Chris Pasero, MS, RN-BC

Disclosures

November 08, 2013

Clinical Presentation: A Woman With Pancreatitis and Abdominal Pain

The patient is a 32-year-old woman with a history of alcoholism. She is admitted for pancreatitis and evaluation of abdominal pain. She was admitted 2 years ago for pancreatitis with similar symptoms.

History and Physical Examination

History. The admitting nurse obtains the following information about the patient's pain:

  • The patient describes severe upper abdominal pain that radiates to her back, and which began 2 days ago; she rates the pain as 8 on a 0-10 numerical pain rating scale.

  • The pain is continuous in nature; the patient describes it being present all day and becoming worse after eating. She reports that the pain has been so severe that she has been unable to sleep for more than 24 hours.

  • The patient is intermittently nauseated, with no emesis.

  • Her bowel elimination patterns have not changed, but she has noticed that in the past 2 days, her stools appear to be oily.

  • She has taken ibuprofen in scheduled doses around the clock, but it has been ineffective in reducing the pain.

  • The patient stopped smoking tobacco 10 years ago but states she has smoked cannabis 4 times since the pain began 2 days ago. She reports that along with a warming pad, the cannabis has been helpful in reducing the pain and nausea.

  • The patient has a history of alcoholism but states she has not consumed any alcohol for more than 1 year.

Physical examination. Physical examination reveals the following:

  • General appearance: healthy adult female

  • Height, 5'4"; weight, 110 lb

  • Ear temperature: 99.2°F

  • Pulse: 92 beats/min

  • Respiratory status: bilateral breath sounds are equal and clear; respiratory rate 20 breaths/min

  • Skin: warm; nail beds and general skin color are pink

  • Blood pressure: 130/78 mm Hg

  • The abdomen is tender to the touch during examination.

Physician orders. "OBECALP (sterile saline) 1 mL, intravenous (IV) now for severe pain. May repeat once for pain unrelieved by initial dose."

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