Possible/Anticipated Medications

Your patient is a 52-year-old male with a history of smoking and alcohol abuse. He presents to the ED with complaints of “my skin looks yellow, my stomach hurts, and I feel nauseous”. He is taken to CT and a tumor near the pancreas is observed. It appears to be blocking the common bile duct. Develop a plan of care for the patient. Use the attached concept map.

Grading Criterion:

1.  The student must list at least 3 risk factors related to the medical diagnoses.
2. The student must list at least 6 possible/anticipated medications that the client may be on
3. The student is to describe one subjective statement that they client may say related to the medical diagnosis
4. The student is to list at least 3 objective assessments that would be expected with a client who has the medical diagnosis. Anticipated S/S or manifestations of the medical diagnosis.
5. The student is to list at least 6 specific sources of diagnostic data that would relate or be expected to be ordered for the client who has the medical diagnosis. “Labs” is not appropriate. What specific lab would provide you with information related to the medical diagnosis (Lithium level, Dilantin level etc.)
6. Identify at least three possible nursing diagnosis written in a 2-part format based on your subjective and objective criterion you established (2-part = Nursing diagnosis …. related to (R/t) symptoms….)
7. Identify at least 5 nursing interventions that you would do for your client (NO MEDICATIONS)
8. Identify at least 2 medical interventions such as treatments or procedures
9. List at least 5 major teaching points such as teaching about medications, risk factors, medical procedures or anticipated diagnostic procedures.

Concept Map for Patient Care:

Risk Factors:

1. Smoking
2. Alcohol abuse
3. Advanced age

Possible/Anticipated Medications:

1. Pancreatic enzyme replacement therapy (e.g., pancrelipase)
2. Pain management medications (e.g., acetaminophen, opioid analgesics)
3. Antiemetics (e.g., ondansetron)
4. Proton pump inhibitors (e.g., omeprazole)
5. Antibiotics (if infection is present)
6. Chemotherapy agents (if indicated)

Subjective Statement: “I’ve been feeling really tired lately, and I’ve noticed my skin turning yellow. My stomach has been hurting for a while now, and I feel sick to my stomach most days.”

Objective Assessments:

1. Jaundice (yellowing of skin and eyes)
2. Abdominal tenderness or pain, especially in the epigastric region
3. Nausea and vomiting
4. Weight loss
5. Elevated liver enzymes (AST, ALT)
6. Palpable abdominal mass (if tumor is large enough)

Specific Sources of Diagnostic Data:

1. Serum bilirubin levels
2. Serum amylase and lipase levels
3. CT scan of abdomen
4. MRI of abdomen
5. Endoscopic retrograde cholangiopancreatography (ERCP)
6. Biopsy of the tumor for histological analysis

Nursing Diagnoses:

1. Impaired Nutrition: Less than Body Requirements related to abdominal pain and nausea.
2. Risk for Infection related to obstructed biliary system.
3. Acute Pain related to tumor near the pancreas.

Nursing Interventions:

1. Provide small, frequent meals to aid digestion.
2. Monitor vital signs and signs of infection.
3. Administer pain medications as prescribed and monitor pain relief.
4. Position patient comfortably and provide relaxation techniques.
5. Assist with activities of daily living as needed.
6. Educate patient on the importance of maintaining hydration and nutrition.

Medical Interventions:

1. ERCP to relieve bile duct obstruction.
2. Surgical resection of tumor if feasible.

Teaching Points:

1. Importance of smoking cessation and reducing alcohol intake to improve overall health and prognosis.
2. Proper administration of prescribed medications and potential side effects.
3. Signs and symptoms of infection to report to healthcare provider promptly.
4. Explanation of planned procedures such as ERCP and surgical resection.
5. Dietary modifications to manage symptoms and optimize nutrition, including avoiding fatty or spicy foods.