A 52-year-old patient is admitted with severe acute pancreatitis. Lipase is 1,800 U/L and abdominal pain is 9/10. Which nursing actions support early identification of severe disease and reduce the risk of complications? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Severe acute pancreatitis nursing priorities: bowel rest with NG decompression if needed, serial 48-hour labs to apply Ranson criteria, aggressive isotonic fluid resuscitation (LR preferred over NS), and monitoring for Cullen and Grey-Turner signs as markers of hemorrhagic pancreatitis. Choice 1 is wrong because current ACG guidelines do NOT recommend routine prophylactic antibiotics in acute pancreatitis — they are reserved for documented or strongly suspected infected necrosis.
Mortality in severe pancreatitis is driven by third-spacing and necrosis. The two highest-yield nursing actions are aggressive LR resuscitation in the first 24 hours and serial labs (BUN trend especially predictive). Routine prophylactic antibiotics fell out of favor because they did not reduce mortality and selected for resistant organisms.
52-year-old admitted with severe acute pancreatitis. Lipase 1,800 U/L (≈4× upper limit), epigastric pain 9/10 radiating to the back, nausea and vomiting. Ranson criteria are being applied to estimate severity over the first 48 hours.
Ranson criteria — Severity score for acute pancreatitis using values at admission and at 48 hours; ≥3 criteria predicts severe disease.
Cullen / Grey-Turner sign — Periumbilical and flank ecchymosis from retroperitoneal hemorrhage in hemorrhagic pancreatitis.
Aggressive fluid resuscitation — Lactated Ringer 5 to 10 mL/kg per hour titrated to UOP ≥ 0.5 mL/kg/h, BUN trend, and hemodynamics.