Nursing 211

N211: Health Differences Across the Lifespan I Include anemia, hyperbilirubinemia, prolonged PT, elevated ESR due to liver inflammation, hypoalbuminemia when there is malnutrition, liver failure. Elevated alkaline phosphatase, AST, ALT when there is liver failure or damage. Altered blood glucose doe to liver damage. High elevation of AFP (alpha-fetoprotein). Ultrasound, CT scan and MRI may reveal focal liver lesions. Definitive diagnosis is made through biopsy or aspiration of lesion. Nursing Diagnosis • Pain related to tumor growth • Altered nutrition, less than body requirements, related to anorexia and altered metabolism • Fluid volume excess related to portal obstruction resulting in ascites and edema • Activity intolerance related to fatigue, anemia, and effects of chemotherapy and/or radiation therapy • Anxiety and knowledge deficit related to diagnosis of cancer and treatments • Altered body image related to ascites Medical Interventions Partial hepatectomy, liver transplantation, radiation therapy (palliative) to shrink tumor or reduce pain or pressure on surrounding structures. Chemotherapy has a limited response; systemic chemotherapy or regional infusion of chemotherapy directly into the hepatic artery. Nursing Interventions Include pain management, administer analgesics, and provide small, frequent meals of foods high in nutritional value. Monitor weight, intake and output, monitor ammonia levels, monitor liver functions studies and serum electrolytes. Encourage energy conservation. Allow patient and family to express feelings regarding diagnosis. Maintain fluid and sodium restrictions as ordered. 3.14 Pancreatic Cancer Pancreatic Cancer involves the ductal epithelium and is an adenocarcinoma. Cancer may originate in any area of the pancreas, the head, body or tail. Cancer is usually located in the head of the pancreas, deep within the tissue, often causing obstruction of the common bile duct. Metastasis almost occurs prior to symptoms of with invasion of tumor into the posterior wall of the stomach, duodenal wall, colon and common bile duct. Nursing Assessment

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