CRITICAL THINKING SUMMARY
Student: ____Stephanie Ford__________________________
Client Dx: _ Pancreatitis secondary to alcohol abuse____________ Age: __54___
Allergies: ____NKA_________________________________________
The MEDICAL DIAGNOSIS that brought the client to the hospital is:
abdominal pain, chills, sweats, nausea, vomitting
PATHOPHYSIOLOGY of diagnosed disease: (From text)
Pancreatitis is the inflammation of the pancreas. Usually digestive enzymes
secreted by the pancreas do not become active until they reach the small intestine.
When the pancreas is inflamed, the enzymes inside it attack and damage the tissue
that produce them. There is also acute and chronic pancreatitis(Mayo, 2014).
SYMPTOMS typically seen with this diagnosis include (as identified in your text):
Acute: upper abdominal pain, abdominal pain that radiates to your back, abdominal pain
that feels worse after eating, nausea, vomiting, tenderness when touching the abdomen.
Chronic: upper abdominal pain, losing weight, steatorrhea (Mayo,2014).
CLIENT’S SYMPTOMS of the diagnosed disease include:
Abdominal pain, nausea and vomiting
NUTRITIONAL ASSESSMENT:
Height (actual or estimated): ___172.7 cm_______ Weight (actual or estimated): __62.8 kg____
Estimate Ideal Body Weight (Male: 105lb + 6 lb/inch > 5’. Female: 100lb + 5lb/inch > 5’): __153 lbs
Does this client have characteristics of a well-nourished person? Yes _____ No _x____
Explain your answer.
The patient was not a well nourished person and there are many factors/ conditions that
would lead a nurse to believe this. The cause of the pancreatitis was secondary to alcohol
abuse and the patient was going through withdrawals during the stay in the hospital. His
hair and nails were very dry and brittle and he appeared to be dehydrated, which was
being treated with intravenous fluids. His BMI was in the normal range (21) despite a
recent weight loss from the nausea and vomiting. The patient is a frequent alcohol user
and drinks a fifth of alcohol every day, this resulted in an ethanol level of 418. His urea
nitrogen was a 6 and this shows a malfunction level in the liver or possibly liver disease.
Other liver labs such as the AST, ALT and lipase were all elevated. This also shows a
condition with the liver. The abnormality of the labs are more than likely due to alcohol
abuse. This patient was also NPO due to the pancreatitis and had generalized weakness
overall.
PSYCHOSOCIAL STAGE OF DEVELOPMENT
What is the client’s developmental stage?
The pt. is in the generativity vs. stagnation stage of Erikson's stages of development (McLeod,
2008).
Has he/she met the necessary accomplishments? Yes _____ No __x___
Explain.
This patient is a middle aged adult and does not have a spouse or a job/career, and lives alone.
He admits to being an alcoholic and drinks a fifth of alcohol every day. He presented to the ED
very intoxicated and suicidal/homicidal. The patient plans to seek out rehab/ support after his stay
in the hospital.
How is this illness affecting the client’s ability to meet these necessary accomplishments?
The illness is affecting the patient from seeking out help for his alcohol abuse. The patient
is also affected by withdrawal symptoms and this decreases his abilities to properly care
for himself
NURSING DIAGNOSIS/OBJECTIVES/INTERVENTIONS
Indicate below the 2 priority nursing diagnoses that are most relevant for your client.
#1 NURSING DIAGNOSIS (problem r/t)
Acute pain related to pancreatitis
DEFINING CHARACTERISTICS (S/S) that support this diagnosis:
Pt. complains of abdominal pain
Increase lipase levels (indication of pancreatitis)
Use of hydromorphone while in the hospital
OBJECTIVE/CLIENT OUTCOME for this diagnosis:
Pt. will receive alcohol abuse help upon release of the hospital and this will decrease
incidence of pancreatitis, therefore decreasing acute pain
NURSING INTERVENTIONS that will assist the client to resolve the above identified diagnosis:
1.Assess pts. pain hourly, in order to stay on top of pain medication administration
2.Ask the client to identify a comfort/pain level that is acceptable to them. This will help them to
complete daily activities
3.Treat pts. pain with a multimodal approach, work to find a medication regimen that works best for
the pt.
#2 NURSING DIAGNOSIS (problem r/t)
Anxiety r/t alcohol withdrawal aeb tremors, anxiousness, and irritability
DEFINING CHARACTERISTICS (S/S) that support this diagnosis:
Tremors
Anxiousness
Above an 8 on the CIWA
OBJECTIVE/CLIENT OUTCOME for this diagnosis:
Pt. will withdrawal from alcohol slowly and the symptoms will decrease so that the pt.
receives less than an 8 on the CIWA scale. This should happen within a couple days of
the hospital stay
NURSING INTERVENTIONS that will assist the client to resolve the above identified diagnosis:
1.Monitor the patient for withdrawal symptoms and administer the appropriate medications to
control withdrawal
2. Continually complete the CIWA scale in order to determine the necessary steps
3.Keep patient comfortable(pain under control) so that the anxiety is lessened
COMPLICATIONS:
If this client’s condition were to worsen, what would be the most likely reason and why?
If the patient's condition were to worsen it would most likely be secondary to his continued
alcohol abuse and not following his instructions of being NPO. This would cause more
inflammation of the pancreas and pain.
How would you know this is happening?
The patient would complain of more pain, possibly be nauseated/ vomiting, and the
abdomen would be very tender to touch.
What will you do if this happens?
If this happens I would investigate into what caused the worsening of the symptoms. I
would make sure the patient was complying with the NPO status and not drinking any
alcohol. The best thing for a patient with pancreatitis is to rest and avoid the intake of food.
To regulate the intense pain I would also talk to the doctor about pain medication. I would
also monitor the patients labs to make sure other issues were not arising.
PHYSICIAN PRESCRIBED MEDICATIONS AND INTERVENTIONS
MEDS/IVs/TX/DIET
(Include dose, route,
frequency)
REASON PRESCRIBED
(Drug Classification,
What is it treating?)
Antianxiety, benzodiazepine
Chlordiazepoxide, 50mg= 2
caps, PO, q6hr
Folic acid, 1 mg=1 tab, PO,
daily
Withdrawal from alcohol,
anxiety
Water soluble vitamin
Prevention of anemia
Thiamine, 100 mg=1 tab,
PO, daily
Water soluble vitamin
Dietary supplement for pts.
with alcoholism
Enoxaparin, 40 mg=0.4ml,
subq, daily
Anticoagulant
Prevention of blood clots
Acetaminophen, 650 mg=2
tabs, PO, q4hr, PRN
Antipyretic, nonopioid
analgesic
Decrease fevers and pain
Hydromorphone, 0.5
mg=0.5ml, IVpush, q3hr
PRN
Opioid agonist
Pain reliever
NURSING IMPLICATIONS
FROM TEXT
(Checking for adverse
reactions, preparation &
administration concerns)
Dizziness, headache,
sedation, diarrhea,
vomiting, rashes
CLIENT DATA FROM
YOUR ASSESSMENT
(What data is important to
know before & after
giving)
Assess for anxiety, level of
sedation, complete CIWA
Rash, irritability, difficulty
sleeping, fever
Assess for anemia, monitor
plasma folic acid levels,
hemoglobin, hematocrit
Weakness, pulmonary
edema, vascular collapse,
hypotension, GI bleeding,
cyanosis
Dizziness, headache,
edema, constpation,
increase in liver enzymes,
urinary retention,
hyperkalemia
Hepatotoxiciity,
constipation, increase in
liver enzymes, renal failure,
neutropenia, stevens
johnson syndrome
Confusion, sedation,
euphoria, blurred vision,
respiratory depression,
hypotension, constipation,
dry mouth, urinary retention
Assess for thiamine
deficiency, nutrition status
Assess for bleeding,
thrombus, monitor CBC,
platelet count,stools for
blood,
Assess overall health
status, alcohol usage,
assess pain and fever
status, Monitor LDH, AST,
ALT and prothrombin time
Assess BP, pulse, and
respirations before and
after, assess bowel
function, pain, lung sounds
Analysis of Diagnostic Tests
DIRECTIONS:
1.
List all diagnostic and laboratory tests pertinent to the patient's medical diagnosis or medical
treatments (i.e. medications) and provide the patient values for each test. Explain why they are
pertinent for this patient.
2.
List any screening diagnostic and laboratory tests that are not within normal limits. Explain why
these tests are increased or decreased in relation to your patient's medical condition.
Diagnostic/Lab Test
Patient Values
Analysis of Values
Urea Nitrogen
6 Low
Liver damage can cause low
levels of urea
AST
125 High
Indicates liver damage
Indicates liver damage
ALT
125 High
155 High
13.6 Low
High levels indicate damage to
the pancreas or a blockage of
the pancreatic duct
Pt. is anemic
40.3 Low
Indicates anemia
4.35 Low
Indication of anemia
122 Low
Low from pancreatitis and
vitamin deficiencies
418 Critical
Pt. level is that of a fatal level.
This is the amount of alcohol in
the blood
Lipase
Hemeglobin
Hematocrit
RBC
platelet
Ethanol level
Resources
Ladwig, G. B., & Ackley, B. J. (2011). Mosby's Guide to Nursing Diagnosis (third ed.).
Maryland Heights, MO: Mosby Inc
Mayo Clinic. (2014). Pancreatitis. In Mayo. Retrieved April 20, 2014
McLeod, S. (2008). Erik Erikson. In Simply Psychology. Retrieved February 10, 2014