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Nursing 272: Final Semester > Unit 3: Pancreatic Cancer > Flashcards

Unit 3: Pancreatic Cancer Flashcards

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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)
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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
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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
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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
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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
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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
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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
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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

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9
Q

When is the cancer unresectable?

A

if the cancer has spread to distant lymph nodes or there is metastasis to the liver

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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

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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

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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

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13
Q

What procedures can the patient undergo to reconstruct the GI tract?

A
  • Pancreatojejunostomy
  • Hepaticojejunostomy
  • Gastrojejunostomy
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14
Q

Pancreaticojejunostomy

A

anastomosis of the pancreas to the jejunum

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15
Q

Hepaticojejunostomy

A

anastomosis of the hepatic duct to the jejunum

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16
Q

Gastrojejunostomy

A

anastomosis of the stomach to the jejunum

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17
Q

Vagotomy

A
  • surgical resection of the vagus nerve

- done to decrease acid secretion in the stomach and decrease peptic ulcer formation

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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
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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
Q

Assessments: Vital Signs

A
  • tachycardia r/t to fever and pain
  • elevated BP r/t pain and anxiety
  • fever r/t infection d/t blocked bile ducts
26
Q

Assessment: Fluid Intake and Output

A
  • 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
Q

Assessment: Serum Glucose

A

-elevated b/c of impaired insulin secretion d/t tumor or d/t removal of the pancreas, which secretes insulin

28
Q

Assessment: Weight

A

-weight loss d/t anorexia d/t presence of tumor and malabsorption

29
Q

Assessment: Muscle Mass

A

-cachexia (weight loss) secondary to loss of muscle mass is common b/c of decrease appetite and altered protein metabolism

30
Q

Assessment: Pain location, intensity, duration

A
  • 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
Q

Assessment: Abdomen

A

distention and enlargement of the abdomen b/c of presence of ascites

32
Q

Assessment: Skin color

A

jaundice d/t tumor obstruction of bile flow

33
Q

Assessment: Pruritis

A

accumulation of bile salts under the skin causes itching

34
Q

Assessments: Postoperative Assessment

A

post-op monitor vital signs, pain, glucose, NGT output, abdominal assessment, and surgical site

35
Q

Nursing Actions for Pancreatic Cancer

A
  • 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
Q

Actions: Provide IV fluids

A

hypovolemia occurs b/c of third-space losses in the retroperitoneum from autodigestion of the pancreas and capillary leak

37
Q

Actions: Maintain NPO status

A

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
Q

Actions: NGT to low suction

A

decompresses stomach b/c postoperative abdominal distention and decreased GI motility can place strain on the surgical anastomosis

39
Q

Actions: Never manipulate NGT

A

NGTs are placed by the surgeon, and manipulation can increase the risk of anastomotic breakdown

39
Q

Actions: Never manipulate NGT

A

NGTs are placed by the surgeon, and manipulation can increase the risk of anastomotic breakdown

40
Q

Actions: Administer insulin

A

pancreatic cancer affects the ability of the pancreas to produce and secrete insulin, leading to hyperglycemia

41
Q

Actions: Encourage coughing, deep breathing, and use of incentive spirometry every hour while awake

A

prevents atelectasis, improves oxygenation, and prevents post-op pneumonia

42
Q

Actions: Administer analgesics an antiemetics as ordered

A
  • Pain management post-op for incisional pain and discomfort

- Pre-operative pain management for pain caused by tumor compression

43
Q

Actions: Nutritional Supplements

A

help improve calorie input, prevent weight loss, and promote postoperative surgical wound healing
-high-calorie, high-protein supplements

44
Q

Patient Teachings

A
  • 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
Q

Evaluating Care Outcomes

A
  • 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
Q

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

A. Periumbilical bruising

Nursing 272: Final Semester (79 decks)

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