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Pancreatitis
Due to the patient being in acute distress I believe it would be imperative for the patient to be sent to the nearest hospital for closer medical management. As discussed by Stafford and Wood (2017), homelessness is correlated with enormous health inequalities, including shorter life expectancy, higher morbidity, and significant use of acute hospital services. Patients frequently go undiagnosed and untreated due to the inability to see health providers and not having the financial ability or resources. Per the information in the case study the patient appears to be suffering from acute pancreatitis and requires treatment in the acute care setting. The patient’s increased blood pressure, severe abdominal pain, pallor appearance, guarding and history of pancreatitis are all important factors for the patient requiring hospitalization. The provider should also discuss the negative outcomes that can be associated with untreated pancreatitis such as the development of acute respiratory distress syndrome and acute renal failure (Wu et al., 2021). The patient should be aware that hospitalization is vital so the patient can receive the appropriate pancreatitis treatment including pain management, provision of fluids and nutritional care (Johnstone, 2018).
Once the patient has been admitted to the hospital imaging should be performed to confirm the diagnosis of pancreatitis and assess the severity. Computed tomography, or a CT scan, should be the imaging performed to confirm the severity when pancreatitis is suspected (Hines & Pandol, 2019). Magnetic resonance imaging, or MRI, may be utilized to define pancreatic and biliary ductal anatomy, and assess for the causes of the pancreatitis episode (Hines & Pandol, 2019). Ultrasounds are not frequently utilized due to overlying bowel making visualization difficult however, ultrasound may be used to assess for gallstones and common bile duct stones (Hines & Pandol, 2019). Laboratory studies should also be taken once the patient is admitted to the hospital, these include amylase, lipase, alanine aminotransferase, CBC, CMP, lipid panel, and triglyceride levels (Basnayake & Ratnam, 2015). Amylase and lipase levels rise within hours of an episode of acute pancreatitis and are key components in diagnosing pancreatitis along with abdominal pain and radiological findings (Basnayake & Ratnam, 2015). Due to the patient’s fever he should also have urine and blood cultures obtained.
Ranson’s criteria are used to predict severity and mortality of acute pancreatitis. Five parameters are assessed on admission, and the other six are assessed at 48 hours post admission. One point is given for each positive parameter for a maximum score of 11 (Basit et al., 2019). Chances of mortality increase as the amount of points increase. Pancreatitis is severe if three of more criteria are met. Early identification is key to decrease mortality.
While the patient is hospitalized there should be no stress on the gastrointestinal tract, so nothing by mouth. During this time patients should have IV fluids to prevent dehydration. Morphine should be accessible for pain control to prevent increased pressure within the sphincter of Oddi. If pancreatitis is severe a nasogastric tube or small bowel tube may be placed. If pancreatitis is severe or there are complications it could lead to surgical intervention. Oral feedings should not be started until all complications have been treated, the patient is free from nausea and vomiting, and amylase and lipase levels have returned to normal. Antibiotics may be used to control any infection.
The etiology of his pancreatitis is most likely his alcohol abuse. The patient needs to be educated on the importance of abstaining and the risks of continuing to drink. The patient should be provided with alcohol abuse programs and support groups that are offered. A low-fat diet will also help in the recovery process and help prevent reoccurrence. Information and resources for homeless shelters or programs for the homeless should also be provided to the patient in order to get the appropriate medical care and attention for follow ups.
References
Basit, H., Ruan, G. & Mukherjee, S. (2019). Ranson Criteria. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482345/
Basnayake, C., & Ratnam, D. (2015). Blood tests for acute pancreatitis. Australian Prescriber, 38(4), 128–130. https://doi.org/10.18773/austprescr.2015.043
Hines O. & Pandol S. (2019). Management of severe acute pancreatitis. British Medical Journal, 367(l6227). doi:10.1136/bmj.l6227
Johnstone, C. (2018) Pathophysiology and nursing management of acute pancreatitis. Nursing Standard. doi: 10.7748/ns.2018.e11179
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. https://doi.org/10.3390/ijerph14121535 (Links to an external site.)
Wu, Q., Wang, J., Qin, M., Yang, H., Liang, Z. & Tang, G. (2021). Accuracy of conventional and novel scoring systems in predicting severity and outcomes of acute pancreatitis: A retrospective study. Lipids in Health and Disease, 20(41). https://doi.org/10.1186/s12944-021-01470-4 (Links to an external site.)
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