Week Five Flashcards
Pancreatic Cancer
Risk of developing pancreatic cancer increases with age, 2/3 are >65 years
* Slightly more men than women are affected by pancreatic cancer.
* Cigarette smoking is one of the biggest risk factors for 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
Confusion IS NOT a normal sign of ageing
Possible Causes for Patients Confusion?
DELIRIUM
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
What Assessments fo you need to perform?
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 Patient?
- 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
Confusion Assessment Method - CAM
Nine categories of questions
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 - what signs are unique to delirium?
Irritability
* Incoherent speech
* Visual hallucinations
* Changing levels of consciousness
Delirium: misdiagnosis, lack of recognition and discrimiantion
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. See
article here.
* Untreated, delirium can have devastating consequences in older patients
with high rates of morbidity and mortality
the three d’s
- delirium
- depression
- dementia
three types of delirium:
- hyperactive
- restless, agitated, and aggressive
- they may hallucinate and remove tubes or fall out of bed - hypoactive
- inactive, withdrawn, quiet and sleepy - mixed
- fluctuate between hypo and hyperactive symptoms
What medication is likely related to change in mental status?
morphine sulfate
- Drug induced delirium is most likely linked to benzodiazepines, opiates, antidepressants and anticonvulsants
How would you explain to family?
Explain that he is experiencing delirium, explain what delirium is
- Explain the symptoms: unable to think clearly, inattention, not fully aware of
environment
- Explain duration (a few hours to days)
- Usually only temporary and reversible if treated – treatment focuses on
cause of delirium and avoiding worsening delirium
Focus of Care
Promote respiratory function; treat infection and prevent injury
Outcome statement addressing patient’s risk for injury
For example:
- Return to previous functioning but consider impact of pancreatic cancer
- Remaining safe and injury free during delirious phase
- Safe and supportive discharge
Focus of ongoing assessment
- VS
- Resp and neurological status
- Repeated CAM
- Lab results esp WBC
