A patient admitted to the hospital with a suspected diagnosis of acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? (Select all that apply)

Choice A reason: Appendicitis is likely, as severe right lower quadrant pain migrating from the periumbilical area, accompanied by diarrhea and anorexia, is classic. Inflammation of the appendix causes localized pain, nausea, and gastrointestinal symptoms. Imaging (e.g., CT scan) confirms appendicitis, which requires urgent surgical intervention to prevent rupture and peritonitis.

Choice B reason: Pancreatitis typically presents with epigastric or left upper quadrant pain radiating to the back, often with nausea and vomiting, not right lower quadrant pain. Diarrhea and anorexia are less specific to pancreatitis. The pain’s location and migration pattern make appendicitis more likely than pancreatic inflammation in this case.

Choice C reason: Peritonitis causes diffuse abdominal pain, fever, and rigidity, not localized right lower quadrant pain. It often results from appendicitis rupture but is not the primary diagnosis here. The patient’s symptoms suggest early appendicitis, not secondary peritonitis, which would show more systemic signs like high fever and rebound tenderness.

Choice D reason: Mechanical bowel obstruction causes crampy, diffuse abdominal pain, distension, and vomiting, with constipation more common than diarrhea. The localized right lower quadrant pain and migration from the navel align with appendicitis, not obstruction. Imaging would differentiate, but the symptom pattern strongly supports appendicitis over bowel obstruction.

Choice A reason: Decreased mentation is a DIC symptom, as microthrombi impair cerebral perfusion, and bleeding may cause hypovolemia, reducing oxygen delivery to the brain. Hypoxia and metabolic disturbances from organ dysfunction further contribute to confusion or altered consciousness, making this a key clinical sign of severe DIC.

Choice B reason: Increased urine output is not typical in DIC. Microthrombi and hypovolemia from bleeding reduce renal perfusion, leading to oliguria or acute kidney injury. Increased urine output occurs in conditions like diabetes insipidus, not DIC, where renal compromise is common due to microvascular clotting and shock.

Choice C reason: Fever is common in DIC, often due to underlying triggers like sepsis or inflammation, which activate the clotting cascade. Cytokine release in these conditions elevates body temperature. Fever reflects the systemic inflammatory response, making it a frequent symptom in DIC, especially when infection is the precipitating cause.

Choice D reason: Dyspnea occurs in DIC due to pulmonary microthrombi impairing gas exchange, leading to hypoxia. Hemorrhage into alveoli or pulmonary edema from organ dysfunction may also contribute. Respiratory distress is a critical symptom, reflecting lung involvement in DIC’s microvascular clotting, requiring urgent intervention to restore oxygenation.

Choice E reason: Six-second capillary refill indicates poor perfusion, common in DIC due to hypovolemia from bleeding and microthrombi obstructing peripheral circulation. Prolonged refill reflects shock or vascular compromise, a key sign of DIC’s systemic impact, necessitating immediate treatment to address coagulopathy and restore hemodynamic stability.