Med Surg Case Study #36: Sharee Thomas

Sharee Thomas | 55 years old

Chief Complaint: Sharee Thomas presents with severe upper abdominal pain radiating to the back, accompanied by nausea and vomiting.

Medical History:

• Long history of alcohol abuse

• Smoking history

• Hypertension

• Type 2 Diabetes Mellitus

• Previous episodes of acute pancreatitis

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Nurse's Note:

• Patient reports severe, sharp upper abdominal pain radiating to the back, rated 9/10. Patient is nauseated and has vomited twice since the onset of pain. Observed to be in distress and clutching the abdomen.

Vital Signs:

• Blood pressure: 148/90 mmHg

• Heart rate: 112 bpm

• Respiratory rate: 22 breaths/min

• Temperature: 99.8°F (37.7°C)

• SpO2: 95% on room air

Provider's Orders:

• Administer normal saline IV continuously at 100 mL/hr.

• Initiate NPO status.

• Order serum amylase and lipase levels, CBC, and glucose tolerance test.

• Administer morphine 2 mg IV for pain management.

• Obtain abdominal ultrasound and CT scan.

• Consult gastroenterology.
  

1241

Blood tests show elevated amylase and lipase levels, and increased WBC count.

Nurse's Note:

Patient received morphine with partial pain relief, now rating pain as 6/10. Abdominal ultrasound and CT scan completed; awaiting results. Patient is more comfortable but still experiencing intermittent waves of pain.

Vital Signs

• Blood pressure: 144/88 mmHg

• Heart rate: 105 bpm

• Respiratory rate: 20 breaths/min

• Temperature: 99.5°F (37.5°C)

• SpO2: 96% on room air

Provider's Orders:

• Administer acetaminophen 650 mg PO for additional pain relief.

• Monitor blood glucose levels every 4 hours.

• Initiate pancreatic enzyme replacement therapy.

• Schedule endoscopic retrograde cholangiopancreatography (ERCP) for further evaluation.

1802

ERCP completed; findings include ductal strictures and calcifications.

Nurses Note: Patient reports some relief from abdominal pain post-ERCP.

Family educated about alcohol cessation and dietary modifications to manage symptoms.

Vital Signs:

• Blood pressure: 140/85 mmHg

• Heart rate: 100 bpm

• Respiratory rate: 18 breaths/min

• Temperature: 99.2°F (37.3°C)

• SpO2: 97% on room air

Provider's Orders:

• Start a clear liquid diet, progressing as tolerated.

• Administer a multivitamin supplement.

• Arrange follow-up appointment with the gastroenterologist.

• Provide referrals to a smoking cessation program and a support group for alcohol abuse.

Follow Up Questions:

Question 1: What are the major causes of chronic pancreatitis in Sharee’s case?

Question 2: Why was an ERCP ordered for Sharee?

Question 3: What are the implications of elevated serum amylase and lipase levels in Sharee’s case?

Question 4: Why is it essential for Sharee to avoid alcohol and smoking following her diagnosis?

Answers to Questions Below

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Answers

Question 1: What are the major causes of chronic pancreatitis in Sharee’s case?

The major causes of chronic pancreatitis in Sharee's case are likely:

• Alcohol abuse: Sharee has a long history of alcohol abuse, which is a leading cause of chronic pancreatitis. Over time, excessive alcohol consumption damages the pancreas, leading to inflammation and scarring.

• Smoking: Smoking is another risk factor for chronic pancreatitis. It can worsen inflammation and contribute to pancreatic damage.

Question 2: Why was an ERCP ordered for Sharee?

An ERCP is a valuable diagnostic tool for chronic pancreatitis. It was ordered to provide detailed information about the anatomy of the pancreas and pancreatic ducts, identify any obstructions or strictures, and obtain tissue samples for analysis.

Question 3: What are the implications of elevated serum amylase and lipase levels in Sharee’s case?

Elevated serum amylase and lipase levels indicate active inflammation of the pancreas and are diagnostic markers for acute exacerbations of chronic pancreatitis. They are released into the bloodstream when pancreatic cells are damaged. The severity of the elevation can also provide clues about the extent of pancreatic damage.

Question 4: Why is it essential for Sharee to avoid alcohol and smoking following her diagnosis?

• Alcohol cessation: Alcohol is a major culprit in Sharee's case. Continued alcohol consumption will further damage the pancreas and worsen her symptoms. Avoiding alcohol is crucial to prevent further inflammation and slow disease progression.

• Smoking cessation: Smoking can hinder healing and increase the risk of complications like infections. Quitting smoking can improve her overall health and potentially slow pancreatic damage.

Med Surg Case Study #36: Sharee Thomas