# Situation: A 48-year-old man weighing 72 kg is admitted to the medical ward with mild acute pancreatitis related to heavy alcohol use. He has no organ failure. He is receiving lactated Ringer's solution intravenously (IV) and IV morphine for pain. On day 2 his pain is controlled with the ordered analgesic, his nausea has resolved, and he says he is hungry. Bowel sounds are present. According to current guidelines, which diet order should the nurse anticipate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630398  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 48-year-old man weighing 72 kg is admitted to the medical ward with mild acute pancreatitis related to heavy alcohol use. He has no organ failure. He is receiving lactated Ringer's solution intravenously (IV) and IV morphine for pain.

On day 2 his pain is controlled with the ordered analgesic, his nausea has resolved, and he says he is hungry. Bowel sounds are present. According to current guidelines, which diet order should the nurse anticipate?

## 보기

1. Nothing by mouth until the lipase is normal
2. Clear liquids for 3 days, then solid food
3. A low-fat solid diet as tolerated **✔ 정답**
4. Tube feeding through a nasogastric tube

**정답: 3**

## 해설

Current guidelines start oral feeding within 24–48 hours in mild acute pancreatitis once pain and nausea allow, beginning with a low-fat solid diet; prolonged 'pancreatic rest' is no longer recommended. Tube feeding is reserved for clients who cannot eat, and a clear-liquid phase is not required.

## 심화 해설

The diet order to anticipate
On day 2 his pain is controlled, his nausea has resolved, he is hungry, and bowel sounds are present. Current guidelines start oral feeding within 24–48 hours in mild acute pancreatitis once pain and nausea allow, beginning with a low-fat solid diet. The nurse should therefore anticipate an order for a low-fat solid diet as tolerated. Prolonged "pancreatic rest" is no longer recommended.

Why early feeding is now preferred
For many years, clients with pancreatitis were kept nothing by mouth until pain and enzymes normalized, on the theory that food would stimulate the pancreas and worsen inflammation. Evidence has since shown the opposite. Early oral feeding maintains the gut barrier, reduces bacterial translocation from the bowel, and is associated with fewer infections and shorter hospital stays. Long periods without food allow the intestinal lining to weaken, which can let bacteria enter the circulation and infect pancreatic tissue. A low-fat diet limits stimulation of pancreatic enzyme secretion while still providing nutrition.

| Approach | Current status |
| --- | --- |
| NPO until lipase normalizes | Outdated; not required |
| Clear liquids for several days before solids | Older stepwise practice; not required |
| Low-fat solid diet when tolerated | Recommended in mild disease |
| Nasogastric or nasojejunal tube feeding | For clients who cannot eat, often in severe disease |

Why the other orders are wrong
Waiting for the lipase to normalize is unnecessary; the lipase level does not guide feeding and does not reflect severity. Clear liquids for three days is an older stepwise practice; a low-fat solid diet can be started directly when tolerated. Tube feeding is reserved for clients who cannot eat, usually those with severe pancreatitis, while this client is hungry and his nausea has resolved.

Nursing application
The nurse confirms readiness to eat (controlled pain, no nausea or vomiting, bowel sounds present), offers small low-fat meals, and monitors for recurrence of pain, nausea, or vomiting after eating. The nurse also continues alcohol cessation counseling, since alcohol was the cause of this episode.

Exam takeaway
Key point In mild acute pancreatitis, feed early by mouth with a low-fat solid diet once pain and nausea allow. Options that delay feeding until enzymes normalize reflect outdated practice.

## 임상 시나리오

Early Feeding in Mild Acute PancreatitisLow-fat solids when the client is ready
Current guidelines start oral feeding within 24–48 hours in mild acute pancreatitis once pain and nausea allow. A low-fat solid diet can be started directly.

Early feeding protects the gut barrier and reduces infectious complications. Waiting for lipase to normalize or using a clear-liquid phase is not required, and tube feeding is reserved for clients who cannot eat.

CautionMonitor for return of pain, nausea, or vomiting after meals, and continue alcohol cessation counseling.

## 핵심 개념

- **Acute pancreatitis** — Sudden inflammation of the pancreas, commonly caused by gallstones or alcohol.
- **Early oral feeding** — Starting food by mouth soon after admission once pain and nausea allow.
- **Low-fat diet** — A diet limiting fat intake to reduce stimulation of pancreatic enzyme secretion.
- **Gut barrier** — The intestinal lining that prevents bacteria from passing into the bloodstream.

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