Considering the patient’s homelessness and lack of insurance, what action should the practitioner take?

     The NP should stabilize the patient and call EMS to transfer the patient to the closest Emergency room. The patient should be reassured that regardless of the patient’s residential status or ability to pay- he will not be denied care. The Emergency Medical Treatment & Labor Act (EMTALA) requires emergency departments to provide a medical screening examination to any individual who comes to the emergency department. It prohibits emergency rooms from refusing to examine or treat individuals with an emergency medical condition (Centers for Medicare & Medicaid Services, 2024).

When the patient asks why his condition cannot be managed outside of the hospital, how should the practitioner respond? 

      The NP should explain to the patient the seriousness of his condition. If left untreated, pancreatitis can lead to life-threatening complications. Mortality is approximately two percent in most acute pancreatitis cases but can increase to thirty percent in patients with (acute/ chronic) organ system failure (Swaroop Vege, 2024). Shock, renal failure, respiratory problems, and pancreatic necrosis are only a few potential complications. Close monitoring is essential to identify complications promptly. The treatment for pancreatitis includes fluid resuscitation, pain control, and nutrition support (Swaroop Vege, 2024).

When the patient arrives at the hospital for further diagnostic work-up, what tests will likely be performed to evaluate the patient’s condition? 

      Serum testing should include the following per Swaroop Vege (2024): complete blood count, comprehensive metabolic panel, C reactive protein (CRP), and lactate. “Serial measurements in patients with acute pancreatitis are not useful to predict disease severity, prognosis, or for altering treatment (Swaroop Vege, 2024). Diagnostic Imaging such as an abdominal x-ray, ultrasound, and/or Magnetic Resonance Imaging) (Dunphy et al., 2023). The CT is not recommended, according to Swaroop Vege (2024), related to necrosis usually does not set in (enough for imaging) up to seventy- two hours following the initial presentation. 

What criteria are used to assess the severity of pancreatitis? 

Initial examination criteria should include assessment for fluid loss, any organ failure (especially cardiac, respiratory, and kidney systems), and (SIRS) systemic inflammatory response syndrome score (Swaroop Vege, 2024). Several scoring systems can be used to assess the severity of pancreatitis. Other scoring systems exist with many factors including such indications as follows: clinical assessment, laboratory, radiologic risks, and serum markers (Swaroop Vege, 2024). Per Swaroop Vege (2024), the APACHE II system and the systemic inflammatory response syndrome score have been reviewed to be the most accurate and applicable to the early determination of this condition. The other standard scales are not recommended to be utilized in the first twenty- four to seventy- two hours of onset (Swaroop Vege, 2024). No system replaces a thorough physical and diagnostic assessment by the provider.

What is the treatment plan for managing this patient? If medications are to be prescribed, provide full prescription details. 

     The treatment goal for acute pancreatitis is to limit the severity of the pancreatic inflammation and prevent further complications (Dunphy et al., 2023). The treatment consists of maintaining fluid status. This can be done with IV hydration of normal saline or lactated ringers; although more recent studies suggest being more selective with IV LR support (Swaroop Vege, 2024).  This is inconclusive and in debate; this concept can only be validated through further clinical trials/ studies (Swaroop Vege, 2024). 

     Pain control is often delivered via IV including both effective fluid resuscitation and opioids are effective for pain control. If adequate/ therapeutic fluid resuscitation can be obtained – this has been revered to assist in emergent pancreatitis (Swaroop Vege, 2024). Fentanyl has become a front line of analgesic for acute pancreatitis (Swaroop Vege, 2024). This is primarily due to efficacy and better administration with various comorbidities (Swaroop Vege, 2024). Meperidine has been the traditional treatment choice over morphine. Fentanyl can be given as a bolus or a constant infusion depending on weight and gender (birth).      

     The patient should have nothing by mouth for at least twenty- four hours and can advance to clear liquids if pain-free, serum levels are reaching the normal limits, and bowel sounds are present (Swaroop Vege, 2024). As the patient tolerates a clear liquid diet, progression to low-fat, solid foods is possible.  

What patient education should be included after the pancreatitis is resolved? 

     Specific client education should be provided education based on the predisposing conditions resulting in an acute pancreatic event (Swaroop Vege, 2024). Gallstones, alcohol intake, post-procedures (ERCP), drug-induced, and hereditary traits are common origins (Swaroop Vege, 2024). Per Swaroop Vege (2024), studies only show approximately twenty percent of acute pancreatitis occurrences have no known origin.  

     Basic teaching points include maintaining a low-fat diet and staying properly hydrated. Avoidance of alcohol and smoking cessation is very pertinent, no matter the etiology. These two activities act as huge irritants to potentially restimulate even mild pancreatitis (Swaroop Vege, 2024). It is recommended that smaller meals are eaten throughout the day rather than more traditional diets with three larger meals: easier on the digestive system (Swaroop Vege, 2024). Some clients may need so proper nutrition is obtained. The patient MUST be educated on recognizing early signs of an acute pancreatic attack; dependent on origin (Swaroop Vege, 2024). 

     Generally, sudden, severe constant pain in the upper part of the abdomen (Swaroop Vege, 2024). These sensations could wrap around your upper body and radiate to the back in a band-like pattern or directly (Swaroop Vege, 2024). Multiple days of pain are usual; often only relieved by forward-leaning posture (Swaroop Vege, 2024). Alcoholics may see early nausea and vomiting forty- eight to seventy – two hours following a binge episode (Swaroop Vege, 2024). Gallstone discomfort typically occurs before pancreatic signs in those cases related to stones (Swaroop Vege, 2024). Seeking immediate medical attention must be heavily emphasized to decrease potential mortality (Swaroop Vege, 2024). 

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