Abdominal pain

The nurse practitioner (NP) is working at a health clinic in a homeless shelter during the early evening. A 48-year-old African American man approaches the practitioner and asks to have his blood pressure taken, saying that he has not had it checked “in a while”. The man appears to be in some type of distress and experiencing pain. The man walks slowly, using a guarded manner, and he appears diaphoretic. His mucous membranes also appear pale. The patient’s blood pressure is 210/98. The patient reports that he has not been diagnosed with hypertension previously. The patient reveals that he has severe abdominal pain that is radiating to his back. The nurse finds a heart rate of 110, respirations 30 with shallow inspirations, and temperature 102.2°F. The patient’s skin is cool and clammy.

The patient reports a history of alcoholism, homelessness, and lack of access to health care. He says that the symptoms have been present and worsening over 3 days. The man says he thinks he might have pancreatitis again, which he had “a couple years ago”. The NP recommends that the man should be seen at a hospital for his condition, but the patient says he does not have health insurance, so he does not want to go.

The NP proceeds with a physical examination, finding severe abdominal pain in the epigastric area, yellowed sclera, no abdominal distention, and hypoactive bowel sounds. The clinic is equipped with basic materials but no means to conduct lab or radiologic testing.

Considering the patient’s homelessness and lack of insurance, what action should the practitioner take?
When the patient asks why his condition cannot be managed outside of the hospital, how should the practitioner respond?
When the patient arrives to the hospital for further diagnostic work-up, what tests will likely be performed to evaluate the patient’s condition?
What criteria is used to assess the severity of pancreatitis?
What is the treatment plan for managing this patient? If medications are to be prescribed, provide full prescription details.
What patient education should be included after the pancreatitis is resolved?

Sample Solution

he 1960s emerge then as a decade when the different revolutionary regimes in the Arab world moved from the initial flush of success, which independence and its aftermath had brought, towards a process of formulating some of the ideological principles in which the revolution had been or was to be based, and of putting such principles into practice. This process almost inevitably led to a number of challenges, particularly from those whose view of revolution in general and of the particular revolution in question was different from that of the authorities. The challenges which took written from were of varying degrees of frankness. As many novelists have observed. The copious use of symbolism at this time was not merely an artistic phenomenon but a matter of strict practicality. The more explicit writers could be handled with considerable severity, as Sabri Hafiz notes. 71 The attitude of intellectuals to the governmental structure in Egypt, and their sense of alienation, is portrayed with brilliant clarity in Mahfouz’s novel, Thartharah fawq al-Nil (Chatter on the Nile, 1966; Adrift on the Nile, 1993), a work which clearly antagonized the Egyptian authorities at the highest level and almost led to his incarceration. 72
The June War of 1967 has clearly been a defining moment in the modern history of the Arab nations. The Arabic term used to describe it is al-naksah, meaning, “set back” (in itself, a typically creative use of the language’s own potential for verbal puns, the earlier 1948 War was termed al-nakbah, “the disaster”). But as a large number of anguished studies of the event and its implications were to point out, it was in fact a devastatingly terminal blow to the pretensions carefully nurtured by the political sector during the early years of independence and revolution; in the words of Faruq Abd al-Qadir, an Egyptian critic of drama, it was “a total defeat of regimes, institutions, structures, ideas, and leaders.” 73 Halim Barakat is both a sociologist and novelist, and his novel, ‘Awdat al-tair ila al-bahr (the return of the Flying Dutchman to the sea, 1969; Days of Dust, 1974) manages to identify some of the major sources of the anger and resentment that were to follow. For the Arabs this was a war with no heroes; where the battle for control of the air was concerned – and that was crucial – it was over much too quickly. What made the impact even worse and the anger more intense was that the Arab world was being told by its leaders until the very last moment that it was on its way to a glorious victory. In the view of many, these events provided an all-too-graphic illustration of the kinds of problems to which intellectuals and litterateurs had been addressing themselves, in necessarily guarded and often symbolic terms, throughout the earlier years of the decade and before. Now, however, the carefully crafted images of political leaderships and the visions of a wonderful future based on notions of equality and justice were shown to be cruel distortions of the realities of the Arab world; the extent of the disease was shown to be so great th

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