Next Generation NCLEX (NGN)
Case Study with Solutions
(All Case Studies Included)
(2023/2024)
Patient Profile: Jane Smith, a 32-year-old female,
... [Show More] presents to the emergency department with complaints of severe abdominal pain, nausea, and vomiting. She has a medical history of cholecystitis and a previous cholecystectomy. She reports that the pain started in the right upper quadrant and has since radiated to her right shoulder. She denies any recent trauma or illness. Assessment Findings: Vital signs: Blood pressure 130/80 mmHg, heart rate 90 bpm, respiratory rate 18 bpm, temperature 37.2°C (99°F) Abdominal examination reveals tenderness in the right upper quadrant with guarding Laboratory results: Complete blood count: WBC 14,000/mm³, hemoglobin 13.5 g/dL, hematocrit 40% Liver function tests: Elevated levels of AST, ALT, and total bilirubin Amylase and lipase levels within normal range Diagnosis: Based on the patient's symptoms, history of cholecystitis, and physical examination findings, the nurse suspects acute pancreatitis. Plan of Care: Pain management: Administer analgesics as prescribed, such as intravenous morphine, to alleviate pain and promote patient comfort. Assess pain levels regularly using a pain scale and adjust medication dosages accordingly. Monitor for any adverse effects of pain medications, such as respiratory depression or sedation. Nausea and vomiting management: Administer antiemetic medications, such as ondansetron, to control nausea and vomiting. Encourage the patient to avoid oral intake until nausea subsides to prevent further discomfort and potential exacerbation of symptoms. Provide frequent oral hygiene to relieve dry mouth and promote patient comfort. Monitoring and supportive measures: Monitor vital signs regularly, including temperature, heart rate, blood pressure, and respiratory rate, to assess for any signs of deterioration or complications. Maintain strict intake and output records to monitor fluid balance and detect any signs of dehydration. Insert a nasogastric tube if necessary to decompress the stomach and relieve gastrointestinal symptoms. NPO (nothing by mouth) and bowel rest: Maintain the patient on NPO status to allow the pancreas to rest and reduce pancreatic secretions. Provide intravenous fluids and electrolyte replacement as prescribed to maintain hydration and electrolyte balance. Collaborate with the healthcare team to determine the optimal timing for resuming oral intake based on the patient's clinical progress. Education and discharge planning: Provide the patient with information about acute pancreatitis, including its causes, symptoms, and risk factors. Discuss the importance of adherence to a low-fat diet and abstinence from alcohol to prevent future episodes of pancreatitis. Arrange for follow-up appointments with the healthcare provider to monitor the patient's progress and adjust the treatment plan if necessary. Solution: The patient's symptoms, history, and assessment findings indicate acute pancreatitis. The nurse's plan of care focuses on pain management, nausea and vomiting control, monitoring and supportive measures, NPO status and bowel rest, as well as patient education and discharge planning. By effectively managing the patient's pain, the nurse can enhance comfort and facilitate recovery. Regular assessment of pain levels and adjustment of analgesics accordingly are essential to meet the patient's individual needs. Concurrently, antiemetic medications help alleviate nausea and vomiting, promoting patient comfort and minimizing the risk of dehydration. Close monitoring of vital signs, fluid balance, and electrolyte levels is crucial for early detection of complications and to ensure appropriate interventions. Maintaining the patient on NPO status and providing intravenous Case Study: Patient Profile: John Davis, a 45-year-old male, is admitted to the hospital with a chief complaint of shortness of breath and chest pain. He has a medical history of hypertension, hyperlipidemia, and obesity. He is a smoker and admits to occasionally skipping his medications. He reports experiencing increased fatigue and decreased exercise tolerance over the past month. [Show Less]