Angeles University Foundation Angeles City

Case Study
ACUTE PANCREATITIS secondary to Cholecystolithiasis

Submitted By: Amansec, Ma. Carmina A. Bautista, Christopher Bontogon, James Russel Submitted To: Mrs. Abigail A. Buan. R.N. Date of submission: September 18, 2007

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I. INTRODUCTION In our generation today, fast foods are ubiquitous, junk foods, high caloric foods and salty foods are the favorites of the majority especially the young generation. People often neglect the possible complication that can possibly occur with their routine of eating. The current complication that often arises today are: diabetes mellitus, hypertension, and cardiovascular diseases . . . . One of which is pancreatitis or the inflammation of the pancreas. Before our duty in every rotation ends, we are obliged to present a case study with regards to the patient that we have handled. And fortunately we had this case regarding Acute Pancreatitis resolved Cholecystolithiasis. Our main objective in conducting this case study is to come across about the causes and other factors that caused the patient to have this acute pancreatitis. By merely establishing rapport to gain the patient’s trust and together with the significant others we were able to gather data and information that will be of help for our case study. The first thing we did is the student nurse- patient interaction and as well as interacting with the significant others, then reviewing the patient’s chart. A. Current trends about the disease condition. Statistical data: Extrapolated Population Estimated Incidence Used Acute Pancreatitis in North America (Extrapolated Statistics) USA 86,369 293,655,4051 Canada 9,561 32,507,8742 Mexico 30,870 104,959,5942 Acute Pancreatitis in Caribbean (Extrapolated Statistics) Puerto Rico 1,146 3,897,9602 Acute Pancreatitis in South America (Extrapolated Statistics) Brazil 54,147 184,101,1092 Colombia 12,444 42,310,7752 Venezuela 7,358 25,017,3872 Acute Pancreatitis in Northern Europe (Extrapolated Statistics) Denmark 1,592 5,413,3922 1,533 WARNING! Finland 5,214,5122 (Details) Country/Region Sweden 2,643 8,986,4002 2

Acute Pancreatitis in Western Europe (Extrapolated Statistics) Britain (United Kingdom) 17,726 60,270,708 for UK2 Belgium 3,043 10,348,2762 France 17,771 60,424,2132 Ireland 1,167 3,969,5582 Netherlands (Holland) 4,799 16,318,1992 United Kingdom 17,726 60,270,7082 Wales 858 2,918,0002 Acute Pancreatitis in Central Europe (Extrapolated Statistics) Austria 2,404 8,174,7622 Germany 24,242 82,424,6092 Poland 11,360 38,626,3492 Switzerland 2,191 7,450,8672 Acute Pancreatitis in Eastern Europe (Extrapolated Statistics) Russia 42,345 143,974,0592 Acute Pancreatitis in the Southwestern Europe (Extrapolated Statistics) Portugal 3,095 10,524,1452 Spain 11,847 40,280,7802 Acute Pancreatitis in the Southern Europe (Extrapolated Statistics) China 382,014 1,298,847,6242 Hong Kong. 2,016 6,855,1252 Japan 37,450 127,333,0022 Taiwan 6,691 22,749,8382 Acute Pancreatitis in Southeastern Asia (Extrapolated Statistics) Malaysia 6,918 23,522,4822 Philippines 25,365 86,241,6972 Singapore 1,280 4,353,8932 Thailand 19,078 64,865,5232 Vietnam 24,312 82,662,8002 Acute Pancreatitis in Oceania (Extrapolated Statistics) 5,856 19,913,1442 1,174 3,993,8172

Australia New Zealand

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Pancreatitis is a condition in which the pancreas becomes inflamed. Scientists Discover Article Date: 16 Mar 2006 . Researchers at the University have now discovered that caffeine can partially close special channels within cells. The caffeine effect. This extrapolation calculation is automated and does not take into account any genetic. Under these conditions. excessive amounts of calcium are released from stores within the cells of the pancreas. is 4 . these extrapolations may be highly inaccurate (especially for developing or third-world countries) and only give a general indication (or even a meaningless indication) as to the actual prevalence or incidence of Acute Pancreatitis in that region. It is often triggered by alcohol consumption which causes digestive enzymes to digest part of the pancreas.10:00 PDT Scientists at the University of Liverpool have found how coffee can reduce the risk of alcohol-induced pancreatitis. These statistics are presented only in the hope that they may be interesting to some people. environmental. Professor Petersen explains: "The primary cause of the build up in calcium ion concentration is movement of calcium ions from a store inside the cells into the cell water through special channels in the store membrane. Canadian or Australian prevalence or incidence statistics. We have found that caffeine. and racial or other differences across the various countries and regions for which the extrapolated Acute Pancreatitis statistics below refer to. This explains why coffee consumption can reduce the risk of alcoholic pancreatitis. Coffee Can Reduce Risk Of Pancreatitis. reducing to some extent the damaging effects of alcohol products on the pancreas. Special organelles. The statistics used for prevalence/incidence of Acute Pancreatitis are typically based on US. Professor Ole Petersen and Professor Robert Sutton. which are then extrapolated using only the population of the other country. The excess calcium then activates protein breakdown. also become damaged and cannot produce the energiser that normally allows calcium to be pumped out of the cells. have found that cells in the pancreas can be damaged by products of alcohol and fat formed in the pancreas when oxygen levels in the organ are low. cultural. present in drinks such as coffee can at least partially close these channels. but have been unable to determine how. destroying the cells in the pancreas. from the University's Physiological Laboratory and Division of Surgery. UK. social. As such. however.*These statistics are calculated extrapolations of various prevalence or incidence rates against the populations of a particular country or region. *The extrapolation does not use data sources or statistics about any country other than its population. causing severe abdominal pain. called mitochondria. Scientists have known for some time that coffee can reduce the risk of alcoholic pancreatitis.

we can.nurse to their patients. Essentially. so we have to search for better agents. for the first time. As a result of this research however. "At the moment there is no specific pharmacological treatment for pancreatitis. Some of the effects of the non-oxidative alcohol products on isolated pancreatic cells cannot be reversed. society and government in achieving the wellness of the patient is one of the reasons in choosing this case.1.weak and excessive coffee intake has its own dangers. Enriching and elevating the quality of nursing as a call. As well as to have an experience and be familiar in handling. C. which is where the problem originates. career. For the group the only way to carry out the different nursing interventions is obtaining full range of knowledge and the only way to meet it is personal interest by curiosity. Reasons for choosing such case for presentation. it is about the outcome of proper nursing care and the provision of giving consistent information or knowledge concerning the disease. managing and providing compassionate health services to a patient who has it and provide any intervention or management indicated based on the specific etiology." B. Objectives C. explaining why excess alcohol intake can be so dangerous. To find out and apprehend the significance of concerning the family. (Nurse. begin to search for specific chemical agents that target the channels causing the excessive liberation of calcium ions inside the cells. We are also hoping that these findings can be used to warn against the dangers of binge drinking.centered) 5 . vocation or a profession is one of the major errands and the foundation of nursing profession The reason and enthusiasm of the group in choosing the case for presentation is to hold close with the information and management of the condition for the group to give their full and quality service as student.

etiology and risk factors involve in its acquisition and progression. its pathophysiology.centered) o Describe the disease process. diagnostic procedures. its indication and their essential relationship to the disease condition. C. treatment regimen and nursing care based on her level of understanding. o Cooperate in the necessary medical and nursing interventions II. (Patient. o Analyze the different laboratory and diagnostic procedure.o Formulate nursing care plans based on the prioritized health needs of the patient.2. o Assist patient and family to participate in patient’s care as circumstances allow. o Gain proper knowledge and understanding about the existing disease condition. sociology. NURSING ASSESSMENT Personal History 6 . o Determine the personal and pertinent family history of the patient and relate it to the present state.

Ms. CSFP near their relatives and occupied an apartment which has an area of 300 meter square. they migrated here at pampanga last 2000. they have some relatives who has been very supportive to their family in terms of financial crisis. but they buy cooked foods from outside and they store their food on a plate with cover. originally. 1984 at Riverside Ormoc city.Ms. body weakness hasn’t stopped until other manifestation occurs which is abdominal pain. Past Illness 7 . wash clothes and to take a bath when someone from the family died. Starting at their house. Upon assessing her together with the Significant others. Also believes that when a person bite his or her tongue means that someone remembers you and lizards are bad luck. They don’t tend to consult to the near health clinic if illness occurs. CSFP. At the age of 8 years old. Leyte. And they do not have any problem regarding to their electrical and water bills. sleeps. While their source of lighting is coming from a fluorescent bulb. She had use analgesics like alaxan for his. She and her family is not allowed to sweep. Has an unhealthy body that’s why she can’t play in her friends. She was born on January 05. we also jotted down notes especially those potential factors that could contribute to her disease. Beyonce taught that this is only normal. which more than 20% of adequate ventilation. She only gets inside their house watching T.V and after that just takes e rest then afterwards. but due to unreasonable decision. She only gets inside of her house watching TV and after that sleeping. But they only consult to a hospital when illness persist. Snowhite 23 years old is the 4th eldest child of Mr. Ms. And it is adequate to their family. But up until she reached the age of 20 body weakness has not already been stopped until the other manifestation occur which is abdominal pain. She had to use pain reliever like Alaxan. Snowhite thought that is only normal to experience abdominal pain one in a while. Their apartment is concrete and consists of 3 windows. She said that using alaxan is the best way to have enough energy. she started to experience body malaise. Mrs. dividing 300 meter square into 9 persons which will result into 33 square meter each. Ms. Usher who loves to ate junk foods 10 times a day and to drink 8 oz of soft drink 3 times a day. But up until she reached the age of 20. Maybe because she is supplying her body enough fluid. and estimating the area. Snowhite easily gets tired that was she can’t engage in recreation together with her friends. Their source of water is coming from NAWASA and they store it on a pitcher. and Mrs. Where they resided at Juliana. As mentioned a while ago. she started to experience body malaise. She is a Filipina and a roman catholic. they have house in Leyte. Snowhite is a High school Graduate of central school at Leyte. They don’t usually prepare foods. She lives at Juliana. At the age of 8 years old.

She was not able to stand and was cramping with pain. When she was in her 2nd year high school. which lasted for a month. And unfortunately when they reached the center. They resort in using “herbal medicine”. If they do not have enough money to avail medicines during times of sickness they usually take paracetamol such as Biogesic. According to Mr. that was not tolerable by sleeping. At the age of eight. That is why her brother Shriek. According to her she just sleeps when she had abdominal pain. Usher. She said that she can’t recall. she experienced having measles that lasted for a week. Usher (Mrs. Mr. Snowhite had a fever and headache when she was two years old. The pain she experience was usually at the epigastric region. Snow white experience remittent abdominal pain. Snowhite’s uterus was diagnosed with benign myoma through checkup at Makabali. According to Mrs. It was treated through taking of the medicines that was prescribed by her physician but she can’t remember the name of the drugs anymore. Mr. decided to send her to the hospital. according to her she screams when this pain happened. making them to transfer her to Jose B. she acquired Chicken fox that lasted for two weeks. sends her to the health center near their residence. Usher. reported that Mrs. 8 . she had mumps. Usher took egg and salt as a form of healing for the chicken pox. When she was ten years old. Their first choice of hospital was at Makabali but because there is no available bed she was not admitted their. like Yerba Buena for headache and they usually make use of the decoction in preparing for this. Snowhite’s father). their physician prescribed antibiotic for her measles. Three weeks prior to the admission.Mrs. her mother. Ms. Mrs. they applied TINA on the mumps. the midwife was not around so what they did is self-medicate. Snowhite was diagnosed of acute pancreatitis due to the gall bladder stone formation. Lingad. Ms. Then three days before the admission she had severe abdominal pain. Present Illness At the age of twenty-three. She said that she can still tolerate the pain at this time. Usher give her daughter Biogesic for this. but they can’t recall what specific name of antibiotics was given. which also diminishes upon sleeping? She feels the same way two weeks prior to admission. She is experiencing abdominal pain a month prior to the admission.

FAMILY HEALTH-ILLNESS HISTORY Moth Father Died @ old age age Died @ old age Died @ old age Died @ old age A1 A2 Mother A3 A4 A5 A6 Father “Hypertension ” Sis 1 Bro 1 Bro 2 Snowhite Acute Pancreatitis. mumps and benign uterine myoma Sis 2 Bro 3 9 .

And she has been diagnosed of benign uterine myomas. Usher got marriage. Usher is noted to be hypertensive. they were blessed with 6 children.Family Health-illness History: Ms. Snowhite which suffering from acute pancreatitits. she has been diagnosed of Acute Pancreatititis secondary to cholecystolithiasis. Aside from her present disease. Usher (Ms. Mrs. Snowhite father). Her grandparents on both maternal and paternal side have died due to old age. Snowhite mother) is the third sibling on their family. When Mr. Which are 3 girls and 3 boys in ratio. and Mrs. she had a past illness such as childhood illness like mumps. While Mr. has no siblings meaning to say that he is the only child of his parents. On the other hand. All of their children are well and in good health except for Ms. But Mr. It means that they don’t die on such illnesses that commonly geriatric would have experienced such as renal impairment or heart attack. And she is the only girl among seven children of her parents. They were all healthy and normal. Usher (Ms. 10 . Until. Snowhite’s family has a few history of pertinent illness. But all of them has have not experienced any serious health-illness.

normocephalic.36. characterized by a normal body figure. wrinkle. raise eyebrows.80bpm R.20bpm B/P.A. forehead. 2007) T. close eyes. purse lip.2007 Physical Assessment The Integument Skin [] Has no odor [] Has a uniform brown to whitish complexion [] Ha a good skin turgor [] skin is warm to touch within normal limits [] Presence of scar in the left lower leg [] absence of edema Hair [] Evenly distributed black hair Extends until below the shoulder [] Thick and silky [] Absence of Pediculosis Nails [] Long and dirty finger nails and toe nails. She responds appropriately to every question asked to her at moderate pace and as long as she can tolerate the pain.8*C P. Physical Examination General Appearance The patient has a proportionate body built. Physical Assessment (August 23. She is cooperative and exhibits thought association. and symmetrical [] Smooth and uniform in consistency [] Absence of nodules or masses Face [] Symmetrical facial movements (can smile frown. and puff cheeks) Scalp [] presence of dandruff [] Absence of Pediculosis 11 . show teeth. [] Light brown to pink in color [] Convex curve [] Good capillary refill (less than 4 seconds) The Head Skull [] Rounded.110/80mmHg August 23. The patient has synchronized body movements though an attack of abdominal pain causes her to twitch at times.

Lacrimal sac. smooth and shiny details of iris visible Pupils [] Equally round and reactive to light accommodation Visual [] patient can see objects in the periphery even when looking straight ahead [] able to read printed words at a distance of 14 inches Extra ocular Muscles [] coordinated movements of both eyes The Ear and Hearing Auricles [] same as facial skin [] symmetrical [] aligned with the outer canthus of the eye [] firm and not tender [] pinna recoils after it is folded External Ear Canal [] presence of dry to wet cerumen [] normal voice tone audible 12 .The eyes and vision Eyebrow [] Hair evenly distributed with the skin intact [] Symmetrically aligned equal movement Eyelashes [] Equally distributed [] Curled slightly outward Eyelids [] Skin intact [] Absence of discharges and discoloration [] Closes symmetrically [] 10-15 blink/min Bulbar Conjunctiva [] Transparent [] Capillaries are evident [] whitish sclera [] Palpebral Conjunctiva [] Shiny and smooth Lacrimal gland. And Nasolacrimal duct [] Absence of tenderness [] Absence of tearing when palpated [] Cornea [] Transparent.

[] able to hear watch thick on both ears [] able to speak out whispered words The Nasal Cavity Nose [] symmetrical and straight [] absence of discharges or flaring [] air moves freely as patient breaths through the nares The Mouth and Oropharynx Lips and Buccal Mucosa [] Pinkish in color but lips [] able to purse lip Inner lip and front teeth [] complete number of teeth [] smooth and white [] shiny tooth enamel [] pinkish moist gums [] firm texture Buccal Mucosa and Back teeth [] no retraction of gums [] absence of plaque and tartar [] tongue located in the midline [] not able to protrude tongue fully Hard/Soft Palates [] pink. smooth palate [] no discharges or flaring Uvula [] located midline of soft palate Oropharynx and tonsils [] no discharges [] slightly pink and smooth [] Gag reflex The Neck and Lymph nodes Neck [] Muscles equal in size and strength [] head centered [] can freely move the head Lymph Nodes [] not palpable The Thorax and Lungs [] full and symmetric chest expansion [] spine vertically aligned [] spinal column straight 13 .

firm. smooth [] with coordinated muscle movement [] No tenderness or swelling [] No deformities noted 14 . or nodules The Abdomens [] normal bowel sound [] no presence of binder The Bones and Joints [] no swelling or tenderness [] no signs of crepitation [] absence of nodules [] joints move smoothly The Extremeties [] symmetrical in shape. generally symmetric [] unequal [] no discharges [] both nipples are not inverted and is present [] no tenderness. masses.[] left and right shoulders are of the same height [] absence of abnormal breath sounds\ The Heart [] symmetric pulse volumes [] full pulsations thrusting quality [] cardiac beating remains the same when the patients breaths The Peripheral Pulses [] symmetric pulse volumes [] full pulsations [] limbs not tender [] skin in the peripheries is uniformly pink in color [] temperature not excessively warm and cold [] no edema The Breast and Axillae [] round.

Ask the client to read words on a piece of paper with each eye first then both eyes. The client will be able to make chewing movements. open the mouth against resistance move jaw from side to side and open mouth widely. and able to follow the movement of the penlight. The client was able to smile. alcohol.Cranial Nerve Assessment Cranial Nerve Cn1: Olfactory {sensory} Assessment Technique Ask client to identify different aromas with each nostril Separately with eyes close. frown. Patient was able to read the words written on a paper “olfactory” Pupils are equally round and reacted to light accommodation Has good coordination of eye movement and able to follow the movement of the penlight The client was able to elicit chewing movements. puff the cheeks and Cn2: Optic {sensory} Cn3: Oculomotor {motor} Cn4: Trochlear {motor} The client will be able to follow the movement of the penlight. raise eyebrow. Ask the client to make chewing movements. The client will be able to read the words. open the mouth against resistance. raise eyebrow. frown. Pupil will constrict upon introduction of light. puff the cheeks and show Expected Outcome The client will be able to identify to different aromas unless such conditions like cold is present. The client has a good coordination of eye movements. Ask client to look straight ahead then approach the pupil with a penlight and observe for pupil constriction Ask client to hold the head still and follow the penlight as it moves in the six cardinal eye movements. raise eyebrow. open the mouth against resistance move jaw from side to side and open mouth widely. Responses Patient was able to identify different aroma like cologne. move jaw from side to side and open mouth widely. The client will be able to follow the movement of penlight The client will be able to smile. puff the Cn5: Trigeminal {motor} Cn6: Abducens {motor} Cn7: Facial{sensory and motor} 15 . Have the client to hold his head steady and follow the penlight direction Ask the client to smile. frown.

78bpm RR. The client will able be to hear and repeat the words whispered to him.2007 Physical Assessment (August 3123.teeth. Ask the client to protrude the tongue cheeks and show teeth. [] Light brown to pink in color 16 . The client was able to elicits gag reflex. August 31. Cn12: Hypoglossal {motor} A. the client was able to hear and repeat the words whispered to him/her. The client was able to protrude his/her tongue. The client will be able to protrude this tongue show teeth. The client cannot cough effectively The client was able to elevate the shoulders against the resistance and turn the head from side to side.120/80mmHg Skin [] Has no odor [] Has a uniform brown to whitish complexion [] Ha a good skin turgor [] skin is warm to touch within normal limits [] Presence of scar in the left lower leg [] absence of edema Hair [] Evenly distributed black hair Extends until below the shoulder [] Thick and silky [] Absence of Pediculosis Nails [] Long and dirty finger nails and toe nails. The client will be able to elevate the shoulders against the resistance and turn the head from side to side.4*C PR. Cn8:Vestibulocochlear Have the client to /Acoustic repeat the {sensory} whispered few words at the clients back.36. Client elicits gag reflex The client will be able state name without hoarseness of voice.23bpm B/P. Cn9:Glossopharyngeal Ask the client to {sensory and motor} swallow the open mouth widely and say “AH” Cn10: Vagus Ask the client to {motor} cough and say it name Cn11: Accessory {motor} Ask the client to elevate shoulders against the resistance and turn head from side to side. 2007) T.

[] Convex curve [] Good capillary refill (less than 4 seconds) The Head Skull [] Rounded. show teeth. normocephalic. wrinkle. close eyes. forehead. raise eyebrows. purse lip. And Nasolacrimal duct [] Absence of tenderness [] Absence of tearing when palpated [] Cornea [] Transparent. Lacrimal sac. and puff cheeks) Scalp [] presence of dandruff [] Absence of Pediculosis The eyes and vision Eyebrow [] Hair evenly distributed with the skin intact [] Symmetrically aligned equal movement Eyelashes [] Equally distributed [] Curled slightly outward Eyelids [] Skin intact [] Absence of discharges and discoloration [] Closes symmetrically [] 10-15 blink/min Bulbar Conjunctiva [] Transparent [] Capillaries are evident [] whitish sclera [] Palpebral Conjunctiva [] Shiny and smooth Lacrimal gland. smooth and shiny details of iris visible Pupils [] Equally round and reactive to light accommodation Visual [] patient can see objects in the periphery even when looking straight ahead [] able to read printed words at a distance of 14 inches Extra ocular Muscles 17 . and symmetrical [] Smooth and uniform in consistency [] Absence of nodules or masses Face [] Symmetrical facial movements (can smile frown.

smooth palate [] no discharges or flaring Uvula [] located midline of soft palate Oropharynx and tonsils [] no discharges [] slightly pink and smooth [] Gag reflex 18 .[] coordinated movements of both eyes The Ear and Hearing Auricles [] same as facial skin [] symmetrical [] aligned with the outer canthus of the eye [] firm and not tender [] pinna recoils after it is folded External Ear Canal [] presence of dry to wet cerumen [] normal voice tone audible [] able to hear watch thick on both ears [] able to speak out whispered words The Nasal Cavity Nose [] symmetrical and straight [] absence of discharges or flaring [] air moves freely as patient breaths through the nares The Mouth and Oropharynx Lips and Buccal Mucosa [] Pinkish in color but lips [] able to purse lip Inner lip and front teeth [] complete number of teeth [] smooth and white [] shiny tooth enamel [] pinkish moist gums [] firm texture Buccal Mucosa and Back teeth [] no retraction of gums [] absence of plaque and tartar [] tongue located in the midline [] not able to protrude tongue fully Hard/Soft Palates [] pink.

generally symmetric [] unequal [] no discharges [] both nipples are not inverted and is present [] no tenderness. masses.The Neck and Lymph nodes Neck [] Muscles equal in size and strength [] head centered [] can freely move the head Lymph Nodes [] not palpable The Thorax and Lungs [] full and symmetric chest expansion [] spine vertically aligned [] spinal column straight [] left and right shoulders are of the same height [] absence of abnormal breath sounds\ The Heart [] symmetric pulse volumes [] full pulsations thrusting quality [] cardiac beating remains the same when the patients breaths The Peripheral Pulses [] symmetric pulse volumes [] full pulsations [] limbs not tender [] skin in the peripheries is uniformly pink in color [] temperature not excessively warm and cold [] no edema The Breast and Axillae [] round. or nodules The Abdomens [] normal bowel sound [] no presence of binder The Bones and Joints [] no swelling or tenderness [] no signs of crepitation [] absence of nodules [] joints move smoothly 19 .

Patient was able to read the words written on a paper “olfactory” Pupils are equally round and reacted to light accommodation Has good coordination of eye movement and able to follow the movement of the penlight The client was able to elicit chewing movements. Pupil will constrict upon introduction of light. The client will be able to follow the movement of Cn5: Trigeminal {motor} Cn6: Abducens {motor} 20 . firm. Ask the client to make chewing movements. open the mouth against resistance move jaw from side to side and open mouth widely. smooth [] with coordinated muscle movement [] No tenderness or swelling [] No deformities noted Cranial Nerve Assessment Cranial Nerve Cn1: Olfactory {sensory} Assessment Technique Ask client to identify different aromas with each nostril Separately with eyes close. open the mouth against resistance. The client has a good coordination of eye movements. open the mouth against resistance move jaw from side to side and open mouth widely. The client will be able to make chewing movements. Responses Patient was able to identify different aroma like cologne. Have the client to hold his head steady and follow Expected Outcome The client will be able to identify to different aromas unless such conditions like cold is present. move jaw from side to side and open mouth widely. alcohol.The Extremities [] symmetrical in shape. Cn2: Optic {sensory} Cn3: Oculomotor {motor} Cn4: Trochlear {motor} The client will be able to follow the movement of the penlight. The client will be able to read the words. Ask the client to read words on a piece of paper with each eye first then both eyes. Ask client to look straight ahead then approach the pupil with a penlight and observe for pupil constriction Ask client to hold the head still and follow the penlight as it moves in the six cardinal eye movements.

raise eyebrow. Client elicits gag reflex The client will be able state name without hoarseness of voice. frown. frown.the penlight direction Cn7: Facial{sensory and motor} Ask the client to smile. penlight The client will be able to smile. raise eyebrow. The client will able be to hear and repeat the words whispered to him. The client was able to protrude his/her tongue. the client was able to hear and repeat the words whispered to him/her. The client cannot cough effectively The client was able to elevate the shoulders against the resistance and turn the head from side to side. The client will be able to protrude this tongue and able to follow the movement of the penlight. Cn9:Glossopharyngeal Ask the client to {sensory and motor} swallow the open mouth widely and say “AH” Cn10: Vagus Ask the client to {motor} cough and say it name Cn11: Accessory {motor} Ask the client to elevate shoulders against the resistance and turn head from side to side. The client will be able to elevate the shoulders against the resistance and turn the head from side to side. raise eyebrow. frown. puff the cheeks and show teeth. The client was able to smile. Cn8:Vestibulocochlear Have the client to /Acoustic repeat the {sensory} whispered few words at the clients back. puff the cheeks and show teeth. The client was able to elicits gag reflex. Ask the client to protrude the tongue Cn12: Hypoglossal {motor} 21 . puff the cheeks and show teeth.

0.9 WBC DO: 08-18-07 DR: 08-18-07 . which implies that there is no presence of infection. which means tat there is no alterations in the blood Hgb of the patient.Measures the percentage by volume of packed red blood cells in a whole blood sample . polycythemia.To check the volume of RBC in the blood. 127 g/L 115-155g/L BLOOD COUNT Hematocrit DO: 08-18-07 DR: 08-18-07 DO: 08-21-07 DR: 08-21-07 . 22 .48 -There is a normal level of Hematocrit.F. which means that there is a normal concentration in the contents of blood that indicates absence of abnormality. Diagnostic and Laboratory Procedures Diagnostic/ Date Indications Laboratory ordered or Purposes Procedures Date Results BLOOD This test.38 0. measure the grams of DO: hemoglobin 08-21-07 found on a DR: deciliter (100 08-21-07 ml) of whole blood Results Normal Values Analysis and Interpretation of Results -There is a normal level of Hgb. 5. -To aid diagnosis of abnormal states of hydration.Part of the CBC is the WBC reports the number of white cells -There is a normal level of WBC. DO: COUNT usually 08-18-07 performed as DR: Hemoglobin 08-18-07 part of a cbc. and anemia.38 – 0.

It compromises majority of WBC.35 -Are in first line defense against infection.10 x 10 g/l Lymphocyte DO: 08-18-07 DR: 08-18-07 DO: 08-21-07 DR: 08-21-07 Neutrophils DO: 08-18-07 DR: 08-18-07 DO: 08-21-07 DR: 08-21-07 .0. It is the primary cell to respond during an acute inflammatory response.45. 0.To determine infection or inflammation. 0..20.65 0.There is an increase in the level of neutrophils due to impairment in the immune system or inflammatory response. 5. which means that the kidney 23 . .Are important humeral and cell mediated immunity. 0.09 -This indicates that the patient has a debilitating illness or immunodeficie ncy.DO: 08-21-07 DR: 08-21-07 found in micro liter (cubic millimeter of whole blood cell) .76 -There is a normal level of creatinine.0. -Capable of ingesting and -.

The test provides. Alkaline Phospatase DO: 08-18-07 DR: 08-18-07 .Creatinine DO: 08-18-07 DR: 08-18-07 -To evaluate renal function and disorder .100 mmol/L is functioning well.306 IU/L . 24 . Pancreatic cancer raised ALP levels and increase may indicate biliary abstraction. 62.9 58. which means there is no bone or liver/kidney disease present. a more sensitive measure of renal damage than blood urea nitrogen levels because renal impairment is virtually the only cause of creatinine metabolism. . the free flow of bile 127.The primary importance of measuring alkaline phosphatase is to check the possibility of bone disease or liver disease.The Alkaline Phosphatase level is within normal range.5 64. Since the mucosal cells that line the bile system of the liver are the source of alkaline phosphatase.To detect and monitor liver and/or bone disease.

After:  Apply pressure on the puncture site.  Inform the SO that the test requires blood sample. During:  Wipe with cotton balls and alcohol the site where insertion is done.Nursing Responsibilities: Prior:  Explain the procedure to the patient’s SO. tell who will do the test and when.  Tell that there will be discomfort from the needle that will be inserted and pressure from the tourniquet.  Send the specimen immediately to the laboratory 25 .  Inform the SO that there are no food or fluid restrictions.  Try to get a sample once.  Tell the client’s SO when the needle will be inserted for them to get prepared.

After: 26 . Transparency: -normal turbid Sugar: negative -normal Albumin: negative PH: acidic -due to the protein in the glomerulus’s normal increase value indicates infection. Even with Albumin: +3 normal findings. It can be used to screen patients for kidney and urinary tract disease and can help detect metabolic or systemic disease.030 Pus cell: 6-8/HPF Color: dark yellow -Indicates that the patient lacks water and has a concentrated urine due to the protein in the glomerulus’s / maybe due to the patients diet. Nursing Responsibilities: Prior:  Explain the procedure to the patient's significant others that these test assess response to treatment. -normal Specific gravity: 1. Results Transparency: of urine test are turbid based on the elements that Sugar: negative make up urine.2/ HPF -Genitourinary tract infection. these elements have certain PH: neutral characteristics.005-1.  Instruct the SO to collect urine specimen. commonly used screening test for urinary and systematic pathologies DO: 08-23-07 Routine Color: dark urinalysis brown to red serves many functions. During:  Plan to obtain the specimen when the patient is calm and physically still.  Tell the patient's significant others that specimen will be taken. drug and disease.  Collect urine by clean catching.035 Pus cell: 1. Specific gravity: 1.Urinalysis -Routine U/A is an important.

Intrahepatic ducts are not dilated. The coomon ducts is 4mms in luminal diameter. ANATOMY AND PHYSIOLOGY 27 . Multiple calcific foci. No definite focal hepatic mass seen. Please correlate and follow. If there is a necessary urine collection. Gallbladder wall is not thickened. The gallbladder measures 63 x 16 mms. 3. Impression: Sonographically right liver cholecystolithiasis.9mm size are seen in the gallbladder body and neck. Parenchyma is homogenous in echopattern and normal in echogenecity. instruct SO to collect the urine in every urisnation and put it in the bedside. III. Ultrasound Report: The liver is not enlarged.up.

place your hand in the center of your belly just below your lower ribs with your fingers pointing to the left. Then. sandwiched between the stomach and the spine. which runs the length of the pancreas. tumors are rarely palpable (able to be felt by pressing on the abdomen. The main duct is about one-sixteenth of an inch in diameter and has many small side branches. The other part is nestled in the curve of the duodenum (small intestine). Because of the pancreas' deep location.) It also explains why many symptoms of pancreatic cancer often do not appear until the tumor grows large enough to interfere with the function of nearby structures such as the stomach. To visualize the position of the pancreas. 1-1 Parts of Pancreas The pancreas is made up of glandular tissue and a system of ducts. Fig. It lies partially behind the stomach. or gallbladder. The pancreatic duct merges with the bile duct to form the ampulla of Vater (a widening of the duct just before it enters the duodenum. keeping the other three fingers together and straight. The main duct is the pancreatic duct. try this: Touch the thumb and "pinkie" finger of your right hand together. It drains the pancreatic fluid from the gland and carries it to the duodenum.) 28 . liver.Where is the pancreas located? The pancreas is located deep in the abdomen. Your hand will be at the approximate level of your pancreas. duodenum.

when tumors interfere with these functions. For descriptive purposes. The superior mesenteric blood vessels run behind this part of the gland. The part of the pancreas that a tumor arises in will effect how it is treated. which forms an impression in the side of the gland. 1-3 Islets of Langerhans. Tumors can arise in either part. the endocrine and exocrine parts. there are two ways the pancreas is divided into parts: by parts of the overall shape and by the function of its cells. Tail is the thin tip of gland in the left part of abdomen in close proximity with the spleen. Head is the widest part of the gland. Neck is the thin section between the head and the body of the gland. Body is the middle part of gland between the neck and the tail. 29 . Since the parts have different normal functions. different kinds of symptoms will occur. 1-2 Your doctor will probably refer to different parts of the pancreas when discussing your situation. the vast majority arises in the exocrine (also called non-endocrine) part.Fig. nestled in the curve of the duodenum. There are two very important blood vessels. However. It is found in the right part of abdomen. Fig. the superior mesenteric artery and vein cross in front of the uncinate process. Function of the Pancreas The pancreas can also be thought of as having different functional components. Pancreas is the part of the gland that bends backwards and underneath the body of the pancreas.

the food flows directly into the first part of the small intestine. This tube descends from the mouth and through an opening in the diaphragm. (The diaphragm is a dome shaped muscle that separates the lungs and heart from the abdomen and assists in breathing.) Immediately after passing through the diaphragm's opening. It is here in the duodenum that bile and pancreatic fluids enter the digestive system. The flow of the digestive system is often altered during the surgical treatment of pancreatic cancer. They are secreted in the duodenum where they assist in the digestion of food. insulin and glucagon work together to maintain the proper level of sugar in the blood. the sugar glucose is used by the body for energy. These are the exocrine (exo= outward) cells of the pancreas that produce and transport chemicals that will exit the body through the digestive system. 1-4 The pancreas is an integral part of the digestive system. The pancreatic hormones. called the duodenum. What is bile? 30 . Fig. the esophagus empties into the stomach where acids that break down the food are produced.These are the endocrine (endo= within) cells of the pancreas that produce and secrete hormones into the bloodstream. Acinar cells. Food is carried from the mouth to the stomach by the esophagus. The chemicals that the exocrine cells produce are called enzymes. Therefore it is helpful to review the normal flow of food before reading about surgical treatment. From the stomach.

) Bile is a greenish-yellow fluid that aids in the digestion of fats. Definition of the disease 31 . Fig. THE PATIENT’S ILLNESS A. a small pouch nestled underneath the liver. which then empties into the duodenum. 1-5 (Flow of bile indicated by green arrows.) The food. which comprise the small intestine. The common bile duct actually enters the head of the pancreas and joins the pancreatic duct to form the ampulla of Vater. The cystic duct runs to the gallbladder. large intestine. These ducts join to form the ampulla of Vater.Fig. IV. bile and pancreatic fluid travels through many more feet of continuous intestine including the rest of the duodenum. jejunum and ileum. rectum. After being produced by cells in the liver. then through the cecum. The pancreatic duct runs the length of the pancreas and joins the common bile duct in the head of the pancreas. The gallbladder stores extra bile until needed. which then empties into the duodenum. the bile travels down through the bile ducts. which merge with the cystic duct to form the common bile duct. 1-6 (Flow of pancreatic fluid indicated by dark yellow arrow. and anal canal. Synthesis of the disease 1. What is pancreatic fluid Instead of carrying bile. the pancreatic duct carries the pancreatic fluid produced by the acinar cells (exocrine) of the pancreas.

particularly ultrasonography. Comparison of Cholelithiasis and Cholecystitis: 32 . those who do not have symptoms. Pancreatic tissue is damaged. The third hormone produced by the endocrine cells of the pancreas affects gastrointestinal functioning. tissue and cells of the pancreas return to normal. stomach. Patients recover fully from the disease. chymotrypsin. and the tissue and cells function poorly. Acute pancreatitis occurs when the pancreas suddenly becomes inflamed but improves.32 Small bile duct stones may also be asymptomatic and may pass spontaneously. Asymptomatic gallstones--Many gallstones are asymptomatic and many go undiagnosed. and amylase. cholecystitis. in the investigation of non-specific abdominal symptoms. lipase. and those whose condition is complicated by. Symptoms may be persistent or sporadic. or obstructive jaundice. Two of these hormones. Increasingly. fats. The pancreas is considered a gland. This then tapers off to give an annual rate of 1-2% of asymptomatic patients becoming symptomatic. The pancreas returns to its normal architecture and functioning after healing from the illness. Its endocrine function produces three hormones. but choledocholithiasis increases the rate of symptom development and the incidence of complications such as obstructive jaundice and pancreatitis to around 20% over five years. the enzymes begin the process of breaking down a variety of food components. With chronic pancreatitis. This trend reflects the increasing use of abdominal imaging. Patients with gallstones fall into three groups – those who have symptoms. among others). These enzymes are passed into the duodenum through a channel called the pancreatic duct. In the duodenum. The pancreas is unusual because it has both endocrine and exocrine functions. are central to the processing of sugars in the diet (carbohydrate metabolism or breakdown). damage to the pancreas occurs slowly over time. proteins.30 31 The rate of symptom development is maximal in the early years after diagnosis. After an attack of acute pancreatitis. A gland is an organ whose primary function is to produce chemicals that pass either into the main blood circulation (called an endocrine function). and in almost 90% of cases the symptoms disappear within about a week after treatment. Most gallstones that are asymptomatic remain so. closely associated with the liver. The pancreas's exocrine function produces a variety of digestive enzymes (trypsin. including. asymptomatic stones are discovered incidentally during investigations of other problems. insulin and glucagon. but the condition does not disappear and the pancreas is permanently impaired.The pancreas is located in the midline of the back of the abdomen. or pass into another organ (called an exocrine function). pancreatitis. and starches. Roughly 10% of patients with asymptomatic stones will develop symptoms within five years of diagnosis and roughly 20% by 20 years. and duodenum (the first part of the small intestine). for example. This hormone is called vasoactive intestinal polypeptide (VIP).

33 . Sedentary lifestyle – lacks exercise and other physical activities that contribute to the increase in fat accumulation in the body. • Jaundice – obstruction of bile ducts • Intolerance to fatty foods.A.Certain inherited diseases. **Precipitating Factors: • High fat diets .Abnormalities in one or more genes may predispose some people to pancreatitis. Cholecystitis • Fever • Increase WBC • Abdominal guarding with rebound tenderness. increase your risk of pancreatitis. • • • • Age – teenagers are more prone in having gallstones due to excessive eating of high in sodium foods like junk foods. Cholelithiasis • Epigastric pain • Heartburn • Right upper abdominal pain – radiation to scapular. Ethnicity .Pancreatitis occurs more frequently in men. particularly cystic fibrosis. possibly because men are more likely to abuse alcohol than women are. Other medical conditions . • • Obesity – having a high fat diet increases your risk in being obese.peritoneal involvement. Sex . • Increase Serum Bilirubin • Increase Alkaline Phosphatase • Increase serum amylase and lipase (pancreas involved) 2.most especially an increase in sodium foods results in the formation of gallstones. Predisposing/ Precipitating Factors ** Predisposing Factors: • Family history . B.Black Americans are more likely to develop pancreatitis.

accumulation of bile due impaired excretion from the liver and to the skin. Other symptoms may include nausea. tobacco and even pollution may damage your pancreas. Signs and Symptoms Acute pancreatitis usually begins with a sharp. which is exacerbated in the supine position. Hypotension – typical and reflects hypovolemia and shock caused by the loss of large amounts of protein. vomiting. severe pain in the upper abdomen that may last for a few days. The pain may be sudden and intense or it may begin as a mild pain that is aggravated by eating and slowly gets worse. the abdomen may be swollen and very tender. Health Promotion and Preventive Aspects of the Disease Most people with acute pancreatitis recover completely. Boring epigastric pain. Ecchymosis (bruising). It may be constant pain that is just in the abdomen or it may reach to the back and other areas. But even if you experience no lingering symptoms.      Nausea and Vomiting-due to reflux of bile from common bile duct which will stimulate the CTZ of the labyrinth of the brain.  3. Abdominal pain and tenderness and back pain result from irritation and edema of the inflamed pancreas. Abdominal distension leading to cyanosis Jaundice. it is poorly localized and radiates to the back. fever and an elevated pulse.rich fluid into the tissues and peritoneal cavity.• Smoking .Some researchers theorize that the stress of metabolizing drugs. it's important to take steps to keep your pancreas as healthy as possible: 34 . Pancreatitis typically presents with the following signs and symptoms:  Abdominal pain – is the major symptom of pancreatitis. In addition. which stimulate the nerve endings.in the flank or around the umbilicus may indicate severe pancreatitis.

eat smaller. Discuss with your doctor or a dietitian how much fat to eat each day because some fat is essential. o Stop smoking – Tobacco use increases your risk of pancreatitis.o Avoid excessive alcohol use – Overuse of alcohol is the leading cause of chronic pancreatitis and a contributing factor in many acute attacks. Instead of large meals. A healthy diet emphasizes fresh fruits and vegetables. and limits fats. 35 . whole grains. If you can't voluntarily stop drinking alcohol. o Limit fat in your diet .be sure to drink enough liquids so that you don't become dehydrated. especially if you also drink alcohol. get treatment for alcoholism. but it will reduce your risk of dying of your disease. more frequent meals. especially saturated fats such as butter. o Drink plenty of liquids . the greater the amount of digestive juices your pancreas must produce. Limiting fat will help reduce loose and oily stools that result from a lack of pancreatic enzymes. Abstaining from alcohol may or may not reduce your pain. Dehydration may aggravate your pain by further irritating your pancreas.The more you eat during a meal. o Eat smaller meals .Eating a high-fat diet can raise your blood-fat levels and increase your risk of gallstones — both risk factors for pancreatitis. and lean protein.

Pathophysiology Book-based Acute Pancreatitis 2nd to Cholecystolithiasis Predisposing Factors: Family history Age Sex Ethnicity Other medical conditions Types of stones Pigment Precipitating Factors: High fat diets Obesity Sedentary lifestyle. smoking and drugs Cholesterol (insoluble) Decrease bile acid synthesis Unconjugated pigments in the bile Precipitate to form stones Infection Liver cancer Hemolysis Increase cholesterol synthesis in liver Bile super saturation with cholesterol Gallstone formed 36 . Long term alcohol abuse.

Gallstone formation Cholelithiasis Obstructed cystic duct Acute Pancreatitis Pancreatic Duct obstructed Gall bladder contracts Common bile duct obstructed Lodge @ the ampulla of vater Bile duct obstructed already Gall bladder becomes distended Inflammation Infection Spasm & edema Reflux of bile Pancreatic juice Fundus of the gallbladder Release of chemical mediator Fever occurs Becomes in contact in Over distention the abdominal wall causes pain Tenderness in right th At 9th and (RUQ) upper quadrant10 IC Cartilage During deep inspiration Activation of Trypsin Erosion and secretin Hemorrhage Increase vascular Necrosis permeability Vasodilatation Irritation occurs/ edema Radiating in the back 37 .

Shorter deep shallow inspiration Abdominal tenderness 38 .

Pathophysiology (Book-based): Before cholecystitis occurs, there would be first a trigger that will cause the inflammation of the gall bladder. And these are the stones that formed and will lodges to the duct. Sooner, it will accumulate on the common bile duct where it will occlude the release of enzyme that aids in carbohydrate, protein and fat digestion. According to research, there are two types of stones where different origin has; it is either pigment stone or cholesterol stone. Let’s first differentiate these two before proceeding to the physiology of it. The first stone that is known is called pigment stone. According to the research, there are different factors which contribute to the formation of pigment stone. It’s either due to hemolysis, liver cancer or infection. Due to these conditions, there are affectations occurs. For example, if the patient has liver cancer, all we known that liver aids in fats and bile emulsification. So, if the liver is impaired, there is no hepatocytes that will release and aid in emulsification. Thus, it’s creating unconjugated bile after which sooner or later, it will form a gall stone. The last known cause of gall stone formation is due to supersaturated cholesterol. If there is an abnormal decrease in level of bile acid that will emulsify cholesterol. There is a tendency that fat deposition occurs, because there is already no substance that will emulsify fats thus it will only become supersaturated and will form stone. So gall stone formed, there is an occlusion will occur either on the cystic duct or on the pancreatic duct. Again, dividing this occlusion into two will help us to understand the disease. First, if the gall stone will lodge in the cystic duct where gall bladder passes its enzyme, it will now call it obstructed cystic duct. So, as the process goes on and on, too many factors that will contribute to the formation of the stone then lodge on the duct, and accumulate etc... In the next time that the patient will eat and digest foods. Gall bladder will contract in order to facilitate that digestion. However, there is already an obstruction that will make the gall bladder distended. In order to analyze it very well, I will compare the gall bladder to a gall bladder that when a balloon is over inflated, there is a tendency that it will burst. That’s how gall bladder it will look like if that scenario happens. Then due to over distention, inflammation occurs that will result to release of chemical mediators such as histamine and serotonin that will cause fever due to vasodilation and increase in blood vessel permeability that will attract other WBC cells to migrate from the site of infection. So, as the result of infection, fever occurs. Now, due to over distention of the gall bladder, the fundus of the gall bladder will come in contact with the abdomen that will cause pain that will radiating on the back due to over pressure that applies on the nociceptor. Also, the over distended fundus will affect the 9th and 10th Intercostals cartilage that will result to tenderness on the Right Upper Quadrant, so one of the manifestation of the disease is dyspnea.

39

Secondly, if the gall stone will lodge on the pancreatic duct (duct where common bile duct consist), there would be a tendency that it will obstruct the common bile duct or either the ampulla of vater. And Acute Pancreatitis will likely to occur. Let assume that the ampulla of vater obstructed, there will be over spasm on the area thus it will lead to edema. Due to spasm, there will be a reflux of bile and pancreatic juice. Then assuming that the patient will attempt to eat again food, there will be the activation of trypsin and secretin that also aid in digestion. But obstruction impede the release thus it will cause autodigestion. Due to this, there will be inflammation and fever occurs. But the severe result may cause necrosis or erosion on the lining that will cause hemorrhage thus irritation occurs and abdominal pain occurs. So, summarizing the manifestations, the common manifestation of acute pancreatitis is abdominal pain. Now, it will only depend on the person of how she/he can tolerate the pain that inflicting to it.

40

Pathophysiology (Patient-centered) Acute Pancreatitis 2nd to Cholecystolithiasis Predisposing Factors: Family history Age Sex Ethnicity Other medical conditions e.g. mumps Precipitating Factors: High fat diets Obesity Sedentary lifestyle, Long term alcohol abuse, smoking and drugs

Cholesterol stone

Eat a lot of junk foods rich in fats

Past illness due to mumps

Decrease bile acid synthesis

Decrease Water intake and increase carbonated soft drinks

Increase cholesterol synthesis in the liver

41

Super saturation of bile occurs with cholesterol Cholelithiasis Occurs Obstructed cystic duct Acute Pancreatitis Pancreatic Duct obstructed Gall bladder contracts Common bile duct obstructed Lodge @ the ampulla of vater Bile duct obstructed already Gall bladder becomes distended Inflammation Activation of Trypsin and secretin Spasm & edema Fundus of the gallbladder Becomes in contact in the abdominal wall Reflux of bile that triggers Nausea and vomiting Over distention causes pain At 9th and 10th IC Cartilage 42 .

43 . Tenderness in right upper quadrant (RUQ) During deep inspiration Vasodilatation Erosion Increase vascular permeability Necrosis Shorter deep shallow inspiration As evidenced by Respiratory rate ranging from 23-28 breaths per minutes.Radiating in the back that manifested last year (2006) and reoccurs last month. Hemorrhage Irritation occurs/ edema Abdominal tenderness that manifested last year (2006) and reoccurs last month.

because there is already no substance that will emulsify fats thus it will only become supersaturated and will form stone.. there will be the activation of trypsin and secretin that also aid in digestion. This symptoms were already manifested last year but reoccurred last month. The patient fond of eating junks foods and drinking carbonated soft drinks that contribute to the disease. In the next time that the patient ate and digested foods. So. inflammation occurs Now. Gall bladder will contracted in order to facilitate that digestion. Also. there will be over spasm on the area thus it will lead to edema. 44 . However. the gall stone was lodged on the pancreatic duct (duct where common bile duct consist). dividing this occlusion into two will help us to understand the disease. as the process goes on and on. there will be inflammation and fever occurs. the fundus of the gall bladder will come in contact with the abdomen that will cause pain that will radiating on the back due to over pressure that applies on the nociceptor. there would be a tendency that it will obstruct the common bile duct or either the ampulla of vater. Partly. there would be first a trigger that will cause the inflammation of the gall bladder. Secondly. so one of the manifestation of the disease is dyspnea. But the severe result may cause necrosis or erosion on the lining that will cause hemorrhage thus irritation occurs and abdominal pain occurs. First. The gall stone formation is due to supersaturated cholesterol. it will accumulate on the common bile duct where it will occlude the release of enzyme that aids in carbohydrate. Again. Sooner..Pathophysiology (Patient-centered) Before cholecystitis occurs. and accumulate etc. Due to this. But obstruction impeded the release thus it will cause autodigestion. protein and fat digestion. there will be a reflux of bile and nausea and vomiting occurs. And these are the stones that formed and will lodges to the duct. The patient had an abnormal decrease in level of bile acid that will emulsify cholesterol due to over consumption of carbonated drinks. it will now call it obstructed cystic duct. there is an occlusion will occur either on the cystic duct or on the pancreatic duct. There is a tendency that fat deposition occurs. Then assuming that the patient attempted to eat again food. the gall stone was lodged in the cystic duct where gall bladder passes its enzyme. Due to spasm. too many factors that will contribute to the formation of the stone then lodge on the duct. So gall stone formed. The ampulla of vater obstructed. And Acute Pancreatitis will likely to occur. there is already an obstruction that will make the gall bladder distended. previous illness shows that the patient experienced mumps which causes by virus that may consider a probable cause of the disease. Then due to over distention. due to over distention of the gall bladder. the over distended fundus will affect the 9th and 10th Intercostals cartilage that will result to tenderness on the Right Upper Quadrant.

45 . IVF’s Medical management/treatment Date ordered /Date performed/ Date Changed Date Ordered: Aug 18-22. through regulation of urine output. 2007 Date Changed: Aug 23. D5 LRS (Lactating Ringer’s Solution)--Hypertonic General Description: fluid and electrolyte supplement/replace ment LR solution is given to the patient because it induces blood/fluid loss due to over distention of the tissue site on her gall bladder due to secretion of cholecystokinin that allows contraction on the gall bladder that causes trauma or over spasm. Upon administering the IVF solution.5.5.8 mmol/L Chloride: 108 111 mmol/L normal: 136normal: 3. MEDICAL MANAGEMNET a. 2007 Date Performed: Aug 18-22. her electrolytes level did not change. Thus. It also stabilizes her Blood Pressure within normal range. THE PATIENT AND HIS CARE A.V. It also educes the risk of edema. Nor did not also show any progress to her hematocrit level. the patient did not manifest any untoward responses. The LR is used because the byproducts of lactate metabolism in the liver counteract acidosis. which is a chemical imbalance that occurs with acute fluid loss. However.0 normal: 101- It means that her ideal level of electrolytes is still sustainable to function on different body parts. As evidenced by: Electrolytes: Sodium: 138 145 mmol/L Potassium: 3. 2007 General description Indications or purposes Clients response to the treatment 1.

plasma tends to go out side the blood cell that makes it hypotonic (solute is greater inside than the outside). So it happens that the patient is at risk for Dehydration and electrolyte losses due to over-spasm of the pancreas or excretion problem 46 . the amount of solute (RBC) is higher than the solvent. which is the plasma that acts as a suspension. It means that due to fluid/blood loss.Noticing that her Hematocrit level is on border of low to normal level. Solute Solvent Due to Fluid loss of the patient.

6. Explain the procedure to the patient. hold the neck of it properly as you inserting the IV line into the bottle. For inserting IV bottles to an IV line: Do not touch the upper head of the IV. And adverse effects associated with it. Be careful in inserting the needle if vein for insertion is detected. and stay on focus on the procedure. 5. in turn. may result from a combination of fluid loss from vomiting. and special instruction for administration. 3. 7.that led to inadequate blood volume which. Just be calm. Be certain that you know the expected action. Instead. safe dosage. internal bleeding. Prepare the necessary equipments. Check to see if there are any special circumstances surrounding administration to the patient. or oozing of fluid from the circulation into the abdominal cavity in response to the pancreas inflammation. 47 . range. 4. a phenomena known as Third Spacing Nursing responsibilities: Prior: 1. Wash hands thoroughly. 2.

48 . Assess for any signs of edema or bulging of vein if it is not properly inserted. Properly put all used materials after the insertion on the garbage. Regulate the flow rate or drop rate as the doctor’s order 3. Pinch the IV tubing *If the needle is in the vein. if it is in the vein: a. Chart the procedure including time. After: 1. Bring the IV bottle lower than the patient’s arm. properly place the micro pore on the respective area and for aesthetic purpose. b. Check if there’s doctor’s order of KVO (Keep vein out). observe for the backflow of blood in the distal portion of the IV tubing. Always check the needle of the IV. Always observe aseptic technique in preparing and administering 2. 2. name and dosage and the patient’s response to the administration. 3. 9. During: 1.8. After needle was inserted.

9 % NaCl (Sodium Chloride)--Hypertonic Date ordered /Date performed/ Date Changed Date Ordered: Aug 23.8 normal: 3.5. it shows good hydration on her body. When patient was administered saline solution.this was ordered to prevent from further activation of the pancreas and the gall bladder to secretes certain enzyme that causes acute inflammation.111 mmol/L Interpreting her result. If you notice that her electrolytes level were still in normal range: Electrolytes: Sodium: 138 normal: 136. 2007 Aug 25. if the patient starts to eat some foods that is rich in fats. 2007 Aug 24. her pancreas and gall bladder will stimulates enzymes (Exocrine) that will breaks down large molecules to small Clients response to the treatment General Description: fluid replacements. It is given to the patient because she cannot tolerate to intake foods or either oral fluids and has NPO DIET from August 18-20. There is no abruptly decrease of electrolytes level. 2007 Aug 24. 2007 Date Changed: -----(Continue meds) General description Indications or purposes D5 .5.9% NaCl solution or in simple term “Saline”.145 mmol/L Potassium: 3. 24 and 25. as an example is that. 2007 Date Performed: Aug 23.0 mmol/L Chloride: 108 normal: 101. it means that there is no any sign of dehydration occurs due to normal level of electrolytes. D5 0. 2007 Aug 25. 49 .Medical management/treatment 2.

abdominal pain and nausea. there will be an accumulation and formation that causes inflammation. but due to the obstructed portion on the gall bladder. She may experience some symptoms of inflamed gall bladder like vomiting. 50 . electrolytes. To replenish her body from mush fluid loss. there is large possibilities that her body might loss fluids and at the same time. Due to vomiting and abdominal pain.molecules.

8. Pinch the IV tubing *If the needle is in the vein. 7. 2. properly place the micro pore on the respective area and for aesthetic purpose. Be certain that you know the expected action. and special instruction for administration. Wash hands thoroughly. 3. and stay on focus on the procedure. Always observe aseptic technique in preparing and administering 2. Just be calm. 5.Nursing responsibilities: Prior: 1. During: 1. 51 . range. Check if there’s doctor’s order of KVO (Keep vein out). 4. Explain the procedure to the patient. Always check the needle of the IV. After needle was inserted.Regulate the flow rate or drop rate as the doctor’s order 3. Prepare the necessary equipments. Check to see if there are any special circumstances surrounding administration to the patient. 2. And adverse effects associated with it. After: 1. 6. if it is in the vein: c. For inserting IV bottles to an IV line: Do not touch the upper head of the IV. Properly put all used materials after the insertion on the garbage. 3. Bring the IV bottle lower than the patient’s arm. Instead. Assess for any signs of edema or bulging of vein if it is not properly inserted. Be careful in inserting the needle if vein for insertion is detected. safe dosage. hold the neck of it properly as you inserting the IV line into the bottle. 9. Chart the procedure including time. d. observe for the backflow of blood in the distal portion of the IV tubing. name and dosage and the patient’s response to the administration.

an anticholinergic stimulator. When the patient stimulates an unpleasant stimuli either mechanical due to trauma on Clients response to the treatment Client feels relieve from pain upon painkiller administered. Which at the same time. Drugs Name of drugs/generic name/brand name 1. Due to its mechanism of action which act as an agonist at the kappaopioid recpetor site.Meperidine/Deme rol /Stadol/Talwin/ Pethanol Date ordered/Date Performed/Date Changed Date Ordered: Aug 18-25.b. As evidenced by report of gradual decrease in pain severity and unguarded abdominal area. 2007 Meperidine TAB 1 tab OD Date Changed: ----(Continue Meds) Route of administration/ Dosage/frequency of administration Route/dosage/frequency: Meperidine 25 mg IV NOW Indications or purposes General action: analgesics Meperidine is indicated for the treatment of moderate to severe pain. 52 . And no side effect documented on the patient. 2007 Date performed: Route/dosage/frequency: Aug 18-25.

the pancreas and gall bladder. That stimulates an unpleasant sensory impulses. and chemical which either due to secretion of enzyme trypsin/secretin which was occluded due to obstructed ampulla of Vater to the common bile duct going to the gall bladder that resulted to autodigestion on the pancreas. then the nociceptor (pain recpetor) sense the stimuli which will send action (nerve-pain impulse) from the nerve-endings going to the higher brain. then the nerve-pain 53 .

Now. Or to the Paleospinothalam ic (Slow pain) which consist of C-fibers and abeta fibers together with substantia gelatinosa that has small diameter. It tends to close the opening of the ganglion in order to blocked the passing of Cfibers.impulse travels into either Neospinothalamic (Fast pain) which consist of a-delta fibers that has wide diameter. and if adelta fibers reaches first. to travel along to the Dorsal root of ganglion going to the CNS. the action of here 54 .

operating heavy machinery). convulsions. 4. Women of childbearing potential who become. procarbazine or phenelzine which when administered together may cause dangerous side-effects such as suffer agitation. 2. 5.Drug is that before nerve-pain impulse reaches the brain. headache. meperidine content already binds to the terminal nerveendings of the brain which either periphery or centrally which prevents of further transmission of impulses. driving. Discourage use of MAOI’s drug such as sibutramine. or suffers from hyperthyroidism. delirium. asthma. has an enlarged prostate or urinary retention problems. Patients should be advised to report pain and adverse experiences occurring during therapy. 3. 55 . and/or hyperthermia. Specific Nursing responsibilities: 1. or Addison's disease. Advise patient that the drug may impair mental and/or physical ability required for the performance of potentially hazardous tasks (e. or are planning to become pregnant should be advised to consult their physician regarding the effects of analgesics and other drug use during pregnancy on themselves and their unborn child.g. Assess also for has a history of seizures or epilepsy.. Individualization of dosage is essential to make optimal use of this medication.

10. Assess for renal function. range. 5. Keep in mind for the TEN R’s for administering drugs such as right Patient. Use with caution. Do not touch label or capsule with your hands. Wash your hands. shape and precipitating color of the drug (If IV use). 3. special instruction for administration. After: 1. frequency and duration of the therapy. offer the patient Ice cube to suck so that to prevent any unwanted taste of the drug. 6. Assess for history of medication used. 2. 3. Instruct patient to take the medication as directed for the full course of the therapy.General Nursing responsibilities: Prior: 1. check for the patency of the IV if it is flowing. Inform the patient about the action of the drug and what are the expected side effects on it. it must not given for patient having renal failure. such as noting for any color. 5. Pour the required no. Due to adverse-effects of the medication such as constipation and dry mouth 56 . During: 1. Check the written medication order for completeness. 2. 6. 9. Assess for Hepatic function. If IV ordered. Also for oral route. follow up water or liquids after the medication is administered. and route of administration. Do not confuse on the other contraptions attached on the IV fluid. amount/dosage. Be certain that you know the expected action. 7. 2. dosage. safe dosage. Into the bottle cap then into the medication cup. Document Response to the medication. Read the desired route for administering the drug. 8. as the liver is responsible for detoxifying harmful substances. If Oral route desired. Advise Patient to increase Fluid intake if permitted. 4. And adverse effects associated with the drugs. Assess for edema on the IV site. 3. 4. It should include the drug name. and right route.

drowsiness and fatigue./Zegerid Aug 18-22.Name of drugs/generic name/brand name Date Ordered/Date Performed/Date Changed Route of administration/ Dosage/frequency of administration Route/dosage/frequency: Omeprazole 40 mg IV OD Indications or purposes Clients response to the treatment 2. which means the patient 57 . 2007 Aug 25. patient to avoid further complication. 2007 Date Changed /Discontinued: Aug 23. patient has not elicited any untoward or undesired response to the medication. 2007 Date Reperformed: Aug 24. No Omeprazole was signs of dizziness. 2007 Date Performed: Aug 18-22. ordered to the which are the side effects of the drug. Due to low lymphocyte level. it prevents the patient from acquiring ulcerative form.Omeprazole/Lo Date Ordered: sec/Prilosec/Prilos ec OTC. the patient has a low immune system that causes neutrophil to increase in value. 2007 General action: Upon administering the medication. As the General action implies. Anti-ulcer agent.

is at risk for infection. or duodenal ulcer. Omeprazole was given to prevent any further infections that can cause ulcer. they are thought be a acidophile bacteria (2-4 ph) 58 . intrinsic factor and parietal cells. Although ph content stomach is very acidic due to secretion of gastrin that secretes pepsinogen. such as peptic ulcer. H. some bacterial infections can live. HCl. Pylori.

3. the contents of a PRILOSEC Delayed-Release Capsule can be added to applesauce. preferably in the morning. Read the desired route for administering the drug. 2. as the liver is responsible for detoxifying harmful substances. b. amount/dosage. Bring the IV bottle lower than the patient’s arm. 4. Pinch the IV tubing *If the needle is in the vein. 6. 7. check for the patency of the IV if it is flowing. Use with caution. 8. 4. such as noting for any color.Specific Nursing Responsibilities: 1. if it is in the vein before administering the drug by any of the following method: a. If IV ordered. and right route. 1. PRILOSEC Delayed-Release Capsules should be taken before eating. do not cruch or chew. 5. shape and precipitating color of the drug (If IV use). Capsules should not be swallowed nor crushed or chewed. During: Administer the dose before meals. Assess for Hepatic function. Assess for history of medication used. Always check the needle of the IV. Keep in mind for the TEN R’s for administering drugs such as right Patient. General Nursing Responsibilities: 1. 2. Capsules should be swallowed whole. Assess for renal and hepatic function in order to evaluate the functional ability of the organs. it must not given for patient having renal failure. 4. Check Laboratory test CBC with differential count.Do not confuse with Prisolec with Prinivil. observe for the backflow of blood in the distal portion of the IV tubing  59 . Assess for edema on the IV site. upon the therapy. 6. 2. 5. Do not confuse on the other contraptions attached on the IV fluid. Maybe adminitered concurrently with antacids. 3. 3. For patients who have difficulty swallowing capsules. 7. Assess for renal function. Prior: Inform the patient about the action of the drug and what are the expected side effects on it Assess patient routinely for epigastric or abdominal pain and frank occult of blood in stool or emesis. 5.

diarrhea. abdominal if experience. Due to an acute inflammation of the Pancreas.8. 2007 Aug 20. 9. Inserted the needle into the injection port and inject the drug slowly for a period of 1-7 minutes. Document Response to the medication. it showed a relatively value that infection is impending so the action of drug is needed in immediate time.4 normal: 5. which is low. 2007 Date Performed: Aug 18. 2007 WBC Count: 13. neutrophil accumulates on the site of inflammation to phagocytes (cell eating) any invading microorganism such as From the very first day the medication is administered. Caution patient to avoid other activities requiring alertness until response is known to the medication. 5. Regulate the drop rate as desired. Indications or purposes Clients response to the treatment General action: antiinfective. 6.10 x 10 g/l Neutrophils: 0. As evidenced by laboratory results of: Aug 18. 2007 Aug 19. Instruct patient to take the medication as directed for the full course of the therapy. After: 1. 2007 Route of administration/ Dosage/frequency of administration Route/dosage/freq uency: Metronidazole 500 mg q 6 hrs. Advise Patient to report onset of stools. Name of drugs/generic name/brand name 3. NSAID’s drug or aspirin that may increase GI irrtitation. Clean the injection port with cotton swab without alcohol. Advise patient to avoid alcohol. 2007 Aug 19. 3. 10. Metronidazole was given to the patient due to its neutrophil value. 4.91 60 .Metronidazole/AP O-Metronidazole/ Metric21/MetroCrea m/Metro Gel/Flagyl Date ordered/Date Performed/Date Changed Date Ordered: Aug 18. 2. Instruct patient to increase in fluid intake as permitted.

10 x 10 g/l Neutrophils: 0.0.76 Normal: 0.24 Normal: 0.35 Results shows that Lymphocyte and WBC count of the patient came back to normal value except for neutrophils.65 Lymphocytes: 0. 2007 bacteria or virus.9 Normal: 5.65 Lymphocytes: 0. 07 WBC Count: 5.20. And If this so happen to the patient. As far as we remember. which still has a high count.0.0.09 normal: 0. particularly as a result of bacterial infection.45.Aug 20.45.35 After 3 days of continuous medications of the patient. laboratory exam were taken and results were as follows: B. normal: 0. means that the patient is still at risk for infection. the action of the neutrophil is that during the acute phase of inflammation. metronidzole potent effect will do.0. The action of the drug to the patients body (Pharmacodynamic) is to convert any aerobic bacteria to an anaerobic form by the enzyme redox enzyme pyruvateferredoxin oxidoreductase that disrupting the Helical DNA structure of the Bacteria that inhibiting nucleic acid synthesis. 2007 Date Changed: Aug 21.20. Aug 21. 61 .

shape and precipitating color of the drug (If IV use). 62 . 11. Prepare the necessary equipments. or may administered with food or milk to minimize GI irritation. and right route. Keep in mind for the TEN R’s for administering drugs such as right Patient. 9. 3. 4. Monitor intake and output and daily weight the patient especially for patient on sodium restriction.neutrophils leave the vasculature and migrate toward the site of inflammation in a process called chemotaxis. 6. 5. Monitor Neurologic status duing and after the administration. 3. During: 1. and special instruction for administration. 12. amount/dosage. it must not given for patient having renal failure. Obtain specimen for culture and sensitivity. Assess for history of medication used. Administer on a empty stomach General Nursing Responsibilities: Prior: 1. as the liver is responsible for detoxifying harmful substances. such as noting for any color. Assess for renal function. Check Laboratory test for the result of AST. Specific Nursing responsibilities: 1. Inform the patient about the action of the drug and what are the expected side effects on it 4. 7. Explain the procedure to the patient. 2. Use with caution. safe dosage. ALT AND LDH that may be altered. Wash hands thoroughly. 2. Be certain that you know the expected action. 10. 8. 5. Administer on an empty stomach. And adverse effects associated with the drugs. obtain a history of culture and sensitivity beofre initiating therapy. Assess for Hepatic function. range. Assess for infection at the beginning and duing the theapy.

observe for the backflow of blood in the distal portion of the IV tubing. b. Vamine Glucose 500 cc IV in AM to run for 8 Vamine glucose is hours. 4. irritability and decrease mental capacity to initiate a response. the glucose which is 63 . if it is in the vein before administering the drug by any of the following method: a. Regulate the flow rate or drop rate as the doctor’s order After: 1. Vamine Glucose Date ordered/Date Route of administration/ Performed/Date Dosage/frequency of Changed administration Date Ordered: Aug 18-20. such as able to answer questions appropriately. given to the patient because she has restricted parenteral nutrition. Always check the needle of the IV. it shows that patient expected reaction was seen. Name of drugs/generic name/brand name 4. 2. when she was asking or underwent assessment because a sign of decrease glucose level in the brain is that being manifested by confusion. this puts patient at risk for injury. Advise patient not to perform any activities. Always observe aseptic technique in preparing and administering drugs. insufficient or is contra-indicated. Tablets may crushed for patient with difficulty of swallowing (dyspahgia) 3. which requires massive movement. name and dosage of drug and the patient’s response to the administration. considering her condition. Caution patient not to take alcoholic beverages at least 1 day after the treatment. Bring the IV bottle lower than the patient’s arm. 2007 Date Re-ordered: Aug 22-25. It has Glucidic and nitrogenized caloric intake (acid amino of When vamine glucose was administered. Chart the procedure including time. 2007 Indications or purposes Clients response to the treatment Route/dosage/frequency: General action: glucose supplement. 5. Due to adverse-effect of lightheadedness.2. 2007 Date performed: Aug 18-20. Pinch the IV tubing *If the needle is in the vein.

As we know. especially. Although there are certain times. carbohydrates serve as our energy source. proteins and fats. Our patient was kept on NPO for a number of days. will be release on the islet of langerhan in the form of glucagons by gluconeogenesis which will be facilitate by gluconeolysis particularly in the alpha cells. 64 . Due to absence of any nutrition that she needs. carbohydrates.Date reperformed: Aug 22-25. which will be converted into glucose after a series of conversion that after which. 2007 Date Changed: ----(Continue Meds) the series L). It does not alter the proper level of functioning. Vamine glucose will act as glucose replacement for those patients who have disorder in the Gastrointestinal tract essential for functioning sustained in her body. that patient became irritable due to the pain that she feels.

7. and right route. During: 65 . Inform the patient about the action of the drug and what are the expected side effects on it 4. 3. Prepare the necessary equipments. Keep in mind for the TEN R’s for administering drugs such as right Patient. 5. 6. Explain the procedure to the patient. That may cause cross-sensitivity of the patient on it. without initiating any activation. Nursing responsibilities: Prior: 1. which will be distributed to those particular parts of the body. Due to administering intravenously. do not confuse on othe rcontraptions that were attached on the main line. vamine glucose do not need to undergo directly to the mucosal line of the GI that may initiate an activation of organs related to it which will again may cause an secretion of digestive enzymes. Thus it will flow directly into the veins. Assess for history of medication used. amount/dosage.such as the condition of the patient. 2. Wash hands thoroughly.

Bring the IV bottle lower than the patient’s arm.0 mmol/L Chloride: 108 101.111 mmol/L As previously stated normal: a while ago. Always observe aseptic technique in preparing and administering 2. because 66 . Always check the needle of the IV. normal: Intralipid also was given to the patient in normal: order to prevent the gall bladder from activating the enzyme It shows that the medication that was cholecystokinin to given to her is effective.5. observe for the backflow of blood in the distal portion of the IV tubing After: 1. Properly put all used materials after the procedure on the garbage.145 mmol/L Potassium: 3. Chart the procedure including time. Based on the result: Electrolytes: Sodium: 138 136. it did not manifest any loss of nutrients or electrolytes either.5. if it is in the vein: a. just like Vamine glucose. 2007 Date Re-ordered: Aug 22-25. 2. Name of drugs/generic name/brand name 5. But were not emulsifies fats and only considering this result. 2007 Date reperformed: Aug 22-25. name and dosage and the patient’s response to the administration. Regulate the flow rate or drop rate as the doctor’s order 3. Intralipid Date ordered/Date Performed/Date Changed Date Ordered: Aug 18-20.8 3. Assess for any signs of edema or bulging of vein if it is not properly the needle is not properly inserted. 2007 Route of administration/ Dosage/frequency of administration Route/dosage/frequency: Intralipid 500 cc IV in PM to un for 8 hours Indications or purposes General action: nutritional supplement (especially fats) Clients response to the treatment When Intralipid was administered. Pinch the IV tubing *If the needle is in the vein. 3. 2007 Date performed: Aug 18-20. b.1.

Intralipid was being alter to Vamine glucose. As notice. 67 . Which inhibiting the stimulation of different enzyme from digestion process. As the result of dislodged/occlusion on the gall stone in either on the ampulla of Vater or on the common bile duct.3 . The purpose also of giving intralipid intravenously is that her lipase level is in high value.300 there are certain instances that the effectively of the drugs may not be potent enough. its synergism effect help each other sustain body’s functioning.Date Changed: ----(Continue Meds) neutralized acids in the digested foods. In which the overdistended organ will be inflammed as soon as there any stimulation. Lipase: RESULT: Hi – 510 U/L NORMAL RANGE: 2.

Keep in mind for the TEN R’s for administering drugs such as right Patient. Bring the IV bottle lower than the patient’s arm. name and dosage and the patient’s response to the administration 3. Explain the procedure to the patient. Chart the procedure including time. Pinch the IV tubing *If the needle is in the vein. Do not confuse on othe rcontraptions that were attached on the main line. and right route. Tramadol /Ultram Date ordered/Date Performed/Date Changed Date Ordered: Aug 23-25. 7. observe for the backflow of blood in the distal portion of the IV tubing After: 1. Inform the patient about the action of the drug and what are the expected side effects on it 4. if it is in the vein: A. Client feels relieve from pain upon painkiller administered. Always observe aseptic technique in preparing and administering 2.Nursing responsibilities: Prior: 1. Prepare the necessary equipments. As evidenced by report of gradual decrease in pain severity and unguarded abdominal 68 . Assess for history of medication used. amount/dosage. Always check the needle of the IV. Wash hands thoroughly. Assess for any signs of edema or bulging of vein if it is not properly the needle is not properly inserted. 2. 3. 5. During: 1. Properly put all used materials after the procedure on the garbage. 6. 2. That may cause cross-sensitivity of the patient on it. 2007 Date performed: Route of administration/ Dosage/frequency of administration Route/dosage/frequency: Tramadol 50 mg IV q 8 hours Indications or purposes Clients response to the treatment General actions: Analgesia for moderate to moderately severe pain. B. Regulate the flow rate or drop rate as the doctor’s order 3. Name of drugs/generic name/brand name 6.

They are commonly located presynaptically or postsynaptically. As the process.Aug 23-25. when the patient stimulates an unpleasant stimuli either mechanical due to trauma on the pancreas and gall bladder. area. Tramadol was also given to the patient. 2007 Date changed: ----(Continue Meds) Just like meperidine. But the only differences it has is that it binds on the mu-opioids receptors (which has high affinity to enkephalins and betabeta-endorphine) that inhibit the reuptake of serotonin and norepinephrine. and chemical which either due to secretion of enzyme trypsin which was occluded due to obstructed ampulla of Vater to the common 69 .

then the nociceptor (pain recpetor) sense the stimuli which will send action (nervepain impulse) from the nerve-endings going to the higher brain. Or to the Paleospinothalamic (Slow pain) which consist of C-fibers and a-beta fibers together with substantia gelatinosa that has small diameter. to travel 70 .bile duct going to the gall bladder that resulted to autodigestion on the pancreas. That stimulates an unpleasant sensory impulses. then the nervepain impulse travels into either Neospinothalamic (Fast pain) which consist of a-delta fibers that has wide diameter.

along to the Dorsal root of ganglion going to the CNS. May occur within recommended dosage range. May be administered without meals. meperidine content already binds to the terminal nerveendings of the brain which either periphery or centrally which prevents of further transmission of impulses. Assess Blood pressure and Respiratory rate during and periodically. which is Narcan if overdosing occurs. the action of here Drug is that before nerve-pain impulse reaches the brain. It tends to close the opening of the ganglion in order to blocked the passing of C-fibers. 4. Now. 71 . Because the common side effect of the drug is constipation. Specific Nursing responsibilities: 1. Prepare an antidote. 3. Assess Bowel function routinely. 5. 2. Monitor patient for seizures. and if a-delta fibers reaches first.

General Nursing Responsibilities: Prior: 1. Keep in mind for the TEN R’s for administering drugs such as right Patient. 4. cough. 2. During: 1. decrease hemoglobin. liver enzymes. Do not confuse with tramadol and Toradol. Should be discontinued gradually after long-term use to prevent withdrawal symptoms. 5. 3. Wash hands thoroughly. 5. avoid patient to avoid concurrent use of alcohol.a nd breathe every 2 hours to prevent atelectasis. advise patient to changes position slowly to minimize orthostatic hypotension. After: 1. 2. caution patient to avoid driving or other activities that require alertness until response to medication is known. 7. and right route. Explain the procedure to the patient. 6. May be given without regards to meals. and intensity of pain before and 2-3 hours (peak) after administration. Prepare the necessary equipments. encourage patient to turn. 3. and proteinuria. 3. That may cause cross-sensitivity of the patient on it. 9. Assess the type. 2. may cause an increase in creatinine. Regularly administered doses may be more effective than prn administration. Inform the patient about the action of the drug and what are the expected side effects on it 4. Assess for history of medication used. location. Instruct the patient on how and when to ask for pain medication. do not confuse on othe rcontraptions that were attached on the main line. Because sideeffect of tramadol is dizziness. 4. 8. 72 . amount/dosage.

due to over crowded number of calculi that stuck into it. “again” which is because of occluded calculi/gallstone. effect documented. 2007 Date changed: ----(Continue Meds) When buscopan was administered. And may be. No sidethe common bile duct. NO signs of spasm occur such as pain. Patient does not smooth muscle located on guarded her abdomen. Due to the over-spasm of the patient’s gall bladder . Due to it.Name of drugs/generic name/brand name Date ordered/Date Performed/Date Changed Route of administration/ Dosage/frequency of administration Route/dosage/frequency: Buscopan 1 ampule IV q 8 hours Indications or purposes Clients response to the treatment 7. then it tends abrupt severely. which is sometimes called colic. As Buscopan was given to the evidenced by. no report of pain patient in order to prevent upon peak of action of the further contraction of the medication. 2007 butylbromide hyoscine Date performed: butylbromide Aug 23-25. the result is involuntary General action: antispasmodic 73 . the organ tend to contract more to dislodged or to get rid of out the occlusion of the duct. Buscopan/ Date ordered: Butylscopolamine/ scopolamine Aug 23-25.

Regularly administered doses may be more effective than prn administration. Prepare the necessary equipments.contraction of it thus resulting into sudden burst of pain. Assess for history of medication used. Inform the patient about the action of the drug and what are the expected side effects on it 4. Explain the procedure to the patient. Keep in mind for the TEN R’s for administering drugs such as right Patient. 3. 5. Should be discontinued gradually after long-term use to prevent withdrawal symptoms. Instruct the patient on how and when to ask for pain medication. amount/dosage. Monitor Vital signs Every 1 hour. 6. Assess the Bowel sound routinely. 2. 7. 2. and right route. 3. After: 1. Wash hands thoroughly. Avoid patient to avoid concurrent use of alcohol. but rather works to prevent painful cramps and spasms from occurring in the first place. During: 1. Buscopan does not relieve pain since it doesn't 'mask' or 'cover over' the pain. That may cause cross-sensitivity of the patient on it. May be given without regards to meals. Do not confuse on other contraptions that were attached on the main line. 2. 74 . 2. Nursing responsibilities: Prior: 1. Specific Nursing responsibilities: 1.

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2007 Aug 23. 2007 Date reperformed: Aug 24. 3. 2007 Date reordered: Aug 24. 76 . 2007 No foods that are must be taken. 2007 Date Performed: Aug 18. Due to the feelings that patient experience s. Because it may cause irritation to her inflamed bodily organs. NO FOODS ALLOWE D TO BE TAKEN Nursing Responsibilities: Prior: 1. 1. 2007 Aug 22. 2007 Aug 20. 2007 Aug 19. 2007 Date changed: Aug 21. 2. 2007 Aug 25. Check the doctor’s order. Instruct SO not to give anything through the mouth. she restricts herself from eating foods. Prevent further stimulation different enzymes that would lead to auto digestion of the pancreas and the gall bladder.c. Diet Type of Diet Date ordered/date performed/date changed General descriptio n Indication( s) or purposes Specific foods taken Client response and reaction to the medicatio n Upon restricting patient from intake of any forms of foods which either solid or liquid form. 2007 Aug 19. 2007 Aug 20. 2007 Aug 25. Assure IV fluid therapy if patient is NPO. NPO (NOTHIN G PERORE M / NOTHING BY MOUTH) Date ordered: Aug 18.

During: 1. Remove foods and drinks on patient’s side. 4. 2. Place “NPO” sign on the on the bed where the patient can see it always. Assess client’s condition. 3. 77 . Assure that nothing is taken through the mouth either liquid or solid. After: Observe patient’s response on the diet.

2. Give the patient according to what are prescribed. reason that tea. 2007 Aug 22. 2007 Date changed: Aug 24. Also the Soft liquid diet also aids in giving good hydration The following of the are patient. juices >cooked or ready cereals >cooked vegetables >potatoes without skin. 6. coffee.Nursing Responsibilities: 1. 3. The purpose of these is to designed patient that who cannot tolerate general diet. Foods moderately low in fibers. 2007 Food tolerances vary with individuals. Type of diet Date ordered/date performed/date changed General description Indication(s ) or purposes Specific foods taken Client response and reaction to the medication 2. Monitor patient Intake and output. 2007 Date Performed: Aug 21. Most raw fruits and vegetables and course breads and cereals are eliminated. Emphasize the importance of it. 5. Chart the I & O of the patient if needed. 78 . SOFT Date ordered: LIQUID DIET Aug 21. fruit juice risk for dehydration >all fruit was rid-out. Explain the purpose of the diet. The patient is able to tolerate soft liquid diet as far she can. 2007 Aug 23. soft texture and moderately seasons. Do not tolerate the patient if she’s requesting foods that are not under soft liquid diet. 2007 Aug 23. Avoid fried foods and spicy foods. 4. 2007 Aug 22. recommended: That’s one good >milk. Tender foods (not ground or pureed) are used unless the individual needs additional modifications to the diet.

5. Assess patient’s comfort. During: 1. Logroll patient to one side every 2 hours. Place a small pillow under the patient’s head. Indications or Purposes This is to facilitate recovery to normal functioning of the body. 3. After: 1 2 3 4 Inspect the patient’s skin. Place a draw sheet and rubber sheet under patient’s back and head. Place pillow or rolled towel behind the patient’s back. Check the physician’s order.7. 2. 4. d. Determine any degree of circumstances such as the patient is ongoing NGT feeding. 79 . Put a pillow between patient’s legs and on the abdomen. Client’s response to the activity The patient complained of pain when moving. Explain to the purpose of positioning for his safety. Run your hand under the patient’s dependent shoulder and move the shoulder slightly forward. With a pain scale of 9/10 and facial grimaces. Document patient’s reaction and compliance. Activity/ Exercise Type of Date ordered Exercise Date performed Date changed May turn side 08-18-07 to side General Description The patient may move on bed as tolerated. Inform the patient about the condition. 3. 2. Lower height of the bed and elevate side rails. Nursing Responsibilities: Prior: 1.

>To obtain baseline data >To obtain a baseline data and know the needs of the patient. Then the enzyme enters the bile duct. Expected Outcome Short Term: After 3 hrs. >To reduce tension that is occurring. Experiences abdominal pain.3. >To regain loss energy due to untolerated pain. >Provide diversional activities like chatting. the pt. Rationale > To gain the trust of the client and gain cooperation.61 gtts/min. >Perform pain assessment comprehendsively (pqrst). back up into the pancreatic duct. Patient manifested: >(+) Abdominal pain > Guarded her abdomen >Moaning when pain attacks >Irritability & anxiety >Appears restless >Dilated pupils >Skin is pale Patient may manifest: >Difficulty in turning. > Limited to perform motor skills. the patient verbalized methods and techniques in relieving pain. After one day of nursing interventions. Nursing Intervention >Establish rapport. thus reduce intensity of pain. of nursing interventions. Long Term: After one day of nursing interventions. 80 . the patient demonstrated diversional activities to direct pain. Objectives Short Term: After 3 hrs. of nursing interventions the pt will demonstrate diversional activities to direct pain. Nursing Diagnosis Acute Pain R/T inflamed body organs secondary to cute pancreatitis resolved cholecystolithiasis Specific Explanation Pancreatitis is commonly described as auto digestion of the pancreas. then the pt. Long Term: >Monitor vital signs. >To know the location and quality of pain. where they are activated and together with bile.9% NaCl at 500 cc level regulated at 60. >Encourage adequate rest periods. And accompanied by hyper secretion of the exocrine gland of the pancreas. specifically the trypsin. >To know the level of pain. NURSING MANAGEMENT Cues “S” = O “O” IVF of D5 0. >Assess patient’s condition. will verbalize methods I relieving pain. >Note for nonverbal cues. When the pt’s pancreatic duct becomes temporarily obstructed due to obstruct gall bladder that has calculi or stones along the duct.

>Acknowledge reality of situation and feelings of the client. Once the receptors are stimulated the impulse they discharge travels as electrical activity to the spinal cord and on the brain and this becomes the experience of pain.provoked by trauma on her abdomen upon moving. Objectives Nursing Intervention >Stretch linens for comfort.stabbing pain R. >Instruct use of nonpharmacologic techniques such as relaxation. elevated BP >Vital signs taken and recorded: Temp: 36. 81 . Expected Outcome >To establish therapeutic relationship. >Administer medications as ordered by the doctor.10 out 10 ratings T. Pain is caused by actual tissue damage that stimulates the receptive normal receptors. Rationale >Reduce factor that aggravates the pain. >To improve pt’s condition.4:00pm >May manifest increase pulse.on her left upper quadrant S. Q. >To increase the release of endorphins and enhance the therapeutic effects of it. it doesn’t reach the brain. There would be damage on pain system causing pain. distraction. in normal pathways for these impulses is blocked pain since.Cues PQRST Pain Assessment: P.7 c PR: 81 bpm RR: 22 bpm BP: 110/ 60 mmHg >fetal position when pain attacks Nursing Diagnosis Specific Explanation Pain serves as a mechanism to warm us about the potential for physical harm. increase RR.

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further possible injuries. And because she experienced hemorrhage due to previous blood loss through menstruation. >Encourage pt. Rationale Expected Outcome Short Term: >To obtain baseline data Long Term: After one day of nursing interventions patient will demonstrate compliance and able to increase comfort while performing activities After 3hrs of nursing interventions >To obtain a patient identified baseline data and techniques to know the needs of enhance activity the patient. with appropriate rest periods. Specific Explanation Activity Intolerance a psychological or physiological energy to endure or complete required or desired daily activities. >Assisted pt. >Assess patient’s condition. Objectives Short Term: After 3 hrs of nursing interventions patient will verbalize understanding and identify factors affecting activity intolerance. Long Term: >To be able to regain strength. Nursing Intervention >Monitor vital signs. >Acknow ledge the feelings of the client. >Emphasize importance of adequate periods of rest. that result to decreases muscle tone and result to body weakness. intolerance within her physical > To prevent limitations. 83 . >Assist pt. >To establish therapeutic relationship. in going to the comfort room. >To avoid further injury and decrease level of pain that is experienced. to learn and demonstrate appropriate safety measures.Cues “S” = O “O” = Patient manifested: >(+) Restlessness > Weakness >Difficulty in going to the comfort room. >To reduce to do activity fatigue. >Bed rest the whole day >Slowed movement >Small steps Patient may manifest: >Irritability most of the time > Limited to perform motor skills >Shortness of breath Nursing Diagnosis Activity intolerance r/t generalized body weakness secondary to disease condition. Decreased oxygen supply. After one day of nursing interventions patient participated willingly in the desired activities.

>Administered medications as indicated. 84 .Cues Nursing Diagnosis Specific Explanation Objectives Nursing Intervention >Instruct SO to support pt’s ADL’s. >To stimulate observation as well as involvement and participation in activity. Rationale >To prevent the aggravation of pain. >Supported affected body parts. >Encouraged mix of desired activities or stimuli such as reading magazines. >To improve the pt’s condition. Expected Outcome > To maintain position and reduce risk of pressure. or listening to music.

Specific Explanation Knowledge deficit is the lack of cognitive information related to specific topic. Objectives Short Term: After 3 hrs of nursing interventions patient will identify individually appropriate interventions to promote sleep. Encourage questions. Discuss hospitalization and prospective treatment as indicated. >Provides knowledge base from which patient can make informed choices.Cues “S” = O “O” = Patient may manifest: > Statement of misconception > Information misinterpretation. expression of concern. Long Term: After one day of nursing interventions patient will report improvement in sleep or rest patterns. > Unfamiliarity of information resources. >Provide information relevant to his situation. because she do not fully understand its condition. Expected Outcome Short Term: After 3hrs of nursing interventions patient identified appropriate interventions in promoting sleep. >To correct beliefs and promote more reliable information 85 . Which where the patient ask of about her illness. Rationale >To check his level of capability in learning. >To reinforces learning process. >Provide explanations of/ reasons for test procedures and preparation needed. Nursing Diagnosis Knowledge deficit r/t lack of understanding of medical and disease condition. Long Term: After one day of nursing interventions patient reported an improvement in sleeping patterns. Effective communication and support at this time can diminish anxiety and promote healing. >Review disease process/prognos is. >Information can decrease anxiety. >Provide written information / guidelines for the patient. Nursing Intervention >Determine pt’ s ability to learn.

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>Client’s participation enhances client’s control over the situation and may help to instill hope and promote decision-making. consistent. >Using calm. corrected and compensated with her present problem and participated in treatment regimen. works with the student nurses to correct and compensate with her present problem and participate in treatment regimen. >Verbalization and assessment of feelings provide a safe outlet for emotions. > To promote trust and cooperation of the patient and helping to alleviate her problems. >Include client in treatment process and inform her about the things ahead of time if possible. Nursing Intervention >Monitor and record V/S. unhurried approach with explanations helps to minimize the threat of the situation.Cues “S” = O “O” = Patient manifested: > Irritable > Presence of pain > Poor eye contact > Restlessness Nursing Diagnosis Anxiety r/t situational crisis. Which was her first time to be hospitalized and experienced severe dizziness. Assess for possible feelings related to cause of her condition. And also a big threat to her health. > Explain to the patient her condition as well as the treatment and procedures. Expected Outcome Short term: After 3 hours of nursing intervention the pt. unhurried manner. Rationale >To have a baseline data. Objectives Short term: After 3 hours of nursing intervention the pt. 87 . verbalized concerns and fears. verbalized understanding about her situation and able to build up trust with her. will verbalize understanding about her situation and able to build up trust with her. perceived to actual threat to health Specific Explanation The client is in the state of anxiety because of the problem she is experiencing. >Allow client to verbalize feelings and concerns. Long term: After one day of nursing intervention the pt. >Approach the client in a calm. worked with the student nurses. Long term: After one day of nursing intervention the pt. will verbalize concerns and fears. Involving the worries of her family care.

Expected Outcome Short term: After 3hours of nursing interventions. Provide privacy during dressing. grooming. to perform minimalfacial hygiene whenever she cannot tolerate to do so. These will reduce energy expenditure and prevents fatigue and exacerbation.Cues “S” = O “O” = Patient manifested: > Irritable > Presence of pain > Poor eye contact > Restlessness Specific Explanation The deficit may Self care deficit be a result of related to pain transient limitations. Rationale The patient may only require assistance with some self.care activities. Long term: After one day of nursing interventions patient will safely perform self. Long term: After one day of nursing interventions patient was able to perform safely self. bathing etc. 2. Provide frequent encourageme nt and assistance as needed with dressing.care activities.care. ACTUAL SOAPIE’s  August 23. Patient may take longer to dress and maybe fearful of breaches in privacy This will reduce energy expenditure and frustration. This enables the pt.care measures. to maintain autonomy for as long as possible. Nursing Intervention Assess ability to carry out ADL’s like dressing. Encourage pt. Careful examination of the patient’s deficit is required in order to be certain that the patient is not failing selfcare because of lack of materials with arranging the environment to suit the patient’s physical limitations. 2007 S=O 88 . Encourage pt. such as those that the patient experiences like acute pain. to comb her own hair. patient was able to verbalize the importance of self. Nursing Diagnosis Objectives Short term: After 3hours of nursing interventions patient will be able to verbalize understanding on the importance of self care.

of nursing interventions. Stabbing pain provoked by trauma on her abdomen upon moving and radiating on her Left upper quadrant. infusing well on the right cephalic vein with a side drip if Intralipid 10% regulated at 62.8 C PR: 62 bpm 89 . > Provided diversional activities such as chatting > Encouraged verbalization of pain > Kept patient as NPO as ordered by the doctor. with a pain scale of 10/ 10.O = Received patient lying on bed sleeping with ongoing IVF of D5 0.  August 25.9 NaCl with a level of 500 mL regulated at 60 gtts/min.7 C PR: 81 bpm RR: 22 bpm BP: 110/ 60 mmHg A = Acute Pain P = After 3 hrs. 2007 S=O O = Received patient lying on bed with an IVF of 0. I > Established rapport > Monitored Vital signs > Stretched linens for comfort > Assessed patient’s condition > Performed pain assessment comprehensively (pqrst) > Determined possible pathophysiological causes like pancreatitis & cholecystolithiasis > Noted client’s behavior towards pain. (+) Abdominal pain (+) Guarded her abdomen (+) Irritability (+) Moaning when pain attacks Vital signs were taken and recorded: Temp: 36. as evidenced by demonstrated diversional activity.9% NaCl 1L x 60 gtts/ min @ 900 cc level infusing well on the right arm. the patient will demonstrate diversional activities to divert pain. > Noted medications that are to be taken on time E = Goal met. (+) Restlessness Vital signs were taken and recorded: Temp: 37.63 gtts/min.

verbal cues > Regulated the IV Fluid > Assisted patient in going to the comfort room > Provided comfort measures > Noted medications that are to be administered on time.RR: 27 bpm BP: 110/ 70 mmHg A = Acute Pain P = After 3 hrs. of nursing interventions. 90 . > Prescribed medication that is to be taken. E = After 3 hrs. I > Established rapport > Monitored Vital signs > Stretched linens for comfort > Assessed patient’s condition > Assessed level of pain > Encouraged verbalization of feelings towards pain > Observed for non. the patient should verbalize a decrease in pain from 8/10 to 6/10. of nursing interventions patient verbalized a decrease in pain from 8/10 to 3/10.

2. Acute Pain 2.Activity Intolerance 4.2 Pr: 64 bpm Rr: 24 bpm Bp: 100/ 70 mmHg Temp: 36.C. 9 Pr: 71bpm Rr: 28bpm Bp: 110/ 70mmHg Temp: 37 Pr: 60bpm Rr:25bpm Bp:100/ 70 mmHg Temp: 37. 2005) Day 8 (Aug 25.Self-care deficit 5. 2007) Diagnostic/Lab procedures: 1. 2007) Day 4 (Aug 21.5 Pr: 80 bpm Rr: 23 bpm Bp: 110/ 70 mmHg * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Day 2 (Aug 19.3 Pr: 76 bpm Rr: 26 bpm Bp: 110/ 70mmHg Temp: 37.1 Pr: 81 Rr: 22 bpm BP: 110/70 mmHg Temp: 37. VI. 2007) Day 7 (Aug 24. 2007) Nursing Problems: according to prioritization: 1.1 Pr: 68bpm Rr:22bpm Bp:100/ 70 mmHg Temp:36. Client’s Daily Progress in the Hospital Admission (Aug 18.CBC * 91 .Anxiety Vital Signs: 1. 2007) Day 3 (Aug 20.7 Pr: 81 bpm Rr: 22 bpm Bp: 100/ 60 mmHg Temp: 37. Temp. 3. Pr Rr BP Temp: 37.Imbalanced nutrition 3. 2007) Day 5 (Aug 22. 2007) Day 6 (Aug 23. 4.

9 % 1L x 30NaCl x 60 31 gtts/ gtts/ min min * * * * * * 1. D5 LRS 1L x 3031 gtts/ min * * * 1.31 gtts/ min 1.31 31 gtts/ gtts/ min min * * * * * * 1. alternate with Intralipid x 8 hrs.LDH 8.9 % NaCl x 60 gtts/ min * * * 1. D5 0. D5 LRS 1. IVF’S 2. Alkaline phosphatase 4. Vamine Glucose x 8 hrs. creatinine 3.D. D5 0. D5 LRS 1. D5 LRS 1L x 301L x 30.2. D5 0. Blood Transfusion 3.Omeprazole 40g 3.Meperidine 25 mg 2.9 % NaCl x 60 gtts/ min * * * * * * * * * * * * * 92 . B. SGOT 6.I. NGT feeding DRUGS 1. D5 LRS 1L x 30. * * * * * * * 1.Metronidazole 500mg 4.BUN 5. SGPT 7. RBS Medical management 1.

6 .Buscopan 1amp IV q 8 hrs.5. * * * * * * * * * * * * * * * * DIET NPO SOFT LIQUID DIET ACTIVITY /EXERCISES May turn side to side * * * * * * * * * * * * * * * * 93 . Tramadol 50 mg IV q 8 hrs.

Discharge Planning S O- Received patient on bed conscious and  Body malaise  Restlessness  Pain felt on the abdominal are  Facial grimaces  Irritability V/S T- 37.3 RR- 19

PR-98 BP- 130/80 A = Home Maintenance and Management P = After 3 hours of nursing interventions, patient will be able to verbalize understanding on the health teachings for promotion and maintenance of health. I = METHOD Medications: Instructed patient the following home medication  Omeprazole (Anti-ulcer) 40mg two tablets three times a day. Report any sign of adverse effects. Exercise:  Instructed to avoid strenuous and stressful activities such as laundry, straining and bending over and lifting heavy objects.  Encouraged to perform tolerable exercises of activities of daily living such as sweeping the floor and cooking. Treatment:  Emphasized to patient strict compliance to medical regimen.  Take home medications as ordered  Health Teachings:  Instructed to go to JBLMRH for check- up once a month.  Instructed to avoid foods that are high in fats, cholesterol, oily foods and most especially salty foods.  Encouraged rest in between periods of activities  Instructed to avoid lifting heavy objects  Encouraged relaxation technique such as listening to radio and watching television.

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 Emphasized the importance of taking medications strictly as ordered  Stressed the importance of compliance to medical regimen OPD follow-up:  Instructed to come back on September 3, 2007 at Medicine-OPD section near the gate.  Diet:  Instructed to eat low fat, low salt diet VII. CONCLUSIONS AND RECOMMENDATIONS Acute pancreatitis is an acute inflammatory condition of the pancreas that may extend to local and distant extra pancreatic tissues. Acute pancreatitis is sudden inflammation of the pancreas that may be mild or life threatening but that usually subsides. The exact cause of acute pancreatitis may differ among different patients, but in general it is not well understood. It is thought that enzymes normally secreted by the pancreas in an inactive form become activated inside the pancreas and start to digest the pancreatic tissue. Generally the patient needs hospitalization with administration of intravenous fluids to help restore blood volume. Medication for pain and nausea are provided to ease these symptoms and food is withheld until these symptoms have subsided considerably. As a student nurse, it is our responsibility to be knowledgeable enough about the disease our patients have. This is very important to understand their condition and to know why they experience such. Enough information about diseases will help us to know the proper interventions we can provide to our patients. Learn to care and love the patients we are handling, this will help us lessen the pressure and tiredness especially during toxic days of duty. We should also keep our experiences with every patient, because we might encounter the same case in the future. Upon concluding this study, I am fortunate enough to understand the disease condition of our patient. It helps me a lot to read more topics about her condition and find ways to help her. It also gives me awareness that Acute pancreatitis resolved cholecystolithiasis is not only a ordinary illness. It is an illness that can threaten life and puts a person into a danger. It also helps me to understand her different medications that she has, and how it would affect her normal functioning. I only recommend to the different concern citizen to be more aware about the cause of this illness. Let us learn from the experience of our patient, excessive intake of junkfood and carbonated drinks would lead to her illness. Recommend them to be consciously enough to limit Fatty rich foods, or foods rich in monosodium glutamate (MSG). and know priorities of what foods are essential. After conducting this case study concerning Acute Pancreatitis, we recommend this in particular with the chain- smokers, alcoholics and other folks that are fond of eating high sodium foods, high caloric diet.

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VIII. BIBLIOGRAPHY http://www.medicinenet.com/pancreatitis/article.htm http://www.facs.org/spring_meeting/gs09murr.pdf http://www.emedicine.com/radio/byname/pancreatitis-acute.htm http://www.medscape.com/viewarticle/488046_2 http://en.wikipedia.org/wiki/Acute_pancreatitis http://www.pancreasfoundation.org/Docs/pancreatitisinchildhood2.doc http://pathology2.jhu.edu/pancreas/digestsy.cfm *http://en.wikipedia.org/wiki/ *http://wrongdiagnosis.com/ *http://www.medicinenet.com/script/main/hp.asp *Davis’s drug guide for nurses, tenth edition by Judith Hopfer Deglin and April Hazard Vallerand *Medical-surgical Nursing by Brunner and Suddarth. *^ Ginsburg, Ph.D., J.N. (2005-08-22). "Control of Gastrointestinal Function", in Thomas M. Nosek, Ph.D.: Gastrointestinal Physiology, Essentials of Human Physiology. Augusta, Georgia, United State: Medical College of Georgia, p. 30. Retrieved on 200706-29. *^ Laboratory 38. Stomach, Spleen and Liver, Step 14. The Gallbladder and the Bile System. Human Anatomy (Laboratory Dissections). SUNY Downstate Medical Center, Brooklyn, NY (2003-11-17). Retrieved on 2007-06-29. *Abdominal dissection, gall bladder position emphasized (JPG). Human Anatomy (Laboratory Dissections). SUNY Downstate Medical Center, Brooklyn, NY (2003-1117). Retrieved on 2007-06-29.

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2007. 1988. Retrieved on April 4. Online Etymology Dictionary. Volume P Page 68 *Cutler. *http://www. JayDoc HistoWeb. *Norman/Georgetown pancreas *Histology at BU 10404loa *Harper. et al. eds. Anne G.moondragon.org/nutrition/diet/softdiet.. University of Kansas.. Pancreas.html 97 . Baltimore: The William and Wilkins Company. Retrieved on 2007-0629. 1976 ed. Stedman's Medical Dictionary. Douglas. *Physiology at MCG 6/6ch2/s6ch2_30 *New Standard Encyclopedia.*Slide 5: Gall Bladder.

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