Pierre, who is diagnosed with acute pancreatitis, is under the care of Nurse Bryan. Which intervention should the nurse include in the care plan for the client?
A. Administration of vasopressin and insertion of a balloon tamponade
B. Preparation for a paracentesis and administration of diuretics
C. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction
D. Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day
Correct Answer: C. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction
With acute pancreatitis, the client is kept on nothing-by-mouth status to inhibit pancreatic stimulation and secretion of pancreatic enzymes. NG intubation with low intermittent suction is used to relieve nausea and vomiting, decrease painful abdominal distention, and remove hydrochloric acid. Prolonged bowel rest by nothing per os (NPO) to minimize pancreatic secretion was an important part of the therapy for any patient with acute pancreatitis.
Option A: Vasopressin would be appropriate for a client diagnosed with bleeding esophageal varices. The most common cause of late death in acute necrotizing pancreatitis is represented by organ failure through infected pancreatic necrosis (IPN). Therefore there might be a theoretical benefit from antibiotic prophylaxis.
Option B: Paracentesis and diuretics would be appropriate for a client diagnosed with portal hypertension and ascites. Fluid therapy in acute pancreatitis can be seen as double edge sword with risk of necrosis through tissue hypoperfusion by using low fluid quantities and liquid sequestration and increased morbidity with too high volumes
Option D: A low-fat diet and increased fluid intake would further aggravate pancreatitis. The concept of nutritional support in AP has gradually moved towards enteral feeding, due to large evidence proving safety and efficiency. Timing and mode of nutritional support in acute pancreatitis should be based on risk prediction of severity.
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