Epilepsy is a neurological disorder that results from disturbance of the nerves in the brain cells. As a consequence, the disturbance of the brain nerve cells sends the wrong signal to the body. During these periods, a person with epilepsy conveys peculiar behavior or evinces feelings that might be unexplainable such as strange sensations. Depending on the type of disturbance, the seizures range from small and undetected to long-time seizures that involve vigorous shaking. The seizures have no immediate cause, and hence, a person does not deem any seizure that is caused by a particular reason to be epilepsy.
The cause of epilepsy in most individuals is unknown as many people exhibit epilepsy symptoms without following any particular trend. However, there are known causes of epilepsy that include brain injury. If the brain is physically injured to the extent that the nerve system is affected, there are more chances that an individual will have epilepsy. Moreover, stroke might cause epilepsy since the nervous systems, especially the one extended to the brain, will malfunction, leading to the uncoordinated nervous system. Furthermore, drug and alcohol abuse is one of the known causes of epilepsy.
During the time of admission, Mr. Fredrick did not show any signs of a seizure, and hence, this fact was only supposed to be used as side knowledge. Mr. Fredrick is non-verbal in his communication and physically disabled; hence, he might not have been able to express his condition well to the medical officer both by the physical or verbal means. As a consequence, he was assigned to category five. However, judging from the reaction of the care staff, the medical officer ought to have reviewed Mr. Fredrick’s placement. The reason is that it was not normal for the patient to expose such kind of behavior. The practitioner should have reviewed his placement in order to determine whether the situation was as severe as they said. Moreover, while waiting for the review, there was no practitioner to assess the level of pain that the patient was experiencing. In fact, it is in the nurses’ code of professional ethics to review each complaint to establish the level of severity. Mr. Fredrick might have been in severe pain that needed anesthetic. However, the practitioner did not give the patient medical attention as they did not perceive pain as serious as the caregivers protested.
Mr. Fredrick could not verbally express what he felt, and for that reason, CT scan was necessary in order to assess the condition. The CT scan revealed that the patient suffered from Pancreatic Necrosis, which is a serious condition that results from acute pancreatitis. If pancreatitis occurs recurrently, with time, the tissues within the pancreas may become inactive or even necrotize as a result of which one becomes infected. An abscess, which is also an infection, might attack the necrotized tissues in the pancreas, leading to serious complications. When some parts of the pancreas die, they release the digestive enzymes to the fatty tissues. As a result, a bigger number of enzymes corrode the fatty tissue and continue to cause widespread death of these tissues.
There are several factors that might cause pancreatic necrosis, some of which include regular intake of alcohol that might cause the death of one part of the pancreas. Moreover, there might be hereditary pancreatitis that a child inherited from the parents. Additionally, some drugs might cause pancreatitis that in return leads to pancreatic necrosis; some of these drugs include diuretics, gliptins, and mercaptopurine. Furthermore, there are infections that could cause partial death of the pancreas such as mumps and viral hepatitis. Talking about radiation x-ray, it might also damage one part of the pancreas, triggering pancreatic necrosis that develops with time, though it might be a little slow in such cases.
It is possible to clinically diagnose pancreatic necrosis through blood tests. Apparently, it requires further CT evaluation to establish whether it is mild or acute necrosis. However, in this case, it was hard to establish the condition that Mr. Fredrick was suffering from since he could not give any verbal clues. What is more, since he was physically disabled, he might not have given enough physical clues to help the medical officers assess his situation.
Pancreatic necrosis is exhibited in two forms; thus, it can be either infected or sterile necrosis. In both cases, there is a dead pancreatic tissue; however, in sterile necrosis, the dead tissue is not infected. Patients with sterile necrosis are placed on intravenous feeding and placed under close monitoring in order to detect any infection on early stages. However, in case the patient shows no sign of improvement to their condition after two or three weeks and still complains of severe abdominal pains, they might require surgery. Moreover, with time, there might be an infection in the necrosis, and if such a situation occurs, then the medical officer should recommend surgery.
Close attention and clear records are required to ensure enough follow-up with regard to the condition. Clearly kept records dictate whether it is important to perform the surgery or not. After Mr. Fredrick had been diagnosed with pancreatic necrosis, it was important to make sure that there was a proper follow up concerning the condition. Further inquiry would have been made to establish whether the condition was improving or not. If there was enough follow-up combined with extensive CT scan, it could have been foreseen that the condition was deteriorating. In such an incident, it would have been recommended surgery in order to avoid the spread of infection and reduce the amount of pain.
There is also another alternative treatment method which is dual-modality drainage. The method helps reduce the duration of one’s hospitalization and the pain that the patients experience. Using interventional radiology, a percutaneous drainage catheter is placed to the affected tissue through the skin. After the placement of the tube, the patient is transferred to the endoscopy suite. Afterward, the endoscopic procedure is performed on the patient, and more tubes are placed within the pancreas. The drain is used to flush large pieces of dead tissues and control the flow of the pancreatic juice. The endoscopically inserted drains must be in place controlling the flow of the pancreatic juice since it can corrode the intestinal walls causing fistula formation.
The first symptom that is exhibited by a patient suffering from pancreatic necrosis is epigastric abdominal pain. In fact, even in initial stages, the pain is severe and may extend to the back. If not managed immediately, the patient starts to show secondary signs that include nausea and vomiting. To diagnose a patient with pancreatic necrosis, practitioners use two of the following three parameters, namely the first symptom exhibited is abdominal pains, although on its own it is not qualified as the sole reason one overcomes the disease, hence the importance of close monitoring. The second symptom is the elevation of serum amylase and lipase to triple or more levels above what is considered to be normal. However, in cases of chronic pancreatitis with fibrosis, the levels of amylase or lipase may not be elevated as they will have lost their function. The last parameter to conclude the diagnosis is the CT scan. In fact, the CT scan gives finer details about the condition, confirming whether it is pancreatic necrosis and at the same time, giving details about the extent of the damage.
The combination of both triple-phase abdominal CT and abdominal ultrasound methods is considered the best way of evaluating pancreatitis. In cases when pancreatic necrosis is suspected but has not yet been confirmed, it is advisable not to use abdominal X-ray as it lacks the sensitivity required. However, it should be noted that such tests should be repeated after twenty-four hours in case the inflammation is not detected. Repetition of the tests is aimed to ensure that in case it had not revealed itself in the first twelve hours, it is still detected since it requires forty-eight hours in order to manifest itself fully.
After admission, before the lapse of 24-hours, patients with acute pancreatitis should receive endoscopic retrograde cholangiopancreatography. Since Mr. Fredrick had already waited for long enough before receiving any medical attention, while practitioners should have used a post-procedure rectal nonsteroidal anti-inflammatory drug to reduce the risk of severe post-ERCP. Moreover, they could have supplied him with some antibiotics while he waited long enough before they attended him.
Pancreatic necrosis is accompanied by acute abdominal pains. Since the pain levels might be severe, patients diagnosed with the condition should be prescribed a sufficient amount of pain relief to ensure that the pain is maintained at a minimum. Apparently, opioids are one of the best ways of providing means of controlling patients’ pain. They should be given at regular intervals to ensure that the patient is at no time experiences pain as acute abdominal pain might worsen the condition of the patient.
Talking about Mr. Fredrick, he was given infrequent pain relief. The fact that he could not communicate verbally might have had an influence on this since he was supposed to undergo a strict and regular pain relief procedure. The failure to regularly give him pain relief was inconsistent with the previous behavior he had exhibited. Thus, practitioners should have concluded that he experienced severe pain from the abnormal behavior that they had been notified by the caregiver. Since the patient was physically disabled, practitioners should have used intravenous opiates in the form of a pump controlled by one of his caregivers who could increase and reduce the dosage as per the physical judgment about the level of pain he was experiencing.