Pancreatitis/Septic Shock Case Study. GI/Renal/Endocrine Final Assignment
GI/Renal/Endocrine CCRE 1503
Marks /40
Weighted at 20% of your Final Mark
Pancreatitis/Septic Shock Case Study
The following case study is a short answer assignment. Answer all questions numbers 1 through 9. The assignment is worth 20% of your final mark. Weighting of marks has been assigned to each question. Consider the weight of marks as a guide to the detail required for each answer. Please copy the assignment questions and include your answer under each question. APA format is not required for this short answer assignment. However, references for each question must be included with your work as well as a reference page at the end of your case study.
Good luck with your assignment!
Case Study Phase 1
Mr. Jones, a 57 year old male, arrived in the Emergency Department at 2030 hours and is complaining of acute abdominal pain. The pain has been present for approximately 2 days but has increased in severity over the last 8 hours. The pain is localized to the upper-left abdominal quadrant with some radiation to the back. Mr. Jones vomited four times in the last 8 hours with no relief from pain. Mr. Jones has a history of hypertension and heavy alcohol use. He is accompanied by his wife and children; two daughters and one son, all in their mid to late twenties.
Vital Signs: BP 131/77, HR 75 bpm, respirations 22 breaths/minute, temperature 38.1° Celsius.
At 0200 hours
Mr. Jones becomes anxious, unsettled and indicates that the pain in his abdomen has increased. Mr. Jones then proceeds to vomit 125 mL of brown liquid emesis.
Vital Signs:
BP 105/61, HR 95 bpm, respirations 28 breaths/minute, temperature 38.6 Celsius
Mr. Jones is admitted to the Critical Care Unit post diagnostic tests. Diagnosis is pancreatitis.
Questions
1. Discuss nursing priorities of the patient related to the clinical manifestations of pancreatitis. (4 marks)
2. What blood work and diagnostic tests would you expect to be ordered for Mr. Jones and why – please ensure that you describe why you are utilizing the test? (4 marks)
Case Study Phase 2
0400 hours
Mr. Jones is conscious but confused at times. Vital signs on the last assessment indicate a change in condition.
Vital Signs: BP 88/56, HR 120, respirations 30/minute, O2 sat 93% on 6 litres via nasal prongs, temperature 39.9° Celsius.
The most responsible physician (MRP) is notified and has not yet returned the call.
0500 hours
Just prior to the MRP’s arrival Mr. Jones becomes difficult to rouse.
Vital Signs: BP 78/52, HR 125 bpm, respirations 32 breaths/minute, O2 sat 89% via facemask,
temperature 36.9° Celsius, WBC is 32.
Mr. Jones receives a normal saline fluid bolus of 500 mL with little effect. He is started on vasopressors to maintain a BP systolic of 90 or a mean arterial pressure of 70. ABGS are drawn — pH 7.48, PCO2 40 mm Hg, P02 84 mm Hg HC03- 30mmol/L and he is subsequently intubated and ventilated.
3. Interpret the arterial blood gases. (total 2 marks)
4. Explore the medical management for a patient diagnosed with septic shock? (4 marks) Note: ensure you are using current guidelines as set out by the Surviving Sepsis Campaign
Case Study Phase 3
The physician orders intra-abdominal pressure (IAP) monitoring for Mr. Jones. His IAP readings are 22 and 28 mm Hg on two separate measurements.
5. Intra-abdominal pressure monitoring three part question (total 5 marks)
a. Why might this patient require IAP monitoring? (one mark)
b. Explain how the gastrointestinal system might be impacted by increased intra-abdominal hypertension (IAH) and/or abdominal compartment syndrome (ACS). (2 marks)
c. Explain how the cardiac system might be impacted by increased intra-abdominal hypertension (IAH) and/or abdominal compartment syndrome (ACS). (2 marks)
6. Mr. Jones’s cardiac monitor alarms and the following cardiac rhythm is noted. Interpret the following cardiac rhythm and describe appropriate nursing priorities. (You may wish to refer to your Cardiac Course). (1 mark for naming the rhythm, 2 marks for nursing priorities–total 3 marks.)
7. Mr. Jones’s 12 Lead EKG shows the following (see below). Interpret this 12 Lead ECG using the 8 step systematic approach for ECG interpretation (from learning in the Cardiac Course). Please include rhythm, axis, voltage, transition, BBB, hypertrophy, MI location and stage of MI.) (8 marks)
8. Mr. Jones is remains hemodynamically unstable and his creatinine continues to rise. A decision is made to start continuous renal replacement therapy (CRRT). Discuss the nursing considerations specifically related to potential adverse events for Mr. Jones. (5 marks)
Mr. Jones condition is very poor and has a poor prognosis. Discuss key inter-professional priorities related to end-of-life care for Mr. Jones and his family. (You may wish to refer to the End-of-Life section in your Critical Care text.)
___________________________
The nursing priorities for the patient related to the clinical manifestations of pancreatitis include:
Pain management: Pancreatitis is associated with severe abdominal pain. The nurse should assess the intensity and location of the pain, administer prescribed pain medications, and monitor the effectiveness of pain relief measures.
Monitoring vital signs: Vital signs such as blood pressure, heart rate, respiratory rate, and temperature should be closely monitored to detect any signs of deterioration or systemic complications.
Fluid and electrolyte balance: Pancreatitis can lead to fluid and electrolyte imbalances, such as dehydration and hypovolemia. The nurse should assess fluid status, administer intravenous fluids as ordered, and monitor electrolyte levels.
Nausea and vomiting management: Pancreatitis often causes nausea and vomiting. The nurse should assess the frequency and characteristics of emesis, administer antiemetic medications as prescribed, and provide comfort measures to alleviate nausea.
Assessment of nutritional status: Pancreatitis can lead to malnutrition and weight loss. The nurse should assess the patient’s nutritional status, monitor intake and output, and collaborate with the healthcare team to develop a plan for nutritional support if necessary.
The following blood work and diagnostic tests would be ordered for Mr. Jones:
Complete blood count (CBC): This test helps assess for signs of infection, such as an elevated white blood cell count, which may indicate pancreatitis or complications like sepsis.
Serum amylase and lipase levels: Elevated levels of these enzymes are indicative of pancreatic inflammation and can help confirm the diagnosis of pancreatitis.
Liver function tests (LFTs): Pancreatitis can affect liver function, so LFTs, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin levels, are ordered to assess liver health.
Serum electrolytes: Pancreatitis can cause electrolyte imbalances, so measuring levels of sodium, potassium, calcium, and magnesium is important for monitoring and appropriate management.
Coagulation profile: Pancreatitis may affect the clotting factors, so a coagulation profile, including prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR), can help evaluate coagulation status.
Abdominal ultrasound or computed tomography (CT) scan: These imaging tests can provide visual confirmation of pancreatitis, determine the severity of inflammation, and identify any complications such as pancreatic necrosis or fluid collections.
These tests are ordered to Help in the diagnosis, assess the severity of pancreatitis, evaluate organ function, and identify any complications that may require specific interventions or treatments.
