Nursing Diagnosis For Pancreatic Cancer

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Treatments And Side Effects

Pancreatitis | Acute and Chronic Pancreatitis Nursing Lecture Symptoms, Treatment, Pathophysiology

The good news is, we have emerging options for the treatment of metastatic pancreatic cancer and now have the luxury of choice for some patients, said Eileen M. OReilly, MD, associate director for clinical research at Memorial Sloan Ketterings David M. Rubenstein Center for Pancreatic Cancer Research in New York City.

OReilly pointed to the major trials which have defined the two current treatment standards in metastatic disease: FOLFIRINOX and nabpaclitaxel and gemcitabine.

The phase II/III PRODIGE study, conducted in France, looked at FOLFIRINOX compared with gemcitabine in patients with an ECOG performance status of 0-1. The median overall survival was 11.1 months in the FOLFIRINOX arm compared with 6.8 months for gemcitabine corresponding improvements in progression-free survival and tumor response also were reported. FOLFIRINOX has inherent side effects, such as gastrointestinal toxicity, myelosuppression, infection, neuropathy, and fatigue. To compensate for these adverse events, this regimen is often modified to preserve efficacy while ameliorating toxicity, OReilly said, though most patients stop treatment because of disease progression, not toxicity.

The side effect profile for the gemcitabine and nab-paclitaxel combination appears to be more favorable, he added, but he stressed that both regimens should be used with caution in patients with abnormal liver function tests.

Surgery As A Treatment Option

Surgery is not a treatment option for everyone. Surgery may be an option for people whose tumor is located in the head of the pancreas, or in the regions adjacent to the head such as the body or tail of the pancreas. If surgery is a treatment option for you, here is a list of questions that you may want to ask your health care team beforehand:

  • Can surgery remove my tumor? Why or why not?
  • What is a Whipple procedure and is this an option for me?
  • Why is surgery the best option for me?
  • What experience do you have performing pancreatic surgeries?
  • How can I prepare for surgery?
  • What can I expect recovering from surgery to be like?
  • Will I need to be on medications after the surgery?
  • Will this surgery limit me from being physically active? If so, for how long?
  • What are the short term and long term effects of surgery?

Edited by Elizabeth Ezra, OSW-C, LCSW

When Do You Need Us

Part of pancreatic cancer treatment is palliative care. It involves taking care of your nutrition, emotions, and mental health. Patients may find it debilitating to deal with the after-effects of pancreatic cancer post-surgery, and the condition becomes difficult to cope with. This is where our team of nurses and healthcare specialists come into your life and guide in your journey by providing pancreatic cancer home treatment. Our doctors visit your home to assess your condition and suggest the best course of action accordingly, be it supportive care, surgery, or any other medical therapies.

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Pancreatitis Nclex Review Notes

What is Pancreatitis? Inflammation of the pancreas that can lead to digestion of the pancreas by its own enzymes and/or irreversible structural damage to the organ.

Two types of Pancreatitis: Acute and Chronic

Function of the Pancreas:

Where is it located in the body? It is found in the upper abdomen behind the stomach and next to the duodenum. Inside the pancreas are special cells that secrete enzymes and hormones . These cells perform exocrine and endocrine functions.

Endocrine Function:

The endocrine cells called Islet of Langerhans cells produce insulin, glucagon, somatostatin, and pancreatic polypeptide . These substances enter the blood stream via a network of blood vessels surrounding the pancreas.

Exocrine Function:

Another type of cells are called Acinar cells which secrete digestive enzymes into the pancreatic ducts which flow through the ampulla of vater into the duodenum via the major duodenal papilla which is surround by the sphincter of Oddi .

The enzymes secreted by the Acinar cells include:

  • amylase: breaks down carbs to glucose
  • protease: breaks down proteins to amino acids
  • lipase: breaks down fats

***NOTE: while the digestive enzymes are in the pancreas they are not activated until they enter the duodenum where a biochemical change occurs with the assistance of stomach acid.

In addition, lining the small pancreatic ducts are epithelial cells which secrete bicarbonate.

How The Amylase/lipase Ratio Test Is Done:

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-After fasting for 12 hours, the patient drinks a solution of water and juice containing a small amount of radioactive glucose.

-The person is then given an intravenous injection to clear any remaining pancreatic fluid before having blood drawn hourly for three hours.

-A more accurate result can be obtained by measuring amylase and lipase in the blood taken at four hours.

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Complications Of Pancreatic Cancer

As pancreatic cancer spreads, it might lead to consequences like the ones listed below:

  • Weight loss. A variety of circumstances can cause weight loss in persons with pancreatic cancer. Weight loss may occur due to cancer as it consumes the bodys energy. Cancer therapies may produce nausea and vomiting or a tumor pressing on the stomach, making it difficult to eat. Since the pancreas is not producing enough digestive fluids, the body may have problems processing food nutrients.
  • Jaundice.Jaundice can be caused by pancreatic cancer restricting the livers bile duct. The yellow complexion, yellow eyes, black urine, and pale feces are all symptoms. Jaundice is commonly accompanied by abdominal discomfort.
  • Pain. A developing tumor may impinge on nerves in the abdomen, causing significant pain. Pain relievers might make the patient feel more at ease. Radiation and chemotherapy treatments, for example, may help limit tumor development and provide some pain relief.
  • Bowel obstruction. Pancreatic cancer that spreads to or presses on the initial segment of the small intestine might obstruct the passage of digested food from the stomach into the intestines.

Nursing Care Plan For Pancreatic Cancer 1

Anticipatory Grieving

Nursing Diagnosis: Anticipatory Grieving related to the predicted loss of physical well-being, changes in lifestyle, and the patients perceived death secondary to pancreatic cancer as evidenced by changes in eating patterns, sleeping habits, energy levels, sexual appetite, and communication patterns, denial of future loss, suppressed feelings, and depression.

Desired Outcomes:

  • The patient will recognize and express emotions appropriately.
  • The patient will be able to continue with their regular daily routines, look ahead or plan for the future one day at a time.
  • The patient will be able to verbalize understanding of the dying process and how they feel supported.

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Nursing Care Plan For Pancreatitis 4

Nursing Diagnosis: Acute Pain related to obstruction of pancreatic ducts secondary to acute pancreatitis as evidenced by pain score of 10 out of 10, verbalization of sharp abdominal pain, guarding sign on the abdomen, and restlessness

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.

Providing Patient And Family Education

Mayo Clinic Q& A podcast: Pancreatic cancer is one of the deadliest forms of cancer

Listening plays a vital role in patient and family education. To effectively and respectfully communicate with the patient, the nurse must listen patiently and answer questions clearly, candidly, compassionately, and as positively as possible, taking cues from the patient as to what he or she wants to know, as well as when and how to convey this information. During this time of incapacitating fear and insecurity, some patients are better able to deal with cancer by leaving most of the information and decisions to their doctors. For these patients, learning about their condition and participating in medical decisions are threatening and may make coping more difficult.

Other people cope by learning all they can about their cancer and its treatment. They arrive with many questions, are armed with reviews of the medical literature regarding their condition, and struggle to make sense of scientific journal articles replete with seemingly cryptic terms and data. To add to patients’ confusion, health-care professionals may speak to them using an alphabet soup: CT, ERCP, PTC, CEA. The oncology nurse helps by deciphering jargon, defining terminologies, and translating complex medical concepts into language that the patient can comprehend.

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Epidemiology, Definition, Types, Clinical Picture, Pathophysiology, Diagnostic Tools, Staging and Management

Epidemiology, Definition, Types, Clinical Picture, Pathophysiology, Diagnostic Tools, Staging and Management

  • 1. PANCREATIC CANCERPresented by: Ms. Priyanka Malhotra,M.Sc. Nursing 2nd year
  • 2. LOCATION OF PANCREAS
  • 3. Anatomy of PancreasDerived from Pan all Kreas flesh15-20cm long, 2.5 3.8cm broad, 1.2 1.8cm thickWeighs 80gSituated in retro-peritoneum regionHead of pancreas – right side of the abdomen.Body of pancreas – behind thestomach.Tail of the pancreas- left side of the abdomen next tothe spleen.
  • 4. Head, Neck ,Body & Tail of Pancreas
  • 5. Histology80-90% of pancreatic tissue Exocrine Acinar Tissueorganised as lobulesPancreatic duct Interlobular & Intralobular ducts DuctulesAciniMain duct Columnar cells, Ductules Cuboidal cellsClusters of endocrine cells distributed throughout calledIslets of LangerhansIslet: Hormone secretion75% – B Cells- Insulin20% – A Cells- Glucagon5% – D Cells- Somatostatin
  • 6. Posterior Relations Of Pancreas
  • 8. BLOOD SUPPLY OF PANCREAS
  • 14. PATHOPHYSIOLOGY
  • 17. Coronal CT showing pancreatic cancer, dilatedintrahepatic and pancreatic ducts
  • 19. ERCP showing contrast in dilated pancreaticduct .
  • 22. Pancreatoduodenectomy
  • 23. VIDEO ON WHIPPLES PROCEDURE
  • 28. Guidelines for perioperative care forpancreaticoduodenectomy
  • Here Is A List Of Questions That You May Want To Ask Your Health Care Team:

    Since Ive been diagnosed, Ive been overwhelmed. How can I better cope with my diagnosis? A cancer diagnosis turns a persons world upside down emotionally and physically. Your team of doctors, nurses and social workers are valuable sources of support as you cope with a cancer diagnosis. Oncology social workers are licensed professionals who counsel people affected by cancer, providing emotional support and helping people access practical assistance. CancerCares oncology social workers provide individual counseling, support groups and locate services face-to-face, online or on the telephone, free of charge. To learn more, visit www.cancercare.org or call 800-813-HOPE .

    What type of pancreatic cancer do I have? Pancreatic cancer occurs when the cells found in the pancreas begin to change and grow uncontrollably, forming a tumor , which can be either cancerous or benign. The main types of pancreatic cancer are adenocarcinoma and ampullary cancer.

    What stage is my tumor?A tumors stage refers to its size and extent of spread in the bodye.g., whether it has spread to lymph nodes or other organs. Cancer that has spread to other organs is called metastatic cancer. A cancers stage is often denoted by a Roman numeral . The higher the numeral, the more the cancer has spread within the body.

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    Nursing Care Plan For Pancreatitis 6

    Desired Outcome: The patient will demonstrate adequate hydration and balanced fluid volume

    Rationales
    Assess vital signs, particularly blood pressure level. Pancreatic ischemia may lead to third space fluid shifting, which may lower blood pressure levels and put the patient at risk for hypotensive episodes.
    Commence a fluid balance chart, monitoring the input and output of the patient. Include episodes of vomiting, gastric suctioning, and other gastric losses in the I/O charting. To monitor patients fluid volume accurately.
    Start intravenous therapy as prescribed. Electrolytes may need to be replaced intravenously. Encourage oral fluid intake of at least 2000 mL per day if not contraindicated. To replenish the fluids and electrolytes lost from vomiting or other gastric losses, and to promote better blood circulation around the body.
    Educate the patient on how to fill out a fluid balance chart at bedside. To help the patient or the guardian take ownership of the patients care, encouraging them to drink more fluids as needed, or report any changes to the nursing team.
    Prepare the patient to undergo peritoneal lavage, if indicated. To provide a rapid treatment of metabolic abnormalities by removing pancreatic enzymes and toxic chemicals in acute pancreatitis.

    Nursing Care Plan For Pancreatic Cancer 4

    Pancreatitis

    Altered Nutrition: Less Than Body Requirements

    Nursing Diagnosis: Altered Nutrition: Less Than Body Requirements related to hypermetabolism, side effects of chemotherapy, radiation, surgery, and emotional anguish as evidenced by inadequate food intake, altered taste sensations, a decrease in interest in food, a perceived or actual incapacity to swallow food, diminished subcutaneous fat or muscle mass, and abdominal discomfort.

    Desired Outcomes:

    • The patient will exhibit steady or progressive weight gain toward the goal, with laboratory levels normalized, and be free of indications of malnutrition.
    • The patient will participate in specialized initiatives to enhance nutritional intake and stimulate appetite.

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    Patient Care Pathways Track Progress

    Proper patient management, including careful assessment, appropriate interventions, and thorough patient and family teaching, greatly enhances recovery and rehabilitation , but managing patient care throughout today’s express hospitalizations requires a vigilant system for keeping on schedule. Interdisciplinary “patient care maps” facilitate the tracking process by providing detailed checklists for patient monitoring, treatments, lines and drains, medications, activity, diet, tests, consultations and referrals, patient teaching and discharge planning, and evaluation of outcomes. A simplified version of the patient care map is provided to the patient and his or her family so that they can anticipate what will happen each day.

    When the patient deviates from the care pathway for some reason, an amended patient care pathway record sheet may be needed. In many instances, standard alternative pathways can be employed. For example, when a planned resection cannot be performed and palliative procedures, such as a single or double surgical bypass, are substituted, the health-care team switches to a prepared alternative patient care pathway. Family education regarding the new track is begun as part of the new schedule.

    Nursing Care Plan For Pancreatitis 3

    Hyperthermia secondary to infective process of pancreatitis as evidenced by temperature of 38.5 degrees Celsius, rapid breathing, profuse sweating, and chills

    Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

    Pancreatitis Nursing Interventions Rationales
    Assess the patients vital signs at least every 4 hours. To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs administered.
    Remove excessive clothing, blankets and linens. Adjust the room temperature. To regulate the temperature of the environment and make it more comfortable for the patient.
    Administer the prescribed antibiotic and anti-pyretic medications. Use the antibiotic to treat bacterial infection , which is the underlying cause of the patients hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
    Offer a tepid sponge bath. To facilitate the body in cooling down and to provide comfort.
    Elevate the head of the bed. Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

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    Diagnoses Of Pancreatitis Through Taking History

    Acute pancreatitis may be diagnosed by taking the history of a patient.

    If the patient has had pain in the upper abdomen for more than 12 hours.

    -If the patient has a fever with vomiting and diarrhea, this is considered septicemia from peritonitis .

    -In cases with known causes , the diagnosis is made on a history of alcohol abuse and other factors.

    Nursing Care Plan For Cancer 2

    Pancreatic Cancer – Diagnosis (symptoms, signs, CT scan, biopsy, stent)
    • Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to abdominal pain and cramping secondary to cancer, as evidenced by abdominal cramping, stomach pain, bloating, weight loss, nausea and vomiting, and loss of appetite

    Desired Outcome: The patient will be able to achieve weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

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    Is Pancreatitis Easy To Diagnose

    Pancreatitis is an easy diagnosis because the patient will have abdominal pain, vomiting, and other evidence of pancreatic involvement. Anytime that a person has these symptoms, there should be suspicion for acute or chronic pancreatitis. Imaging techniques can help confirm, such as ultrasound to view the pancreas through the skin or by inserting a thin tube through the nose and throat to view the inside the stomach.

    The most interesting part about pancreatitis is that in some cases where its hard for patients to know if they have it because people often dont experience pancreas-related symptoms. This is more common in people who have chronic pancreatitis because they may not experience the same type of pain if there are other problems that lead to these issues instead.

    In some cases where its hard for patients to know if they have pancreas-related symptoms, such as when they have chronic pancreatitis, and people may not experience the same type of pain. This is more common in patients with other problems that lead to these symptoms, such as biliary obstruction.

    Cancer Nursing Care Plan And Nanda Guidelines

    Cancer is a potentially fatal disease caused mainly by environmental factors that mutate genes encoding critical cell-regulatory proteins. The resultant aberrant cell behavior leads to expansive masses of abnormal cells that destroy surrounding normal tissue and can spread to vital organs resulting in disseminated disease, commonly a harbinger of Imminent patient death.

    Most types of a cancer cells clumps together to form a mass or tumor. When a cell breaks away from the tumor, it can be swept into the lymph system or bloodstream and carried to other parts of the body where new tumors can be formed.

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    Nursing Care Plan For Cancer 4

    Acute Pain

    Nursing Diagnosis: Acute Pain related to the tumor pressing on the nerves and bones secondary to cancer as evidenced by reports of discomfort and pain score of 10 out of 10.

    Desired Outcome: The patient will report a reduced level of pain between 0 to 3 out of 10.

    Nursing Interventions for Cancer Rationale
    Promote effective coping strategies and emotional support such as guided imagery, visualization, deep-breathing exercises, or progressive relaxation. These techniques refocus concentration, develop a sense of control, and improve coping mechanisms in dealing with the stress of traumatic damage and pain, which is likely to last for a long time.
    Offer pain relief at least 30 minutes prior to any procedure, such as accessing the central venous lines, or undergoing an imaging test such as a CT scan. This method enables the patient to prepare better for activities and manage discomfort.
    Inform the patient that it is critical to take medicine before the discomfort gets unbearable. This technique relaxes the muscles and increases engagement.
    Monitor any indications of atypical or intense pain, as well as severe, escalating, and disorientated pain that is not alleviated by painkillers. This approach may indicate the emergence of tissue ischemia, infection, and compartmental disease problems.

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