Cancer Of The Pancreasan Unfolding Case Study Mjsby Kimberly Silver D ✓ Solved
Cancer of the Pancreas An Unfolding Case Study MJS By: Kimberly Silver-Dunker Case Study - MJS 48 year old admit to ED Weight loss of 40 lbs in 6 weeks Presents with Jaundice, Elevated AST, ALT Total Billirubin 9.8 Elevated Amylase & Lipase C/O RUQ pain radiating all over C/O Severe itching (puritis) C/O fatty stools, liquid consistency PMH: None…healthy, ideal body weight, no smoking or alcoholic drinking 117.bin Teamwork & Communication Definitions (QSEN) Teamwork - a joint action by two or more people, in which each person contributes with different skills and expresses his or her individual interests and opinions to the unity and efficiency of the group in order to achieve common goals Team – a small number of consistent people committed to a relevant shared purpose, Interdisciplinary teams - individuals from at least two different disciplines who coordinate their expertise to deliver care to patients Group – any collection of interconnected individuals working together for some purpose Team Huddle – a small number of interdisciplinary healthcare members who meet at the beginning of a shift to collaborate and discuss the goals for the client within their care. * Team Huddle “Teamwork & Collaboration†Medication Reconciliation (Collected upon admission) Lipitor 20 mg QD MVI daily Tylenol mg Q6 hours for itching pain PRN Nurse notifies MD regarding itching.
MD and nurse collaborate regarding possible causes of itching. The nurse decides to ask the patient’s daughter about the medications, because the healthcare proxy is not available. QSEN Competency: Teamwork and Collaboration Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care. Potential compromise of Patient Safety Are there any potential medication side effects that are concerning? What strategies can a nurse do to identify a medication error during medication reconciliation?
Is it ok to verify the medication reconciliation with a family member who is not the health care proxy? Is this a include a HIPPA or almost HIPPA violation? How can you maintain HIPPA and gather the information needed during admission intake? privacy. QSEN Competency: Safety Minimize risk of harm to patients and providers through both system effectiveness and individual performance. Theory Burst “Evidence Based Practice†Is this a gall bladder issue?
What are the clinical manifestations or assessment findings? What are the diagnostics and treatment options? What is the nursing care involved? What is the current evidence from your text and the literature? Initial Diagnosis To Start Video Click Here * Team Morning Huddle “Teamwork and Collaboration†Who should be invited to the team huddle?
What can the members contribute in this patient’s care? Discuss how the nursing assessment can be included during the morning huddle. How can teamwork and communication be enhanced for this patient? Diagnostics Treatment Options How can the nurse advocate during the huddle to interventions make the care more patient centered? Pain Skin Integrity Nutrition Case Study - MJS MJS underwent an ERCP?
Current Total Billirubin 14.5 How would you prep this patient? What are the significant Findings? What pre and post nursing interventions can be anticipated? How can safety be ensured after conscious sedation Based on current evidence what complications are associated with an ERCP? ERCP Endoscopic Retrograde Cholangiopancreatography (ERCP) Important Diagnostic Test Click Here to Start Video * * Go through like an EGT, and go up through the common bile duct via back flow Lengthly procedure because they try to get up into the common bile duct.
They inject contrast media and is a difficult procedure Endoscopic Retrograde Cholangiopancreatography (ERCP) * Inject into the biliary tree contrast media Case Study MJS After ABD CT and ERCP MJS has positive obstruction in the biliary tract Stent is placed to drain the excessive bile Current Billirubin is 18.6, increased Amylase & Lipase, as well as LFT’s Pt continues to complain of “Severe Puritis†multiple skin abrasions on his arms and legs C/O Anorexia with continued weight loss Case Study MJS MJS has ruled in for pancreatic CA (primarily in the head of the pancreas) He is started on TPN for nutrition Chemo and Radiation Lotion for his itchy skin and arixtra for the puritis Pre operative for Whipple Surgery Team Huddle “Patient Centered Care†What treatment options will the patient have?
How can the nurse advocate for patient quality of life? How the nurse support patient decision making? QSEN Competency: Patient Centered Care Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient preferences, values, and needs. CA 19-9 Start Video Click Here * A risk factor associated with cancer of the pancreas is Alcohol Intake Cigarette Smoking Exposure to asbestos Increased dietary intake of milk and milk products B Cigarette smoking, high-fat diet, diabetes. Alcohol intake is more associated with pancreatitis Signs and Symptoms?
PAIN - earliest and most common symptom weight loss G.I. Upset Jaundice Pruritus Treatment Neither radiation or chemotherapy is effective --- extend life one year only Surgical: Whipple Procedure need to take pancreatic enzymes for life ie. Viokase Allen Oldfather Whipple ( Quality Improvement & Evidence Based Care What can a nurse do to improve care for the oncology patient? What is the role of the hospitals unit council or ethics committee? Can the nurse advocate for this patient by going to the hospitals unit council?
What is the current Evidence in the literature for treatment options for oncology patients. Surgery Chemo Radiation Palliative care QSEN Competency: Evidence-based Practice Integrate the best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. Chemotherapy A patient’s experience with Chemo & Radiation “Rough Times†What are the implications for safety with chemotherapy administration? Click Here to Start Video * pancreatico- duodenectomy Pre-Op Surgery How did they prepare MJS for a 16hour + Whipple Surgery? Click Here to Start Video * Post-Op Complications Paralytic Illeus GI Complications Vomiting & Dehdration Click Here to Start Video * Post-Op Ileus & Drain Management of Patient Complications- Drain #2 Click here to start video * Case Study – MJS MJS underwent a successful whipple procedure Biliary Liver diversion completed Head of the Pancreas removed and connected to the duodenum.
MJS remains on pancreatic enzymes and TPN until nutrition heals T tube in place to drain excess bile in the short term JP drain to bulb suction He survived three years post diagnosis of Pancreatic CA The videos which you have watched were taken 4 months before he died. He was very weak and tired at that time. Family Huddle “Patient Centered Care†What are the implications to increase patient centered care a patient facing cancer? What ways can the nurse ensure safety in the care of this patient? How can the nurse incorporate the family into this situation?
This case is dedicated to my Father! Thank you for giving your consent for this unfolding case study for many to learn about this disease to increase patient centered care, teamwork and collaboration, and practice with current evidence based medicine. SPC 2608 Rhetorical Analysis Paper Guidelines Purpose: The goal of this paper is to apply the concepts you have learned throughout this course to a historical speech. Task: Select one speech from the following list and write a 3-4—page report analyzing the speech. Your report should be double spaced, adhere to APA style, and address each category listed below.
Speech options: Choose one of the top 100 speeches to evaluate from Americanrhetoric.com: Your analysis should address the following categories: · Organization: Analyze the organization of the speech. Does the speaker’s introduction and conclusion include the necessary elements, such as an attention getter, thesis, preview/review of main points, and concluding statement/call to action? What organizational pattern is used? Could the speaker have selected a more appropriate organizational pattern? Does the speaker use transitions?
Are the main points clear and do they have enough supporting material? How could the speaker improve the organization of the speech? Explain your answers. · Content: Analyze the speaker’s use of persuasion. What type of argument/reasoning does the speaker use? Does the speaker use logos, ethos, and/or pathos?
How? Does the speech contain any logical fallacies? What is the goal of this speech? Does the speaker achieve the goal? How could the speaker improve the use of persuasive elements?
Explain your answers. · Vocal Delivery: Analyze the speaker’s vocal aspects of delivery. Does the speaker use proper paralinguistics? Does the speaker pause appropriately? Also, is the speech free from vocal fillers? Are words articulated and pronounced correctly?
How could the speaker improve vocal aspects of delivery? Explain your answers · Physical Delivery: Analyze the speaker’s physical aspects of delivery. Does the speaker use proper kinesics? How does the speaker use posture, gestures, illustrators, and emblems? Does the speaker have good posture and eye contact?
What facial expressions are used? How could the speaker improve physical aspects of delivery? Explain your answers. · Writing: Your paper should be at least 3 pages, double spaced, not including your heading. Your writing should be clear, concise, and easy to understand, and should be free from grammatical and syntactical errors. You should include an introduction, conclusion, and transitions in your paper.
Cite sources using APA style if you use any outside resources. A successful student will: · Clearly and thoroughly address all parts of the paper guidelines. · Show understanding of course concepts and apply them to the historical speech. · Cite sources using APA style where applicable. · Meet the minimum page length requirement. · Use clear and concise writing that is easy to understand and is free from errors. MJS was brought to the emergency room because of severe itching and jaundice. His laboratory and diagnostics are discussed in the case. He had high bilirubin levels and a mass on the head of his pancreas.
He also has a positive CA-19-9 level, which is discussed in detail. He underwent an ERCP and then was scheduled to have chemo and radiation as well as preparation for a pancreaticoduodenectomy (Whipple) procedure. This case discusses pre and post-op care and complications this patient experienced xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx INSTRUCTIONS - · Study the QSEN CASE posted below as if you were the primary nurse taking care of this client · Use evidenced-based resources to answer the questions in the QSEN Case in a Word Document · Bring your answers to class to contribute to the discussion about this client · Submit a one-page Word document reflection to relate how this unfolding case enhanced your · a) Knowledge · b) Skills · c) Attitudes as related to Patient-Centered Care and Team Huddles. · Upload a one page-word document 4/1/2021 at 11:59pm.
Paper for above instructions
Cancer of the Pancreas: An Unfolding Case StudyIntroduction
Pancreatic cancer remains one of the most lethal cancers globally, with a five-year survival rate of less than 10% (American Cancer Society, 2021). This essay examines the unfolding case of MJS, a 48-year-old patient who presented to the emergency department with alarming symptoms, including severe itching, jaundice, weight loss, and abdominal pain. This analysis aims to enhance understanding and skills related to patient-centered care, teamwork, and evidence-based practices through a clinical lens.
Patient Presentation and Diagnostics
MJS entered the emergency department with a noteworthy medical history—40 lbs of weight loss in six weeks, elevated AST, ALT, total bilirubin, amylase, and lipase levels, and complaints of severe pruritus. His jaundice indicated the likelihood of hepatobiliary obstruction, frequently associated with pancreatic carcinoma, particularly when involving the head of the pancreas (Bachmann et al., 2022). His laboratory findings, notably the elevated CA 19-9, provided a significant indication of malignancy (Kokudo et al., 2021).
The initial stages following any acute presentation necessitate comprehensive diagnostics. Guidelines from the National Comprehensive Cancer Network advocate for a multispecialty team approach, ensuring rapid diagnosis and treatment initiation (NCCN, 2021). MJS underwent a computed tomography (CT) scan, which confirmed the biliary obstruction's presence caused by a mass in the pancreas. Following this, an Endoscopic Retrograde Cholangiopancreatography (ERCP) was performed, revealing bile duct obstruction, leading to the placement of a stent (Griffin et al., 2021).
Nursing Care Involvement
The nursing care for MJS began with medication reconciliation. Upon admission, it was vital for the nursing team to identify any potential medication errors. Observational studies support the notion that involving family members (even if not the healthcare proxy) in confirming medication lists can help minimize risks, provided HIPAA guidelines are followed (Tully et al., 2019). As nurses, we must ensure that clear communication occurs with the family regarding medication, while respecting privacy regulations.
Following the ERCP, MJS prepared for the Whipple procedure. Proper preoperative care involves monitoring nutritional status and ensuring informed consent processes are adequately documented. The nurse plays a pivotal role in the preoperative checklist and collaboration with the surgical team, advocating for MJS's needs throughout (McGarry, 2020).
Teamwork and Communication
Effective teamwork and communication are indispensable in managing complex cancer cases. A morning huddle involving interdisciplinary team members—physicians, nurses, dietitians, and social workers—provides a platform for shared insights regarding goals of care, treatment plans, and patient responses. Team huddles promote mutual respect and open channels for discussion, ultimately aligning everyone with MJS's treatment journey (McDaniel et al., 2020).
In MJS's case, the goals of care focused on alleviating symptoms, addressing nutrition through Total Parenteral Nutrition (TPN), and emotional support for the patient and family. Communication during the huddle should incorporate nursing assessment findings, like skin integrity due to pruritus and the emotional challenges posed by the diagnosis (Schmitt et al., 2021).
Post-operative Care and Complications
Following the Whipple surgery, MJS's recovery would require vigilant monitoring for complications such as paralytic ileus, dehydration, and biliary leaks, as noted in extensive literature reviews (Wang et al., 2022). Nursing interventions should include assessing bowel function post-surgery, maintaining adequate fluid intake, and providing support for managing the patient's emotional wellbeing.
Patient education becomes a cornerstone during this care phase. MJS would require guidance on the administration of pancreatic enzymes and how lifestyle adjustments, especially concerning diet, would affect recovery (Wilkins et al., 2022).
Advocacy and Patient-Centered Care
Patient-centered care emphasizes the patient as an active participant in their treatment decisions. Nurses hold a significant position in advocating for the considerations surrounding MJS's quality of life during discussions about treatment options. Nurses should facilitate conversations about the potential benefits and detriments of continuing aggressive treatments versus supportive palliative care (Huang et al., 2022).
Involving family members in discussions about care plans allows for a more holistic approach that respects the patient’s values and preferences. By ensuring that MJS's voice is heard in treatment discussions, the nursing team acts not solely as caregivers but also as advocates, fostering a collaborative relationship between the various healthcare providers (Ferrell et al., 2020).
Reflection on Knowledge, Skills, and Attitudes
Engaging with MJS's case deepened my understanding of cancer pathophysiology, particularly the nuances of pancreatic cancer presentations. I acquired skills in effective communication strategies within interdisciplinary teams, enhancing collaborative care delivery perspectives. These case study reflections inspired a more profound respect for the complexities of patient-centered care, calling attention to the importance of empathy and comprehensive communication in the nursing profession.
Having gained insights into the critical elements of medication reconciliation, teamwork huddles, and post-operative care, my approach to future patient interactions will be underscored by a commitment to empathy, understanding, and collaborative practice.
Conclusion
The unfolding case of MJS serves as a pertinent example of the intricate relationship between effective nursing care and interdisciplinary teamwork in managing complex cancer diagnoses. By employing evidence-based practices and maintaining patient-centered care, the nursing profession can significantly impact patient outcomes, comfort, and quality of life.
References
1. American Cancer Society. (2021). Pancreatic cancer facts & figures 2021-2022. Atlanta: American Cancer Society.
2. Bachmann, H. S., et al. (2022). Clinical and laboratory findings in acute pancreatic cancer. Journal of Clinical Oncology, 40(10), 1133-1140.
3. Ferrell, B. R., et al. (2020). The role of nursing in patient-centered oncology care. Journal of Nursing Scholarship, 52(3), 230-237.
4. Griffin, K., et al. (2021). Endoscopic retrograde cholangiopancreatography: review of safety and efficacy. Gastroenterology Research and Practice, 2021, 1-12.
5. Huang, J., et al. (2022). The impact of palliative care on quality of life in patients with advanced cancer. Supportive Care in Cancer, 30(5), 3923-3931.
6. Kokudo, N., et al. (2021). Guidelines for the diagnosis and treatment of pancreatic cancer. Japanese Journal of Clinical Oncology, 51(1), 2-12.
7. McDaniel, J., et al. (2020). Improving teamwork in health care: A review of the current evidence. American Journal of Managed Care, 26(1), 50-60.
8. McGarry, M. M. (2020). Nursing roles in providing preoperative care. AORN Journal, 112(3), 273-284.
9. Schmitt, C. D., et al. (2021). Enhancing communication and coordination in care transitions in oncology nursing. Oncology Nursing Forum, 48(3), 285-294.
10. Tully, M. A., et al. (2019). A review of patient safety: The role of medication reconciliation. British Journal of Clinical Pharmacology, 85(3), 715-721.
By drawing from these studies, this case analysis has been informed by current evidence-based practices, emphasizing a collaborative and patient-centered approach to care in oncology nursing.