Care plan: pancreatitis/sepsis?

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Hello, i need some help. I have this case study i need assistance with. Here is the scenario:

"Mrs. Perry has been admitted to the ward via the emergency department (ED) with a historyof severe abdominal pain due to pancreatitis. Mrs Perry informed staff in the ED that she drinks a couple of cases of beer each week”, stating her last drink was the early hours ofthe morning prior to her attending the ED. While doing rounds in the evening you notice thatMrs. Perry has tremors, is very anxious and restless. She has vomited approximately 250mLof bile type fluid. Her skin is cold and clammy to touch and she looks very pale. HR 121/minBP 90/42mmHg, RR 28/min, SpO2 92% on air, Temp.39.8C"

As the nurse caring for Mrs Perry assess and plan her care

Now looking at her observations, it looks like she has sepsis, I need to find one main problem, although she has pancreatitis, sepsis is a main problem so would the nursing diagnosis be: Deficient fluid volume related to vomiting secondary to sepsis as evidenced by decreased BP, High temperature and respiration rate.

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Specializes in Emergency.

Looks like a slew of problems to me. Potential sepsis. Potential alcohol withdrawal. Chronic (?) Pancreatitis.

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So if i was to pick just on main problem, would-be potential sepsis as that seems to be a very dangerous infection

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Specializes in PACU, pre/postoperative, ortho.
Hello, i need some help. I have this case study i need assistance with. Here is the scenario:

"Mrs. Perry has been admitted to the ward via the emergency department (ED) with a historyof severe abdominal pain due to pancreatitis. Mrs Perry informed staff in the ED that shedrinks a couple of cases of beer each week”, stating her last drink was the early hours ofthe morning prior to her attending the ED. While doing rounds in the evening you notice thatMrs. Perry has tremors, is very anxious and restless. She has vomited approximately 250mLof bile type fluid. Her skin is cold and clammy to touch and she looks very pale. HR 121/minBP 90/42mmHg, RR 28/min, SpO2 92% on air, Temp.39.8C"

As the nurse caring for Mrs Perry assess and plan her care

Now looking at her observations, it looks like she has sepsis, I need to find one main problem, although she has pancreatitis, sepsis is a main problem so would the nursing diagnosis be: Deficient fluid volume related to vomiting secondary to sepsis as evidenced by decreased BP, High temperature and respiration rate.

I think you are overlooking some important assessment criteria here. Take another look at the history & what pt is reporting.

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The patient is reporting of having tremors, she's also restless...

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Specializes in PACU, pre/postoperative, ortho.
The patient is reporting of having tremors, she's also restless...

This is what I would say is the priority. She drinks 2 cases/week but hasn't had anything since the early morning before her ER admit. It's not clear exactly how much time has elapsed but it seemed to read as though she had come in the previous day, plenty of time to start seeing signs of withdrawal. Though a high HR, high RR, & fever can all be indicative of potential sepsis, they are also seen with DTs as is the vomiting.

Dehydration probably is the cause of the hypotension but not from vomiting (250 ml x1 isn't that much); more likely from alcoholism. Or maybe this all did start at home with a flare-up of the pancreatitis with a lot more vomiting at home, but at any rate, a secondary problem. Could there be infection? Sure, but if she was presenting in ER with those VS, a sepsis protocol would have aleady been initiated.

So, (again in my opinion) if this is the first set of VS like this along with the other symptoms, your looking at withdrawal & possible severe DTs if the pt is not treated soon.

FYI, I've always been told to assume a pt drinks more than they will own up to.

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Specializes in Family Nurse Practitioner.
Hello, i need some help. I have this case study i need assistance with. Here is the scenario:

"Mrs. Perry has been admitted to the ward via the emergency department (ED) with a historyof severe abdominal pain due to pancreatitis. Mrs Perry informed staff in the ED that she[/font]drinks a couple of cases of beer each week”, stating her last drink was the early hours of the morning prior to her attending the ED. While doing rounds in the evening you notice that Mrs. Perry has tremors, is very anxious and restless. She has vomited approximately 250mLof bile type fluid. Her skin is cold and clammy to touch and she looks very pale. HR 121/min BP 90/42mmHg, RR 28/min, SpO2 92% on air, Temp.39.8C"

As the nurse caring for Mrs Perry assess and plan her care

I don't think this is sepsis - yet. Presumably these are more sudden changes noticed during evening rounds.

I think the answer to what happened to her is in the details of the scenario.

Given that her last drink was over 12 hours ago and she is a chronic drinker what do you think is happening?

Also, what can happen as a result of vomiting especially to someone who many not be so alert?

Hint: See vital signs.

Remember your ABCs to decide what is priority.

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Could she be dehydrated due to vomitting. Well if she is vomitting then there's a fluid volume deficient. So would it be dehydration ?

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Specializes in OR, Nursing Professional Development.

It's not just fluids that are lost with vomiting/diarrhea. However, 250mL isn't really that much in the scheme of things.

However, you still haven't looked at some of the hints re: alcohol. Think about what process patients can go through without alcohol that can have adverse outcomes if it isn't treated and progresses to hyperthermia/seizures. It may be helpful if you converted her temp from celsius to fahrenheit if that's the scale you're used to.

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Specializes in Family Nurse Practitioner.
Could she be dehydrated due to vomiting. Well if she is vomitting then there's a fluid volume deficit. So would it be dehydration ?

Would dehydration cause a fever and drop in pulse oximetry/increased respiratory rate?

As you said before she didn't vomit that much.

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Specializes in Urology.

I like the direction of this thread. Way to go members! This is what I was talking about. OP: You've had a lot of hints, you're getting closer! Members have given you good feedback here. Vital signs and alcohol.... hmm.. think about patients who are alcohol dependant and take another look at those vitals.. Good job everyone.

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The patient could be having alcohol withdrawal ?? Could that be a problem ?

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