Problem
George Hendrix is a 38 year old man who has abused alcohol his entire adult life. Recently, following an episode of binge drinking, George experienced a gradual onset of pain in his upper abdomen that radiated to his back. The pain persisted for several hours and worsened each time that he ate. He also felt nauseous and experienced repeated episodes of vomiting. The pain grew more intense and George decided to drive himself to the emergency department.
The physician who examined George in the ED noted these findings: Intense pain upon palpation of the upper left quadrant of the abdomen, gaseous distension of the intestinal tract, and tachycardia. Diagnostic results: Serum lipase and amylase are both greater than 3 times the upper limit of normal, WBC 14,000 (4.5-11.0 x 109/L) with a shift to the left on the differential, HBG 14 g/dL, HCT 46%, C-reactive protein 250 units/L, and transabdominal ultrasound shows pancreatic inflammation and fluid collection.
This case study relates to acute pain management of this patient's diagnosis.
A. What is the relevant objective and subjective assessment data from the case study?
B. What does this data indicate? What conclusions can you make? What is your preliminary diagnosis(es)?
C. What non-pharmacologic and pharmacologic interventions would you consider? How does each intervention treat the pathophysiology of the diagnosis(es)? What is the priority for each intervention (which interventions are first versus later)? Cai et al. (2021) conducted a systematic review and meta-analysis on pain management for acute pancreatitis. They provide easy to follow recommendations the avoid the use of opioids.
D. What are the important prescribing considerations for the pharmacologic interventions?
E. What outcomes would you anticipate - therapeutic effects and adverse effects? How will you evaluate for these outcomes?
F. What patient education and follow up is required for the medications you have prescribed?