Mr. Rashid, a 68-year-old man with metastatic pancreatic cancer, presents to your family medicine clinic with worsening abdominal pain, poor appetite, weight loss, and increasing fatigue for the last 2 weeks.
His daughter reports that he has been unable to sleep due to pain, is becoming more withdrawn, and has had two episodes of vomiting over the past 3 days.
He is currently on oral paracetamol q4h but says it “doesn’t help anymore.”
The family is struggling with how to care for him at home.
Key focused Assessment
1. Physical Examination
Neurological: mental status, confusion
Abdomen: tenderness, masses, ascites, bowel sounds
General: cachexia, hydration status, distress
Vital signs: temperature, HR, RR, BP
Skin: jaundice, pressure areas
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1. Symptom Management
Start opioid therapy:• Morphine (or equivalent) for moderate–severe cancer pain + breakthrough doses.
Adjuvants:• NSAID if tolerated, or dexamethasone for pain/appetite.• Antiemetics (metoclopramide/ondansetron).
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Consider causes: bowel obstruction, disease progression.
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