Forty-nine–year-old Frank has been a heavy drinker for the past 25 years. He als
ID: 122120 • Letter: F
Question
Forty-nine–year-old Frank has been a heavy drinker for the past 25 years. He also has a history of hypertension, hyperlipidemia, and recent upper respiratory viral infection. Frank’s only current medication is Lasix (furosemide) 40 mg od. He presents with severe epigastric pain that radiates to his back and worsens when lying down. His abdomen is distended, and bowel sounds are hypoactive. Frank has a fever and is diaphoretic and hypotensive, and his serum calcium is very low.
In your initial post answer the following questions:
Frank is being transferred to the ICU. If you were the ICU nurse, what would you have to consider in Frank’s case?
What would you expect in the way of treatment modalities for Frank?
Explanation / Answer
Frank uses a daily dose of Furosemide, 40 mg may be prescribed for treatment of hypertension to reduce high blood pressure and prevent heart attack and kidney problems.
Given symptoms especially a radiating back pain which worsens on lying down is a clear or indicative symptom of Pancreatitis. Since the most common cause of Pancreatitis is high alcohol, and Frank being an aloholic for 25 years. Symptoms include a rapid pulse, fever, nausia, swollen and tender abdomen all because of the inflammation to pancrease.
First intervention in the treatment in the ICU is
Assess nutritional status, respiratory status, fluid and electrolye status, assess abdomen for asccites.
ending oral intake, rehydration and prevention or renal and respiratory insufficiency. Investigate pain on 0-10 pain scale and location. Isolated pain in RUQ indicates head of pancreas and LUQ is tail of pancreas.
help patient with bedrest and comfort, which decreasee the metabolic rate and hence secretions of the GI will reduce the panncreatic activity.
Since supine position increases pain, may ask the person to sit on flexed knees and bend forward.
Assess nutrition and breathing pattern. Improve the breathing pattern , by maintaining in semi-Fowler's position, imporve nutrition.
Observe for intractable pain due to complications of biliary tract like pancreatic abscess and pseudocyst.
Maintain gastric suction to stimulate pancreatic enzyme activity.
Can be prescribed antacids, to reduce GI secretion of HCl to reduce stimulation of pancreas.
Prescribe sedatives and antispasmodics like atropine, to reduce metabolic needs and enzyme secretions.
Narcotic analgesics may be prescribed in case of prolonged pain.
Treatment modalities for Frank:
Monitor for respiratory complications like hypovoleimic shock, lung injury or sepsis. Monitor volume resuscitation, central venous pressure. Entral feeding than TPN or total parenteral nutrition is suggested. Antibiotics only if there is necrotizing pancreatitis symptoms or signs of infection, no prophylactic antibiotic therapy. To avoid infected necrosis, so inducing antibiotic threapy should be beneficial. Intravenous nutritional support can be resorted to. Hypocallcemia correction with i.v. calcium should be done with utmost care. Hypomagnesaemia is found in alcoholics, so Mg correction should be done before hypocalcemia.