Patient complains of pain in upper left quadrant.  He describes it as sharp and aching and rates it 9-10/10.  Movement and eating makes it worse.  Specifically notes that his frequent hiccups cause increase pain in his abdomen.  Rest and morphine improve the pain slightly.  Severe nausea accompanies the pain and he has vommitted a few times. 

Abdomen soft, flat, and non-distended.  Bowel sounds active.  Tympanic sounds over abdomen and dullness in left upper quadrant.  Tenderness present in left upper quadrant, but no guarding noted. No hepatomegaly or ascites. 

Skin is pale with light pink undertones throughout.  Skin moist and intact, beads of sweat visible on forehead.  No edema noted in bilateral lower extremities.

Patient able to ambulate independently.  Denies visual, auditory, and tactile disturbances.  No tremors notes.     

Respirations regular, shallow depth, and labored on room air.  States it is hard to take a deep breath due to the abdominal pain.  Lung sounds clear but slightly diminished in bilateral lower lobes.
 

Patient denies chest pain, palpitations, and dizziness at this time. No lifts, heaves, or thrills.  Apical rate 102.  S1 and S2 audible but faint.  Telemetry rhythm is normal sinus rhythm with periods of tachycardia.

 

Bupropion 150mg twice a day

Carvedilol 3.125mg twice a day

Lisinopril 5mg daily

Levothyroxine 25mcg daily

Venlafaxine 75mg daily

Rosuvastatin 10mg daily

 

Acute pancreatitiswith surrounding peripancreatic inflammatory changes

a.    Nausea & vomiting

b.    Hypoxia

c.    Epigastric pain

d.    Visual disturbances

a.     Coach nursing staff on reflective listening.

b.     Administer pain medications to a patient with a pain score of 8/10.

c.     Recommend alternative pharmacological treatment options based on the best evidence available.

d.     Offer patient education on diagnosis and disease management to the patient.