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Ateneo de Davao University

to the School of Nursing

A Case Study on

Obstructive Jaundice secondary to Pancreatic Head mass Malignant

Fulfillments in the reference for NCM 103 RLE

Submitted to:

Maam Nancy argamento RN! MN

Submitted by:

"ayanghirang# Earl $ohn

%ulle# Christine May !

$amora# $anis Sushmita Marie &!

Ledda# Le'aen Star Ly(a $!

Maino)a*# +re,ie Sharmaine

Ma)undo# Settie $amila

Nomus# Frit*ie eatrice

SN 3A %rou) -

Se)tem.er --# -01/

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TABL O! "O#T #TS

! Ac(no ledgement 22222222222222222222222222222222222222222222222222222222222222

! ntroduction 22222222222222222222222222222222222222222222222222222222222222222222

! .'ecti4es 222222222222222222222222222222222222222222222222222222222222222222222

6! 7atients "ata 2222222222222222222222222222222222222222222222222222222222222222222

6! %enogram 2222222222222222222222222222222222222222222222222222222222222222222222

6 ! "e4elo)ment "ata 22222222222222222222222222222222222222222222222222222222222222

6 ! "efinition of Com)lete "iagnosis222222222222222222222222222222222222222222222222222222

6 ! 7hysical Assessment 222222222222222222222222222222222222222222222222222222222222;! Anatomy and 7hysiology 222222222222222222222222222222222222222222222222222222222

;! Etiology and Sym)tomatology2222222222222222222222222222222222222222222222222222222

; ! 7atho)hysiology222222222222222222222222222222222222222222222222222222222222222222

; ! "octor s rder 22222222222222222222222222222222222222222222222222222222222222222

; ! "iagnostic E,am 2222222222222222222222222222222222222222222222222222222222222222222222

; 6! "rug Study22222222222222222222222222222222222222222222222222222222222222222222222

;6! Surgical 7rocedures2222222222222222222222222222222222222222222222222222222222222222

;6 ! Nursing +heories 222222222222222222222222222222222222222222222222222222222222222

;6 ! Nursing Care 7lan 222222222222222222222222222222222222222222222222222222222222222

;6 7rognosis222222222222222222222222222222222222222222222222222222222222222222222222

; ;! "ischarge 7lan 22222222222222222222222222222222222222222222222222222222222222222

;;! Recommendations 22222222222222222222222222222222222222222222222222222222222222

;;1! References 222222222222222222222222222222222222222222222222222222222222222222222

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12

A"$#O%L D& M #T

efore the formal .eginning of this )a)er# the )ro)onents ould li(e to gi4e

gratitude and ac(no ledgement to those indi4iduals ho ha4e hel)ed them in com)leting

this study< First of all# they ould li(e to than( %od Almighty# for gi4ing them strength#

isdom and (no ledge that they used in ma(ing this case study# for all the .lessings that

=e has sho ered u)on them and for the )eo)le that hel)ed them to im)ro4e as student

nurses and to .ecome .etter indi4iduals!

+hey ould also li(e to gi4e than(s to the )atient and his family for .eingcoo)erati4e in their inter4ie # for gi4ing out necessary information that they needed and

for )artici)ating and .eing )atient during the )hysical assessment!

+hey ould also li(e to ac(no ledge the staff of Surgery > East ?ard at Southern

7hili))ines Medical Center# for .eing (ind and hos)ita.le# for hel)ing them clarify the

information on the )atients chart and for sharing their (no ledge to the )ro)onents!

Also# they ould li(e to gi4e s)ecial than(s to their clinical instructor# Mrs!

Maychel "! Ancog# RN# MN# for hel)ing them choose the )atient and for increasing their

(no ledge in ma(ing this case study and for ser4ing as their guide and mentor! All

studies during the ma(ing of this )resentation ould .e nothing ithout the guidance#

hel) and teachings from her! +o the School of Nursing "ean# Mrs! 7atria 6! Manalaysay#

RN# MAN# 7h" and all the Faculty staff in the School of nursing that are )atient in

hel)ing them to com)lete this )resentation!

And last .ut not the least< the )ro)onents ould li(e to gi4e than(s to their friends

and classmates# for su))orting them and hel)ing them throughout this study .y sharing

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any information that they (no to them! And to their )arents ho are al ays there to

su))ort them )hysically# mentally# emotionally# financially and for encouraging them to

study and ne4er gi4e u) in all the challenges that they are e,)eriencing!

'#T(ODU"T'O#

+he ord @'aundice comes from the French ord @'aune # hich means yello !

?hen e first thin( of 'aundice hat usually )o)s out in our minds is the yello

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discoloration of the s(in! Bes# it is the yello ing of the s(in# .ut not only the s(in .ut also

the sclera in our eyes! t is not a disease# .ut rather a sign that can occur in se4eral

different diseases! No # an o.structi4e 'aundice is a )articular ty)e of 'aundice herein a

)erson may e,)erience the yello ing of the eyes and s(in# a.dominal )ain and e4en

fe4er! ne of the causes of o.structi4e 'aundice is )ancreatic head mass!

A study entitled .structi4e $aundice2 Aetiological S)ectrum# Clinical# iochemical

and Radiological E4aluation at a +ertiary Care +eaching =os)ital as conducted last

-010 in ndia herein 110 )atients ith o.structi4e 'aundice ere confirmed .y

thorough history and )hysical e,amination# .iochemical tests and radiologicalin4estigations as done ith final confirmation of diagnosis in histo)athology! ut

of the 110 )atients# 9- 59D ere male and /: //D ere female! +he mean age of

the study )o)ulation as 50!/ years old range 3 > :5 years old ! Malignant

o.structi4e as common than .enign 9-!83D 4s /8!-8D ! Mass on the head of

)ancreas as commonest etiology in 38 )atients 33!93D !

Mass on the head of )ancreas as the most common cause of o.structi4e 'aundice

as a hole# as ell as most common etiology of malignant o.struction in male )atients!

n females# choledocholithiasis as the most common cause of .iliary o.struction as ell

as most common .enign etiology! enign causes are seen at a com)arati4ely younger age

grou) com)ared to malignant causes 6erma# et al! -010 !

n the 7hili))ines# according to the 7hili))ine Star e.site hich as u)dated

last cto.er 1:# -011# there is no s)ecific estimation of )atients ith o.structi4e 'aundice

)ro.a.ly secondary to )ancreatic head mass malignant# .ut in -005 there ere re)ortedly

1# :83 cases of it in the country!

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"uring the )ro)onents duty in Surgical > East ?ard at Southern 7hili))ines

Medical Center# along ith their clinical instructor# they chose )atient Am.er .ecause

they anted to a))ly to things they ha4e learned in their lectures and to also (no more

a.out the condition of the )atient! +hey ha4e also gi4en great concern and care to ards

the )atient that is hy they ould ant to ha4e a dee)er understanding on his condition

and to find out hat are the things that# as student nurses# they could gi4e or )ro4ide him

ma(e his condition .etter!

OBJ "T') S

%eneral .'ecti4e

?ithin the 3 day e,)osure in Southern 7hili))ines Medical Center Surgical > East

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?ard# the )ro)onents should (no and understand the disease )rocess and conce)t of

.structi4e $aundice )ro.a.ly secondary to 7ancreatic head mass malignant and the

a))ro)riate medical and nursing management regarding the condition of the chosen

client!

S)ecific .'ecti4es

Cogniti4e

Analy*e the clients )ast and )resent health history to identify )reci)itating and

)redis)osing factors that may contri.ute to the )atients )resent condition < "istinguish the anatomy and )hysiology of the organs affected in the )atients

case nurse )ro4ides total care-! 7artially com)ensatory system > nurse and )atient share res)onsi.ility for care3! Educati4e2de4elo)ment system 2 client has )rimary res)onsi.ility for )ersonal

health# ith nurse acting as a consultant!

+he )atient .elongs to the holly com)ensatory system! +he )atient still needs full

care and guidance through the significant others and the medical staff! E4en on the

)atients A"L .efore and after hos)itali*ation! Full care must .e rendered for )atient to

.e a.le to cou) u) to his needs and to .e a.le to ha4e Kuality of life!

P0iloso.0y and Science o- caring

Caring in Nursing

According to ?atson -001 # )art of her theory are four ma'or conce)ts!

?atsons four ma'or conce)ts

1! =uman .eing

=uman .eing refers to @Z!! a 4alued )erson in and of him or herself to .e

cared for# res)ected# nurtured# understood and assisted< in general a )hiloso)hical

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4ie of a )erson as a fully functional integrated self! =e# human is 4ie ed as

greater than and different from# the sum of his or her )arts !

-! =ealth

?atson adds the follo ing three elements to ?= definition of health

A high le4el of o4erall )hysical# mental and social functioning A general ada)ti4e2maintenance le4el of daily functioning +he a.sence of illness or the )resence of efforts that leads its a.sence

3! En4ironmentHsociety

According to ?atson# caring and nursing has e,isted in e4ery society! A

caring attitude is not transmitted from generation to generation! t is transmitted

.y the culture of the )rofession as a uniKue ay of co)ing ith its en4ironment!

/! Nursing@Nursing is concerned ith )romoting health# )re4enting illness# caring for the

sic( and restoring health ! t focuses on health )romotion and treatment of

disease! She .elie4es that holistic health care is central to the )ractice of caring in

nursing!She defines nursing asZ!!

@a human science of )ersons and human health2illness e,)eriences that are

mediated .y )rofessional# )ersonal# scientific# esthetic and ethical human

transactions !

n relation to the )atient# e ould li(e to relate it to $ean ?atsons e,)lanation

on human .eing! Significance of the 4alue of life is focused! 7atients 4alue of life is

essential for caring! n fact )atients condition needs more attention# than any other cases!

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As nurses# our main goal is to alle4iate# )re4ent and care our )atients! n )ractice to $ean

?atsons theory! ?e gi4e im)ortance to those in need! And e gi4e focus to those ho

need the most as e 4alue the ones e care! Noting that e4ery )atient is im)ortant#

.ecause e ant to nurture the life of e4ery human .eing!

!ourteen Basic Human #eeds

6irginia =enderson de4elo)ed the @Fourteen asic =uman Needs +heory u)on

hich nursing care is .ased! =enderson defined nursing in terms of the function of the

nurse in assisting the indi4idual in the )erformance of acti4ities contri.uting to health or its reco4ery that the )atient ould )erform if he had enough strength in a ay that it ill

hel) her achie4e homeostasis as soon as )ossi.le!

+he 1/ com)onents

1! reathe normally!-! Eat and drin( adeKuately!3! Eliminate .ody astes!/! Mo4e and maintain desira.le )ostures!5! Slee) and rest!9! Select suita.le clothes2dress and undress!8! Maintain .ody tem)erature ithin normal range .y ad'usting clothing and

modifying en4ironment:! ee) the .ody clean and ell groomed and )rotect the integumentG! A4oid dangers in the en4ironment and a4oid in'uring others!10! Communicate ith others in e,)ressing emotions# needs# fears# or o)inions!11! ?orshi) according to ones faith!1-! ?or( in such a ay that there is a sense of accom)lishment!13! 7lay or )artici)ate in 4arious forms of recreation!1/! Learn# disco4er# or satisfy the curiosity that leads to normal de4elo)ment and

health and use the a4aila.le health facilities!

As nurses e ould asses and hel) alle4iate the condition of the )atient! Ne,t# is .eing a

hel)er to the )atient! Last# is to .e a )artner ith the )atient! y these# the )atients needs

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hich includes .reathing normally# eating and drin(ing adeKuately# eliminating .ody

astes# mo4ing and maintaining desira.le )ostures# slee)ing and resting# .eing ell2

dressed# ha4ing the right .ody tem)erature# ha4ing good hygiene are met! ?e are .eing

)art of the )atients care and reco4ery to im)ro4e )atients Kuality of life!

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#U(S'#& "A( PLA#

Date andTime

"ues #eeds #ursingDiagnosis

Ob4ective o- "are #ursing 'ntervention valuation

August --#

-01/83 shift

G 00am

Ob4ective:

Fatigue$aundiceall o4er the

.ody6italsigns

+ 2 39o C< 7R 2 80 .)m< RR 2 1G c)m< 72 130HG0mm=g

A

C+

6

+B2E;E

neffecti4e tissue

)erfusion rHtdecrease inhemoglo.in in the

.lood(: Red .loodcells are )roducedin the .onemarro hich isthe soft tissue inthe center of most

.ones! Red .lood

After 3 days of

nursing care# )atientill .e a.le to

a ndicateadeKuate

)erfusion suchas 4ital signsithin clientsnormal range#free from )ain#and a.sence of

1 Monitor 4ital signs#

assess ca)illary refill#s(in color H mucousmem.ranes# nails!

(: )ro4ides informationa.out the degree H adeKuacyof tissue )erfusion and hel)determine the need for inter4ention!- Ele4ate the head of .ed

as tolerated!(: increased lung e,)ansion

After 3 days of

nursinginter4ention#

)atient as a.leto

a "emonstrateadeKuate

)erfusionsuch as 4italsigns of + 238!1o C< 7R 2

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La.oratoryresult

=emoglo.in2 119 gHLNormalrange 1352185 gHL=ematocrit 20!35 Normalrange 0!/020!5-R C Count 23! 5GNormalrange /!-029!10

R C

SE

7A++ER

N

cells carry o,ygento all )arts of your

.ody! ?hen your red .lood cell or hemoglo.incount is lo # )artsof your .ody donot get enougho,ygen to do their or(! +hiscondition is calledanemia and canma(e you feel4ery tired!Anemia is acondition in hichthe num.er of red

.lood cells or their o,ygen2carrying ca)acity

is insufficient tomeet )hysiologicneeds# hich 4ary

.y age# se,#altitude# smo(ing#and )regnancystatus! t is asym)tom of anunderlyingcondition# such asloss of .lood

edema! . ncrease

hemoglo.inle4el at normalrange

and ma,imi*e o,ygenationto cellular needs! Notecontraindicated if there ishy)otension!3 Monitor res)iratory

effort auscultation of .reath soundsad4entitious notice!

(: dys)nea# heart )ro.lems .ecause of the rush sho sold heart strain Hcom)ensatory increase incardiac out)ut!/ n4estigate com)laints

of chest )ain H )al)itations!

(: cellular ischemia affectsmyocardial tissue H )otentialris( of infarction!5 7ro4ide su))lemental

o,ygen as indicated!(: to ma,imi*e the trans)ortof o,ygen to tissues!9 Administer antimicro.ial

agents as ordered!(: to treat the infection andsu.seKuently decrease therelease of inflammatorymediators8 Administer 4aso)ressors

e!g! do)amine#

80 .)m< RR 21: c)m< 7 21-0H:0mm=g# freefrom )ainand a.senceof edema!

&OAL M T5 . ?asnt a.le

to securela.oratoryresult of hematology!

&OAL U#M T5

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com)onents#elementsinadeKuate or lac( of nutrientsneeded for theformation of thered .lood cells#resulting indecreased o,ygen2carrying ca)acityof .lood"oenges# 1GGG !

nore)ine)hrine and )ositi4e inotro)ic agents

e!g! do.utamine if ordered

(: to maintain adeKuate )erfusion )ressure andcardiac out)ut!: Eat green leafy

4egeta.les and coo(edred meat

(: to o.tain the iron# folicacid and 4itamins needed to

.uild and maintain red .loodcells!G Encourage to drin( a

glass of orange 'uice(: to hel) increase irona.sor)tion!10 Encourage to ta(e iron

ta.lets as )rescri.ed .y

the )hysician!(: to hel) raise red .loodcell count!

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Date6Time

"ues #eeds #ursingdiagnosis

Ob4ectives o- care #ursing interventions valuation

August--# -01/8 0023 00)m

Su.'ecti4e["ili 'ud na(o(aya itulona(oang gi(aon[as 4er.ali*ed!

.'ecti4e

2 /3 (g

2 ?ea(ness of musclesreKuired for s allo ing or mastication