A 44 year old male patient has

A 44 year old male patient has been admitted to the medical surgical unit of the hospital for after seeking treatment for nausea vomiting, and severe abdominal pain. The patient developed sudden and intense pain in the right upper quadrant the evening before and waited for a few hours before seeking treatment. He has a history of substance abuse and has been in rehabilitation for both alcohol and stimulant abuse. He currently still uses both alcohol and methamphetamines, despite previous attempts of treatment at detoxification centers. Upon admission, the patient is anxious and restless, complaining of severe pain that is unrelieved by pain medication. The nurse contacts the physician to ask for further orders for opioid medications to treat the pain. The physician also orders further diagnostic tests to confirm the cause of the patient’s pain and symptoms, as well as a 500 mL bolus of lactated Ringer’s solution IV, followed by a regular rate of LR at 150mL/hr. 1. What type of diagnostic tests would most likely be ordered that could determine the cause of this type of abdominal pain? 2. What laboratory tests would the physician most likely order? 3. What effects would the patient’s history of drug and alcohol abuse have on his abdominal pain? The physician orders an abdominal ultrasound and several laboratory tests, including a CBC, metabolic panel, glucose, serum amylase, and serum lipase. The nurse is also given an order for IV fentanyl to be given prn every 4 hours for pain control. After undergoing the ultrasound, the physician considers that the patient may have acute pancreatitis cause by inflammation; there are several lesions noted on the pancreas that may have been caused by chronic alcohol abuse. 4. Based on the diagnosis of acute pancreatitis, what changes in laboratory values would the nurse expect to see in this patient? 5. Why is pain control such an important component of management of acute pancreatitis? Following diagnosis and continued administration of pain medications, the patient is still complaining of pain. The nurse notes several areas of petechiae on his abdomen, particularly in the right upper quadrant. While once complaining vocally about the pain, the patient now is more quiet, lethargic, grimacing, and guarding the abdomen. His vital signs are: HR: 102 bpm, RR: 22/min, BP: 94/68 mmHg, T: 101.0° F. The nurse contacts the physician, who leaves orders for blood pressure support medications, supplemental oxygen, and antibiotics. The patient is transferred to the ICU for further care. 6. In addition to contacting the physician, how should the nurse intervene in this situation? 7. What types of complications do the patient’s signs and symptoms indicate SCIENCE HEALTH SCIENCE NURSING NURSING 316

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