Pancreatic Head Mass

Submitted by:
4NU01
CABRAL, Nolan B.

October 13, 2015

Background

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.
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.
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.

A. DEMOGRAPHIC DATA
Name: Patient Y.B
Address: Neuva Viscaya
Age: 74 years old
Gender: Female
Date and Time of Admission: N/A
Diagnosis: Pancreatic Head Mass
B. Chief Complaint:
Abdominal pain and discomfort
C. Present History of Illness:
Prior to admission, patient was having abdominal discomforts. She was
then diagnosed with diabetes and was sent home. 2 months prior to
admission patient then had an episode of extreme abdominal pain was
sent back to the hospital. Patient was then diagnosed for Pancreatic
head mass. Patient was transferred to St. Lukes on September 14,
2015.
D. Family History of Illness
Patients family has history of hypertension and DM.
E. Social History
Patient does not smoke, drink alcohol or use recreational and illicit
drugs.

F. Allergies

NKA

Vital Signs
Temperature
Pulse rate
Respiratory rate
Blood pressure
O2 saturation
Pain scale (VAS)

Upon Admission
37.6
87
24
150/100
96%
--

Anatomy:
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.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.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. 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.

Pathophysiology:

PANCREAS

Head

Body

Pancreatic Cancer
Formed
Regional Lymph
Nodes
Liver
Lungs
Duodenum
Stomach
colon

Tail

Exocrine

Endocrine

Ductal epithelium
Acinar Cells
Connective Tissue
Lymphatic Tissue

Diagnostics:
HEMATOLOGY TEST
September 14, 2015
Test

Results

Normal values

Clinical Significance

WBC

12.73/uL

5-10

Indicates bacterial

Count
Hemoglob

10.6 g/dL

F: 12.0-16.0

infections
Indicates anemia

in
Hematocri

34.0 %

F: 38.0-46.0

Indicates anemia

Platelet

3483 u/L

150-450 103 u/L

Within normal range

Count
Segmente

57.0 %

40.0-60.0

Within normal range

rs (%)
Lymphocy

21.0(%)

20.0-40.0 %

Within normal range

te (%)
Monocyte

1.0 %

2.0-8.0 %

Within normal range

(%)
Eosinophil

6.8%

1.0-6.0 %

Indicates allergic reactions

0.8%

0.1-1.0 %

Within normal range

(%)
Basophil

Blood Chemistry
September 14, 2015
Tests
Glucose
Sodium
Creatinine
Cholesterol
Direct HDLC
LDL
VLDL

Results
10.3
mmol/L
122.3mmol/
L
180.9
ummol/L
2.7 mmol/L
.6mmol/L
1.20mmol/L
.56mmol/L

Normal Value
4.10-59.0
137.0-145.0
71.0-133.0
0.00-5.20
1.00-1.60
1.71 4.60
0.00-1.03

Clinical Significance
Indicates
hyperglycemia
Indicates renal
insufficiency
Indicates renal
function
Within normal range
Indicates risks in CAD
Within normal range
Within normal range

Potassium
Triglycerides
Urea

4.4ummol/L
1.23mmol/L
24.3mmol/L

3.50-5.10
00.-1.69
2.50-6.10

Within normal range

Within normal range
Indicates impaired
renal function

Normal Value
-4.2 6.2%

Clinical Significance
Indicates DM

HbAlc
September 14, 2015
Tests
HbAlc

Results
-7.5 %

Drug Study:
Generic
Name/Brand
Name
Unasyn

Mechanism of Action

Uses

Contraindicatio
n

Side Effects

Nursing
intervention

Inhibits cell wall synthesis

during bacterial multiplication.

Anti-Bacterial

Contraindicated
to patients
hypersensitive to
drug or other
penicillin.
Use cautiously in
patients with
other drug
allergies
( especially to
cephalosporins)
because of
possible crosssensitivity, and
in those with
mononucleiosis
because of high
risk of
maculopapular
rash.

CV:
thrombophlebitis,
vein irritation
GI: diarrhea,
Nausea,
pseudomembranous
colitis,vomiting,
stomatitis, gastritis,
black hairy tongue,
enterocolitis.
HEMATOLOGIC:
agranulocytosis,
leucopenia, anemia,
eosinophilia.
SKIN: pain at
injection site.
OTHER:
hypersensitivity
reaction,anaphylaxi
s,overgrowth of non
susceptible
organisms.

Mechanism of Action

Uses

Contraindicatio
n

Side Effects

Ask patient about

allergic reactions to
penicillin. Obtain
specimen of culture
and sensitivity test.
In patient with
impaired renal
function, decrease
dosage..
Monitor liver
function test results
during therapy,
especially in patients
with impaired liver
function.
If large doses are
given or if therapy is
prolonged, bacterial
and fungal
superinfectiton may
occur, especially in
elderly, debilitated
or
immunosuppresssed
patient.
Nursing
intervention

Ampicilin
Sodium and
Sulbactam
Sodium

Generic
Name/Brand
Name

Captopril
Capoten

Generic
Name/Brand
Name

nhibits ACE, preventing

conversion of angiotensin I to
angiotensin II, a potent
vasoconstrictor. Less angiotensin
II decreases peripheral arterial
resistance, decreasing
aldosterone secretions, which
reduces sodium and water
retention and lowers blood
pressure.

> Hypertension
> Diabetic
nephropathy
> Heart failure
> left
ventricular
dysfunction
after acute MI.

>Contraindicated
in patients
hypersensitive to
drug or other
ACE inhibitors.
> Use cautiously
in patients with
impaired renal
function or
serious
autoimmune
disease,
especially
systemic lupus
erythematous,
and in those who
have been
exposed to other
drug that affect
WBC counts or
immune
response.

CNS: dizziness,
fainting, headache,
fatigue, fever.
CV: tachycardia,
hypotension
GI: abdominal pain,
anorexia,
constipation, dry
mouth, nausea and
vomiting.
METABOLIC:
hyperkalemia
RESPIRATORY:
dry, non productive
cough.
OTHER:
angioedema

> Monitor patients

BP and PR
frequently.
> Elderly patients
may be more
sensitive to drugs
hypotensive effects.
> Assess patient for
signs of angioedema.
> Drug causes more
frequent occurrence
of cough, compared
with other ACE
inhibitors.
> Dont confuse
Captopril with
Capitrol.

Mechanism of Action

Uses

Contraindicatio
n

Side Effects

Nursing
intervention

Metronidazole
Flagyl

DRUG

> Direct-acting trichomonacide

and amebicide that works inside
and outside the intestines. Its
thought to enter the cells of
microorganisms that contain
nitroreductase, forming unstable
compounds that bind to DNA
and inhibit synthesis causing cell
death.

MECHANISM
OF ACTION

> Amebic Liver >Contraindicate

abscess
d in patients
> Intestinal
hypersensitive to
amebiasis
drug or other
>Trichomoniasi ACE inhibitors.
s
> Use cautiously
> Refractory
in patients with
trichomoniasis
impaired renal
> Bacterial
function or
infections
serious
caused by
autoimmune
anaerobic
disease,
organisms.
especially
>To prevent
systemic lupus
postoperative
erythematous,
infection in
and in those who
contaminated
have been
and potentially exposed to other
contaminated
drug that affect
colorectal
WBC counts or
surgery.
immune
> Bacterial
response.
Vaginosis
> Use
cautiously in
patients who
take
hepatotoxic
drugs or have
hepatic disease
or alcoholism.
INDICATION
CONTRAINDICATION

CNS: headache,
fever, dizziness,
incoordination,
confusion,
irritability,
depression,
weakness, insomia.
CV: edema,
flushing,
EENT: rhinitis,
sinusitis,
pharyngitis
GI: nausea,
abdominal pain,
stomatitis,
vomiting, diarrhea,
constipation, dry
mouth.
GU: darkened
urine, polyuria
OTHER: decreased
libido, overgrowth
of non susceptible
organism.

ADVERSE
EFFECTS

> Monitor liver

function test results
carefully in elderly
patients.
> Observe patient
for edema,
especially if hes
receiving
corticosteroids,
> Record number
and character of
stools when drug is
used to treat
amebiasis..

NURSING
RESPONSIILITIES

Generic
Name:
Isophane
Insulin
Brand name:
Humulin N
Classification
:
Anti-diabetic
Dosage:
70/30

Insulin is a
hormone
secreted by
beta cells of
the pancreas
that, by
receptormediated
effects,
promotes the
storage of the
bodys fuels,
facilitating
the transport
of
metabolites
and ions
(potassium)
through cell
membrane
sand
stimulating
the synthesis
of glycogen
from glucose,
of fats from
lipids, and
proteins from
amino acids.

-Treatment of
type 2 diabetes
mellitus that
cannot be
controlled by
diet or oral
drugs.
-Treatment of
severe
ketoacidosis.
-Treatment of
adults with
diabetes who
require basal
insulin for
control of
hyperglycemia.

Contraindicated
with allergy to pork
products (varies
with preparations;
human insulin
notcontraindicated
with pork allergy).

Endo :
hypoglycemi
a
Local :
lipoatrophy,
lipohypertrop
hy, pruritus,
edema,
swelling

-Assess for
symptoms of
hypoglycemia
(anxiety,
restlessness, mood
changes, confusion,
drowsiness,
nausea).
-Monitor blood
glucose every 6
hours during
therapy.
-Be aware that
some patients may
develop insulin
resistance and
require large insulin
doses to control
symptoms of
diabetes.
-Monitor serum
glucose level to
assess effectiveness
of drug and dosage.

DRUG
Generic
Name:
FeSO4 + FA
Brand Name:
Classification
:
Enzymatic
mineral and
Iron
preparation
Stency;
Vitamins

MECHANISM
OF ACTION
essential
component
in the
formation of
hemoglobin,
myoglobin
and
enzymes. It
isnecessary
for effective
erythropoies
is and
transport or
utilization of
oxygen

INDICATION
-The
prevention or
treatment of
ironand folate
deficiency
anemia due to
inadequate
diet,
malabsorption
pregnancy,
and blood
loss.

CONTRAINDICATION
Patients receiving
repeated blood
transfusions;
anaemia not due to
iron and folate
deficiency

ADVERSE
EFFECTS
-Dizziness
-N & V
-Nasal
Congestion
-Dyspnea
-Hypotension
-CHF
-MI
-Muscle
cramps
-Flushing

NURSING
RESPONSIILITIES
-Advise patient to
take medicine as
prescribed.
-Caution patient to
make position
changes slowly to
minimize orhtostatic
hypotension.
-Advise patient to
consult physician if
irregular heartbeat,
dyspnea, swelling of
hands and feet and
hypotension occurs.
-Inform patient that
angina attacks may
occur 30 min. after
administration due to
reflex tachycardia.
Encourage patient
to comply with
additional
intervention for
hypertension like
proper diet, regular
exercise, lifestyle
changes and stress
management.

Nursing Care Plans:

Assessment
Objective:
-Presence of
wound
scarring
-Facial
Grimace
-Vas of 8/10

Diagnosis
Paint r/t post sx

Planning
Short Term Goal:
Patient will be able
to lower pain scale to
4/10
Long Term Goal:
Patient will be able to
maintain low vas and
demonstrates pain
relieving exercises

Intervention
-Monitor V/S

Rationale
-Get baseline data and see
fluctuations in v/s to see if
patient is in pain

-Asses Pain

-To evaluate what kind of

pain and its frequency

-Instruct distraction
techniques

-A good non-pharmacologic
way to relieve pain

-Explain reason why there

is pain

-Patient will be able to

understand the reason for pain

Collaborative:
-Give pain medications as
ordered (paracetamol)

-Alleviate pain

Evaluation
Goal is met.

Assessment
Objective:
-Presence of
melena
-Post surgery
- Low Hbg
count

Diagnosis
Risk for deficient
fluid volume
related to active
fluid loss

Planning
Short Term Goal:
-Patient will
maintain urine output
>30cc/hr
-Patient will
demonstrate good
skin turgor.
>Patient CBC result
will be normal
Long Term Goal:
Patient will maintain
adequate fluid and
electrolyte balance

Intervention
-Weigh daily
-Monitor intake and output

-Monitor Skin turgor

-Monitor vital signs.

Evaluate peripheral pulses,
capillary refill
-Observed temperature and
mucous membranes
-Monitor urine
-Encourage increased fluid
intake to 3000 mL per day
as individually appropriate
or tolerated.
-Monitor laboratory studies
(CBC, electrolytes, serum
albumin)

Rationale
-Sensitive measurement of
fluctuations in fluid balance
- To find out the balance of
fluids in the body that is
needed for daily metabolism
- To find out the less
interstitial fluid / loss can lead
to loss of skin elasticity
-Reflects adequacy of
circulating volume
-Dry mucous membranes
which are an indicator of
dehydration
-The reduced amount of urine
as indicators of reduced fluid
in the body
-Assists in maintenance of
fluid requirements

-Provides information about

level of hydration and
corresponding deficits

Evaluation
Goal is met.

ASSESSMENT
Objective:
-VAS of 8/10
-facial grimace
-cannot perform
ADLs alone
-with limited range of
motion
-immobility
-body weakness

DIAGNOSIS
Activity intolerance

PLANNING
Short term:
After 8 hrs of nursing
intervention patient
will demonstrate
increased tolerance to
activity.

INTERVENTION
1
Monitor vital
signs and record.
2
Assess ability
to perform ADL.
3
Assess
physical mobility
status.
4
Assist patient
to do ADLs.

5
Assist to do
active range of
motion exercise.
6
Promote rest
and comfort.
7
Emphasize
importance of
frequentambulation.
8
Administer
medications as
prescribed.

RATIONALE
1. to help determine
patients current
health status
2. to determine the
capacity of patient in
doing ADLs
3. To know if there is
change in patients
physical condition
4. to minimize fatigue
and to evaluate his
capabilities in doing
ADL
5. to maximize full
strength
6
to conserve
energy
7
to promote
circulation
8. to relieve pain

EVALUATION
Goal partially met. Pt
demonstrated
increased tolerance to
activity by getting out
of bed still with
assistance but without
any abnormal
changes in vital signs.