M.J.. is a 65-year-old woman who is admitted to the step-down unit from the emergency
department (ED) with nausea and vomiting and epigastric and left upper quadrant
abdominal pain that is severe, sharp, and boring and radiates through to her mid back. The
pain started 24 hours ago and awoke her in the middle of the night. M.J. is a divorced,
retired sales manager who smokes a half-pack of cigarettes daily. The ED nurse reports
that M.J. is anxious and demanding, she denies using alcohol. Her vital signs are as follows:
100/70, 97, 30, 100.2° F (37.9° C) (tympanic), SpO2 88% on room air and 92% on 2 L of
oxygen by nasal cannula (NC). She is in normal sinus rhythm. She is under the care of the
hospitalist service. She has no primary care provider and has not seen a physician “in
years.”
You are assisting the RN and the RN informs you that the ED nurse reported that the admitting
diagnosis is acute pancreatitis of unknown etiology. An abdominal ultrasound showed “no
cholelithiasis, gallbladder wall thickening, or choledocholithiasis. The pancreas was not well
visualized due to overlying bowel gas.” An abdominal CT is scheduled for the morning.
Admission labs have been drawn; a clean-catch urine specimen was sent to the lab, and the urine
was dark in color.
1. What are the usual causes of pancreatitis?
Autoimmune diseases, excessive drinking of alcohol, infections, gallstones, medications,
metabolic disorder, surgery, and trauma
2. What other information do you need from the ED nurse regarding M.J.s
care?
a. Medication list
b. History of surgery
c. Family history
d. Any history of GI disease
e. allergies
f. Nutrition (what kind of diet?)
CASE STUDY PROGRESS - Chart View
Medication Administration Record
Esomeprazole 40 mg IV push daily
Metoclopramide 10 mg IV push every 6 hrs
Metronidazole 500 mg IV piggyback every 8 hrs
Morphine sulfate 5 mg IV push every 4 hrs as needed
Ondansetron 4 mg IV push every 6 hrs as needed
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, 3. Indicate the expected outcome associated with each medication she is receiving.
a. Esomeprazole: treat the symptoms of GERD and other conditions involving excessive
stomach acid.
b. Metoclopramide: increases muscle contractions in the upper digestive tract. This speeds up the
rate at which the stomach empties into the intestines.
c. Metronidazole: antibiotic used to treat bacterial infections of the vagina, stomach, liver, skin,
joints, brain and spinal cord, lungs, heart, or bloodstream.
d. Morphine: opioid medication to treat moderate to severe pain.
e. Ondansetron: prevent nausea and vomiting.
4. Which admission order would you question
5. What preparation is needed for M.J.’s CT scan?
If M.J’s CT scan is ordered with contrast, she cannot eat anything three hour prior to the CT
scan. Clear liquid is allowed.
CASE STUDY PROGRESS
Upon assessment you note the following abnormalities: M.J. is restless and alert, lying on her
right side in a semi-fetal position. Assessment findings are as follows: Skin is cool, diaphoretic,
and pale with poor skin turgor; mucous membranes are dry. ECG shows sinus tachycardia, rate
106, heart sounds without murmurs or rubs. Peripheral pulses are palpable at 1+ in four
extremities. Respiration rate 24, but unlabored on 2 L O2/NC with Spo2 90%. Breath sounds are
extremely diminished in lower left lobe (LLL) posteriorly—otherwise, clear to auscultation
throughout. She complains of nausea and is having dry heaves. Bowel sounds are hypoactive
throughout. Abdomen is distended, firm, and tender in a diffuse fashion to light palpation, with
guarding noted. The admission chest x-ray report reads, “moderate pleural effusion in the left
lower lobe.”
6. Your institution uses electronic charting. Based on the assessment given, document your
findings.
☐ Neurologic:
☐ Respiratory: sinus tachycardia, RR 24, SpO2 90 % with nasal cannula 2L/min, breath sounds
diminished on LLL posteriorly.
☐ Cardiovascular pulse rate 106/min, heart sound regular without murmurs, peripheral pulse
grade +1 in all four extremities.
☐ Gastrointestinal: hypoactive bowel sound, dry heaves, abdomen distended, firm and tender
when palpated with guarding noted.
☐ Genitourinary
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department (ED) with nausea and vomiting and epigastric and left upper quadrant
abdominal pain that is severe, sharp, and boring and radiates through to her mid back. The
pain started 24 hours ago and awoke her in the middle of the night. M.J. is a divorced,
retired sales manager who smokes a half-pack of cigarettes daily. The ED nurse reports
that M.J. is anxious and demanding, she denies using alcohol. Her vital signs are as follows:
100/70, 97, 30, 100.2° F (37.9° C) (tympanic), SpO2 88% on room air and 92% on 2 L of
oxygen by nasal cannula (NC). She is in normal sinus rhythm. She is under the care of the
hospitalist service. She has no primary care provider and has not seen a physician “in
years.”
You are assisting the RN and the RN informs you that the ED nurse reported that the admitting
diagnosis is acute pancreatitis of unknown etiology. An abdominal ultrasound showed “no
cholelithiasis, gallbladder wall thickening, or choledocholithiasis. The pancreas was not well
visualized due to overlying bowel gas.” An abdominal CT is scheduled for the morning.
Admission labs have been drawn; a clean-catch urine specimen was sent to the lab, and the urine
was dark in color.
1. What are the usual causes of pancreatitis?
Autoimmune diseases, excessive drinking of alcohol, infections, gallstones, medications,
metabolic disorder, surgery, and trauma
2. What other information do you need from the ED nurse regarding M.J.s
care?
a. Medication list
b. History of surgery
c. Family history
d. Any history of GI disease
e. allergies
f. Nutrition (what kind of diet?)
CASE STUDY PROGRESS - Chart View
Medication Administration Record
Esomeprazole 40 mg IV push daily
Metoclopramide 10 mg IV push every 6 hrs
Metronidazole 500 mg IV piggyback every 8 hrs
Morphine sulfate 5 mg IV push every 4 hrs as needed
Ondansetron 4 mg IV push every 6 hrs as needed
This study source was downloaded by 100000819885058 from CourseHero.com on 02-08-2022 05:32:46 GMT -06:00
https://www.coursehero.com/file/109821811/NCLEX-challenge-2docx/
, 3. Indicate the expected outcome associated with each medication she is receiving.
a. Esomeprazole: treat the symptoms of GERD and other conditions involving excessive
stomach acid.
b. Metoclopramide: increases muscle contractions in the upper digestive tract. This speeds up the
rate at which the stomach empties into the intestines.
c. Metronidazole: antibiotic used to treat bacterial infections of the vagina, stomach, liver, skin,
joints, brain and spinal cord, lungs, heart, or bloodstream.
d. Morphine: opioid medication to treat moderate to severe pain.
e. Ondansetron: prevent nausea and vomiting.
4. Which admission order would you question
5. What preparation is needed for M.J.’s CT scan?
If M.J’s CT scan is ordered with contrast, she cannot eat anything three hour prior to the CT
scan. Clear liquid is allowed.
CASE STUDY PROGRESS
Upon assessment you note the following abnormalities: M.J. is restless and alert, lying on her
right side in a semi-fetal position. Assessment findings are as follows: Skin is cool, diaphoretic,
and pale with poor skin turgor; mucous membranes are dry. ECG shows sinus tachycardia, rate
106, heart sounds without murmurs or rubs. Peripheral pulses are palpable at 1+ in four
extremities. Respiration rate 24, but unlabored on 2 L O2/NC with Spo2 90%. Breath sounds are
extremely diminished in lower left lobe (LLL) posteriorly—otherwise, clear to auscultation
throughout. She complains of nausea and is having dry heaves. Bowel sounds are hypoactive
throughout. Abdomen is distended, firm, and tender in a diffuse fashion to light palpation, with
guarding noted. The admission chest x-ray report reads, “moderate pleural effusion in the left
lower lobe.”
6. Your institution uses electronic charting. Based on the assessment given, document your
findings.
☐ Neurologic:
☐ Respiratory: sinus tachycardia, RR 24, SpO2 90 % with nasal cannula 2L/min, breath sounds
diminished on LLL posteriorly.
☐ Cardiovascular pulse rate 106/min, heart sound regular without murmurs, peripheral pulse
grade +1 in all four extremities.
☐ Gastrointestinal: hypoactive bowel sound, dry heaves, abdomen distended, firm and tender
when palpated with guarding noted.
☐ Genitourinary
This study source was downloaded by 100000819885058 from CourseHero.com on 02-08-2022 05:32:46 GMT -06:00
https://www.coursehero.com/file/109821811/NCLEX-challenge-2docx/
