A 46-year old female patient admitted 2 days ago to the progressive care unit for acute biliary pancreatitis. The patient has no history of alcohol use/abuse. The patient has been treated with fluids, antiemetic, and opiate analgesics for pain. Patient is complaining of respiratory difficulty.
1) Describe the physical progression of pancreatitis leading to respiratory instability:
2) Define the term below- be specific and provide examples
Complete the table below .
|Patient Care Equipment
|Rationale- explain in your own words why these are an important for those with pancreatitis
|Triple Lumen Central line
|Continuous ECG monitoring
|Indwelling urinary catheter
|Intravenous catheters- 2
|Blood sugar testing at bedside
4) Describe the order for Calcium gluconate 1 gram/50ml. Why might this be ordered for those with pancreatitis? Include one nursing consideration when administering this medication. Assessment of the Patient’s Condition and Recommendation Essay Discussion Paper
5) What priority communication would you expect to have with family member of this patient about their changing health status?
6) Outline 3 priority nursing interventions for this unstable patient with pancreatitis.
7) Outline an SBAR you would use when communicating the following critical data points to the provider: Increasing SOB, decreasing SpO2,increased pain from muscle cramps, new onset of confusion
Ans 1 Acute pancreatitis is a medical condition characterized by inflammation of the pancreas. The pancreas is a gland that helps in the digestion of food and produces hormones such as insulin. Acute pancreatitis can occur due to various reasons such as gallstones, high levels of triglycerides, alcohol consumption, and certain medications.
The physical progression of pancreatitis can lead to respiratory instability due to several reasons. Firstly, as the pancreas becomes inflamed, it releases harmful substances into the bloodstream, leading to a systemic response known as a systemic inflammatory response syndrome (SIRS). SIRS can cause fluid to build up in the lungs, leading to fluid accumulation in the air spaces, making it difficult to oxygenate the bloodstream. This can result in respiratory distress and the patient may experience shortness of breath, wheezing, and rapid breathing.
Secondly, the patient’s pain and discomfort may lead to increased muscle tension and decreased chest expansion, further exacerbating respiratory difficulties. Additionally, the patient may be given opiate analgesics for pain management, which can cause respiratory depression and make it difficult for the patient to breathe.
In conclusion, the physical progression of pancreatitis can lead to respiratory instability due to the effects of SIRS, increased muscle tension, decreased chest expansion, and the use of opiate analgesics. It is important to monitor the patient’s respiratory status closely and provide appropriate interventions to manage any respiratory difficulties that may arise.
- Hemodynamic instability refers to a disturbance in the body’s blood flow and pressure. Hemodynamic instability can occur due to various reasons such as fluid loss, heart disease, and sepsis. In such cases, the blood flow and pressure may not be sufficient to meet the body’s metabolic demands, leading to decreased oxygen delivery to the vital organs and tissues. The patient may experience symptoms such as low blood pressure, rapid heartbeat, lightheadedness, and decreased mental alertness.
- Trousseau’s sign is a clinical sign in which spasm of the hand and wrist occurs after inflation of a blood pressure cuff. This sign is indicative of underlying hypocalcemia, which can occur in patients with pancreatitis due to impaired calcium metabolism. Hypocalcemia can result in muscle and nerve dysfunction, leading to symptoms such as muscle cramps, twitching, and tingling sensations in the extremities.
- Chvostek’s sign is another clinical sign used to diagnose hypocalcemia. This sign is elicited by tapping the facial nerve near the cheek, which causes muscle contractions of the facial muscles in patients with hypocalcemia.
- ARDS, or Acute Respiratory Distress Syndrome, is a serious condition in which the lungs become inflamed and fluid accumulates in the air spaces, making it difficult for the patient to oxygenate the bloodstream. ARDS can occur as a complication of various medical conditions such as sepsis, pneumonia, and pancreatitis.
Ans 3 Patient care equipment is an essential component of the care of patients with pancreatitis. The following are some important pieces of equipment and their rationale for use in patients with pancreatitis:
- Triple Lumen Central Line: A central line is a long, thin tube that is inserted into a large vein in the neck, chest, or groin. A triple lumen central line has three separate channels for administering medications, fluids, and obtaining blood samples. This type of central line is important for patients with pancreatitis as it provides quick and easy access for administering medications and fluids, and for monitoring the patient’s vital signs.
- Continuous ECG monitoring: Electrocardiogram (ECG) is a test that measures the electrical activity of the heart. Continuous ECG monitoring allows for continuous monitoring of the patient’s heart rate and rhythm, which is important for early detection of any changes in the patient’s heart function.
- Incentive Spirometer: An incentive spirometer is a device used to help the patient maintain good lung function and prevent lung complications. Patients with pancreatitis may be at risk of developing respiratory difficulties, and using an incentive spirometer can help prevent these difficulties by encouraging the patient to take deep breaths and maintain good lung function.
- Indwelling Urinary Catheter: An indwelling urinary catheter is a tube that is inserted into the bladder to drain urine. This type of catheter is important for patients with pancreatitis as it allows for continuous monitoring of the patient’s fluid status and can help prevent urinary retention and urinary tract infections.
- Intravenous catheters (2): Intravenous (IV) catheters are small, flexible tubes that are inserted into a vein for the administration of fluids, medications, and blood transfusions. Two IV catheters are important for patients with pancreatitis as they provide quick and easy access for administering medications and fluids, and for obtaining blood samples.
- Oxymask: An Oxymask is a type of oxygen delivery device that delivers high-flow oxygen to the patient through a mask. This type of equipment is important for patients with pancreatitis as it can help prevent or treat respiratory distress and ensure adequate oxygenation of the bloodstream.
- Blood sugar testing at bedside: Blood sugar testing is important for patients with pancreatitis as hyperglycemia (high blood sugar) can occur as a complication of the condition. Bedside blood sugar testing allows for quick and easy monitoring of the patient’s blood sugar levels, allowing for prompt treatment if necessary.
Ans 4 Calcium gluconate is a medication that is commonly used to treat patients with pancreatitis. It is an intravenous (IV) calcium salt that is used to help replace calcium in the body, which can be depleted in patients with pancreatitis. Assessment of the Patient’s Condition and Recommendation Essay Discussion Paper
The order for Calcium gluconate 1 gram/50ml may be ordered for patients with pancreatitis for several reasons. Firstly, calcium is a crucial electrolyte that helps regulate muscle function, including the smooth muscle of the digestive system. In patients with pancreatitis, there is an increased risk of muscle dysfunction, including spasms of the smooth muscle in the bile ducts and the digestive system, leading to pain and other symptoms. By replacing calcium in the body, Calcium gluconate can help alleviate muscle spasms and improve patient comfort.
Secondly, Calcium gluconate can help treat or prevent hypocalcemia, a condition in which the level of calcium in the blood is too low. Hypocalcemia can occur in patients with pancreatitis as a result of the release of digestive enzymes, which can damage the parathyroid glands and interfere with the body’s ability to produce and regulate calcium. By replacing calcium in the body, Calcium gluconate can help prevent or treat hypocalcemia and its associated symptoms, including muscle cramps, tingling and numbness, and seizures.
One nursing consideration when administering Calcium gluconate is to closely monitor the patient’s vital signs, including heart rate, blood pressure, and respiratory rate. Calcium gluconate can have a direct effect on the heart and circulatory system and can cause an increase in heart rate, blood pressure, and respiratory rate. As such, it is important for the nurse to closely monitor the patient for any changes in vital signs and to report any significant changes to the physician promptly.
Ans 6 As a nurse, it is important to prioritize communication with the family members of a patient who is experiencing changes in their health status, especially in cases of critically ill patients like the one described in the scenario.
The priority communication with the family members of the patient with pancreatitis would involve keeping them informed about the patient’s condition, including any changes in their symptoms, treatment, and prognosis. This communication is important because it helps the family understand what is happening with the patient and provides them with a sense of comfort and reassurance.
In addition to keeping the family informed about the patient’s condition, it is also important to provide them with emotional support. This may include offering words of encouragement, listening to their concerns, and addressing any questions they may have. By providing emotional support, the family is more likely to be engaged in the patient’s care, which can be beneficial for both the patient and the family.
Finally, it is important to involve the family in the patient’s care plan and decision-making process. This can include involving them in discussions about the patient’s treatment options, goals of care, and any potential risks or benefits of different treatments. By involving the family in the decision-making process, they are able to provide input and make informed decisions that are in the best interest of the patient.
Ans 6 For a critically unstable patient with pancreatitis, there are several priority nursing interventions that need to be carried out in order to ensure the best possible outcome for the patient. These include:
Pain management: Pain is a common symptom of pancreatitis and can greatly impact the patient’s well-being. As a nurse, it is important to assess the patient’s pain regularly and provide appropriate pain management interventions, such as administering analgesics or positioning the patient in a comfortable position.
Monitoring vital signs: Regular monitoring of the patient’s vital signs is crucial in detecting any changes in the patient’s condition. This includes monitoring the patient’s heart rate, blood pressure, respiratory rate, and oxygen saturation levels.
Fluid management: Pancreatitis can cause fluid imbalances in the patient’s body, which can lead to dehydration or fluid overload. As a nurse, it is important to closely monitor the patient’s fluid status, administer IV fluids as needed, and monitor for signs of fluid overload, such as shortness of breath or increased heart rate.
Nutrition support: Patients with pancreatitis may have difficulty eating or may not feel like eating due to the pain and discomfort they experience. As a nurse, it is important to provide nutrition support, such as through enteral or parenteral nutrition, to ensure the patient is getting the nutrients they need to recover.
Monitoring for complications: Pancreatitis can lead to several complications, including infections, organ failure, or sepsis. As a nurse, it is important to monitor the patient for any signs of these complications, such as changes in the patient’s mental status, temperature, or laboratory values.
Providing patient and family education: It is important for the patient and their family to understand the causes, symptoms, and treatment options for pancreatitis. As a nurse, it is important to provide patient and family education to help them understand the patient’s condition and be an active participant in the patient’s care.
Ans 7 An SBAR (Situation, Background, Assessment, Recommendation) is a structured communication tool used to effectively communicate critical information between healthcare providers. It is an important tool for ensuring clear and concise communication, especially in high-stress or emergency situations.
When communicating about a critically unstable patient with pancreatitis, the SBAR should include the following information:
An SBAR (Situation, Background, Assessment, Recommendation) is a structured communication tool used to effectively communicate critical information between healthcare providers. It is an important tool for ensuring clear and concise communication, especially in high-stress or emergency situations.
When communicating about a critically unstable patient with pancreatitis, the SBAR should include the following information:
Situation: Increasing SOB (shortness of breath), decreasing SpO2 (oxygen saturation), increased pain from muscle cramps, new onset of confusion
Background: Patient is a 46-year-old female with acute biliary pancreatitis admitted 2 days ago to the progressive care unit. The patient has been treated with fluids, antiemetic, and opiate analgesics for pain.
Assessment: The patient is now complaining of increased shortness of breath, decreasing oxygen saturation levels, increased pain from muscle cramps, and new onset of confusion.
Recommendation: Requesting an immediate evaluation by the provider, administering supplemental oxygen per the provider’s orders, and starting pain management measures per the provider’s orders.
This SBAR provides the provider with a clear and concise summary of the patient’s situation, including important background information, the assessment of the patient’s condition, and the recommended course of action. By using an SBAR, the nurse can ensure effective and efficient communication with the provider and help ensure the patient receives the appropriate care in a timely manner. Assessment of the Patient’s Condition and Recommendation Essay Discussion Paper