Discussion Post- The Homeless Patient Assessment & Management Plan The nurse practitioner (NP) is working at a health clinic in a homeless shelter during the early evening. A 48-year-old African American man approaches the practitioner and asks to have his blood pressure taken, saying that he has not had it checked “in a while”.
The man appears to be in some type of distress and experiencing pain. The man walks slowly, using a guarded manner, and he appears diaphoretic. His mucous membranes also appear pale. The patient’s blood pressure is 210/98. The patient reports that he has not been diagnosed with hypertension previously. The patient reveals that he has severe abdominal pain that is radiating to his back. The nurse finds a heart rate of 110, respirations 30 with shallow inspirations, and temperature 102.2°F. The patient’s skin is cool and clammy.
The patient reports a history of alcoholism, homelessness, and lack of access to health care. He says that the symptoms have been present and worsening over 3 days. The man says he thinks he might have pancreatitis again, which he had “a couple of years ago”. The NP recommends that the man should be seen at a hospital for his condition, but the patient says he does not have health insurance, so he does not want to go.
The NP proceeds with a physical examination, finding severe abdominal pain in the epigastric area, yellowed sclera, no abdominal distention, and hypoactive bowel sounds. The clinic is equipped with basic materials but no means to conduct lab or radiologic testing. Discuss the following:
Considering the patient’s homelessness and lack of insurance, what action should the practitioner take?
When the patient asks why his condition cannot be managed outside of the hospital, how should the practitioner respond?
When the patient arrives at the hospital for further diagnostic work-up, what tests will likely be performed to evaluate the patient’s condition?
How will the severity of the pancreatitis be assessed when the patient is hospitalized?
How should the patient’s condition be managed when hospitalized?
What patient education should be included after the pancreatitis is resolved?
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Considering the patient’s homelessness and lack of insurance, what action should the practitioner take?
In this scenario, the nurse practitioner (NP) should consider the patient’s access to care and financial status when making decisions about the patient’s care. The NP should prioritize the patient’s health and well-being, even if this means advocating for hospital admission despite the patient’s lack of insurance. In the case of acute symptoms like the ones presented in this scenario, the NP should provide a referral for the patient to be seen at the nearest hospital for further Assessment and management.
When the patient asks why his condition cannot be managed outside of the hospital, how should the practitioner respond?
The NP should explain to the patient that the severity of his symptoms and the potential complications of pancreatitis require a comprehensive Assessment that can only be performed in a hospital setting. The NP should also inform the patient that a hospital admission will provide access to the necessary diagnostic tests, such as imaging and laboratory studies, that will help determine the cause and extent of his symptoms. Additionally, the NP should emphasize that prompt treatment in a hospital setting can prevent further complications and improve the patient’s overall prognosis.
When the patient arrives at the hospital for further diagnostic work-up, what tests will likely be performed to evaluate the patient’s condition?
Upon arrival at the hospital, the patient is likely to undergo several diagnostic tests to evaluate his condition, including:
Blood tests: This includes a complete blood count (CBC) and blood chemistry tests to evaluate for signs of infection, dehydration, and organ dysfunction.
Imaging studies: An abdominal CT scan or an ultrasound may be performed to evaluate the extent of the patient’s pancreatitis and to determine if there are any complications, such as pseudocyst formation.
Endoscopic retrograde cholangiopancreatography (ERCP): This test may be performed to evaluate the bile ducts and the pancreas for any blockages or abnormalities.
How will the severity of the pancreatitis be assessed when the patient is hospitalized?
The severity of pancreatitis can be assessed through several methods, including:
Serum amylase and lipase levels: Elevated levels of these enzymes indicate pancreatic inflammation.
APACHE II (Acute Physiology and Chronic Health Assessment) score: This score provides a numerical score that indicates the severity of illness and predicts the risk of mortality.
Balthazar CT score: This score provides a numerical score based on the extent of pancreatic and peripancreatic inflammation seen on abdominal CT scans.
How should the patient’s condition be managed when hospitalized?
The patient’s condition should be managed through a combination of supportive care and treatment for the underlying cause of the pancreatitis. This may include:
Pain control: The patient may be given pain medication to manage abdominal pain.
Intravenous fluids: The patient may receive fluids through an IV to help maintain hydration and to improve circulation.
Nutritional support: The patient may receive enteral or parenteral nutrition if they are unable to eat.
Antibiotics: If there is evidence of infection, the patient may receive antibiotics to treat the infection.
Treatment for underlying causes: If the patient has any underlying conditions that contribute to the development of pancreatitis, such as gallstones or alcohol use, these conditions should be treated.
What patient education should be included after the pancreatitis is resolved?
Once the patient’s pancreatitis has resolved, they should receive education on how to prevent future
The management plan for the homeless patient with suspected pancreatitis is crucial to ensure proper treatment and recovery. In this case, the NP should refer the patient to the hospital for further Assessment and management, despite the patient’s lack of insurance and reluctance to seek medical care. Once the patient arrives at the hospital, the severity of the pancreatitis can be assessed through laboratory tests, such as serum amylase and lipase levels, and imaging studies, such as an abdominal CT scan. The management of the condition will involve pain control, fluid and electrolyte balance, and possibly antibiotics if there is an infected component. Inpatient management may also include nutritional support and treatment for any underlying conditions, such as alcoholism. After the resolution of the pancreatitis, patient education should be a key component of the discharge plan, including the importance of follow-up care, a healthy diet, and avoiding triggers, such as alcohol. With a proper Assessment and management plan, the homeless patient with suspected pancreatitis can receive the necessary care to recover and prevent future complications.
