Roy is a 56-year-old male who presents to the emergency department (ED) with severe midepigastric abdominal pain

Roy is a 56-year-old male who presents to the emergency department (ED) with severe midepigastric abdominal pain, nausea, and vomiting. He has a history of hypertension. On physical assessment, he is noted to have abdominal distension and tenderness with palpation. The physician questions Roy about his social history with alcohol, smoking, and illicit drugs. He admits to drinking a few beers and smoking a pack of cigarettes every day. The physician orders laboratory tests and a CT scan of the abdomen. Roy’s wife privately speaks to the physician to inform him that Roy actually drinks at least a six-pack of beer daily with an even higher intake on the weekends. This past weekend, Roy and his friends drank heavily while watching football.

1. Based on Roy’s presenting signs and symptoms and his significant alcohol history, it is possible that Roy has _____________________.

2. Fill-in Identify three digestive enzymes secreted by the exocrine pancreas and their function:

1. __________________________________________________________________________

2. __________________________________________________________________________

3. __________________________________________________________________________

3. Select all that apply Identify clinical manifestations associated with Roy’s condition:

❑ Acute, severe abdominal pain that occurs 24 to 48 hours after a heavy meal or alcohol intake

❑ Hypercalcemia

❑ Nausea unrelieved by vomiting

❑ Hypervolemia

❑ Ecchymosis in the flank or umbilical area

❑ Abdominal guarding

4. Roy’s laboratory test results are back and the abnormal results are noted below. Is each high or low compared to normal?

Amylase 300 High or low?
Lipase 210 High or low?
WBCs 16,000 High or low?
Glucose 168 High or low?
Calcium 8.1 High or low?
5. Identify why the above laboratory tests are abnormal in relation to his diagnosis.

1. Amylase:________________________________________________________________

2. Lipase:__________________________________________________________________

3. White blood cells:_________________________________________________________

4. Glucose:__________________________________________________________________

5. Calcium:__________________________________________________________________

6. When Roy’s wife asks how the condition develops, the nurse’s best response is:

A. “It is autodigestion of the pancreas by its own enzymes; it occurs most often with gallstones or long-term alcohol use.”

B. “It is most often caused by tumors of the pancreas or intestines.”

C. “It occurs when the pancreas is damaged by frequently eating spicy, hot foods combined with alcohol.”

D. “It occurs in patients with hypertension who have blood pressures that are high for prolonged periods.”

7. Roy is admitted to a medical unit with the following orders. Explain the rationale for each:

Bed rest
Incentive spirometer 10 breaths every 1 to 2 hours
NPO (strict)
IV fl uids of Lactated Ringer’s at 125 mL/hr
Ondansetron (Zofran) 2 mg IV every 6 hours PRN
Morphine 2 mg IV every 2 hours PRN
Fingerstick blood sugars every 6 hours
Sliding-scale insulin coverage with lispro (Humalog)

8. Order: Morphine 2 mg IV every 2 hours PRN Morphine is supplied as 5 mg in 2 mL. Calculate the dose of morphine to be given in mL: ________________________

9. Identify whether the following statements about the medical management of acute pancreatitis are true or false:

T or F: Patients with Roy’s condition require aggressive respiratory care because of the high risk of pulmonary infiltrates, effusions, and atelectasis.

T or F: Nasogastric tubes are routinely ordered in patients with this condition in order to remove gastric secretions.

T or F: Hypotension and decreased urine output are treated with fluids and blood products to replace fluid lost.

T or F: After recovery from the condition, patients are advised to avoid high-fat foods, heavy meals, and alcohol.

10. After educating Roy and his wife about the need to turn and reposition every 2 hours, the nurse determines that the wife understands the information when she states:

A. “Turning every 2 hours will help to reduce the pain he is feeling.”

B. “Getting out of bed and walking is actually the best for him.”

C. “Frequent position changes help prevent skin breakdown and lung problems.”

D. “Keeping him flat in bed will help him to breathe better.”