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This Concept Map, created with IHMC CmapTools, has information related to: Pancreatitis, Patient Data 29y.o. male with acute pancreatitis after binge drinking. Has had pancreatitis at least 3 other times. Rates pain 10/10. Has hx of abusing prescription drugs and alcohol. Has financial, employment, and legal issues. Desires to stop using drugs and alcohol but does not feel he will be successful. Voices hopelessness. Around 185,000 cases of acute pancreatitis occur each year. A large number of those are from alcohol abuse (Smeltzer, Bare, Hinkle, & Cheever, 2010). ???? Problem #2 Imbalance nutrition, less than body requirements r/t inadequate intake, altered panacreatic secretion, lack of ileus motility, N/V, and increased nutritional needs due to acute illness Outcomes: ST: Pt will have adequate nutritional intake during hospitalization IT: Pt will have BMI of 18.1 within 1mo. LT: Pt will maintain a BMI between 18.5-and 24.9 within 6 mo. Interventions: 1. Monitor IV intake 2. Treat N/V with anti emetics and NG to LIS 3. Facilitate dietary consult 4. When Patient able, provide PO intake as tolerates per MD/NP order 5. Instruct to eliminate alcohol from diet 6. Educate on healthy nutrition choices taking into account patient preferences, resources, and culture 7. Monitor weight and labs (Smeltzer et al., 2010), Elimination and exchange: Gastrointestinal function Acute pancreatitis Nasogastric suction N/V ???? ????, Patient Data 29y.o. male with acute pancreatitis after binge drinking. Has had pancreatitis at least 3 other times. Rates pain 10/10. Has hx of abusing prescription drugs and alcohol. Has financial, employment, and legal issues. Desires to stop using drugs and alcohol but does not feel he will be successful. Voices hopelessness. Around 185,000 cases of acute pancreatitis occur each year. A large number of those are from alcohol abuse (Smeltzer, Bare, Hinkle, & Cheever, 2010). ???? Problem #3 Risk for electrolyte imbalance r/t poor nutrition, N/V and nasogastric tube treatment side effect Outcomes: ST: Nausea and vomiting will resolve within 24 hr IT: Will not develop electrolyte imbalance during hospitalization NG will be discontinued within 4 days LT: Pt will not have reoccurance of risk causing pancreatitis within nest 12 mo. Interventions 1. Monitor skin turgor, mucous membrane status, and VS q 8hr and prn 2. Assess and record nasogastric drainage amounts 3. Monitor labs daily 4. Administer IV fluids and replace lost electrolytes 5. Monitor and report manifestations of multiple organ failure such as neuro, cardiac, renal, and respiratory changes (Ackley & Ladwig, 2011; Smeltzer et al., 2010), Patient Data 29y.o. male with acute pancreatitis after binge drinking. Has had pancreatitis at least 3 other times. Rates pain 10/10. Has hx of abusing prescription drugs and alcohol. Has financial, employment, and legal issues. Desires to stop using drugs and alcohol but does not feel he will be successful. Voices hopelessness. Around 185,000 cases of acute pancreatitis occur each year. A large number of those are from alcohol abuse (Smeltzer, Bare, Hinkle, & Cheever, 2010). ???? Problem# 5 Hopelessness r/t past failures at cessation of alcohol and drug use as well as legal and financial troubles Outcomes: ST: Will verbalize awareness of 2 community resources within 24 hrs IT: Will use at least 1 community resource within 2 weeks of discharge from the hospital LT: Will verbalize hopefulness within 2 mo. Interventions 1. Assist patient to identify 5 strengths 2. Assess spiritual values 3. Evaluate past successful coping strategies 4. Provide basic teaching of problem solving skills once acute pain has subsided to a level that would not interfere with ability to learn 5. Provide a list of resources available to patient in his community including legal aid, AA, mental health services (Townsend, 2008), Patient Data 29y.o. male with acute pancreatitis after binge drinking. Has had pancreatitis at least 3 other times. Rates pain 10/10. Has hx of abusing prescription drugs and alcohol. Has financial, employment, and legal issues. Desires to stop using drugs and alcohol but does not feel he will be successful. Voices hopelessness. Around 185,000 cases of acute pancreatitis occur each year. A large number of those are from alcohol abuse (Smeltzer, Bare, Hinkle, & Cheever, 2010). ???? Problem # 4 Health seeking behavior r/t desire to stop use of alcohol and drugs Outcomes: ST: Agrees to meet with discharge planner/social worker to discuss voluntary admission to inpatient treatment center for addictions IT: Attends treatment addiction treatment program and obtains 1 mo. sobriety LT: Maintains sobriety for 12 months Interventions: 1. Add and reinforce motivating factors to seek treatment 2. Give positive feedback for healthy choices 3. With permission, include family in discussion 4. Review resources and identify options for treatment 5. With permission, provide a former addict with similar age and background who has been sober for 2+ years to meet and talk with patient 6. Collaborate with discharge planner/social worker to describe treatment options and arrange for discharge to treatment center (Falvo, 2009; Townsend, 2008), ???? ???? Problem # 4 Health seeking behavior r/t desire to stop use of alcohol and drugs Outcomes: ST: Agrees to meet with discharge planner/social worker to discuss voluntary admission to inpatient treatment center for addictions IT: Attends treatment addiction treatment program and obtains 1 mo. sobriety LT: Maintains sobriety for 12 months Interventions: 1. Add and reinforce motivating factors to seek treatment 2. Give positive feedback for healthy choices 3. With permission, include family in discussion 4. Review resources and identify options for treatment 5. With permission, provide a former addict with similar age and background who has been sober for 2+ years to meet and talk with patient 6. Collaborate with discharge planner/social worker to describe treatment options and arrange for discharge to treatment center (Falvo, 2009; Townsend, 2008), Problem # 4 Health seeking behavior r/t desire to stop use of alcohol and drugs Outcomes: ST: Agrees to meet with discharge planner/social worker to discuss voluntary admission to inpatient treatment center for addictions IT: Attends treatment addiction treatment program and obtains 1 mo. sobriety LT: Maintains sobriety for 12 months Interventions: 1. Add and reinforce motivating factors to seek treatment 2. Give positive feedback for healthy choices 3. With permission, include family in discussion 4. Review resources and identify options for treatment 5. With permission, provide a former addict with similar age and background who has been sober for 2+ years to meet and talk with patient 6. Collaborate with discharge planner/social worker to describe treatment options and arrange for discharge to treatment center (Falvo, 2009; Townsend, 2008) ???? ????, Nutrition: Ingestion NPO Paralytic ileus Nasogastric tube in place Serum amylase and lypase elevated Protein deficiency- low albumin hx of poor nutrition prior to hospitalization Temp 101.3 BMI 17.8 ???? Problem #2 Imbalance nutrition, less than body requirements r/t inadequate intake, altered panacreatic secretion, lack of ileus motility, N/V, and increased nutritional needs due to acute illness Outcomes: ST: Pt will have adequate nutritional intake during hospitalization IT: Pt will have BMI of 18.1 within 1mo. LT: Pt will maintain a BMI between 18.5-and 24.9 within 6 mo. Interventions: 1. Monitor IV intake 2. Treat N/V with anti emetics and NG to LIS 3. Facilitate dietary consult 4. When Patient able, provide PO intake as tolerates per MD/NP order 5. Instruct to eliminate alcohol from diet 6. Educate on healthy nutrition choices taking into account patient preferences, resources, and culture 7. Monitor weight and labs (Smeltzer et al., 2010), Comfort: Physical Comfort Rating pain 10 out of 10 Abdomen tender to palpation Guards and grimaces with movement Nasogastric tube to low intermittent suction due to nausea and paralytic ileus Restless and irritable ???? Problem # 1 Acute pain r/t excess stimulation of pancreatic enzymes, irritation of peritoneum, and irritation of nares and pharynx by nasogastric tube placement Outcomes: ST: Will rate pain 0-3 within 30 min. of medication administration IT: Symptoms will decrease and resolve within 5 days, No erosion of nasal or oral mucosa will occur during hospitalization LT: Cause of pancreatitis will cease (Alcohol abuse) and chronic pancreatitis will not develop Interventions 1. Assess pain q2hr and prn. 2. Administer pain medication per /NP orders (Morphine Sulfate 5mg IVP q 2 hr) and assess effectiveness. 3. Provide nonpharmacologic pain relief measures such as distraction, relaxation, guided imagery, and healing touch. 4. Lubricate nares and apply viscous lidocaine to back of throat 5. Anchor NG tube to decrease movement 6. Provide meticulous oral care and maintain moist oral mucosa 7. Notify MD or NP of pain not relieved or increase in intensity of pain (Smeltzer, et al., 2010), Problem #3 Risk for electrolyte imbalance r/t poor nutrition, N/V and nasogastric tube treatment side effect Outcomes: ST: Nausea and vomiting will resolve within 24 hr IT: Will not develop electrolyte imbalance during hospitalization NG will be discontinued within 4 days LT: Pt will not have reoccurance of risk causing pancreatitis within nest 12 mo. Interventions 1. Monitor skin turgor, mucous membrane status, and VS q 8hr and prn 2. Assess and record nasogastric drainage amounts 3. Monitor labs daily 4. Administer IV fluids and replace lost electrolytes 5. Monitor and report manifestations of multiple organ failure such as neuro, cardiac, renal, and respiratory changes (Ackley & Ladwig, 2011; Smeltzer et al., 2010) ???? ????, Self-perception: Self-concept Voices hopelessness and fear that he cannot succeed at sobriety Has legal and financial issues Feels he is a burden to his family Has symptoms of depression ???? Problem# 5 Hopelessness r/t past failures at cessation of alcohol and drug use as well as legal and financial troubles Outcomes: ST: Will verbalize awareness of 2 community resources within 24 hrs IT: Will use at least 1 community resource within 2 weeks of discharge from the hospital LT: Will verbalize hopefulness within 2 mo. Interventions 1. Assist patient to identify 5 strengths 2. Assess spiritual values 3. Evaluate past successful coping strategies 4. Provide basic teaching of problem solving skills once acute pain has subsided to a level that would not interfere with ability to learn 5. Provide a list of resources available to patient in his community including legal aid, AA, mental health services (Townsend, 2008), Problem # 4 Health seeking behavior r/t desire to stop use of alcohol and drugs Outcomes: ST: Agrees to meet with discharge planner/social worker to discuss voluntary admission to inpatient treatment center for addictions IT: Attends treatment addiction treatment program and obtains 1 mo. sobriety LT: Maintains sobriety for 12 months Interventions: 1. Add and reinforce motivating factors to seek treatment 2. Give positive feedback for healthy choices 3. With permission, include family in discussion 4. Review resources and identify options for treatment 5. With permission, provide a former addict with similar age and background who has been sober for 2+ years to meet and talk with patient 6. Collaborate with discharge planner/social worker to describe treatment options and arrange for discharge to treatment center (Falvo, 2009; Townsend, 2008) ???? Problem# 5 Hopelessness r/t past failures at cessation of alcohol and drug use as well as legal and financial troubles Outcomes: ST: Will verbalize awareness of 2 community resources within 24 hrs IT: Will use at least 1 community resource within 2 weeks of discharge from the hospital LT: Will verbalize hopefulness within 2 mo. Interventions 1. Assist patient to identify 5 strengths 2. Assess spiritual values 3. Evaluate past successful coping strategies 4. Provide basic teaching of problem solving skills once acute pain has subsided to a level that would not interfere with ability to learn 5. Provide a list of resources available to patient in his community including legal aid, AA, mental health services (Townsend, 2008), Problem # 1 Acute pain r/t excess stimulation of pancreatic enzymes, irritation of peritoneum, and irritation of nares and pharynx by nasogastric tube placement Outcomes: ST: Will rate pain 0-3 within 30 min. of medication administration IT: Symptoms will decrease and resolve within 5 days, No erosion of nasal or oral mucosa will occur during hospitalization LT: Cause of pancreatitis will cease (Alcohol abuse) and chronic pancreatitis will not develop Interventions 1. Assess pain q2hr and prn. 2. Administer pain medication per /NP orders (Morphine Sulfate 5mg IVP q 2 hr) and assess effectiveness. 3. Provide nonpharmacologic pain relief measures such as distraction, relaxation, guided imagery, and healing touch. 4. Lubricate nares and apply viscous lidocaine to back of throat 5. Anchor NG tube to decrease movement 6. Provide meticulous oral care and maintain moist oral mucosa 7. Notify MD or NP of pain not relieved or increase in intensity of pain (Smeltzer, et al., 2010) ???? Problem # 4 Health seeking behavior r/t desire to stop use of alcohol and drugs Outcomes: ST: Agrees to meet with discharge planner/social worker to discuss voluntary admission to inpatient treatment center for addictions IT: Attends treatment addiction treatment program and obtains 1 mo. sobriety LT: Maintains sobriety for 12 months Interventions: 1. Add and reinforce motivating factors to seek treatment 2. Give positive feedback for healthy choices 3. With permission, include family in discussion 4. Review resources and identify options for treatment 5. With permission, provide a former addict with similar age and background who has been sober for 2+ years to meet and talk with patient 6. Collaborate with discharge planner/social worker to describe treatment options and arrange for discharge to treatment center (Falvo, 2009; Townsend, 2008), ???? ???? Problem # 4 Health seeking behavior r/t desire to stop use of alcohol and drugs Outcomes: ST: Agrees to meet with discharge planner/social worker to discuss voluntary admission to inpatient treatment center for addictions IT: Attends treatment addiction treatment program and obtains 1 mo. sobriety LT: Maintains sobriety for 12 months Interventions: 1. Add and reinforce motivating factors to seek treatment 2. Give positive feedback for healthy choices 3. With permission, include family in discussion 4. Review resources and identify options for treatment 5. With permission, provide a former addict with similar age and background who has been sober for 2+ years to meet and talk with patient 6. Collaborate with discharge planner/social worker to describe treatment options and arrange for discharge to treatment center (Falvo, 2009; Townsend, 2008), Patient Data 29y.o. male with acute pancreatitis after binge drinking. Has had pancreatitis at least 3 other times. Rates pain 10/10. Has hx of abusing prescription drugs and alcohol. Has financial, employment, and legal issues. Desires to stop using drugs and alcohol but does not feel he will be successful. Voices hopelessness. Around 185,000 cases of acute pancreatitis occur each year. A large number of those are from alcohol abuse (Smeltzer, Bare, Hinkle, & Cheever, 2010). ???? Problem # 1 Acute pain r/t excess stimulation of pancreatic enzymes, irritation of peritoneum, and irritation of nares and pharynx by nasogastric tube placement Outcomes: ST: Will rate pain 0-3 within 30 min. of medication administration IT: Symptoms will decrease and resolve within 5 days, No erosion of nasal or oral mucosa will occur during hospitalization LT: Cause of pancreatitis will cease (Alcohol abuse) and chronic pancreatitis will not develop Interventions 1. Assess pain q2hr and prn. 2. Administer pain medication per /NP orders (Morphine Sulfate 5mg IVP q 2 hr) and assess effectiveness. 3. Provide nonpharmacologic pain relief measures such as distraction, relaxation, guided imagery, and healing touch. 4. Lubricate nares and apply viscous lidocaine to back of throat 5. Anchor NG tube to decrease movement 6. Provide meticulous oral care and maintain moist oral mucosa 7. Notify MD or NP of pain not relieved or increase in intensity of pain (Smeltzer, et al., 2010)