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Mr. N is a 45-year old automobile mechanic.  He is divorced…

Mr. N is a 45-year old automobile mechanic.  He is divorced with two children who are in college.  He has always been an unhappy person.  Every time a misfortune came along, he became more depressed.  He frequently spent time just sitting in his house feeling sorry for himself.    Whenever those periods of depression came upon him, he knew only one way out of them:  alcohol.  He started drinking beer and whiskey when he was in high school.  His intake increased as he grew older.  Several years ago after Mr. N drank too much he awoke with a sever epigastric pain that radiated to his back.  He was sweating, felt nauseous, and had to vomit.  His abdomen was sore to touch and felt swollen.  He could tell that he had an elevated temperature.  This continued for a couple of days before he went to a neighborhood clinic to see a physician.  The physician took a medical history and did an examination that included lab values.  The physician told Nr. N that he had acute pancreatitis with an enlarged fatty liver.  He told him that his liver enzymes were elevated and that if he continued drinking, he could develop a very severe liver disease.  He also told him that if he stopped drinking, his liver could clear up in a matter of weeks.  He encouraged Mr N to follow a low-fat, high-protein diet with absolutely no alcohol.  Mr. N’s height was 5’11” and he weighed 170 lbs.  The physician sent home with the following prescriptions: Pancrease (Lipancreatin) for 3 days Potassium chloride (Slow-K) for 3 days   Labs:  Liver Function AST  183 U/L (14-20 U/L)                  Total Bilirubin  3.2 mg/dl (0.3-1.0 mg/dl) ALT  132 U/L (10-40 U/L)                   Direct Bilirubin  0.1 mg/dl (0-0.2 mg/dl) ALP  253 U/L  (25-100 U/L)              CPK* 150 U/L (38-174 U/L) PT**   12.2 secs (11-13 secs)            Amylase  485 U/L  (25-125 U/L) *Creatine phosphokinase                  Lipase  329 U/L  (0-160 U/L) ** Prothrombin time His basic metabolic panel was all normal, with the exception of: Glu  190 mg/dl (70-110 mg/dl)       Ser Alb 2.9 g/dl (3.5-4.8 g/dl)                K  3.1 mEq/L (3.5-5.2 mEq/L)          Mg 1.7 mEq/L (1.8-2.6 mEq/L) The physician advised Mr. N not to take pancreatin with antacids.  He also strongly advised him to eat a well-balanced diet with ample protein, and to take a multiple vitamin and mineral supplement daily for the next several months.  He emphasized again that Mr. N would absolutely have to avoid alcohol.   1. Explain the reasoning behind the diet order Mr. N received:  “low-fat, high-protein with absolutely no alcohol”.  (2 pts.)   2. List two values that are indicative of liver disease and two values that are indicative of pancreatitis.  (4 pts)   3. Explain the purpose of the physician giving Mr. N the Pancrease and potassium chloride. (2 pts)   4.  Write a PES statement for Mr. N’s chart note (3 pts)   5.  Write the Intervention and 1 SMART goal. (3 pts)