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Nursing Case Analysis Guide

This case analysis discusses two patient cases: 1) Evelyn Bean, who is being admitted for gallbladder removal surgery and may require a procedure to remove gallstones from the common bile duct. 2) Joe Harrison, who presents with severe abdominal pain and is diagnosed with acute pancreatitis based on markedly elevated serum amylase and lipase levels. His symptoms of pale, bulky stool and dark tea colored urine correlate to the pathophysiology of pancreatitis. Based on his lab results and symptoms, his mortality risk from pancreatitis is 15%. He develops hypocalcemia as a complication which requires calcium supplementation.

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Ivy Lupac
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© © All Rights Reserved
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Topics covered

  • pale stool,
  • surgical complications,
  • dietary restrictions,
  • medical analysis,
  • medical terminology,
  • digestive health,
  • alcohol consumption,
  • fluid and electrolytes,
  • stratorrhea,
  • patient symptoms
569 views3 pages

Nursing Case Analysis Guide

This case analysis discusses two patient cases: 1) Evelyn Bean, who is being admitted for gallbladder removal surgery and may require a procedure to remove gallstones from the common bile duct. 2) Joe Harrison, who presents with severe abdominal pain and is diagnosed with acute pancreatitis based on markedly elevated serum amylase and lipase levels. His symptoms of pale, bulky stool and dark tea colored urine correlate to the pathophysiology of pancreatitis. Based on his lab results and symptoms, his mortality risk from pancreatitis is 15%. He develops hypocalcemia as a complication which requires calcium supplementation.

Uploaded by

Ivy Lupac
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Topics covered

  • pale stool,
  • surgical complications,
  • dietary restrictions,
  • medical analysis,
  • medical terminology,
  • digestive health,
  • alcohol consumption,
  • fluid and electrolytes,
  • stratorrhea,
  • patient symptoms

Lupac, Virness Ivy S.

BSN-3A

CASE ANALYSIS

1. Evelyn Bean, 52 years of age, is admitted to the same-day surgery unit for an elective laparoscopic
cholecystectomy. The patient presents with jaundice of the skin and sclera. The patient’s urine is dark
and the patient stated that she has clay-colored stools. She stated she has occasional colicky pain in her
right upper quadrant of her abdomen radiating to her back. The patient had preadmission testing 1
week ago and the results are on the patient’s chart. The record of patient education and an informed
written consent are also on the chart.

What additional procedure will be performed if the common bile duct is obstructed by a gallstone?

If the bile duct is obstructed by gallstone/s, these will be removed by using ERCP – endoscopic
retrograde cholangiopancreatography. This is a minimally invasive procedure that combines x-ray and
upper endoscopy. These stones should be removed because it can lead to life-threatening infection and
buildup of bilirubin which can cause complications.

 The nurse in the same-day surgery unit provides the discharge instructions to the patient and family
before the patient goes for surgery so the patient is fully awake to receive the instructions and ask
questions. What written and verbal instructions should the nurse provide?

 Instruct the patient to eat nothing the night before the surgery. She can have sips of water with her
medications but she must avoid eating and drinking at least four hours before the procedure. Inform
the patient regarding the tests that will be run before the operation. Blood tests, x-ray, and EKG will be
performed prior to the operation.

2. Joe Harrison, a 62-year-old bank executive, presents to the emergency room with severe abdominal
pain. He describes the pain as excruciating, and indicates it is located in the midepigastrium with
radiation into his back. The patient states he has not eaten anything in the past 24 hours, but 2 days ago
attended a wedding dinner and consumed a large meal and about 4 to 5 alcoholic beverages. Mr.
Harrison admits to being a “social drinker,” ingesting 2 to 3 alcoholic beverages several days a week.
Based on his clinical presentation and history, Mr. Harrison is admitted with a diagnosis of rule-out
pancreatitis.
Blood and urine samples are sent to the lab, and the results indicate that the serum amylase and lipase
are markedly elevated. How do these findings correlate to the diagnosis of acute pancreatitis?

Pancreatitis is a condition wherein the pancreas is inflamed which results in rupture of the gland and its
cells. Since the pancreas produces lipase and amylase, the ruptured pancreas causes leakage, hence the
elevated levels of lipase and amylase.

 The nurse notes that Mr. Harrison’s stool is pale and bulky, while his urine is a dark tea color. Correlate
these findings to the pathophysiology of acute pancreatitis.

Patients with pancreatitis may present with a type of diarrhea called stratorrhea wherein the stool
contains fat which makes it pale, bulky, and floats. This is due to the insufficient bile that couldn’t digest
the fat intake of the patient. The urine appears to more dark because it contains more bile than normal.

Harrison’s WBC is 18,500, and his serum glucose is 325. His LDH is 300 IU/L and the AST is 120 U/mL.
Based on the Criteria for Predicting Severity of Pancreatitis, what is Mr. Harrison’s mortality risk?

Using the Ranson’s criterion, mortality risk for a person with pancreatitis can be calculated. For this
patient’s condition, Mr. Harrison, it is 15%.

Harrison develops hypocalcemia secondary to the acute pancreatitis. What nursing interventions should
the nurse implement related to this complication?

Hypocalcemia is primarily caused by precipitation of calcium soaps in the abdominal cavity. Nursing
interventions involves assessment of calcium levels and also fluid and electrolytes level of the patient
because these should be maintained in a normal level. Rise in calcium level needs to be done by
administering infusion of elemental calcium until the symptoms recover.
References:

https://www.uofmhealth.org/conditions-treatments/digestive-and-liver-health/bile-duct-
stones#:~:text=Bile%20duct%20stones%20are%20typically,the%20small%20intestine)%E2%80%94using
%20an

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810896/

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