The nurse is reviewing the physician’s orders written for a male client admitted to the hospital with acute pancreatitis. Which physician order should the nurse question if noted on the client’s chart?
A. NPO status
B. Nasogastric tube inserted
C. Morphine sulfate for pain
D. An anticholinergic medication
Correct Answer: C. Morphine sulfate for pain
Meperidine (Demerol) rather than morphine sulfate is the medication of choice to treat pain because morphine sulfate can cause spasms in the sphincter of Oddi. Histological data show that treatment with morphine after induction of acute pancreatitis exacerbates the disease with increased pancreatic neutrophilic infiltration and necrosis in all three models of acute pancreatitis. Morphine also exacerbated acute pancreatitis-induced gut permeabilization and bacteremia.
Option A: Historically, patients with acute pancreatitis would be kept without food by mouth (nil per os or NPO) until their physician team deemed them ready to eat again, usually based on blood tests or the reported level of pain.
Option B: NGT is used if vomiting is a problem. The tube can be used for a few weeks. It can be used to remove fluid and air and give the pancreas more time to heal. It can also be used to put liquid food into the stomach as the client heals.
Option D: Anticholinergics are used to a variable extent in the treatment of many gastrointestinal conditions, including acute or relapsing chronic pancreatitis, acid-peptic disorders of the upper gastrointestinal tract, chronic inflammations of the intestines, and so-called functional gastrointestinal disorders caused by excessive or abnormal motility.
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