Day 1

1049: Client admitted from the emergency department (ED) with acute pancreatitis. The client is alert and in moderate distress, endorsing severe abdominal pain. Persistent nausea and projectile vomiting. Bowel sounds are hypoactive, and all quadrants have some abdominal distention. Pain with palpation in the epigastric area. Significantly hypotensive in the ED and has since resolved after fluid resuscitation was provided via a newly placed peripherally inserted central catheter (PICC). According to records, this is the second admission for pancreatitis in the past four months. We will start total parenteral nutrition (TPN).

Day 2

0730: 

Day 1

1049:

• NPO
• start total parenteral nutrition (TPN)
• ondansetron 4 mg oral disintegrating tablet (ODT) q 4 hours PRN nausea and vomiting
• fentanyl 50 mcg intravenous push (IVP) q 3 hours PRN pain
• 0.9% sodium chloride (normal saline) infusion at 75 mL/hr
• vital signs q 4 hours
• basic metabolic panel (BMP) tomorrow morning

Day 1

1115:

T 97°F (36.1°C)

P 90

RR 18

BP 117/77

Pulse oximetry reading 96% on room air

Day 2

0800:

T 99°F (37.2°C)

P 94

RR 16

BP 97/57

Pulse oximetry reading 98% on room air

Day 2

0811: Client reporting persistent nausea even with the prescribed ondansetron. He has vomited twice with approximately 75 mL of emesis. He reports abdominal pain rated 7/10 on the Numerical Rating Scale. Notified primary health care provider about client status and lab results. Awaiting orders.