There are several actions that the practitioners can take to cushion the problem the patient is facing, like being homeless and lack of insurance. As a practitioner letting the patient go without being treated because he does not have the insurance cover is not an option because the patient is in acute distress (Stafford, 2017). The practitioner should educate the patient and make sure he understands his condition is a life-threatening situation. The patient needs to be transported to the nearest hospital and be treated for pancreatitis. Practitioners should ensure that the patient stays in the hospital for more effortless follow-up, considering he is homeless.
The practitioner should explain to the patient that his condition cannot be managed outside of the hospital because acute pancreatitis is a potentially lethal disease ( Mederos, 2021). The patient seems to be in a very severe condition, including the state where he has a blood pressure of 210/98, heart rate of 110, a temperature of 102.2F, respirations of 30/min, among other symptoms. The patient should also be educated if he does not go to the hospital, his symptoms can become more severe, which would cause persistent organ failure (>48 hours) ( Mederos, 2021).
Several tests should be done to evaluate the condition of the patient. The test includes a blood test such as (Serum lipase and amylase, CBC and differential, CMP, CRP, and aspartate aminotransferase/ alanine aminotransferase) (Tenner S, 2018). The imaging tests are also essential, and this involves conducting a chest x-ray, abdominal ultrasound, abdominal computed tomography scan, and magnetic resonance cholangiopancreatography (MRCP). The pancreatic function test is also another test to be performed for the diagnosis and endoscopic ultrasound.
When the patient is hospitalized, the nurse practitioner needs to assess the patient’s condition for further measures because it varies in severity (Mederos, 2021). The severity of pancreatitis is classified as mild, moderate, or severe. Mild acute pancreatitis is the most common, and it does not involve an organ failure or local or systemic complications; it usually resolves in the first week of treatment. Moderately severe acute pancreatitis is the presence of transient organ failure, which resolves within 48 hours of treatment. Severe acute pancreatitis is the persistent organ failure (>48 hours) ( Mederos, 2021).
The main goal of treating pancreatitis is providing supportive treatment to reduce the risk of progression to organ failure. Also, we need to treat the underlying cause and manage local complications. The most crucial aspect of medical management is the adequacy of fluid replacement and pain medication ( Tenner S, 2018). Prophylactic antibiotics and arterial oxygenation measurements are essential in the management of the disease. Also, the patient has a history of alcohol consumption; he may need pharmacological treatment for alcohol withdrawal as well; and necessary vitamins such as Thiamine, folic acid, and multivitamins. There should also be surgery recommendations to remove the gallbladder that may be the cause of pancreatitis—conducting the surgery help in reducing the probability of other complications. However, it should come after treatment of the difficulties, considering the severity of the condition. Endoscopic cholangiopancreatography is another way the nurse can use for the treatment and management of the disease.
The patient should be given some education after the resolution of his condition. One of the best advice the nurse practitioners should give this patient is a brief alcohol counseling intervention during admission and ensure he has a case manager in the case to continue the alcohol counseling process after discharge (Stafford, 2017). Also, eating a balanced, low-fat diet, maintaining adequate triacylglyceride control, and stop smoking tobacco or cigarette are other measures to be included in the patient’s self-care after treatment. Other educational measures include advising the patient to take medicines as prescribed by the nurse without skipping even a day, which may cause the severity of the condition again.
References
Mederos, M. A., Reber, H. A., & Girgis, M. D. (2021). Acute pancreatitis: a review. JAMA, 325(4), 382-390.
Stafford, A., & Wood, L. (2017). Tackling health disparities for people who are homeless? Start with social determinants. International Journal of Environmental Research and Public Health, 14(12), 1535
Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: Management of acute pancreatitis. Am J Gastroenterol. 2018 Sep;108(9):1400-15
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