Sande M. Frutiger
Facilitator: Courtney Buck
NUR 437: Pathophysiology
July 19, 2012
I have read and understand the plagiarism policy as outlined in the RNBSN Student Handbook and this module as it relates to the IWU Honesty/Cheating Policy. By affixing this statement, I certify that I have not cheated or plagiarized in the process of completing this assignment. If it is found that cheating and/or plagiarism have taken place, I understand that the consequences of this action may include expulsion from Indiana Wesleyan University.
Sande Frutiger 7/20/2012
Acute Pancreatitis: Disorders of Exocrine Pancreas
J.M., a retired police officer, 64 years of age, arrives at the emergency room with complaints of severe abdominal pain, which he states is non-stop and sometimes can be felt in his back. He rates his pain as a nine on a zero to ten pain intensity rating scale. His girlfriend is with him and states he has been drinking since he was twenty years old and recently has increased his consumption since his divorce one year ago. J.M. states he has atrial fibrillation and does not take suggested medications. He does not smoke and states he eats a balanced diet.
Past medical history includes: fractured shoulder and rotator cuff repair in 2000; atrial fibrillation since age of 23; anabolic steroid abuse for weight-lifting competition starting at age 25 and ending at age 40.
Family history includes: father alive, age 85, alcoholic with hypertension and coronary artery disease; mother alive at 84 with hypertension; sister, age 58, alive and healthy.
Social history includes: third divorce within last year; has two children, a son 36 years of age and a daughter 32 years of age; no grandchildren; retired police officer after 40 years in a metropolitan area; alcohol abuse since age 20, currently consumes 12-18 cans of beer with 1-2 shots of whiskey daily; denies tobacco use; abused anabolic steroids 20 years ago. Denies any illicit drug abuse.
Current medications: Tylenol, 2 tablets orally as needed for pain.
Physical examination: The patient is a Caucasian male that looks his stated age. He is anxious and in acute pain. He is diaphoretic and nauseated.
Vital signs are as follows: BP 90/60; RR 40; HR 130; WT 202 lb; T 100.2; HT 6’ 2”.
J.M. abnormal lab results reveal:
Na 133 meq/L Glucose 515 mg/dL T Bili 1.4 mg/dL
K 3.4 meq/L Hgb 17.7 g/dL Alb 3.2 g/dL
Cl 95 meq/L Hct 54% Amylase 1200 IU/L
HCO3 22 meq/L AST 300 IU/L Lipase 2000 IU/L
Cr 1.9 mg/dL ALT 135 IU/L Trig 881 mg/dL
WBC 17,300/mm3 Ammonia 65 mcg/dL CRP 130 mg/L
Since J.M.’s serum amylase and serum lipase are markedly elevated, along with an elevated white blood cell count, glucose, C-reactive protein and bilirubin (Comprehensive laboratory manual, 2010); the hypothesis is made that the patient is suffering from acute pancreatitis (Porth, 2011, p. 756).
In addition to the lab results, J.M. is displaying the classic signs and symptoms of acute pancreatitis. The onset is usually abrupt, often occurring after a large meal or excessive ingestion of alcohol. Patients may have severe, constant pain in upper abdomen that can extend to back and flanks. Localized pain commonly reflects mild acute pancreatitis, while a more diffuse pain often means necrotizing pancreatitis (“Symptoms,” 2012). “Determination of the cause is important in guiding the immediate management and preventing recurrence. Abdominal ultrasonography is usually performed to assess for gallstones. Computed tomography (CT) of the pancreas is used to detect necrosis and fluid accumulation,” (Porth, 2011, p. 756).