Medical Surgical Nursing

 The patient may be treated with radiation and chemotherapy (fluorouracil and

gemcitabine). If the patient undergoes surgery, intraoperative radiation therapy

(IORT) may be used to deliver a high dose of radiation to the tumor with

minimal injury to other tissues.

Nursing Management

 Pain management and attention to nutritional requirements are important

nursing measures to improve the level of comfort. Skin care and nursing

measures are directed toward relief of pain and discomfort associated with

jaundice, anorexia, and profound weight loss. Specialty mattresses are

beneficial and protect bony prominences from pressure. Pain associated with

pancreatic cancer may be severe and may require liberal use of opioids;

 Promoting Home and Community-Based Care

 specific patient and family teaching indicated varies with the stage of

disease and the treatment choices made by the patient. If the patient elects to

receive chemotherapy, the nurse focuses teaching on prevention of side effects

and complications of the agents used. If surgery is performed to relieve

obstruction and establish biliary drainage, teaching addresses management of

the drainage system and monitoring for complications.

Continuing Care

 A referral for home care is indicated to help the patient and family deal with

the physical problems and discomforts associated with pancreatic cancer and

the psychological impact of the disease. The home care nurse assesses the

patient‘s physical status, fluid and nutritional status, and skin integrity and the

adequacy of pain management.

Tumors Of The Headof The Pancreas

 Sixty to eighty percent of pancreatic tumors occur in the head of the pancreas.

Tumors in this region of the pancreas obstruct the common bile duct where the

duct passes through the head of the pancreas to join the pancreatic duct and

empty at the ampulla of Vater into the duodenum. The tumors producing the

obstruction may arise from the pancreas, the common bile duct, or the ampulla

of Vater.

Clinical Manifestations

 The obstructed flow of bile produces jaundice, clay-colored stools, and dark

urine. Malabsorption of nutrients and fat-soluble vitamins may result from

obstruction by the tumor to entry of bile in the gastrointestinal tract.