The nurse is reviewing the physician’s orders written for a client admitted with acute pancreatitis. Which physician order would the nurse question if noted on the client’s chart?
A. NPO status
B. Insert a nasogastric tube
C. An anticholinergic medication
D. Morphine for pain
Correct Answer: D. Morphine for pain
Meperidine (Demerol) rather than morphine is the medication of choice because morphine can cause spasms in the sphincter of Oddi. Meperidine is usually effective in relieving pain and may be preferred over morphine, which can have a side effect of biliary-pancreatic spasms. Paravertebral block has been used to achieve prolonged pain control.
Option A: Maintain NPO status and gastric suctioning in acute phase; prevents stimulation and release of pancreatic enzymes (secretin), released when chyme and HCl enter the duodenum. Administer hyperalimentation and lipids, if indicated. IV administration of calories, lipids, and amino acids should be instituted before nutrition and nitrogen depletion are advanced.
Option B: Oral feedings given too early in the course of illness may exacerbate symptoms. Loss of pancreatic function and reduced insulin production may require the initiation of a diabetic diet.
Option C: Provide medium-chain triglycerides (MCTs) (MCT, Portagen). MCTs are elements of enteral feedings (NG or J-tube) that provide supplemental calories and nutrients that do not require pancreatic enzymes for digestion and absorption.
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