Pancreatic Mass

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<p>Pancreatic Head mass</p> <p>INTRODUCTION</p> <p>It is a weariness disease to preserve health by to strict a regimen. Our body is the mirror of whatever lifestyle we have. It is the one who suffers on what we put inside.</p> <p> Patient with pancreatic head mass develop acute recurrent pancreatitis in childhood, which usually progresses to chronic pancreatitis and pancreatic cancer in early adulthood. A consistent association has been demonstrated between cigarette smoking and excessive alcohol drinking for the development of pancreatic cancer. Hereditary pancreatitis is a genetic disease caused by a mutation of a cationic trypsinogen gene. it is more common on male than in female because of lifestyle.</p> <p> Sixty percent of pancreatic cancers develop in the pancreatic head; 40% develop in the body and tail. The major symptoms include abdominal pain, anorexia, weight loss, and jaundice. The pain is located in the epigastrium and has a quality characterized as deep and boring. The pain may be intermittent or constant, and is progressive. Painless jaundice indicates a potentially resectable lesion located in the pancreatic head. A predominance of abdominal pain suggests neural plexus involvement, location in the tail, unresectability, and a poor prognosis.</p> <p>The only potentially curative therapy for pancreatic cancer is surgical resection. The standard operation for adenocarcinoma in the pancreatic head or uncinate process is the pancreaticoduodenectomy, or "Whipple operation." The Whipple operation involves resection of the pancreatic head, duodenum, common bile duct, distal stomach, and gallbladder.</p> <p> Pancreatic head mass has been a common disease in people unhealthy lifestyle. I want to know more about this case and enhanced my knowledge about it. I want to be familiar about this case so that I can implement appropriated nursing actions to improve the condition of my client.</p> <p>OBJECTIVES</p> <p> General Objectives To gain knowledge on the certain disease ( Pancreatic Head Mass) aimed at as a part of our course competency, also to provide us complete learning experience that would help us understand and increase the capability in meeting the case as student nurses. To enhance the nurses skills and to develop nurses attitude towards caring and communicating to patient with Pancreatic Head Mass.</p> <p>Specific Objectives To know information about pancreatic head mass. To know the signs and symptoms of pancreatic head mass. To determine the complications that caused by the disease. To enumerate the risk factors that may cause by Pancreatic head mass and the organs that are affected.</p> <p> To be knowledgeable enough with regards to the tests and treatment of the disease. To provide nursing care plan to help patient recover. To evaluate level of patients recovery. To think of nursing plans when the client is discharged.</p> <p>PATIENTS PROFILE</p> <p>Name: Patient X Age: 55 yrs. old Gender: Male Civil Status: Single Birthday: April 23, 1953 Birthplace: Santol, Tanauan Batangas Nationality: Filipino Religion: Roman Catholic Chief Complaint: Abdominal Pain Date of Admission: June 29, 2008 Date of Operation: July 4, 2008 Attending Physician: Dr. Arellano, Gonzales, Reyes, Ilagan</p> <p>CLINICAL APPRAISAL</p> <p> A. Past Health History </p> <p>Patient X was born in their house with normal delivery. He received all the vaccine for his immunization since he was a child. This is his first time to be hospitalized for the reason of abdominal pain. He usually uses analgesics for pain which can be bought in any store of their barangay. He never experienced any vehicular accidents because their place is far from the city and only few vehicles are seen in their place.</p> <p> B. Family History The family of Patient X has a history of tumor. His mother died because of tumor in a part of gastrointestinal area. His other relatives also have cases of tumors.</p> <p> C. Personal History</p> <p>Patient X is fond of drinking alcohol. He drinks alcohol 3-4 times in a week. As his form of work, he plants vegetables in their backyard. He usually sleeps at 9 pm and wakes up at 6 in the morning. Watching TV is his form of relaxation.</p> <p> D. Social History</p> <p>Patient X reached Grade 4, he works as a farmer in their place, Santol, Tanauan Batangas with a monthly income of 1000 pesos. He lives with his two sisters in his mothers house.</p> <p> E. Psychologic History</p> <p>Patient X experienced his major stressor while he was resting after work 3 months ago. He made an eye to eye contact when communicating but find it hard to verbalize words because of his condition. Despite if that, he still can sleep and rests well.</p> <p> F. History of Present Illness</p> <p>3 months ago, Patient X experienced abdominal pain associated with jaundice and weight loss. He is first seen in the private hospital for check-up and referred to Batangas Regional Hospital. He was admitted last June 29 and had his surgery last July 4, 2008.</p> <p>PHYSICAL ASSESSMENT</p> <p>SKIN Inspection &gt; slightly yellowish in color &gt; Abnormal; may indicate high level of bilirubin in the blood.</p> <p>Palpation &gt; temperature within normal range Normal</p> <p>HEAD</p> <p>Inspection &gt;Symmetrical in shape &gt; Normal</p> <p>HAIR Inspection &gt; without infestation of lice &gt;combined black and white hair &gt; with normal &gt; Normal</p> <p>SCALP Inspection &gt; absence of abrasion &gt; Normal</p> <p>EYES EYE BROWS</p> <p> Inspection &gt; symmetrically aligned &gt; Normal</p> <p> EYE LASHES</p> <p>Inspection &gt; with normal distribution &gt; Normal</p> <p> PUPIL</p> <p>Inspection &gt; constricts to penlight</p> <p>&gt; Normal</p> <p> CONJUNCTIVA Inspection &gt; slightly yellowish in color &gt; Abnormal: may indicate high bilirubin level in the blood</p> <p>EARS AURICLE Inspection &gt; Symmetrically aligned &gt; Normal</p> <p> EAR CANAL</p> <p> Inspection &gt; Symmetrically aligned &gt; Normal</p> <p>NOSE Inspection &gt; Presence of NGT</p> <p>&gt;Abnormal; may indicate NPO</p> <p>LIPS Inspection &gt; slightly dry &gt; Abnormal: may indicate low fluid intake through mouth</p> <p>TEETH</p> <p>Inspection &gt; presence of dental cavities &gt; Abnormal: may indicate poor oral hygiene.</p> <p>TONGUE Inspection &gt; positioned centrally &gt; Normal</p> <p>TONSIL Inspection &gt; positioned centrally &gt; Normal</p> <p>LYMPH NODES Palpation &gt; not palpable &gt; Normal</p> <p>SHOULDER Inspection &gt;level shoulder &gt; Normal</p> <p>CHEST Inspection &gt; Symmetrical chest expansion &gt; Normal</p> <p>ABDOMEN Inspection &gt; Presence of sutured wound and Jackson Pratt &gt; Abnormal; may indicate undergone operation</p> <p>UPPER EXTREMITIES HANDS Inspection</p> <p> &gt; thin to touch &gt; Normal</p> <p>NAILS Inspection &gt; convex curvature &gt; Normal &gt; slightly dirty &gt; Abnormal; may indicate poor personal hygiene</p> <p>LOWER EXTREMITIES Inspection/ palpation &gt; no edema &gt; Normal</p> <p>Summary: Almost all the body parts in physical assessment are normal expect from some abnormalities such as yellowish discoloration in the skin and conjunctiva, slightly dry lips, presence of dental cavities, presence of nasogastric tube, presence of sutured wound and Jackson Pratt in the stomach and slightly dirty nails.</p> <p>ANATOMY AND PHYSIOLOGY</p> <p>The pancreas is located retroperitoneal, posterior to the stomach in the inferior part of the left quadrant. It has a head near the midline of the body and a tail that extends to the left where it touches the spleen. It is a complex organ composed of both endocrine and exocrine tissues that perform several functions. The endocrine part of the pancreas consist of pancreatic islets. The islet cells produce insulin and glucagon, which are very important in controlling blood levels of nutrients such as glucose and amino acids.</p> <p> The exocrine part of the pancreas is a compound acinar gland . The acini produce digestive enzymes. Clusters of acini are connected by small ducts, which join to form larger ducts, and a larger ducts join to form pancreatic duct. The pancreatic duct joins the common bile duct and empties into the duodenum.</p> <p> Function of the Pancreas</p> <p>The exocrine secretions of the pancreas include HCO3, which neutralize the acidic chyme that enters the small intestine from the stomach. The increased pH resulting from the secretion of HCO3 stops pepsin digestion but provides the proper environment for the function of pancreatic enzymes.</p> <p>The major proteolytic enzymes are trypsin, chymotrypsin and carboxypeptidase. These enzymes continue the protein digestion that started in the stomach and pancreatic amylase continues the polysaccharide digestion that begun in the oral cavity.</p> <p>PATHOPHYSIOLOGY</p> <p> Pancreatic cancer can arise from both the exocrine and endocrine portions of the pancreas. Of pancreatic tumors, 95% develop from the exocrine portion of the pancreas, including ductal epithelium, acinar cells, connective tissue, and lymphatic tissue.</p> <p> Approximately, 75% of all pancreatic carcinomas occur within the head or neck of the pancreas. 15-20% occur in the body of the pancreas and 5-10% occur in the tail. Typically, pancreatic cancer first metastasizes to regional lymph nodes, then to the liver and less commonly to the lungs. It can also directly invade surrounding visceral organs such as the duodenum, stomach and colon.</p> <p> As in other organs, chronic inflammation is a predisposing factor in the development of pancreatic cancer. Patients with chronic pancreatitis from alcohol, especially those with familial forms, have much higher incidence and an earlier age of onset on pancreatic carcinoma.</p> <p>PANCREAS</p> <p>Head</p> <p>Body</p> <p>Tail</p> <p>Exocrine</p> <p>Endocrine</p> <p>Pancreatic Cancer Formed Regional Lymph Nodes Liver Lungs Duodenum Stomach colon</p> <p>Ductal epithelium Acinar Cells Connective Tissue Lymphatic Tissue</p> <p>NURSING CARE PLAN</p> <p>ASSESSMENT S&gt; Malala pa ang ubo ko, as verbalized by the patient.</p> <p> O &gt; presence of productive cough. &gt; difficulty vocalizing. &gt; excessive sputum &gt; RR= 28 bpm &gt; restless &gt; weak</p> <p>NURSING DIAGNOSIS &gt; Ineffective airway clearance related to presence of secretions in the bronchi.</p> <p>SCIENTIFIC EXPLANATION &gt; Pulmonary complications following surgery are associated with significant morbidity and have been shown to increase the length of hospitalization. Efforts have been focused on the minimization of postoperative risk factors, such as prolonged bed rest and inadequate pain control, and on the routine use of incentive spirometry.</p> <p>PLANNING&gt; After 3 hours of nursing intervention, the client will be able to maintain better airway patency.</p> <p>INTERVENTION</p> <p>RATIONALE</p> <p> &gt; Monitored respiration and breath sounds, noting rate and sound. ( tachypnea, stridor, crackels and wheezes). &gt; Positioned head appropriate for age/ condition.</p> <p> &gt;To note the inactive respiratory distress and/ or accumulation of secretions. &gt; To open or maintain open airway in at-rest or compromised individual.</p> <p> &gt; Elevated head of &gt;To take advantage the bed and changed of gravity position every 2 decreasing pressure hours. on the diaphragm and enhancing drainage of/ &gt; Encouraged deep ventilation to breathing and different lung coughing exercises. segments. &gt; To maximize effort.</p> <p> &gt; Observe signs &gt; To identify infectious process/ and symptoms of promote timely infection intervention. (increased dyspnea with onset of fever, change in sputum color, amount or character.) &gt; To enhance the &gt; Performed clients capability to bronchial tappingexpectorate secretions.</p> <p>EVALUATION The client maintained better airway patency and expectorated secretions readily.</p> <p>ASSESMENTS&gt; Nilalagnat ako. as verbalized by the patient.</p> <p> O&gt; temperature= 39 degrees Celsius &gt; warm to touch &gt;RR= 29 bpm &gt; weak &gt; restless</p> <p>NURSING DIAGNOSIS Increased in body temperature related to tissue trauma secondary to removal of IV.</p> <p>SCIENTIFIC EXPLANATION Fever is a common, fast and easy measurable sign of inflammation and infection. An increase in body temperature often coincides with the liberation of microbiological products or live bacteria into the circulation. During sepsis, hyperthermia may also occur.</p> <p>PLANNING After 2 hours of nursing interventions, the client's temperature will decrease from 39 degrees Celsius to 38 degrees Celsius.</p> <p>INTERVENTION</p> <p>RATIONALE</p> <p> &gt; Monitored vital signs. &gt; Monitored all sources of fluid loss such as urine, vomiting and diarrhea.</p> <p> &gt; To have a guide for nursing actions to be taken. &gt; Potentiates fluid and electrolytes losses.</p> <p> &gt; Noted absence/ &gt;Evaporation is presence of decreased by sweating as body environmental attempts to factors as high increase heat loss humidity and by evaporation, high ambient conduction and temperature, as diffusion. well as body factors producing loss of ability to sweat or sweat glands dysfunction.</p> <p> &gt; Performed tepid sponge bath. &gt; Maintained bed rest.</p> <p> &gt; Heat loss by evaporation and conduction. &gt;To reduce metabolic demands/oxyg en consumption.</p> <p>EVALUATION &gt; Body temperature decreased form 39 degrees Celsius to 38 degrees Celsius.</p> <p>ASSESSMENT S&gt; Medyo sumasakit ang tahi ko, as verbalized by the patient.</p> <p> O&gt; limited mobility &gt; facial grimace &gt; PR= 88 bpm &gt; BP= 140/90 mmHg &gt; with sutured wound on hypogastric region. &gt; Pain Scale= 6 out of 10.</p> <p>NURSING DIAGNOSIS</p> <p>Pain related to tissue trauma secondary to operation.</p> <p>SCIENTIFIC EXPLANATION</p> <p>Unpleasant sensory from actual or potential tissue damage; sudden or slow onset of any intensity from mild to severe. Pain is a signal that something is wrong. It is due to infection and increased number of white blood cells on the sight of incision to fight microorganisms that will enter on the sutured wound and prevent sepsis.</p> <p>INTERVENTION &gt; Monitored vital signs. &gt; Observed non verbal cues/ pain behaviors and other objective defining characteristics.</p> <p>RATIONALE &gt; To have a guide for nursing actions to be taken. &gt; Observations may/may not be congruent with verbal reports or maybe only indicator present when client is unable to verbalize.</p> <p> &gt; Provided comfort measures (therapeutic touch, repositioning, use of heat/cold packs), quite environment and calm activities. &gt; Encouraged use of relaxation techniques such as focused breathing and imaging.</p> <p> &gt; To promote non pharmacological pain management.</p> <p> &gt; To distract attention and reduce tension.</p> <p>EVALUATION</p> <p>The pain decreased to a tolerable level allowing the patient to mobilize wit minimal assistance.</p> <p>DRUG STUDY</p> <p>NAME OF THE DRUG Generic Name: Unasyn Brand Name: Ampicilin Sodium and Sulbactam Sodium</p> <p>CLASSIFICATION ON ACTION</p> <p>Inhibits cell wall synthesis during bacterial multiplication.</p> <p>INDICATIONS</p> <p>Intra-abdominal, gynecologic, and skin structure infections caused by susceptible strains.</p> <p>CONTRAINDICATIONS Contraindicated to patients hypersensitive to drug or other penicillin. Use cautiously in patients with other drug allergies ( especially to cephalosporins) because of possible cross-sensitivity, and in those with mononucleiosis because of high risk of maculopapular rash.</p> <p>ADVERSE REACTION CV: thrombophlebitis, vein irritation GI: diarrhea, Nausea, pseudomembranous colitis,vomiting, stomatitis, gastritis, black hairy tongu...</p>