These are requirements for forum initial posts and cases studies: ALWAYS first present relevant background information and normal physiological content with citations. THEN cover the questions in DETA

Forty-nine-year-old Frank has been a heavy drinker for the past 25 years. He also has a history of hypertension, hyperlipidemia, and recent upper respiratory viral infection. Frank’s only current medication is Lasix (furosemide) 40 mg od. He presents with severe epigastric pain that radiates to his back and worsens when lying down. His abdomen is distended, and bowel sounds are hypoactive. Frank has a fever and is diaphoretic and hypotensive, and his serum calcium is very low.

In your initial post answer the following questions:

1. Frank is being transferred to the ICU. If you were the ICU nurse, what would you have to consider in Frank’s case?

Frank has a history of chronic alcohol abuse and complains of severe, radiating epigastric pain that worsens when laying. Based on his symptoms and his history, he likely has acute pancreatitis (Grossman & Porth, 2013). Clinically, he shows signs of a systemic inflammatory response. He has a fever, diaphoresis, and hypotension. I would be most concerned about infection and complications related to pancreatitis including septic shock. I would anticipate restoring circulating blood volume and treating him for systemic complications related to pancreatitis. I would have to consider that he may have chronic calcifying pancreatitis.

Chronic pancreatitis is an inflammatory disease characterized by scarring of the pancreas and permanent changes. Chronic pancreatitis can cause abdominal pain, diabetes, and steatorrhea (Aghani, 2015). Calcification is a sign of chronic pancreatitis and it develops throughout the pancreas. Sometimes these stones can block the pancreatic duct and cause an acute inflammation. Chronic pancreatitis usually results from recurrent attacks of acute pancreatitis. In addition to chronic alcohol use, recurrent pancreatitis is caused by hypercalcemia or hypertriglyceridemia, genetic mutations, and congenital abnormalities of the pancreas (Aghani,2015) . The incidence of chronic pancreatitis ranges from 4.4 to 11.9 per 100,000 per year (Aghani, 2015). Men are almost two times more likely to suffer with chronic pancreatitis compared in the )United States (Aghani, 2015). There were almost 20,000 hospital admissions for chronic pancreatitis in the U. S. leading to hospitalization costs of $172 million (Aghani, 2015).

I would need to consider the possibly that his signs and symptoms are the result of an acute necrotizing pancreatitis which could have caused a pseudocyst (Grossman & Porth, 2013). Diagnostics can confirm if he has pancreatitis and if it is complicated by an active infection. I would anticipate for either a diagnostic abdominal computed tomography (CT) scan or CT-guided fine needle aspiration (FNA) to determine if we should start anti-microbials (De Waele, 2011). In addition to diagnostic imaging, I would anticipate obtaining serum amylase and lipase laboratory markers to assess to confirm an acute pancreatitis diagnosis (Grossman & Porth, 2013). An elevation in these two markers is consistent with pancreatitis, but its severity cannot be determined by the magnitude of their elevations. A CT can differentiate between mild pancreatitis and a severe, necrotic pancreatitis. Research has suggested that certain biomarkers may be involved in predicting the severity of pancreatitis (Grossman & Porth, 2013). In addition to the imaging studies, amylase and lipase, a complete blood count, renal function panel, calcium levels, liver function panel, Trypsin-selective test, and an arterial blood gas may be needed to guide treatment. Since the pancreas is not functioning properly and contributing to systemic complications, I would anticipate treating him for metabolic disorders, acid/base imbalance, fluid/electrolyte imbalances including hypocalcemia, circulatory shock, cardiac dysrhythmias, gastrointestinal block, and pain.

References

Aghani, Elham.(2015). Introduction to pancreatic disease: Chronic pancreatitis.

Pancreapedia: Exocrine Pancreas Knowledge Base, DOI: 10.3998/panc.2015.3

De Waele, J. (2011). Rational use of antimicrobials in patients with severe acute pancreatitis.

Seminars in respiratory and critical care medicine, 32, 174-80.

Doi: 10.1055/s-0031-1275529.

Grossman, S. & Porth, C.M. (2013). Porth’s pathophysiology: Concepts of altered health

states (9th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.