Unit 3: Pancreatic Cancer Flashcards
1
Q
Causes of Pancreatic Cancer
A
- cigarette smoking
- diets high in fat
- consumption of meat, fried foods, refined sugars, and nitrates (modifiable)
- diabetes
- chronic pancreatitis
- family hx of pancreatic cancer
- some occupational exposure to toxins (ex: gasoline)
2
Q
Pathophysiology
A
- pancreatic tumors may be primary or metastatic, usually originating in the lung, breast, thyroid, kidneys, or skin
- b/c of the rapid growth of the adenocarcinomas in the pancreas, both exocrine and endocrine functions deteriorate as the tumor invades the pancreatic tissue
- pancreatic tumor, b/c of the proximity of other GI organs, may metastasize to the stomach, duodenum, gallbladder, and intestine
- cancer that invades the tail and body of the pancreas may metastasize to the liver via the splenic vein, and the patient may present with an abdominal mass and hepatomegaly
3
Q
Clinical Presentation
A
- directly r/t the degree of pancreatic damage secondary to tumor growth
- may not manifest until significant damage has occurred
- pain (dull pain in epigastric area and back)
- jaundice (obstruction of bile duct)
- weight loss
4
Q
How to Diagnose Pancreatic Cancer
A
- Ultrasound, CT scan, MRI, and/or ERCP to determine presence of mass
- Definitive diagnosis: through histopathology
- Tissue samples are collected by fine-needle biopsy or excisional biopsy through a laparotomy
- may also undergo angiography to determine involvement of vessels surrounding the pancreas
- once diagnosed, the tumor is staged according to the size, extent, lymph node involvement, and metastasis, and course of treatment is determined
5
Q
Laboratory Values
A
- Elevated amylase
- Elevated total and direct bilirubin
- Elevated liver enzymes
- Fecal fat, trypsinogen, trypsin (enzyme that aids in the digestion of protein), and lipase may indicate how the pancreas is functioning and the need for pancreatic enzyme supplementation
6
Q
Treatment for Pancreatic Cancer
A
- Adjuvant therapy; combined chemotherapy and radiation
- External beam radiation to the tumor and surrounding tissue over a 6-week period concurrent with 5-fluorouracil chemotherapy for up to 4 months help improve long-term survival
7
Q
Surgical Management
A
- stage of cancer and the location of the tumor determine whether surgical intervention is an option
- surgical resection is potentially curable; only a small percentage qualify for surgical resection b/c of the latent nature of the clinical presentation
- may undergo surgery to relieve symptoms (palliative surgery), but excision of the tumor is not possible
- a celiac nerve block can be performed to decrease the pain associated with the tumors compression of the celiac nerves surrounding the aorta
- if tumor located in the head, neck, or uncinate process of the pancreas. patient ca undergo the Whipple procedure or pancreaticoduodenectomy
8
Q
Celiac Nerve Block
A
can be performed to decrease the pain associated with the tumors compression of the celiac nerve surrounding the aorta
9
Q
When is the cancer unresectable?
A
if the cancer has spread to distant lymph nodes or there is metastasis to the liver
10
Q
The Patients can go under what procedures if the tumor is located in the head, neck, or uncinate process of the pancreas?
A
- Whipple Procedure
- Pancreaticoduodenectomy
11
Q
Whipple Procedure
A
the head of the pancreas, distal stomach, spleen, gallbladder, common bile duct, portions of the duodenum, proximal jejunum, and lymph nodes are resected
12
Q
Distal Pancreatectomy
A
- removal of the tail and part of the body of the pancreas
- done if the tumor is in the body or tail of the pancreas
13
Q
What procedures can the patient undergo to reconstruct the GI tract?
A
- Pancreatojejunostomy
- Hepaticojejunostomy
- Gastrojejunostomy
14
Q
Pancreaticojejunostomy
A
anastomosis of the pancreas to the jejunum
15
Q
Hepaticojejunostomy
A
anastomosis of the hepatic duct to the jejunum
16
Q
Gastrojejunostomy
A
anastomosis of the stomach to the jejunum
17
Q
Vagotomy
A
- surgical resection of the vagus nerve
- done to decrease acid secretion in the stomach and decrease peptic ulcer formation
18
Q
Postoperative Management of Surgical Procedures
A
- Monitored for exocrine insufficiency (lack of digestive enzymes to properly digest food) and insulin-dependent diabetes mellitus (DM I)
- NGT that is not to be manipulated
- Pain management via PCA
- Pulmonary interventions to encourage lung expansion
- Coughing and deep breathing to prevent pneumonia and atelectasis
- Abdominal assessment
19
Q
Safety Alert: Post-op management for Whipple procedure or Pancreaticoduodenectomy
A
- NGTs are maintained post-op to decompress the stomach, prevent bloating, and remove gastric acid secretions to minimize pressure on the surgical site
- NGTs are placed intraoperatively and are not to be manipulated in any way
- a do not manipulate NGT sign is placed on the wall above the patients head
- NGTs are not to be repositioned, irrigated, or checked for placement b/c these actions can cause breakdown of the anastomotic site
- if a patient removes the NGT, it is not to be replaced by the nursing staff; member of surgical team is notified
20
Q
Anastomosis
A
a connection made surgically between adjacent blood vessels, parts of the intestine, or other channels of the body, or the operation in which this is constructed
21
Q
Connection Check: The nurse receives a patient from the OR after he undergoes a Whipple procedure. The nurse recognizes that this procedure is indicated for the patient who has which disorder? A. Acute pancreatitis B. Peritonitis C. Cholecystitis D. Pancreatic Cancer
A
D. Pancreatic Cancer
22
Q
Nursing Management: Assessment and Analysis
A
- patients with pancreatic cancer present w/ nonspecific clinical manifestations that can be attributed to a variety of GI disturbances
- pain, jaundice, fatigue, anorexia, and weight loss
- vague, nonspecific abdominal and epigastric pain
- pain described as dull and intermittent that sometimes increases in intensity with eating and movement
- jaundice develops in a pattern that is first seen in the mucous membranes, then palms of the hands, and eventually generalized
- complain of pale, greasy stools, which is attributed to a tumor that blocks digestive enzyme release
- pruritis (itching) starting with the palms of the hands, then generalized
- dark-amber urine d/t the accumulation of bilirubin
23
Q
Nursing Diagnoses
A
- Pain: acute or chronic r/t the pressure caused by the pancreatic mass
- Imbalanced nutrition: less than body requirements r/t malabsorption and anorexia
- Anxiety r/t cancer diagnosis
24
Q
Nursing Assessments
A
- Vital Signs
- Fluid intake and output
- Serum glucose
- Weight
- Muscle mass
- Pain location, intensity, duration
- Abdomen
- Skin color
- Pruritis
- Post-op assessment
25
Assessments: Vital Signs
- tachycardia r/t to fever and pain
- elevated BP r/t pain and anxiety
- fever r/t infection d/t blocked bile ducts
26
Assessment: Fluid Intake and Output
- daily intake and output monitor fluid volume status and prevent dehydration
- with the development of ascites, there may be a fluid shift from the intravascular space
27
Assessment: Serum Glucose
-elevated b/c of impaired insulin secretion d/t tumor or d/t removal of the pancreas, which secretes insulin
28
Assessment: Weight
-weight loss d/t anorexia d/t presence of tumor and malabsorption
29
Assessment: Muscle Mass
-cachexia (weight loss) secondary to loss of muscle mass is common b/c of decrease appetite and altered protein metabolism
30
Assessment: Pain location, intensity, duration
- important to note location, intensity, and duration of pain that is cased by the pancreatic tumor compressing surrounding organs and nerves
- pain may radiate to the back b/c of compression of nerves
31
Assessment: Abdomen
distention and enlargement of the abdomen b/c of presence of ascites
32
Assessment: Skin color
jaundice d/t tumor obstruction of bile flow
33
Assessment: Pruritis
accumulation of bile salts under the skin causes itching
34
Assessments: Postoperative Assessment
post-op monitor vital signs, pain, glucose, NGT output, abdominal assessment, and surgical site
35
Nursing Actions for Pancreatic Cancer
- Provide Intravenous (IV) fluids
- Maintain NPO
- NGT to low suction
- Never manipulate NGT
- Administer insulin
- Encourage coughing and deep breathing and the use of incentive spirometer or flutter valve every hour while wake
- Administer analgesics and antiemetics
- Nutritional supplements
36
Actions: Provide IV fluids
hypovolemia occurs b/c of third-space losses in the retroperitoneum from autodigestion of the pancreas and capillary leak
37
Actions: Maintain NPO status
until the return of GI function post-op, then slowly introduce a diet with clear liquids, and then advance to a regular diet to decrease strain on the surgical site
38
Actions: NGT to low suction
decompresses stomach b/c postoperative abdominal distention and decreased GI motility can place strain on the surgical anastomosis
39
Actions: Never manipulate NGT
NGTs are placed by the surgeon, and manipulation can increase the risk of anastomotic breakdown
39
Actions: Never manipulate NGT
NGTs are placed by the surgeon, and manipulation can increase the risk of anastomotic breakdown
40
Actions: Administer insulin
pancreatic cancer affects the ability of the pancreas to produce and secrete insulin, leading to hyperglycemia
41
Actions: Encourage coughing, deep breathing, and use of incentive spirometry every hour while awake
prevents atelectasis, improves oxygenation, and prevents post-op pneumonia
42
Actions: Administer analgesics an antiemetics as ordered
- Pain management post-op for incisional pain and discomfort
| - Pre-operative pain management for pain caused by tumor compression
43
Actions: Nutritional Supplements
help improve calorie input, prevent weight loss, and promote postoperative surgical wound healing
-high-calorie, high-protein supplements
44
Patient Teachings
- Post-operative care: what to expect after surgery, pain management
- Medication regimens; know side effects, pain meds may increase risk of constipation and increase pressure and discomfort in abdominal cavity
- Diet and nutrition; supplements to increase caloric intake, maintain weight, and promote wound healing after surgery
- Signs and Symptoms of hyperglycemia and hypoglycemia
- Disease symptoms, progression, diagnostic procedures, and interventions
- Coping skills, palliative care, and support groups
45
Evaluating Care Outcomes
- the diagnosis of pancreatic cancer generally occurs in a late stage of the disease, and often the patient does not have a prolonged life expectancy
- w/ surgical candidates, it is imperative that they are made aware of the postoperative requirements and restrictions
- b/c diagnosis caries a devastating prognosis, it is important for the healthcare providers to direct the patient to and encourage the use of support systems and self-help books
- encourage patient to be knowledgeable about the disease, treatment, interventions, and restrictions
46
Connection Check: The nurse assesses for which finding in a patient with a positive Cullen's sign?
A. Periumbilical bruising
B. Rebound tenderness
C. RUQ pain with radiation to the shoulder
D. Flank bruising
A. Periumbilical bruising
