A nurse is caring for a 50-year-old male client with acute pancreatitis secondary to gallstones, who has been experiencing severe abdominal pain and nausea for the past 24 hours. The client's serum lipase level is 850 U/L (normal: 10-140 U/L) and amylase is 420 U/L (normal: 30-110 U/L). Which nursing intervention should be the priority?
1Maintain the client on NPO status and insert a nasogastric tube for gastric decompression✓ 정답
2Administer prescribed pancreatic enzyme supplements with meals
3Encourage the client to ambulate frequently to prevent complications
4Provide a high-fat, low-carbohydrate diet to reduce pancreatic stimulation
해설
NPO status and nasogastric decompression are priority to rest the pancreas and prevent enzyme secretion stimulation in acute pancreatitis. Pancreatic enzyme supplements, ambulation, and high-fat diet are contraindicated in the acute phase.
Clinical Judgment
The key in this situation is applying the core principles of early management for acute pancreatitis. The elevated Lipase 850 U/L and Amylase 420 U/L confirm active inflammation. The goal of initial management is to eliminate all factors that stimulate the pancreas, providing "Pancreatic Rest" and halting the autodigestion process. Since oral intake (food, fluids) directly stimulates pancreatic enzyme secretion, maintaining NPO status is essential. Inserting a nasogastric (NG) tube removes gastric contents (Gastric Decompression) to prevent vomiting and reduce the indirect stimulation of pancreatic secretion caused by gastric acid entering the duodenum. Therefore, this is the top-priority initial intervention, along with pain management and fluid resuscitation.
Memory Tip: The keywords for early management of acute pancreatitis are "NPO, NG, IV Fluids, Pain Control". "Resting the pancreas" is the foundation of all treatment.
KR vs US: The initial management principles for acute pancreatitis (NPO, gastric decompression, fluid resuscitation) are the same in both Korea and the US. However, there may be slight differences in the indications for NG tube use (all patients vs. patients with persistent vomiting/distension) depending on hospital protocols. In the NGN, NG tube insertion is considered a standard intervention when symptoms are present (in this case, severe pain and nausea for 24 hours).
임상 시나리오
Clinical Practice Guide
When caring for patients with acute pancreatitis, signs of systemic inflammatory response syndrome (SIRS) such as pain (mainly upper abdominal, radiating pain), vomiting, fever, tachycardia, and hypotension must be closely monitored. Fluid administration and electrolyte correction are important for preventing shock.
Caution: In the acute phase, interventions that can stimulate the pancreas, such as option 2 (pancreatic enzyme preparations) or option 4 (high-fat diet), are absolutely contraindicated. Enzyme preparations are used when there is exocrine insufficiency in chronic pancreatitis. Option 3 (encouraged walking) is important for preventing complications after pain is controlled, but it is not a priority in the early stage with severe pain and unstable condition.
핵심 개념
Acute Pancreatitis — Acute inflammation of the pancreas, with autodigestion due to premature activation of pancreatic enzymes as the main mechanism. It is characterized by severe upper abdominal pain, vomiting, and elevated serum amylase/lipase.
Pancreatic Rest — Basic treatment principles for acute pancreatitis. Stop oral intake (NPO) and, if necessary, minimize pancreatic enzyme secretion through gastric decompression to allow the inflamed organ to heal.
Nasogastric Decompression — A procedure that removes stomach contents and air through a nasogastric tube. It is used for gastrointestinal rest in cases of persistent vomiting, intestinal obstruction, or acute pancreatitis.
Lipase — A fat-digesting enzyme secreted by the pancreas. Blood lipase levels are more specific than amylase and remain elevated for a longer period, making them useful for diagnosing acute pancreatitis.
NPO (Nil Per Os) — Latin for "nothing by mouth." It is prescribed when the gastrointestinal tract needs rest or there is a risk of aspiration, such as in acute pancreatitis, bowel obstruction, or before surgery.