WEEK 9 >>>Chapter 43 Liver, Biliary Tract, and Pancreas Problems Pancreatic Cancer

Question 3 of 3 The family of a patient with recently diagnosed pancreatic cancer asks the nurse why a positron emission tomography (PET) scan is being done since the patient already has a cancer diagnosis. Which is the best response by the nurse?

"A PET scan will show tumor spread and will help the health care provider determine the stage of the cancer." A PET scan is used to determine the stage at time of diagnosis and monitor progress and response to therapy.

Question 2 of 3 The nurse is assessing a patient admitted for evaluation of abdominal pain and suspected pancreatic cancer. The patient reports upper abdominal pain. Which question should the nurse ask the patient to obtain more information about the pain?

"Have you had any significant weight loss?" Pancreatic cancer causes weight loss as a lack of digestive enzymes results in poor absorption.

Question 2 of 6 The nurse is teaching a community group of working adults about ways to reduce their risk for pancreatic cancer. Which statement by a participant indicates a need for further teaching?

"I should decrease the number of cigarettes I smoke per day."

Question 1 of 3 A nurse is teaching a patient about self-management following a total pancreatectomy secondary to pancreatic cancer. Which statement by the patient indicates an understanding of the impact of self-management needs following surgery?

"I will need to give myself insulin injections for the rest of my life." The pancreas is responsible for making insulin. Since the patient's pancreas is removed, the patient will need to receive insulin injections for life.

Question 3 of 3 The nurse is caring for a patient with diagnosed pancreatic cancer. The patient asks why chemotherapy and radiation are required, in addition to surgery. Which is the nurse's best response?

"Radiation alone has not been proven to be effective in pancreatic cancer treatment." Pancreatic cancer does not usually respond well to the use of radiation only. It does respond better with a rounded approach of surgery, chemotherapy, and radiation.

Question 1 of 3 A patient with newly diagnosed pancreatic cancer is admitted to the medical floor with jaundice. The patient asks the nurse why he has yellowish skin when his father with pancreatic cancer never had it. Which is the nurse's best response?

"The yellowish skin color means the tumor is blocking the release of bile from the liver." Jaundice occurs when a tumor on the head of the pancreas obstructs biliary ducts.

Question 3 of 6 A patient has been recently diagnosed with late-stage pancreatic cancer. The family tells the nurse they do not understand how this could happen as the patient never showed signs of cancer or complained of pain. Which would be the best response by the nurse?

"Tumors that start in the tail of the pancreas do not show symptoms until the cancer has already progressed and spread."

Question 2 of 3 A nurse is planning hospice care for a patient with advanced pancreatic cancer. Which action is the most significant to include in the nursing care plan?

Assess the patient for depression and anxiety The nurse should assess the patient's psychological status and coping mechanisms when planning hospice care. Depression and anxiety are common and require psychological support.

Question 5 of 6 A patient presents with abdominal pain and jaundice secondary to biliary obstruction related to metastatic incurable cancer in the pancreatic head. The nurse should expect to prepare the patient for which procedure?

Cholecystojejunostomy

Question 4 of 6 A patient with advanced pancreatic cancer reports severe abdominal pain and anorexia. Which collaborative care procedure would the nurse expect to prepare for the patient?

External radiation

Cholecystojejunostomy

Formation of a new opening between the gallbladder and the jejunum (second part of the small intestine); an anastomosis. Performed to relieve biliary obstruction and/or place biliary stents Performed if surgical removal is not possible

to diagnose pancreatic cancer

Health care providers can use imaging studies or blood tests for tumor markers (such as CA 19-9)

Nursing interventions encompass both symptomatic and supportive measures, including:

Nursing care for pancreatic cancer is similar to that for acute or chronic pancreatitis. Administering medications Providing comfort measures Providing nutritional support, including frequent feedings and supplements Implementing steps to manage the effects of anorexia, or any nausea/vomiting Providing skin care for patients receiving radiation therapy

the fourth leading cause of cancer deaths in the United States, with more than 40,000 people dying each year from it

PANCREATIC CANCER *Pancreatic cancer is usually diagnosed in individuals between the ages of 65 and 80 years old.*

Clinical Manifestations of pancreatic cancer

Pain Related to the location of the malignancy (upper abdomen or left hypochondrium) That is dull, aching, and radiates to the back Often related to eating That is extreme and unrelenting if malignancy has extended to retroperitoneal and nerve plexuses 1. Anorexia. 2. Fatigue. 3. Nausea and flatulence. 4. Change in stools. 5. Steady dull pain in the epigastric region. 6. Weight loss. 7. Jaundice. 8. Onset of diabetes.

Distal pancreatectomy

Removes only the tail of the pancreas or the tail and a portion of the body of the pancreas. The spleen may be removed as well. ** will not need insulin replacement or pancreatic enzymes**

Which should the nurse include in the plan of care for a client undergoing external beam radiation therapy for pancreatic cancer?

Skin care

Risk Factors and Etiology of pancreatic cancer

The causes of pancreatic cancer are not completely understood, but risk factors include: Chronic pancreatitis Diabetes mellitus Advanced age Cigarette smoking (most significant risk factor) Family history High-fat diet Exposure to chemicals Ethnicity (African-Americans more susceptible)

Question 1 of 6 Which is the rationale behind the primary health care provider ordering an endoscopic ultrasound (EUS) for a patient admitted with suspected pancreatic cancer?

To view the pancreas and obtain a biopsy of the tumor

The Whipple procedure and a distal pancreatectomy are the

are the most frequently used surgical procedures for pancreatic cancer. The nursing care for these patients is very extensive and requires nasogastric tube care, drain care, gastrostomy or jejunostomy tube care, pain management, and patient education.

Whipple procedure/Pancreaticoduodenectomy

in this procedure, the *head of the pancreas*, the *duodenum* which is adjacent to the pancreas, *the distal segment of the common bile duct*, and the *distal portion of the stomach* are *removed*.

Radiation therapy and chemotherapy often are not used to treat pancreatic cancer, but may be effective to

manage PAIN and NAusea

Supportive nursing care should also include alternative therapies, such as

music, aroma, and pet therapy. Utilizing chaplain services to provide religious or spiritual care is also recommended and should include family and/or support people as well.

Total pancreatectomy

performed to treat pancreatic cancer. This procedure also involves removing the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach. The pancreas is often not removed because of a patient's reliance on insulin treatment and pancreatic enzymes.

surgery depends on the

size and the location of the tumor. Surgery is often the most successful form of treatment for pancreatic cancer. However, only a fraction of patients are good candidates for surgery

Nursing care involves preparing patients for

surgical procedures, chemotherapy, and radiation treatments; educating patients about the treatment, and managing treatment side effects.