out of his damp gown and assists him in putting on a new dry one. She then dims the lights covers him with a warm blanket and places his call light within reach 30 minutes later.

R and Don administers the IV HYDROmorphone. One hour later, nurse Gerty reents Leo's room to evaluate the outcome of her actions.

Leo's vital signs are BP 1 26/82 millimeters of mercury, heart rate, 70 BPM and respirations, 16 breaths per minute. He appears more comfortable and is sitting up in bed eating ice chips.

How are you feeling now, Leo? Much better.

The pain is still there but it's only three out of 10 and I don't feel nauseous anymore. The medications you and nurse Dawn gave me really helped.

Great. All right, as a quick recap, nurse Gerdy recognized in analyzed cues related to Leo's pancreatitis and in collaboration with R and Don prioritized hypotheses and generated solutions to address this problem.

Nurse Gerdy and R and Don then implemented pharmacologic and non pharmacologic measures and evaluated Leo's outcomes and compared them to the expected outcome.

Since Leo reported increased comfort within one hour, they determined the plan of care was successful.