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E.B. 55y/o Male Primary Diagnosis: Pancreatic Mass (Secondary…
E.B.
55y/o
Male
Primary Diagnosis:
Pancreatic Mass
Pathophysiology:
Osteosarcomas are primary malignant tumors of bone that are characterized by the production of osteoid or immature bone by the malignant cells, approximately 80% to 90% of patients with osteosarcoma developed metastatic disease. A distal pancreatectomy is the surgical removal of the body and tail of the pancreas to treat the metastic pancreatic mass
Secondary Diagnosis
Dysmetabolic Syndrome
Prediabetes
Severe protein calorie malnutrition
is a condition in which a group of risk factors for cardiovascular disease
and type 2 diabetes occur together
2.5% unintended weight loss in the past week
PO intake <50% over the past 5 days
Monitor blood glucose daily
Medical History
acid reflux
anemia
anxiety
Left amputation above the knee
Cellulitis of left leg (after amputation)
chronic renal insufficiency
hiatal hernia
hearing loss (w/ tinnitus)
hyperlipidemia
hypertension
kidney stones
neuropathy
osteosarcoma (treated with chemotherapy (2012-2013))
Family History
Maternal:
colorectal cancer, diabetes, hypertension, high cholesterol
Paternal:
heart disease, diabetes, hypertension
Surgical History
Left above the knee Amputation (2013)
colonoscopy w/ polypectemy (2016)
Portacath placement/removal
Thoracotomy (2015, 2016, 2018, 2019)
Use of prothesis when out of bed and walking
Treatment
Patient received a distal pancreatectomy , splenectomy, and subtotal colectomy to remove osteosarcoma metastases on 2/05/2020
Patient is NPO with a NG tube on low continuous suction for gastric content aspiration
Foley catheter (placed on 2/ for urinary retention
Taking 1 can of Impact AR nutritional supplement via NG tube
Medications administered through PICC line
Risk for infection r/t placement and use of a PICC
Maintain aseptic technique and monitor for signs of infection
Risk for ileus r/t immobility
Encourage walking around the hall and sitting in chair daily
Risk for malnutrition r/t NPO diet
Dietitian recommends TPN (2/12/2020) at rate 95 mL/hr
Risk for thrombosis formation related to surgery
Prophylaxis heparin administration
Promote mobility
Medications
Heparin 5,000 units subcut injection q 12 hrs
Metoprolol Tartrate 2.5 mg IV q 6 hrs
Ondansetron 8 mg IV q 8 hrs
Sodium Chloride 0.45% 100mL/hr continuous IV
Pantoprazole 40 mg IV BID
Potassium Chloride 40 mEq IV ONCE
Albumin 5% 25 mg IVPB q 6 hrs
PRN Mediations
Acetaminophen 1,000 mg PO PRN q 6 hrs
Maalox 30 mL PO PRn q 6 hrs
Hydromorphone 0.25-1 mg IV PRN q 2 hrs
Methocarbamol 1,000 mg POPRN q 6 hrs
Morphine 10 mg IV PRN q 2 hrs
Prochlorperazine 10 mg IV PRN q 6 hrs
-Promethazine 6.25 mg IV PRN q 6 hrs
Abnormal Labs
Low Hct (32.3) & Hgb (10.4) and trending down related to blood loss during and anemia diagnosis
Elevated WBC (trending down) related to the removal of the spleen and bodies respond to surgery
Elevated sodium levels related to chronic renal insufficiency
Low potassium levels (3.1) related to malnutrition
Elevated BUN and Creatinine related to chronic renal insufficiency
Elevated blood glucose levels related to prediabetes diagnosis
Diagnostic tests
CT of abdomen & pelvis w/o contrast (2/09/2020): Abdomen status post surgery
XR chest AP portable (2/05/2020): verify placement of Central Line (IJ)
XR chest AP portable (2/10/2020): verify placement of PICC
Blood and urine labs to assess kidney and liver function, perfusion and oxygenation and electrolyte imbalances
Assess for signs and symptoms of anemia; fatigue, weakness, pallor, headache
Monitor Kidney function
Continue to monitor daily electrolyte levels for nutritional deficiencies
Psycho/social
Lives in Montana with his wife and 4 kids
Works as a teacher