A 25-year-old male is brought to the Emergency Department via EMS after being involved in a motor vehicle collision with fire entrapment. The patient is conscious and in visible pain. You, a student nurse, are assigned to assist with his initial assessment and care.

Exhibits

Calculate the fluid requirements using the Parkland formula. What is the total fluid needed in the first 24 hours?

Rationale:
A. It is caused by dilation of the biliary system is incorrect because, although gallstones and biliary obstruction can trigger acute pancreatitis, this option explains a possible cause of pancreatitis rather than why pain control is a nursing priority. It does not address the physiologic consequences of uncontrolled pain.

B. It decreases the patient’s metabolism is incorrect because pain typically increases metabolic demand and stress hormone release rather than decreasing metabolism. Uncontrolled pain leads to increased oxygen consumption and energy expenditure.

C. It increases pancreatic secretions is correct because pain and stress stimulate the sympathetic nervous system, which can increase pancreatic enzyme secretion. Increased enzyme release worsens pancreatic inflammation and autodigestion. Effective pain control helps reduce pancreatic stimulation, limits further tissue damage, and promotes healing.

D. It is caused by decreased distention of the pancreatic capsule is incorrect because pain in acute pancreatitis is associated with inflammation, edema, and increased distention of the pancreatic capsule, not decreased distention.

Rationale:
A. Conditions that interfere with renal perfusion is incorrect because this describes pre-renal acute kidney injury (AKI). Pre-renal AKI occurs when blood flow to the kidneys is reduced due to hypovolemia, hypotension, heart failure, or shock, leading to decreased glomerular filtration.

B. Conditions that act directly on functioning kidney tissue is incorrect because this describes intrinsic or intra-renal AKI, where the injury is within the kidney itself. Causes include acute tubular necrosis, nephrotoxic medications, infections, or glomerulonephritis.

C. Obstruction of the flow of urine is correct because post-renal AKI occurs when urine cannot exit the kidney, causing backpressure that damages renal function. Common causes include kidney stones, ureteral strictures, bladder outlet obstruction, or enlarged prostate. Early recognition and relief of the obstruction are critical to prevent permanent kidney damage.

D. Hypovolemia or decreased cardiac output is incorrect because these are pre-renal causes of AKI, not post-renal. While they reduce renal perfusion, they do not directly block urine flow, which is the defining feature of post-renal AKI.