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.
Any patient that is diagnosed with acute pancreatitis should be given close medical attention in order to ensure there is minimal inflammation of the tissues. Close monitoring is not possible in the award; thus, the patient should be placed in an intensive care unit. In fact, Mr. Fredrick’s case was more complicated because there was no verbal communication and he was physically disabled. Therefore, these two conditions made his case more sensitive as it required closer attention. Despite performing high levels of monitoring, the medical practitioners placed him in the ward. The practitioners did not accord attention to the patient and eventually did not prescribe him follow up as a result of improper record keeping.
Availability of food in the digestive system accelerates the pancreas to release more digestive enzymes. Since the pain is mostly triggered by the release of the digestive enzymes, no food should be taken into the system. However, it is crucial to give intravenous fluids to the patient to prevent dehydration along with the pain control. Absence of food in the stomach allows the pancreas to rest and hence, oral feeding should be avoided.
To stop feeding Mr. Fredrick was a good medical decision as it insured that there were no digestive enzymes released to the system. In fact, the reduced amount of digestive enzymes meant that the pain levels were reduced and hence, the patient needed less pain relief. However, complete termination of feeding was not appropriate; although his body was inactive, energy for other metabolic activities was also needed. Instead of stopping feeding completely, they could have done post-pyloric enteral feeding by placing a feeding tube radiographically on the third portion of the duodenum. The placement would have ensured that he did lack the energy to conduct various key metabolic activities.
In all patient cases, the most important aspect for a medical practitioner is to keep checking the heart rate. The main concern about the heart rate is because the heart determines the level of activity and severity of any particular condition and its effect on the patient. In Mr. Fredrick’s case, the practitioners failed to keep track of this important aspect. If his heart rate had been monitored, it could have helped establish that the condition was deteriorating and required attention. Thus, low blood pressure that Mr. Fredrick had might have accelerated more conditions due to the inadequate flow of blood to various organs. Since there was not enough follow-up for his condition, any organ might have failed. As a consequence, low blood pressure might have accelerated the condition that might have led to his death.
Due to the fact that by the time of admission Mr. Fredrick was not in a critical condition, it was expected that the practitioners would have to employ extra means to save the condition. The most effective method in his case would have been percutaneous drainage placed under the control of computerized tomography with a clear ultrasonic guide. It would have been effective since Mr. Fredrick was physically disabled and hence unable to conduct any activity. The process would also have prompted his transfer to the intensive care unit. In the intensive care unit, it would have been easy to monitor his progress as the heart rate and the blood pressure would have been closely controlled. Moreover, the procedure is effective for initial palliation in case the pancreatitis is acute ensuring that it is easily contained. In most cases, after the process has been conducted, stabilization occurs even after 48 hours. Additionally, if it was applied during the initial stages of palliation, it would have played a substantial role in stabilizing the patient as he awaited further treatment. The method is also effective since the surgical ablation and the residual necrotic material can easily be removed after the condition of the patient stabilizes.
Ineffective communication was a major reason that could be attributed to the death of Mr. Fredrick. Although the case was rather complicated since he did not have any means of verbal communication, medical practitioners should have been more sensitive in dealing with his issue. After establishing that he had acute pancreatitis, they should have transferred him from the ward to an intensive care unit where they could have given him closer monitoring. Moreover, follow up records are important in a hospital for any patient who has been admitted. Lack of close monitoring and proper records can be attributed to the worsening of Mr. Fredrick’s condition, which later caused his death.
