The nurse is reviewing the physician's orders written for a patient admitted to the hospital 1 hour ago with acute pancreatitis. The patient is in severe pain. Which physician order should the nurse question if noted on the client's chart?

Correct Answer: Morphine 1 mg IV as needed for pain

While morphine is commonly used for pain management, it should be used cautiously in patients with acute pancreatitis.

Morphine has the potential to spasm the sphincter of Oddi, which can increase pressure within the pancreatic duct and exacerbate pain in patients with pancreatitis.

Fentanyl or hydromorphone are typically preferred for pain management in pancreatitis because they do not have the same effect on the sphincter of Oddi.

Why the Other Options Are Incorrect:

"Insert nasogastric tube":

A nasogastric (NG) tube is often used in acute pancreatitis to decompress the stomach and prevent further gastric distention. It is used to manage nausea and vomiting and to reduce pancreatic stimulation. This is a standard intervention for acute pancreatitis and is appropriate.

"IV infusion of 0.9NS at 100cc/hr":

Fluid resuscitation is a critical part of managing acute pancreatitis. Patients often become hypovolemic due to fluid shifts and third-space losses, so maintaining hydration is essential. Normal saline (0.9% NaCl) is a common choice for IV fluid replacement. The infusion rate of 100cc/hr is appropriate for maintaining hydration without causing fluid overload.

"Clear liquid diet":

A clear liquid diet is often recommended in the early stages of acute pancreatitis to allow the pancreas to rest. This diet helps prevent stimulating pancreatic secretion, which can worsen inflammation. Once the patient improves and pain decreases, they may be advanced to a full liquid diet and then regular food.

Summary:

The physician's order for morphine should be questioned in a patient with acute pancreatitis because it can worsen pain by causing spasms of the sphincter of Oddi. Other orders, such as inserting an NG tube for decompression, administering IV fluids for hydration, and starting a clear liquid diet, are appropriate for managing acute pancreatitis.