Assignment task: You should respond to both discussions separately--with constructive literature material- extending, refuting/correcting, or adding additional nuance to their posts.
Minimum 150 words each reply with references under each reply.
Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual)
Discussion 1:
The Homeless Patient Evaluation & Management Plan
Considering the patient's homelessness and lack of insurance, what action should the practitioner take?
The practitioner can communicate the situation with the facility's social workers, who can then take up the matter and search for better clinics around the community where the man can be admitted and his condition addressed. With the help of the social worker, the practitioner can also ensure that the patient learns and takes up an insurance policy that can help him in the future.
When the patient asks why his condition cannot be managed outside of the hospital, how should the practitioner respond?
The practitioner can respond that managing it outside the hospital would be difficult due to the severity of the condition and the need for intensive care and emergency care. In this case, considering it as inpatient care, it would be necessary to delve into the signs and symptoms thoroughly and regard it as an emergency despite the lack of insurance by the patient.
When the patient arrives at the hospital for further diagnostic work-up, what tests will likely be performed to evaluate the patient's condition?
Serum Lipase & Amylase- Examining these two important biomarkers is necessary to diagnose pancreatitis. Specifically, serum lipase serves as an essential biomarker in diagnosing pancreatitis due to its higher sensitivity and ability to be elevated over a longer period of time thus proper in determining the diagnosis of this condition at its early and late stages.
CT Scan- this imaging is important to assess the internal organs' state and determine if an inflammation has occurred. It is a gold standard for diagnosing pancreatic necrosis (Lee & Cho, 2022). For pancreatitis, a possible diagnosis in this case, a CT scan would offer more details about the imminent risks of the inflammation and the presence of gallstones.
Complete Blood Count- as part of the primary test conducted, CBC becomes critical in diagnosing pancreatitis as it offers more information about the state of the cells based on the impact the condition might have had on the body's system.
Comprehensive Metabolic panel- The role of a CMP in diagnosing pancreatitis is that it becomes critical in understanding the state of different electrolyte levels in the body and informs the condition of essential renal markers crucial in pancreatitis diagnosis.
How will the severity of the pancreatitis be assessed when the patient is hospitalized?
The severity of the pancreatitis can be assessed upon hospitalization by checking the patient's mean arterial pressure, white blood cell count, temperature, serum levels, respiratory rate, and heart rate. Elevated results of these components within 24 to 48 hours of admission suggest that the condition presents more risks to the patient, with decreasing values showing a mild risk of the condition. These results are based on the APACHE II scoring system, which has been widely used to determine the severity of pancreatitis upon admission for a long time (Lee & Cho, 2022).
How should the patient's condition be managed when hospitalized?
First-line therapy for this patient would be the utilization of intravenous fluid resuscitation upon admission. The essence of this therapy is that it works to stabilize the body's system and reduce the impact of inflammation in the body. Monitored resuscitation ensures that the inflammation presented by the condition does not further impact the heart rate, blood pressure, or the organs' functioning. It is also essential in reducing dehydration. Considering that the patient also presents abdominal pain, it is necessary to manage this pain using medication such as NSAIDs over rescue analgesia. Also, they perform a similar role to opioids when it comes to reducing pancreatitis-related pain (Cai et al., 2021).
What patient education should be included after the pancreatitis is resolved?
Education should focus on nutritional therapy. Commonly, pancreatitis significantly impacts the digestive system. As such, after treatment, patients should learn to rest and reduce the frequency with which they eat to give time for the pancreas to recover. Education about diet is also necessary as part of the education to adopt for this condition, as a diet free from fat is necessary to facilitate recovery (Lakananurak&Gramlich, 2020). The patient also needs to learn about the need to stop alcohol consumption, as ethanol largely impacts the functioning of the pancreas due to the need to metabolize it. Need Assignment Help?
Discussion 2:
The Homeless Patient with Suspected Pancreatitis: Evaluation and Management Plan
1. Considering the patient's homelessness and lack of insurance, what action should the practitioner take?
- The NP must highlight the urgency of the condition and organize the immediate transfer to the hospital, irrespective of insurance.
- The NP is expected to work with a social worker or a case manager if one is available to help navigate the healthcare system and potentially receive charity care or be enrolled into Medicaid (Hwang et al., 2013).
- The practitioner must write a detailed patient account and promote continuity of care by calling the receiving hospital with a referral note (Hwang et al., 2013).
2. When the patient asks why his condition cannot be managed outside of the hospital, how should the practitioner respond?
- The NP must clarify that such symptoms as abdominal pain that spreads to the back, an increase in temperature, hypertension, and jaundice could be the symptoms of acute pancreatitis or a severe complication, i.e., sepsis or organ dysfunction (Muniraj et al., 2012).
- The NP must explain that lab work and imaging (e.g., serum lipase, CT scan) are required to confirm the diagnosis and are unavailable at the shelter clinic.
- The practitioner is supposed to underline that the delay in care may lead to life-threatening complications that include pancreatic necrosis, shock, or systemic inflammatory response syndrome (SIRS) (Garber et al., 2018).
3. When the patient arrives at the hospital for further diagnostic work-up, what tests will likely be performed to evaluate the patient's condition?
- Serum amylase and lipase levels will be checked; lipase is more specific for pancreatitis (Banks et al., 2013).
- Complete blood count (CBC), liver function tests (LFTs), and blood glucose levels will help identify complications or comorbidities.
- Abdominal ultrasound may be used to check for gallstones or bile duct obstruction.
- CT abdomen with contrast is often performed to assess pancreatic inflammation, necrosis, or fluid collections.
- Blood urea nitrogen (BUN), creatinine, and electrolytes will help assess hydration status and renal function (Kamal, 2014).
4. How will the severity of the pancreatitis be assessed when the patient is hospitalized?
- The Ranson criteria or the BISAP (Bedside Index of Severity in Acute Pancreatitis) score will be used to assess severity and predict mortality risk (Garber et al., 2018).
- Persistent organ failure (>48 hours), systemic inflammatory response, and evidence of pancreatic necrosis on imaging suggest severe acute pancreatitis (Banks et al., 2013).
- Vital signs, urine output, oxygen saturation, and serial laboratory monitoring will be used to track progression.
5. How should the patient's condition be managed when hospitalized?
- Supportive care includes IV fluid resuscitation, electrolyte management, and pain control, often with opioids (Tenner et al., 2013).
- The patient should be monitored for respiratory compromise, renal failure, or sepsis.
- Nutritional support may include early oral feeding if tolerated, or enteral nutrition via nasojejunal tube if not.
- If gallstones are the cause, an ERCP (Endoscopic Retrograde Cholangiopancreatography) or cholecystectomy may be indicated (Stawicki, 2009).
- Alcohol cessation support should be initiated, given his history of alcoholism.
6. What patient education should be included after the pancreatitis is resolved?
- Educate the patient on avoiding alcohol and smoking, which are significant risk factors for recurrence (Yadav &Lowenfels, 2013).
- Recommend a low-fat diet and discuss the importance of hydration and nutrition (Tenner et al., 2013).
- Encourage follow-up care through community health clinics or charity care programs.
- Inform the patient about signs of recurrence and when to seek emergency care.
- Provide referrals to addiction counseling, housing assistance, and primary care services.