Week 5 Flashcards
Pancreatic Cancer at risk age group
Over 65
Other risk factors for Pancreatic Cancer
- Slightly more men than women are affected by pancreatic cancer.
- Cigarette smoking is one of the biggest risk factors for pancreatic cancer.
Detection and 5 year survival rate of Pancreatic Cancer
- Pancreatic cancer is seldom detected in the early, most curable stages, because it doesn’t
cause symptoms until it has spread to other organs. - Combined five-year survival rate for pancreatic cancer—is very low at just 5 to 10 percent.
Whipple procedure
- Primary surgical treatment for pancreatic cancer that occurs within the head of the gland.
- Removal of the head of the pancreas, most of the duodenum (a part of the small intestine), a
portion of the bile duct, the gallbladder and associated lymph nodes. - On average, the surgery takes six hours to complete.
- Most patients stay in the hospital for one to two weeks following the Whipple procedure
What are the main reasons/ underlying causes for confusion
in older people?
- Infection
- Hypoglycaemia
- Side effects of drugs
- Untreated pain
- Dehydration
- Hypoxia
- Anxiety, depression, psychosis
- Delirium
- Underlying pathophysiology: dementia
Is confusion a normal sign of ageing
no
Possible causes for your patient’s confusion?
Dehydration
Electrolyte imbalance – emotional stress
Lung, liver, heart, kidney, brain disorders
Infection, especially UTI, pneumonia, sepsis
Rx* drugs
Immobility
Untreated pain, unfamiliar environment
Metabolic disorders
DELIRIUM
What assessments do you need to perform for delirium
Comprehensive assessment: FANCAPES or similar
Full physical assessment
Vital signs and oximetry; lab results
Specific assessments:
Medications, mental and neurologic status
How should you respond to your patient with delirium?
- Calm and reassuring voice
- Reorient to time and place and surrounding environment (incl people in the
room) - Tell him that you are not experiencing the hallucination with his right now
(recognition that it is a hallucination not reality) - Ask how the hallucination is affecting him (validating his experience)
- Consider interventions that might be calming (music, or massage, sensory
box) but remember patient centred-ness
How would you document his report of what he is seeing?
Hallucinations (seeing/hearing/ feelings things that are not there)
Confusion Assessment Method - CAM (four features)
Four features for diagnostic algorithm:
Feature 1: Acute Onset and Fluctuating Course
Feature 2: Inattention
Feature 3: Disorganized Thinking
Feature 4: Altered Level of Consciousness
1+2 and either 3 or 4 are considered a diagnosis of delirium until proved
otherwise
Other symptoms of delirium
- disorganised thinking
- poor executive functioning
- disorientation
- anxiety
- agitation
- poor recall
- delusional thinking
Compared to dementia which are the signs unique to delirium?
- Irritability
- Incoherent speech
- Visual hallucinations
- Changing levels of consciousness
Delirium: misdiagnosis, lack of recognition and discrimination
- Frequently unrecognized or misdiagnosed in up to 70% of older patients.
- Often misdiagnosed as mood disorder or dementia
- Particular groups of people face additional delayed diagnosis and
misdiagnosis as a result of discrimination and systemic racism - The term “excited delirium” often used as a reason by police to restrain
racialized groups and reported as cause of death in police custody.
Three types of delirium
Hyperactive, hypoactive, mixed
