Acute Pancreatitis + Liver Cirrhosis Case Study

Acute Pancreatitis + Liver Cirrhosis Case Study Patient Profile K.Z. is a 39-year-old male who presents to the emergency department complaining of severe pain in his abdomen that started after he went to bed last night. He has a history of hypertension. He is currently taking hydrochlorothiazide and lisinopril. Subjective Data Has severe, sharp pain in his abdomen and points to his left upper quadrant Pain got worse after he ate breakfast this morning; he vomited, but the pain did not improve Has a 21 pack-year smoking history (½ pack) Drinks about two cases of beer a week Objective Data Physical Examination Temperature 100.9° F, pulse 110, respirations 26, blood pressure 110/62 The patient’s hand started to contract and twitch when the BP cuff squeezed his arm. Height 5’11”, weight 180 lb Oxygen saturation 93% on room air Diminished breath sounds and crackles in left lower lobe Bowel sounds hypoactive in all quadrants Abdomen slightly distended with left upper quadrant tenderness and guarding Diagnostic Studies Chest X-ray: small pleural effusion in left lower lobe Lab values WBC 14,000/µL Hematocrit 45% Hemoglobin 14 g/dL Platelets 190,000/µL Sodium 135 mEq/L Potassium 3.9 mEq/L Calcium 7.9 mg/dL Amylase 188 U/L Lipase 400 U/L Albumin 9g/dL Total Bilirubin 1mg/dL ALT 24 U/L AST 64 U/L Ammonia 24 mcg/dL PT/INR 1.0 mmolL Discussion Questions Based on K.Z.’s presentation, what medical diagnosis do you suspect? What clinical manifestations led you to this conclusion? What are the primary causes for this medical condition and, based on the data, which of these does K.Z. have? Identify interventions you need to implement for K.Z., based on the findings of the low oxygen saturation reading, diminished lung sounds with crackles in the left lower lobe, and chest X-ray results. What are the overall goals of care for K.Z.? Explain why K.Z’s hand began to spasm, and what might be the cause of this and what precautions should be initiated? The wife is concerned that K.Z. has not eaten a good meal in several days. She asks why we aren’t feeding him in the hospital, what do you tell her? What additional nursing interventions are indicated for K.Z. and what is the rationale for each? Part 2: The patient is discharged home 5 days later, but returns to the ED 1 month later after reporting new onset hematemesis. His wife reports he was stressed from missing so many days at work and began drinking alcohol more excessively. His new labs: WBC 10,100/µL Hematocrit 40% Hemoglobin 7.2 g/dL Platelets 91,000/µL Sodium 132 mEq/L Potassium 3.2 mEq/L Calcium 9.0 mg/dL Amylase 130 U/L Lipase 150 U/L Albumin 2.5g/dL Total Bilirubin 4.2mg/dL ALT 128 U/L AST 124 U/L Ammonia 35 mcg/dL PT/INR 1.7 mmolL Physical Examination Temperature 98.9° F, pulse 110, respirations 22, blood pressure 94/55mmHg Oxygen saturation 95% on room air Eyes appear jaundiced Breath sounds clear bilaterally Bowel sounds hyperactive in all quadrants Abdomen moderately distended with right upper quadrant tenderness and guarding When asked if he is taking any new medication, patient states he is taking “some Tylenol” as needed for his abdominal pain since his last admission. Patient can’t remember how much he has gone through. 8. What is the likely cause from this new hematemesis? 9. What new findings are indicative of liver cirrhosis? Why? 10. What procedure will be indicated if the patient continues to have hematemesis? 11. What color stool do you anticipate seeing with his next bowel movement? 12. The gastroenterologist (GI doctor) is able to band the esophageal varices and stop the bleeding. What education would you give to the patient and wife upon discharge? SCIENCE HEALTH SCIENCE NURSING NURSING 110

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