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Juliete Misas Hernandez.
Homeless Patient Evaluation & Management Plan
“Patients may complain of acute onset of fever, nausea and vomiting that is associated with rapid onset of abdominal pain radiating to the midback located in the epigastric region. Frequent causes include drugs, biliary factors and alcohol abuse” (T., pg.237, 2018). Considering the patient’s homelessness and lack of insurance status the Nurse Practitioner (NP) should consider providing education to the patient about options that are available to him regardless of his social economic status. Many homeless individuals due not seek health care access because they are unaware of programs available to them within their own communities as well as homeless shelters. When the patient ask’s why his condition can not be managed outside of a hospital setting it is important for the NP to ensure to the patient about available resources within his community as well as what they are able to see and treat as well which condition will require a visit to a hospital setting. The patient can be seen at a mobile health clinic for homeless people or shelter base clinic like the one his currently visiting but these clinics are only able to evaluate and treat conditions such as behavioral health care, aid in obtaining benefits assistance, providing access to case management, basic dental care, providing immunizations, lab tests, medications, primary care and providing access to health screenings. Their resources are limited to performing only acute medical examinations and treatment, comprehensive physicals as well as Well-childcare. Basically, they are only able to provide basic primary medical care services plus. Conditions such as acute pancreatitis are more severe in nature and require more extensive health care services and monitoring that are simply not available in a community health care setting. It is important to educate that patient that this condition will cause inflammation of the pancreas and its surrounding tissues. While, mild cases may typically resolve within 48 to 72 hours, a severe case can be associated with complications which typically cause multisystem organ failure. Thus, this condition could potentially be life threatening and the only way to be completely certain is with further workup at a hospital. Associated systems with pale, cool and clammy skin may be potential signs of shock.
When the patient arrives at the hospital diagnostic workup should include a CBC, CRP, LFT’s, serum chemistries and urinalysis, CT of the abdomen, abdominal US. “Ranson’s criteria are useful for assessing severity of acute pancreatitis. Identification of early prognostic signs may aid in best indication of a serious outcome alerting the practitioner that the patient might warrant transfer to the intensive care unit” (Hektor, Winland-Brown, Porter & Thomas, pg.608, 2019). Upon hospitalization condition management will depend on severity of the pancreatic inflammation and may range from more conservative treatment options to more aggressive management. Potential condition management may consist of remaining NPO, until symptoms subside. Providing IV fluids, pain management with Meperidine, possible placement of a nasogastric tube if persistent nausea and vomiting, advance diet as tolerated. Severe cases may require ICU transfer for management under a gastroenterologist care with aggressive volume replacement management.
Important patient education upon resolution of pancreatitis is dependent on the cause of the pancreatitis in order to avoid future reoccurrence. Acute pancreatitis has various causes that range from drug induced this patient should immediately cease the causing agent and refrain from future usage. If acute pancreatitis is caused by alcohol abuse, this patient should be instructed to cease all future alcoholic beverage use. If the acute pancreatitis was caused by underlining biliary disease the patient may be educated on the possible need for a future cholecystectomy as well as introducing a diet that a reduced in fat.
References
Hektor, D. L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary care: The art and science of advanced practice nursing. F.A. Davis Company.
T., C. L. M. (2018). Family nurse practitioner certification intensive review: Fast facts and practice questions. Springer Publishing Company, LLC.
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