- You should respond to your peers by extending, refuting/correcting, or adding additional nuance to their posts.
- All replies must be constructive and use literature where possible.
Ferlanda Pierrelus.
The Homeless Patient Evaluation & Management Plan
Many clinicians believe they lack the authority to make a difference in the lives of homeless patients. It is critical to establish confidence and to accept an individual’s situation. Providers must gain a proper understanding of what life is like for these individuals. It might be intimidating to discuss the nuances and practicalities of a patient’s needs, which is why excellent communication is critical. By employing open-ended, simple-to-understand questions, an interpreter to handle language challenges, and a multidisciplinary approach, providers can better assess and deliver tailored care to homeless individuals.
Patients with severe acute pancreatitis or who do not respond to conservative treatment should see a gastroenterologist. Once pancreatitis has been diagnosed, a surgical referral should be made. A patient with a pseudocyst requires long-term monitoring with serial CT scans to monitor the cysts resolution or growth, as well as surgical surgery ( Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J.,2019). Because of the severity of the patient’s condition, the nurse practitioner should refer him to the emergency department and explain the rationale for the referral. As of right now, the patient needs emergency medical attention because the signs and symptoms are potentially life-threatening. The nurse practitioner should make arrangements for the patient to be transported to the nearest hospital as soon as possible.
The practitioner must inform the patient that his current condition cannot be addressed in the clinic due to the clinic’s limited resources and that his situation is critical. He needs additional assessment by a physician. The practitioner should first explain to the patient the signs and symptoms he was exhibiting and possible explanations regarding his previous medical history. She should also explain to him that correct diagnosis requires investigative testing and processes. Additionally, the practitioner should inform the patient that the clinic cannot conduct laboratory tests or other complex diagnostic procedures. As a result, he needed to be sent to a hospital equipped with the necessary equipment, machines, and people.
Pancreatitis is diagnosed when abdominal discomfort is present, serum amylase and lipase levels are increased, and imaging abnormalities associated with acute pancreatitis are present. The gold standard for diagnosis is an abnormally high serum amylase level (up to three times the usual range). A concomitant rise of serum lipase supports the diagnosis of pancreatitis. Additionally, a complete blood count will be performed. Serum calcium levels are symptomatic of saponification and the severity of pancreatitis. Elevated C-reactive protein levels are associated with necrosis of the pancreas( Kalayarasan R., Narayanan S., Sahoo J.,& Mohan P., 2021).
Acute pancreatitis is treated to minimize the severity of pancreatic inflammation, prevent further complications by halting pathological processes, and control symptoms. Fasting is necessary until acute inflammatory symptoms diminish. Parenteral fluid is used to maintain fluid status and prevent hypovolemia. It is also vital to monitor urine production on an hourly basis. Daily monitoring of serum calcium, magnesium, glucose electrolytes, total protein, albumin, amylase, and lipase concentrations, as well as a complete blood count, is essential, with subsequent treatment of anomalies to avoid increased morbidity and mortality. Blood, urine, and sputum cultures should be acquired, and CT-guided needle aspiration of necrotic portions of the pancreas with adequate broad-spectrum antibiotic treatment initiated. Daily arterial blood gas values should be taken, and hypoxemia should be treated appropriately ( Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J.,2019).
The patient should get health education about the need to abstain from alcohol and the benefit of reducing his dietary intake of fat. The patient should know his pharmaceutical regimen, including the proper prescription doses and possible side effects. When patients grasp the purpose of treatment, they are more compliant.
References
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (Eds.). (2019). Primary care: The art and science of advanced practice nursing (5th ed.).
Kalayarasan R. , Narayanan S., Sahoo J., & Mohan P. (2021). Impact of surgery for chronic pancreatitis on the risk of pancreatic cancer: Untying the Gordian knot. DOI: 10.3748/wjg.v27.i27.4371
0 comments