Acute Pancreatitis Part 2

A.
Family Background
Family Members Sex Age Civil Relationship Educational Occupation Religion Place of
Status to the Patient Attainment Residence
Irvin Magno M 29 M Patient Vocational Farming Baptist Batac City
Graduate
Wilma Magno F 29 M Wife College Household Baptist Batac City
Graduate Worker
Jasmine Eunice F 9 S Daughter Grade 4 None Baptist Batac City
Magno
Jessa Mae Magno F 7 S Daughter Grade 2 None Baptist Batac City
John Inso Magno M 5 S Son Kinder None Baptist Batac City
The Family M Belongs to the nuclear type of family. The family composed of the father, mother and 3 children and lives in a
bungalow type of house. They are currently residing at Batac City except for the wife of the patient who is at Singapore where she
works as household worker.
The family practices egalitarian type of authority. Both parents consult each other when it comes to decision making over family
matters. The allocation of resources is done by the patient. the family resides patrilocally since they are living within the vicinity of his
father’s side and relatives. As described, the patient’s house is a bungalow type fully furnished with 2 bedrooms, a dining area, a
living room, 1 comfort room and a garage. They have a private tricycle for transport service. The family also owns appliances like
television, refrigerator, washing machine, cooking appliances, electric fan and others. Their source of water for general use is jetmatic
pump from deep week and mineral water for cooking and consumption.
There is a good relationship between and among family members. As claimed by the patient, even though his wife is at Singapore, he
makes sure that they do video call at least 3-4x a week together with their children. They are able to express their feelings toward each
other. At times, the patient claimed that he hits his children’s but with his palm because of stubbornness, he always makes sure that
after, he talks to his children and points out that what they are doing is not good. The patient believes that sparing the rod will spoils
his children.
The patient is 29 years old and works in the farm and cultivates he land that his father owns. He also manages their home since his
wife is mile away from them. He always makes sure of the welfare of his children. Together with his mother, he takes care of his
children. His mother is his yoke in rearing his children since their house is just located adjacent to their house. Sometimes his children
go to their grandparents’ house when he is out for work and during weekdays and even weekends. As claimed, “haan nak met ag
malmalem jay taltalon, nu laketdi malpas ubrak idjayen agawid nakun ta innak aginana ken aywanan dagiajy annakun.”
The patient’s wife is a household worker in Singapore for almost 2 years. She is a management graduate but opt to do such work
because Singapore is easier to do cross-country going to Canada as claimed by the patient.
His first child is 9 year-old female and currently in 4 th grade at MMMES. His second child is a 7 year-old female ad currently on 2 nd
grade at MMMES. His last child is a 5 year-old male and currently at kindergarten level due to pandemic his 3 children are studying at
home with the modules given by the school. According to the patient, the modules given by school is a struggle in his part because he
needs to guide his children.
Socio- Economic Status
The main source of income of the family is the money sent by his wife. The patient works
as farmer. He further claimed that the plant rice during rainy season and corn for sunny
season. He also claimed that the money raised from farming will be treated accordingly
as to production cost and the net money. The production cost (fertilizer, padanom, seeds,
labor and the like) will be deducted from the gross income and this will be used for the
next season of planting. The net money will be kept untouched and are used for
emergency purpose as in health emergencies, unexpected school contributions and
sometimes for leisure. Thus, the main monthly source income of the family is Php
13,000.00 which is being sent by his wife. The patient is the one doing the budgeting and
breakdown of the money as to food, drinking water, electricity, children’s allowances,
groceries and miscellaneous which include gasoline, cellphone load including pre-paid
internet load, drinking water, gasul and buying of alcoholic beverages and cigarettes and
what is left will be deposited in their saving’s account. As claimed, “sakto lag deta
gasgastwen mi nukwa ngem nu dadduma adda met maduldulin mi.” He make sure that
the income is adequate for their family and likewise saves for healthservices from net
income of farming.
The family spends Php 2,000- 3,000 for their food and groceries in which Php 1,500-
2,000 such as shampoo, soap, snacks, toothpaste, condiments and others. Allowances for
the 3 children in the school Php 1,800. Electricity in which Php 800- 900. Miscellaneous
for Php 2,000 – 2, 500 such as gasoline, cellphone load including pre-paid internet load,
drinking water, gasul and buying of alcoholic beverages and cigarettes.
Expenses Amount Percentage
Food Php 2,000.00- 3,000.00 29%
Miscellaneous Php 2,000.00- 2,500.00 24%
Groceries Php 1,500.00- 2,000.00 20%
Allowances Php 1,800.00 18%
Electricity Php 800.00-900.00 9%
Total Php 6, 800.00- 10, 200.00 100%
Monthly Income Php 13,000.00

Monthly Expenses Php 6, 800.00- 10, 200.00
Monthly Savings Php 2,800.00- 6,200.00
Monthly Expenses
Food
Electricity 27%
17%
Allowance
17%
Miscellaneous
22%
Groceries
18%
B. Health History
A. Family Health History
The genogram revealed that there are certain hereditary diseases that runs in the family.
Specific diseases include hypertension, diabetes mellitus and asthma.
On his father side, both of his grandparents already died and claimed that senility is the
main contributing factors of their death. Second generation of his family on paternal sides
revealed that there 3 members died due to heart attack as complication of hypertension
and 1 member died due to the same disease but with diabetes mellitus. As what the
patient recalled, they are all diagnosed with hypertension but not religiously taking
maintenance drugs. Death of the family were all sudden in their 50’s and 40’s. 2 of the
remaining alive member of the second generation are diagnosed with hypertension and
diabetes and currently taking their maintenance. 1 member is diagnosed with sole
hypertension is also taking their maintenance and 1 is diagnosed to have increased
cholesterol and is also currently taking maintenance drugs. The maintenance drugs were
amlodipine, losartan, metformin and rosuvastatin. Also, they are chewing ashitaba leaves
to lower down their blood pressure. This was an advice from a family friend who is
working in a herbarium. None of the members who are diagnosed of diabetes mellitus is
on insulin injection.
On the maternal side, both of grandparents already died was not able to recall the exact
cause but affirmed that senility contributed to their death. 1 member of the second
generation died due to heart attack as a complication of hypertension. As claimed, it was
diagnosed but the family member was not taking his medicine religiously. 3 members of
the family is diagnosed with hypertension and one of which is currently on dialysis due to
CKD secondary to hypertensive nephrosclerosis. Furthermore, one member is also
diagnosed with asthma.
With respect to the third generation, 1 of his sister died due to pneumonia secondary to
prolonged vegetative state since she has cerebral palsy. 2 members of the 3rd generation
is diagnosed with hypertension and is currently on maintenance medication.
The patient was not sure if the family members experienced childhood illnesses nor given
all primary vaccination. As verbalized “awan sa met pelang dagita idi panawen da. Uray
siyak jak ammo nu nagbakbakuna ak idi. Dagijay annako a, kumpleto da bakuna.” The
family just experiences common cough and colds, fever, flu, stomach ache and headache.
According to the patient, the older generation resorts to herbal medicines like oregano
and lagundi decoction for cough, guyabano and atis leaves patch for stomach and
headache. They also increase their oral fluid intake and take in hot soup of dinengdeng or
tinolang native chicken. And as claimed, they are effective in reliving symptoms, but
when gets worst they go to the health center for consultation.
It was also noted that some of the family members drinks alcohol and smokes cigarette.
B. Past Health History

The patient claimed that he experienced childhood illnesses like chicken pox, mumps and
measles however, no traditional treatment was given to him. He further said that in those
times, his father brought him to the hospital for treatment and consultation. He is also not
sure if he had completed all his primary vaccination. During his childhood days, he was
in and out of the hospital due to weak lungs. He had undergone 6 months treatment for
primary complex and several times confined due to pneumonia. He had gone 1 minor
surgery which is circumcision during his elementary days in the hospital.
September of 2016, he was rushed at the tertiary hospital emergency room due to
epigastric pain. He was attended by an internist and considered acute appendicitis. He
was referred to a general surgeon at the ER level but said that it is not appendicitis. CBC
was done which revealed leukocytosis and urinalysis was done which revealed UTI and
presence of hemoglobin in the urine hence prompted the order of KUB ultrasound.
Discharge diagnosis was acute peptic disease rule out urolithiasis, He was sent home with
omeprazole and ciprofloxacin. The KUB ultrasound was unremarkable. He claimed that
he never met accidents nor undergone blood transfusions.
The client is a cigarette smoker which consumes 2-3 sticks per day. He started smoking
when he was 18 years old.
C. Present Health History

The client is also alcoholic drinker. They have drinking session with his cousins or
barkadas after farm or playing basketball usually during dusk. They usually do it 3-4
times a week where they can consume 750 ml of emperador for 3 person or 1 bilog gin
for 2 person.
Last December 2019, the client experienced vomiting and severe abdominal pain after a
night of binge alcoholic drinking with carbonated drinks as chaser with his friends. The
vomiting was characterized as intermittent and was accompanied by abdominal pain
specifically on the epigastric area radiating to back as claimed. At first, the abdominal
pain was tolerable but then went to be felt very severe epigastric pain that radiates to
back. As verbalized “permi sakit na idi tay kasla matirtiritir ta uneg tiyan mo. Ti sakit na
ket kasla maawanan ka pay ti puoten. Permi ti sakit na idi isu nagpaitarayak ospital.” He
was admitted at a tertiary level hospital and was managed as case of acute pancreatitis.
Laboratory tests were done including lipase (737.09 U/L) which is significantly higher
from the normal range (13-60), liver enzymes were also noted slightly higher than the
normal range (SGOT- 50 and SGPT - 48). His CBC, serum electrolytes and lipid profile
were all in the normal range. He stayed at the hospital for 4 days and was given
discharged medication of Vitamin B complex once a day. He was also advised not to
drink alcohol again and carbonated drinks by his attending physician.
Interval history revealed that he rested for 2 weeks and resume farming after. For 3
months, he did not take any alcoholic drinks nor carbonated beverages but after that he
began to take those drinks again. When asked why he resumed the habit despite the
advice from his attending physician, he answered with a smile and said “saggabassit met
lang.” but as time goes by, he claimed that light drinking was then developed into binge
drinking. Usual binge drinking sessions were resumed.
Until October 04, 2020, he attended a birthday party of his friend’s daughter but a small
gatherings. They had binge alcoholic drinking sessions. As claimed, they consumed 3
bottles 750ml of emperador for 4 person with chaser of carbonated drinks and ice cold
water. They also had raw meat of lamb as pulutan. The following morning, October 05,
2020, the patient experienced epigastric pain9/10 pain scale that radiates to the back. He
was nauseated and had no appetite to eat breakfast and lunch. The pain persisted but no
management was done. All he thought that it was just a hangover but afternoon of that
same day about 4pm, the pain became worst with 10/10 pain scale. He was guarding his
abdomen and on fetal position. He was moaning and he had vomited thrice.
He requested his sister to accompany him at the tertiary hospital emergency room. He
was seen by Dr. Baccay with chief complaint of epigastric pain hence admission at 6:05
PM with admitting diagnosis of acute pancreatitis.
C. Developmental Data
A. Robert Havighurts
Robert Havighurst believe that learning is basic to life and that the people continue to
learn throughout life. Havighurst’s main assertion is that development is continuous
throughout the entire lifespan, occurring in stages, where an individual moves from one
stage to the next by means of successful resolution of problems or performance of
developmental tasks. These tasks are typically encountered by most people in the culture
where the individual belongs.
When people successfully accomplish and master these developmental tasks, they feel
pride and satisfaction, and consequently earn the approval of their community or society.
This success provides a sound foundation which allows them to accomplish
developmental tasks that they will encounter at later stages.
Conversely, when people fail to accomplishing a developmental task, they’re often

unhappy and are not accorded the desired approval by society, resulting in the subsequent
experience of difficulty when faced with succeeding developmental tasks.
IM is 29 years old and he belongs to early adulthood (18-35 years old). At this age
according to Havighurst, the individual is expected to:
Task Justification
Met Partially Unmet
Met
Choose a partner  IM achieved this task since he is
already married to his wife,
WM. Though WM is not the
first girlfriend of IM, he claimed
that he felt the spark when he
met her. They are high school
batch mates. They got married
first on a civil wedding on
January 2010 and ended in a
church wedding on December of
the same year.
Establish a family  IM achieved this task since he

already build a family. He has 3
children namely JEM, JMM and
JIM. They all go to school and
during weekends if IM has no
work in farm, they bond together
in the form of watching movies
and or video call with their
mother.
Manage home  Managing a home is a task for
women however, this can be
applied to IM since his wife is
working abroad. It can be correct
to say that IM achieved this task
since he is the one taking care of
his children, with the help of his
mother, and manages their
home. He sees to it that there is
orderliness and cleanliness in
their house. He also teaches his
children how to take care of their
home and gradually trains them
in doing household chores.
Establish a career  IM entered college as a nursing
student, however, he did not
push it and finished 2nd year. He
transferred to another school and
finishes Nursing Aide
Certificate. After, he then again
went to school and finished
vocational course of computer
technician. When asked why he
didn’t pursue any of those, he
answered that by that time, he
impregnated his wife and no one
took care of her. He went to full
time husband but then later
decided to cultivate the land that
his father owned when the latter
began his health to deteriorate.
And up to this day, he still
cultivates the land and make
earnings out from it. If we dig
deeper, IM might be stagnated
on this task since he wasn’t able
to fully establish his career
which is partially achieved.
Analysis:
At the age of 29, IM developed all the task expected for his stage of development under
Havighurst Theory however, not fully accomplished. He is still 29 years old and he has more
time to fully accomplish all the task expected to him. This outcome will help him to achieve the
next task that he will be having at the later part or next stage of his life.
B. Kohlberg’s Theory of Moral Development

The morality of an individual’s decision was not Kohlberg’s concern; rather, he focused on the
reasons an individual makes a decision. According to Kohlberg, moral development progresses
through three levels and six stages. Levels and stages are not always linked to a certain
developmental stage, because some people progresses to a higher level of moral development
than others.
Kohlberg observed that growing children advance through definite stages of moral development
in a manner similar to their progression through Piaget's well-known stages of cognitive
development. His observations and testing of children and adults, led him to theorize that human
beings progress consecutively from one stage to the next in an invariant sequence, not skipping
any stage or going back to any previous stage. These are stages of thought processing, implying
qualitatively different modes of thinking and of problem solving at each stage.

There are 3 levels in Kohlberg’s Stages of Moral Development. First level is called the premoral
or preconventional level; second level is called the conventional level and the third level is called
the postconventional level.
Situation Level Stage Cues

The client witnessed Postconventional Universal Priciples The client verbalized
a crime which Level that he will report his
involved his best best friend to the
friend who is a policeman because
breadwinner of their it’s wrong to steal
family. His best things and for him to
friend stole gadgets avoid doing it again
(cellphone and because it is against
laptop) and some the law. And also, his
jewellery. The best friend needs to
authority gave a Php face the consequence
200,000.00 whoever of her wrong doing.
will catch the
suspect. What shall
you do?
Analysis:
The client is on the third level which is the Postconventional Level and in the Stage 6 (Universal
Principles) in which the client reported his friend of his wrong doing it is one sign of fighting for
justice and also he is in favors of equality in which he did not cover up his friend but rather did
what is right. He portrays a person who fights for human rights which is evident in his action of
telling the truth.
D. Patterns of Functioning
Eating Pattern
Before Illness During Illness
(Before December 2019) (December 2019- October 5, 2020)
The client is used not to eat his breakfast. During the acute phase of his illness, he
He just only drinks a cup of coffee before eats but in lesser amount or worst, he has
going to farm. He eats his lunch at about poor appetite and anorexic. It is also noted
11:30 – 12 NN and is usually composed of that during the acute phase of his illness,
rice, vegetables, meat or fish. He eats his he was put into NPO to further rest his GI
dinner at about 7:00-7:30 PM which tract suppressing the release of digestive
usually composed of rice, vegetables, meat enzymes. During remission phase, he
or fish. He also eats his snack in the resumed his usual pattern of eating but
morning and in the afternoon which now, he was able to do the habit of eating
usually composed of carbonated drinks and his breakfast. His breakfast usually
biscuits. The client has no known allergies composed of rice, different preparation of
to food and food preparation is usually eggs, hotdogs, corned beef, and dried fish
boiling, steamed, raw and seldom frying. and sometimes what is left during dinner
He said that he eats fruits like banana, will be served for breakfast. He eats his
oranges, apples and grapes since his lunch 11:30 – 12 NN and is usually
children are fond of those. He also said composed of rice, vegetables, meat or fish.
that he often eats salty and seldom eats He eats his dinner at about 7:00-7:30 PM
greasy or oily food. which usually composed of rice,
vegetables, meat or fish. He also eats his
snack in the morning and in the afternoon
which usually composed of carbonated
drinks and biscuits.
Analysis: There is a change in the eating pattern of the client and can be attributed to the
treatment and management of his disease and also advice from his health care provider.
Drinking Pattern
The client is fond of drinking coffee before During the acute phase of his illness, the
he goes to the farm. He also fond of client claimed that he has poor appetite
carbonated drinks during his snacks in AM even drinking water only. He was on NPO
and PM. He also uses carbonated drinks as but claimed that sometimes drink a little
chaser during their alcohol drinking amount of water to ease the thirst and
sessions. He usually consumes dryness of his mouth. During remission
approximately 1-2 liters of mineral water a phase, he temporarily stops consuming
day especially at times when he goes to the carbonated drinks and alcoholic beverages
farm. for 3 months but after that, he resumed
with his previous habit. He usually
consumes 1-2 liters of mineral water a day.
Analysis: There is a change in the drinking pattern of the client as part of his treatment.
Modification of the drinking habit is advised after his first hospitalization.
Bladder Elimination Pattern

According to the client, the amount and The client urinates at an average of 6-8
frequency of urination depends on the times a day with 100-150 cc per voiding.
amount of fluid intake. The client urinates Color of urine varies from clear to amber.
at an average of 6-8 times per day with No hematuria noted. No difficulty and
100-150 cc per voiding. As claimed, the painful urination, no slow streaming, no
color of the urine varies from clear to urgency and no incontinence.
amber and no hematuria. He also stated
that there is no difficulty and painful
urination, no slow streaming, no urgency
and no incontinence.
Analysis: There is no significant changes in the bladder elimination of the client.
Bowel Elimination Pattern

The client stated that he defecates once a During acute phases or in NPO state, the
day usually in the early morning. He client stated that he does not defecate
characterized it as formed to semi-formed unless he have eaten solid foods. It was
yellowish to dark brown in color and only on the remission phase where he
odorous. Bowel elimination goes out in experiences bowel movement since he eats
natural way. solid food and is usually once a day during
early morning. He characterizes it as
formed to semi-formed in consistency,
yellowish to dark brown in color and
odorous. Bowel elimination goes out in
natural way.
Analysis: The change in the elimination pattern can be attributed to treatment of the
patient. It can be further stated that the natural process of stool formation is not achieved
since no solid foods are being ingested to be digested by the body. Thus, there is no
significant change in the bowel elimination pattern of the client.
Bathing Pattern
The client bathes himself 3 times a day. During acute phase of his illness, he only
Early morning, before going to farm, in the bathes himself once usually in the
afternoon and during evening. He can use morning. He usually stays in the hospital
2 pails of water in bathing and uses bed and he is not comfortable in taking a
shampoo and bath soap. The patient does bath in the hospital CR. During remission
not require assistance during bathing. phase, the usual pattern of 3x a day of
bathing. He uses shampoo and bath soap
and need no assistance in the performance
of bathing.
Analysis: The change in the bathing pattern can be attributed to the change in the usual
environment of the client during acute phase of his illness. Thus, there is no significant
change in the bathing pattern of the client.
E. Level of Competencies
Physical Competency
The client is a farmer. He goes to the field During the acute phase of his illness, usual
and tilts it for living. He sometimes carry routine of going to farm, doing household
sacks of rice, sacks or corn and fertilizers. chores and others were not done since he
He also does household chores like was hospitalized. Remission phase
cooking, cleaning the interior house and revealed he temporarily stopped for 2
their backyard. He also does laundry. He weeks to get some rest and then continued
can take care of himself with good working in the farm as well as doing
grooming. He does not need assistance in household chores. He can take care of
the performance of his day-to-day himself with good grooming and does not
activities of living. need assistance in performing activities of
daily living.
Analysis: There is no significant change in the physical competency of the client.
Emotional Competency
The client stated that he can relate to other The client still relate to the people he
people he communicates with. He can communicates with. He can still express
express his emotions appropriately in a his emotions in an appropriate manner.
decent manner. He does not get easily
irritated but if there are circumstance that
escalated his emotions to the extremes, he
still able to express it without being
aggressive. He further said that he can
control his emotions and he is not easily
waivered.
Analysis: There is no significant change in the emotional competency of the client.
Intellectual Competency
The client decides for himself. He is The client is oriented to time, place and
oriented to time, places and person. He is person. He is aware of what is happening
also aware of what is happening to his to his surroundings He can answer
surroundings. He can easily follows and questions and follow verbal commands.
understands instructions given to him.
Analysis: There is no significant change in the intellectual competency of the client.
Social Competency
The patient has good interpersonal The patient still has good interpersonal
relationship with his family, relatives and relationship with his family members,
neighborhood. If he has time, he goes out relatives and neighborhood. During his
with his friends and cousins to play hospitalization, some of his friends visited
basketball in their area. Further, he him. Also, he still attends to the
involves himself in the community like in community assembly and clean up drive
assembly meeting and clean up drive in during the remission phase.
their barangay.
Analysis: There is no significant change in the social competency of the client.
Spiritual Competency
The client is affiliated with Baptist. He During the acute phase, he bargains to God
goes to church every Sundays. He said that that he will not drink alcohol again as
he respects and follows their spiritual claimed. He always pray for his fast
beliefs but claimed and verbalized that recovery since no one will look after his
“deta lang inom ken sigarilyo ti children. As claimed, “maasyan nak met
pagbasbasolak.” He also prays at night kada parents ko nga mangkitkita kadkuada
before sleeping and reads the Bible. The (children) ita nga agsakitak, namuna ta
content of his prayers are his personal lakay ken baket da metten.” He also prays
intentions, his family especially the safety for the safety of his whole family.
of his wife and children.
Analysis: The client has strengthened spiritual competency which enhances his coping
to his disease.
F. Physical Assessment
Date Performed: October 05, 2020 @ 8 am
General Appearance
The client is a 29-year old male, seen on bed, on upright position. He is mesomorph in
terms of body built. He is feeling pain on his epigastric area radiating to his back with
8/10 on pain scale, noted guarding behavior, grimacing face and the pain intensifies as
client moves. The client is slightly irritable but cooperative and obeys simple verbal
command and answers to questions asked as far as his memory is concerned. He is
wearing a blue shirt and a jersey short. He has an IV fluid of D5lr 1L at 100 cc/hour
inserted on left cephalic vein via intravenous catheter gauge 20.
Vital Signs:
Body Temperature: 37.0° C using infrared thermometer
Pulse Rate: 98 beats in one full minute, regular
Cardiac Rate: 96 beats in one full minute, regular
Pulse Rate: 20 breaths per minute, regular
Blood Pressure: 120/90 mmHg in upright position
Weight: 56. kgs
Height: 1.58 meters
BMI: 22.4 kg/m2 = within normal percentile calculated for Filipino male
Head-to-Toe Assessment
a. Head
- Normocephalic
- Scalp lighter in color than complexion
- Evident and evenly distributed white hair
- No tenderness or mass noted upon palpation
b. Face
- With symmetrical facial features
- Able to move facial muscles at will
- No involuntary muscle movements noted
c. Eyes
- With symmetrical and evenly distributed eyebrows
- With upper eyelid partially covering the iris
- With yellowish sclera
- With pinkish upper and lower conjunctive
- With visual acuity of 20/20 using Snellen Chart
- With good peripheral vision
- Pupils are equal, round and reactive to light and accommodation
d. Ears
- Bean-shaped symmetrical earlobes
- Skin is same color as complexion
- No pain or tenderness upon palpation of mastoid process and auricles
- Minimal cerumen noted upon inspection
- No lesions or discharges noted
- With good hearing acuity – able to repeat what examiner said through the
voice test
e. Nose
- Nose in midline
- With patent nares
- No discharges noted
- No alar flaring
- No tenderness, mass or pain noted upon palpation
f. Mouth
- With dry, symmetrical lips, no lesions noted
- With pinkish buccal mucosa
- Presence of all upper and lower teeth
- Tongue is in midline position
- With pinkish uvula and in midline position
- With intact gag reflex
g. Neck
- No mass or lumps noted upon inspection
- Not distended jugular vein
- With good range of motion
h. Chest
- Moves symmetrically when breathing
- Respiratory rate of 20 breaths per minute
- Clear breath sounds, no retractions noted
- No murmur noted upon auscultation
- Cardiac rate of 96 beats per minute
i. Abdomen
- Flat abdomen
- Noted tenderness upon direct palpation on the epigastric area
- Noted rebound tenderness upon palpation of the epigastric area
- No lesions noted
- Bowel sounds auscultated as follows:
RUQ: 5 bs/min
RLQ: 6 bs/min
LUQ: 6 bs/min
LLQ: 5 bs/min
- No bladder distention
j. Upper extremities
- Symmetrical
- Skin is moist, no lesions noted
- With toned upper am
- Pinkish nail beds with capillary refill of < 2 seconds
- Good range of motion
k. Lower extremities
- Symmetrical
- With toned legs
- Skin is moist, no lesions noted
- Pinkish nail beds with capillary refill of < 2 seconds
- Good range of motion
l. Genital and anus
- Not assessed
G. On-going Appraisal
Day 1 October 6, 2020
The client was seen lying on bed on semi-fowlers position, fair in appearance with
ongoing PLR 1L at 41gtts/min. Still noted with yellowish sclera. He complained of
abdominal pain specifically on the epigastric area radiating to back with pain scale of
6/10. He was given PRN medications which afforded relief. He was still on NPO.
Dr. S had her rounds and shifted the client’s IV fluid to Plain LR. Previous ordered
laboratories were noted hence new orders from her. She ordered repeat lipase, BUN and
creatinine. She also ordered LDH today. The client was started on CBG monitoring and
previous order of whole abdominal CT scan was facilitated which confirmed the
diagnosis of acute pancreatitis.
On this day, the client was infused of 3375 cc of both D5LR and PLR. The client urinated
8 times with approximately 3000 cc and had no bowel movement that day. No other
complaint except the abdominal pain stated above. Vital signs were taken as follows:
Body Temperature: 36.4°C-36.8°C via infrared thermometer
Blood Pressure: 100/70 –140/80 mmHg
Pulse Rate: 83-115 bpm
Respiratory Rate: 20-28 bpm
CBG monitoring: 108-128 mg/dl
The client was seen sitting on bed with feet dangled, fair in appearance with ongoing
PLR 1L at 41 gtts/min. Still noted with yellowish sclera. He complained of abdominal
pain specifically on the epigastric area upon direct palpation with pain scale of 4/10. He
was not given pain reliever since he claimed it was tolerable. He was maintained on
NPO.
Dr. S had her rounds today and previous laboratories were noted with results, lipase
yielded to 893 hence an order to repeat serum lipase tomorrow.
On this day, the client was infused of 3000 cc of PLR. The client urinated 7 times with
approximately 2500 cc and had 1 bowel movement that day. No other complaint except
the abdominal pain stated above. Vital signs were taken as follows:
The client claimed that he ate 1 pack of skyflakes at 5PM before he was taken blood for
CBG hence the increase in the CBG monitoring.
The client was seen sitting on bed with feet dangled, fair in appearance with ongoing IV
fluid of PLR 1L at 41gtst/min. Still noted with yellowish sclera. No abdominal pain was
noted all throughout the day but still maintained on NPO. Dr. S had her rounds and
previous laboratory results were noted, lipase is 790 which prompted her to order a repeat
serum lipase tomorrow.
On this day, the client was infused of 3000 cc of PLR. The client urinated 8 times with
approximately 2400 cc and had no bowel movement that day. No other complaint noted.
Vital signs were taken as follows:
The client was seen sitting on bed with feet dangled, fair in appearance with ongoing IV
fluid of PLR 1L at 41gtts/min. Still noted with yellowish sclera. No abdominal pain was
noted all throughout the day but still maintained on NPO. The client complained of
hunger. Dr. S had her rounds and previous laboratory results were noted, lipase increased
to 1400 which prompted her to order a repeat serum lipase tomorrow.
On this day, the client was infused of 3000 cc of both PLR and D5LR. The client urinated
6 times with approximately 2400 cc and had no bowel movement that day. No other
complaint noted except for hunger. No melena noted. Vital signs were taken as follows:
The 60 mg/dl CBG was taken at 6pm. It was referred to Dr. S and shifted the current IV
fluid of PLR to D5LR with same regulation. After 1 hour, repeat CBG taken which
yielded to 159 mg/dl.
The client was seen sitting on bedside chair, fair in appearance with ongoing IV fluid of
D5LR 1L at 41gtst/min. Still noted with yellowish sclera. No abdominal pain was noted
all throughout the day. Dr. S had her rounds and previous laboratory results were noted,
lipase is 640. The client was ordered to have soft diet for lunch and may possibly
discharged tomorrow if continuously no abdominal pain.
On this day, the client was infused of 3000 cc of D5LR. The client urinated 6 times with
approximately 2100 cc and had no bowel movement that day. No other complaint noted.
Blood Pressure: 120/80-100 –130/80 mmHg
The client was seen sitting on bedside chair, fair in appearance with intact heplock. Still
noted with yellowish sclera. No abdominal pain was noted. Dr. S had her rounds and
ordered that the client is for discharge.
He was advised not to take alcoholic beverages again. He was given a take home
medications of Multivitamins 1 tablet OD and to come back for OPD follow up on
October 20, 2020 at 8AM.
Blood Pressure: 120/80-100 –130/80 mmHg
After the hospital bills were settled, the client left the hospital at 6:05 PM.
H. Medical Management
A. Laboratory and Diagnostic Procedures
Hematology
1. Complete Blood Count
A complete blood count is a group of tests used for basic screening purposes. It is
probably the most widely ordered laboratory test. It identifies the total number of blood
cells (WBC, RBC and platelets) as well as hemoglobin, haematocrit and RBC indices.
The results can provide valuable diagnostic information regarding the overall health of
the client and the client’s response to disease and treatment.
Purpose: This was done to the client to check for the presence of dehydration through the
hematocrit. It is also done to check the overall blood count of the client.
Date ordered: 10/05/2020
Ordered by: Dr. G
Result Unit Reference Interpretation
10/05/2020 Range
Hemoglobin 160.00 g/L 140-175 Normal

Hematocrit 0.48 0.41-0.50 Normal
RBC 5.60 10^12/L 4.5-5.9 Normal
MCV 85.40 fL 80-100 Normal
MCH 28.60 g/dL 27-32 Normal
MCHC 33.50 g/dL 31-35 Normal
RDW 13.30 % 12-16 Normal
WBC 14.74 10^9g/L 4.50-11.00 Abnormal
Differential Count
Segmenters 0.88 0.50-0.70 Abnormal
Lymphocytes 0.06 0.20-0.40 Abnormal
Monocyte 0.06 0.02-0.08 Normal
Eosinophil 0.00 0.01-0.04 Abnormal
Basophil 0.00 0.00-0.01 Normal
Platelet Count 275.00 10^9g/L 150-450 Normal
Analysis: It can be deduced that the client’s overall blood count is good. The client is not
dehydrated however the WBC is slightly higher than the normal. This can be attributed to the
inflammation. It is supported by Askey (2008) that in acute pancreatitis, leukocytosis happens
due to the presence of inflammation. Furthermore, increase in segmenters may also be attributed
to the inflammation present since neutrophils are the ones to first respond during inflammation.
Lymphopenia is common in acute illness, especially in the presence of neutrophilic leukocytosis.
Eosinopenia, with often absence of cells on the differential count is very common in acute illness
and typically has no significance.
Nursing Responsibilities Rationale
1. Check the doctor’s order To confirm the laboratory tests that is
to be done to the client.
2. Tag to the computer (HOMIS) This will notify the laboratory
the laboratory tests to be done. department for their information.
3. Inform the client about the type To increase client’s awareness
of procedure and its purpose. regarding the procedure to be done
thereby facilitating full cooperation.
4. Explain the client that a tingling In order for the client to know what
sensation may be felt while to expect during specimen collection.
collecting the specimen.
5. Follow up result, refer to the Referring results to physician
attending physician for any especially abnormal results will
abnormalities and attached to prompt necessary intervention and
chart. adjustments of present treatment and
care.
6. Document the procedure For legal purposes.
including response.
7. Instruct client to eat green leafy This will help to boost immune
vegetables and high CHON diet system and healing.
when full diet is resumed.
Chemistry
2. Serum Lipase
Lipases are digestive enzymes secreted by the pancreas into thhe duodenum. Different lipolytic
enzymes have specific substrates, but overall activity is collectively described as lipase. Lipase
participates in fat digestion by breaking down triglycerides into fatty acids and glycerol.
Purpose: This was done to confirm the diagnosis of acute pancreatitis and also done to monitor
the progression of the disease.
Date ordered: 10/06 – 10/10
Ordered by: Dr. G and Dr. S
10/06 10/08 10/09 10/10 Unit Referenc Interpretation

e
Lipase 893.71 732.74 1358.8 670.24 U/L 13.00- Abnormal
60.00
Analysis: The significant increase in the serum lipase is indicative and confirms the diagnosis of
acute pancreatitis. This is supported by Leeuwan, et al (2006) which stated lipase is released into
the bloodstream when damage occurs to the pancreatic acinar cells. Its presence in the blood four
times higher than the normal value indicates pancreatic disease because the pancreas is the only
organ that secretes this enzyme. Other references tell that up to 3x elevated than the normal it is
considered significant.
care.
including response.
7. Maintain client on NPO. This will rest his GI tract and will
halt the release and accumulation of
digestive enzymes.
3. Serum Electrolyte
Sodium is an electrolyte regulated by the kidneys and adrenal glands. Sodium is the most
abundant cation in the extracellular fluid. Sodium plays a major role in maintaining homeostasis
in variety of ways including maintenance of osmotic pressure of extracellular fluid, regulation of
renal retention and excretion of water, maintaining acid-base balance, regulation of potassium
and chloride, stimulation of neuromuscular reactions and maintaining systemic blood pressure.
Potassium is the most abundant intracellular cation. It is essential for the transmission of
electrical impulse in cardiac and skeletal muscles. It also functions in enzyme reactions that
transforms glucose into energy and amino acids into proteins. Potassium helps maintain acid-
base equilibrium and it has a significant and inverse relationship to pH.
Calcium is the most abundant cation in the body and participates in almost all vital body
processes. Circulating calcium is found in the free or ionized form. Ionized calcium is the
physiologically active form of circulating calcium. About half of the total amount of calcium
circulates as free ions that participates in blood coagulation, neuromuscular conduction,
intracellular regulation, glandular secretion, and control of skeletal and cardiac muscle
contractility. Calcium plays a central role in the pathogenicity of panreatitis.
Purpose: This was done to the client to check for dehydration and hypocalcemia.
Ordered by: Dr. G
Result Unit Reference Range Interpretation
Sodium 145.1 mmol/L 136-150 Normal
Potassium 4.22 mmol/L 3.4-5.3 Normal
Ionized Calcium 1.13 mmol/L 1.00-1.20 Normal
Analysis: It can be deduced that the client has no dehydration and there is no hypocalcemia and
no advancement of the disease such as in necrotizing pancreatitis.

care.
including response.
4. Kidney Profile (BUN, Creatinine)
Blood Urea Nitrogen levels reflect the balance between production and excretion of urea. Urea is
a non-protein nitrogen compound formed in the liver from ammonia as end product of protein
metabolism. Urea diffuses freely into extracellular and intracellular fluid and is ultimately
excreted by the kidneys.
Creatinine is the end product of creatine metabolism. Creatine resides almost exclusively in the
skeletal muscle, where it participates in energy-requiring metabolic reactions. The creatinine
blood test is used to assess kidney function. It is often ordered with BUN.
In dehydration, BUN and Creatinine levels may be elevated because of renal hypoperfusion.
Purpose: This was done to the client to check for dehydration and client had episode of nausea
and vomiting.
Date ordered: 10/05/2020- 10/06/2020
Ordered by: Dr. G
10/05 10/06 Unit Reference Interpretation

range
BUN 6.90 6.30 mmol/L 1.7-8.3 Normal
Creatinine 60.00 70.00 umol/L 44.2-150.3 Normal
Analysis: It can be deduced that the client has no dehydration.

care.
including response.
5. Liver Profile (AST, ALT)

AST and ALT are considered to be two of the most important tests to detect liver injury. AST
and ALT exist in large amount in the liver. Serum AST and ALT rises when there is cellular
damage to the tissues where the enzyme is found.
Purpose: This was done since the client is alcoholic and liver enzymes is one parameter for
Ranson’s criteria and APACHE scoring.
Ordered by: Dr. G
Result Unit Reference range Interpretation

SGPT/ALT 22.22 U/L Up to 45 Normal
SGOT/AST 15.94 U/L Up to 35 Normal
Analysis: It can be deduced that the client’s disease has no liver extension.

care.
including response.
6. Serum LDH
Lactate dehydrogenase is an enzyme that catalyzes the reversible conversion of lactate to
pyruvate within cells. Because many tissues contain LDH, elevated total LDH is considered non-
specific indicator of cellular damage unless other clinical data make the tissue origin obvious.
Purpose: This was done to the client since LDH is one parameter for Ranson’s Criteria and can
be used for APACHE scoring.
Ordered by: Dr. S
Result Unit Reference Interpretation
range
Lactate 195.38 U/L 225-450 Abnormal

dehydrogenase
(LDH)
Analysis: The above result is not remarkable to the Ranson’s criteria and APACHE scoring. In
pancreatitis, LDH should be significantly high. Healthline maintains that low LDH levels are not
usually harmful.




care.
including response.
7. Chest X-ray
Chest X-ray makes images of the heart, lungs, airways, blood vessels and the bones of spine and
chest. It provides information about the chest that may not be available through other means. It
may reveal abnormalities when there are no physical signs and symptoms of pulmonary
pathology.
Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of
peripancreatic organs and/or remote organ systems in different degree such as the lungs. Pleural
effusion also indicates severity of the disease. It may also include ARDS, hypoxia and
atelectasis.
Purpose: This was done to the client to check for possible pulmonary complications.
Ordered by: Dr. G
Result/Impression:
Thoracic Scoliosis
No significant pulmonary and cardiac findings
Analysis: The result shows that there is no pulmonary complications involved. It can be deduced
that the pancreatitis is not severe. Thoracic scoliosis may be attributed to the nature of the
client’s work which is farming and it demands carrying heavy loads on the head, shoulder and
back.

1. Check the doctor’s order To confirm the procedure that is to be
done to the client.

2. Complete request form To notify the radiology technician on
accurately to be forwarded in duty.
the radiology department.

3. Instruct the client to remove all Metal objects can interfere with the
metal accessories such as radiographic beam and to avoid
jewelries, coins in the pocket, unnecessary images of metal objects
belt, dentures and other metallic in the plate.
objects.
4. Refer results to the physician Referring results to physician
and attach to patient’s chart. especially abnormal results will
prompt necessary intervention
adjustments of present treatment and
care.
including the response of the
client.
8. Whole Abdominal CT Scan
Abdominal CT scan is a noninvasive procedure used to enhance certain anatomic views of the
abdominal structures, but it becomes invasive when a contrast medium is used. Differentiations
can be made among solid, cyctic, inflammatory or vascular lesions and suspected hematomas
and aneurysm can be identified. Iodinated contrast medium is given intravenously for blood
vessel and vascular evaluation or orally for bowel and adjacent structure evaluation.
Purpose: This was done to confirm the diagnosis of pancreatitis.
Date ordered: 10/05/2020 – 10/06/2020
Ordered by: Dr. G
Result:
The CT scan images reveal diffuse enlargement of the pancreas. It still exhibits homogenous
enhancement with parenchymal hypodensity. There is note of minimal peripancreatic fat
stranding and minimal intraperitoneal fluid noted at the bilateral conal space.
The bowels are unremarkable.
The liver and spleen are of normal size and tissue homogenecity. There are no focal masses
noted within.
There are no enlarged lymph nodes noted
The adrenal glands are normal
The kidney shows good excretory function and are of normal size, position and configuration.
The urinary collecting structures and urinary bladder are normal.
The seminal vesicles and prostate gland are unremarkable
The visualized lung bases are clear
Impression:
Findings are compatible with acute interstitial pancreatitis
Minimal ascites
Analysis: The CT scan shows a confirmed diagnosis of acute pancreatitis.

1. Check the doctor’s order To confirm the procedure that is to be
done to the client.
2. Complete request form To notify the radiology technician on
accurately to be forwarded in duty.
the radiology department.
3. Secure consent for the For legal purposes and protection.
procedure.
4. Assess allergy to shellfish or Iodinated dye may cause allergic
iodinated dye. Do skin test for reactions.
contrast medium.
5. Assess for claustrophobia. The procedure involves putting client
into a tunnel-typed machine.
6. Check for creatinine and or This will check for the efficiency of
kidney profile. the kidney to excrete the contrast
medium.
7. Instruct and maintain client on This will clear the gastrointestinal
NPO 8 hours prior to procedure tract to provide more accurate results.
or depending on institutional
policy.
8. Informed client to anticipate This is administered to distinguish
drinking diluted barium gastrointestinal organs from other
solution 1 hour before the abdominal organs.
procedure.
9. Assist the client to remove all Metal objects can interfere with the
metal accessories such as radiographic beam and can alter the
jewelries, coins in the pocket, results of capturing unnecessary
belt, dentures and other metallic images.
objects.
10. Instruct client to cooperate fully Movement produces unreliable
and follow directions. Instruct results.
to remain still until the
procedure is done.
11. Refer results to the physician Referring results to physician
and attach to patient’s chart. especially abnormal results will
prompt necessary intervention
adjustments of present treatment and
care.
12. Observe for delayed allergic Iodinated dye may cause delayed
reactions like rash, urticarial, hypersensitivity reaction.
tachycardia, nausea and
vomiting 24 hours up to 3 days.
13. Instruct client to increase oral To eliminate the contrast medium.
fluid intake after the procedure.
including the response of the
client.
15. Maintain client on NPO until This will rest the GI tract preventing
further orders. stimulation of release of digestive
enzymes.
9. Electrocardiography
An electrocardiography (ECG) is a graphic representation of the electrical activity, impulse
formation and conduction of the heart. The electrical act produces electrical current that can be
measured by applying electrodes in the skin and amplifying them through an ECG apparatus to
produce a graphic read-out or display.
Purpose: This was done to rule out cardiac pathology since the client presented epigastric pain.
Ordered by: Dr. G
Result/Interpretation:
Normal Axis
Regular Sinus Rhythm
Analysis: The result shows that there is no problem in the electrical conductivity of the heart.
Hence, ruled out cardiac pathology.

1. Check the doctor’s order. To confirm the procedure that is to be
done to the client.

2. Inform and explain to the To alleviate anxiety and gain
patient and significant others cooperation.
about the procedure.

3. Fill-up request accurately and To notify the ECG nurse.
forward to ECG nurse.

4. Assist client to remove all To prevent alterations of result.
metallic objects in the body.

5. Instruct the client to stay still To prevent alterations of result.
and avoid unnecessary
movements during the
procedure.
6. Refer the result to the physician So that the physician will be able to
for reading and attached to determine the appropriate
chart. management to the client especially
abnormal results.
7. Document the procedure. For legal purposes.

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A.

Monthly Income Php 13,000.00

B. Past Health History

C. Present Health History

Conversely, when people fail to accomplishing a developmental task, they’re often

Establish a family  IM achieved this task since he

B. Kohlberg’s Theory of Moral Development

Situation Level Stage Cues

Bladder Elimination Pattern

Bowel Elimination Pattern

Hemoglobin 160.00 g/L 140-175 Normal

10/06 10/08 10/09 10/10 Unit Referenc Interpretation

no advancement of the disease such as in necrotizing pancreatitis.

Nursing Responsibilities Rationale

4. Kidney Profile (BUN, Creatinine)

10/05 10/06 Unit Reference Interpretation

Analysis: It can be deduced that the client has no dehydration.

Nursing Responsibilities Rationale

5. Liver Profile (AST, ALT)

damage to the tissues where the enzyme is found.

Ranson’s criteria and APACHE scoring.

Date ordered: 10/05/20

Ordered by: Dr. G

Result Unit Reference range Interpretation

Nursing Responsibilities Rationale

Lactate 195.38 U/L 225-450 Abnormal

to be done to the client.

the laboratory tests to be done. department for their information.

of procedure and its purpose. regarding the procedure to be done

thereby facilitating full cooperation.

sensation may be felt while to expect during specimen collection.

collecting the specimen.

attending physician for any especially abnormal results will

abnormalities and attached to prompt necessary intervention and

chart. adjustments of present treatment and

Date ordered: 10/05/2020

Ordered by: Dr. G

No significant pulmonary and cardiac findings

Nursing Responsibilities Rationale

done to the client.

accurately to be forwarded in duty.

the radiology department.

metal accessories such as radiographic beam and to avoid

jewelries, coins in the pocket, unnecessary images of metal objects

belt, dentures and other metallic in the plate.

and attach to patient’s chart. especially abnormal results will

prompt necessary intervention

adjustments of present treatment and

including the response of the

8. Whole Abdominal CT Scan

Nursing Responsibilities Rationale

Nursing Responsibilities Rationale

done to the client.

patient and significant others cooperation.

about the procedure.

forward to ECG nurse.

metallic objects in the body.

and avoid unnecessary

movements during the

chart. management to the client especially

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