PRESENTATION
LYCEUM OF THE PHILIPPINES UNIVERSITY- BATANGAS
Capitol Site, Batangas City
PANCREATIC PSEUDOCYST
Prepared By:
Submitted to:
Dra. Annabelle Iturralde
INTRODUCTION
Pseudocyts is applied to a collection of fluid that arises from loculation of
inflammatory processes, necroses or hemorrhages. This type represents the
overwhelming majority of clinically important cyst and is almost always
associated with pancreatitis. Pseudocyts may also follow traumatic injury to
the abdomen with direct damage and hemorrhage in the pancreas. Acute
pancreatitis or trauma precedes the clinical discovery of a pseudocyst in nine
of ten cases.
These cyst are usually solitary and most measure 5-10 cm in diameter.
They may be situated with in the pancreatic substance, but more often they
are found adjacent to the pancreas, particularly in the region of the tail of the
pancreas. The cyst walls may be thin or thick and fibrous. Characteristically,
they do not have an epithelial lining and have no connection of
communication with surrounding ductal systems. There may have a marked
inflammatory reaction in the fibrous capsule and often organizing blood clot,
old blood pigment, precipitates of calcium and cholesterol crystals. The cyst
fluid is usually serons and turbid .
Pseudocyst produce abdominal pair and intraperitoneal
hemorrhage and if infected, may cause generalized peritonitis.
However, their clinical significance lies in their being discovered as
an abdominal mass in a location that strongly suggest a primary intra
abdominal malignancy. The diagnosis is made by ultrasonography or
CT sacnning with the ultrasound, pseudocysts are evident as
sonolucent areas with re;atively smooth, well outlines. They are
usually unilocular, multi-loculation suggests a neoplastic cyst. CT
scanning adds specificity by ultrasound in this settting.
1)The patient condition. State the patient profile, past medical history,
personal, social, and family as well as history of present illness.
2) Asses the physical appearance of the patient and the recognizes
the clinical manifestations of the disease.
3) Identify, interpret and understand laboratory examination and
diagnostic tests indicated and its significant finding.
4) Understand the anatomical parts and explain the nature and
identify the cause, disease process and manifestation of the disease.
5)Utilize the nursing process in the delivery of cared based in the
clients needs and concerns.
6) Enumerate and analyze the drugs that have been administered to
the patient.
7) Provide information on the prognosis and discharged planning
intended to the patient condition.
PATIENT’S
PROFILE
• NAME: Child X
• AGE: 16 years old
• SEX: Female
• DATE OF BIRTH: January 19, 1992
• CIVIL STATUS: Teen
• ADDRESS: Brgy. Look Balete Batangas
• NATIONALITY: Filipino
• RELIGION: Roman Catholic
• DATE OF ADMISSION: December 5, 2008
• PHYSICIAN: Dr. Arellano,Dr. Gonzales and Dr. Reyes
• CHIEF COMPLAINT: Abdominal pain
• ADMITTING DIAGNOSIS. Pancreatic Pseudocyst s/s explore by acute
hemorrhologic pancreatitis.
• FINAL DIAGNOSIS: Pancreatic Pseudocyst
CLINICAL
APPRAISAL
A. Past Health History
B. Family History
Her father is a security guard and her mother is a plain housewife. She
has 2 brothers and 3 sisters. They have a history of disease hypertension,
hypotension and cancer of the bone in mother side.
C. Personal History
D. Social History
Their house are made of cement and woods. They have only four
neighbors. They welcomed all persons on their house especially their
relatives. They believe in “anting-anting” for them to have a healthy
life.
E. Psychological History
The vital sign was taken, temperature 36.1, 36.6, 36.1, blood
pressure 90/70, 100/70, 100/60, pulse rate 74, 76, 69, respiratory
rate 25, 27, 25 and her height is 153 and weight is 24.8 kg.
PHYSICAL
ASSESSMENT
BODY PARTS METHOD FINDINGS ANALYSIS
Eyes
Report
Both kidneys are normal in size and echopattern. The right kidney
measures 7.1x2.3 cm
withcortical thickness of 0.78 cm, while the left kidney measures 10.6x4.5
cm with cortical
thickness of 1.7 cm. No stone mass or hydronephrosis seen.
Uterus is anteverted normal in size measuring 4.7 x 2.2 cm.
Myocardial echopattern is
homogenous. No focal mass is seen. Endometrial lining is not thickened
and measures 0.7 cm.
The abdominal aorta is not dilated and measures 0.76 cm in its
widest diameter.
Urinary bladder is well distended it’s wall is not thickened. There is no
stone or mass seen.
There is a well defined cystic structure at the left adnexa which
measures 3.8x3.0x3.o cm. Leveling fluid and hyperechoic structure is
seen with in the cyst probably fat fluid density.
IMPRESSION
Two anechoic structures detected at upper mid abdomen intimate to
the anterioir surface of the pancreas. This may relate to pseudocyst
of the pancreas, differential diagnosis is marked distended stomach
and duodenum bulb. Correlation with abdominal CT scan with oral
contrast is suggested.
SURGICAL PATHOLOGY REPORT
Gross description:
Received two specimen
A. The labeled “omentum” consists of a yellow fragment of
fibroadipose tissue measuring 4.5x3x1 cm. There is a few cream
while nodules at the surface cut sections show yellow doughy
surface.
Block 5(2)
Chemistry
Remarks
Troponon I: Hba/C (N.V. 4.5-6.3 %) Typhidot H. Pylori
SUMMARY
OF THE
LABORATORY
RESULT
As the laboratory exam has been released I found some
abnormalities in the blood. The neutrophil was decreased that may
caused a folic deficiency. The eosinophil indicates eosinophilia and
the basophil is decreased indicates anemia plastic. The lymphocytes
indicates lymphopenia.
The first step in the digestive system can actually begin before the
food is even in your mouth. When you smell or see something that you just
have to eat, you start to salivate in anticipation of eating, thus beginning
the digestive process. Food is the body's source of fuel. Nutrients in food
give the body's cells the energy they need to operate. Before food can be
used it has to be broken down into tiny little pieces so it can be absorbed
and used by the body. In humans, proteins need to be broken down into
amino acids, starches into sugars, and fats into fatty acids
and glycerol.
Pancreas
The pancreas is located posterior to the stomach and in close
association with the duodenum. The pancreas is a 6-10 inch elongated
organ in the abdomen located retro peritoneal. It is often described as
having three regions: a head, body and tail. The pancreatic head abuts the
second part of the duodenum while the tail extends towards the spleen.
The pancreatic duct runs the length of the pancreas and empties into the
second part of the duodenum at the ampulla of Vater. The common bile
duct commonly joins the pancreatic duct at or near the point.
The pancreas is near the liver, and is the main source of enzymes for
digesting fats (lipids) and proteins - the intestinal walls have enzymes
that will digest polysaccharides. Pancreatic secretions from ductal cells
contain bicarbonate ions and are alkaline in order to neutralize the acidic
chyme that the stomach churns out. Control of the exocrine function of
the pancreas are via the hormone gastrin, cholecystokinin and secretin,
which are hormones secreted by cells in the stomach and duodenum, in
response to distension and/or food and which causes secretion of
pancreatic juice.
DIGESTIVE SYSTEM
Variations in Embryology of pancreas Arterial supply to the pancreas
portal And duct variation.
Venous antomy.
Venous drainage Lymphatic supply to the Innervation of the pancreas
From the pancreas pancreas
PATHOPHYSIOLOGY
PANCREATIC PSEUDOCYST
Inflammation of edema
Fat necrosis
Objective:
>facial grimace connotes pain
P-lying & sitting position
Q-stabbing pain
R-left hypochondriac region
S-6 scale
T-constant
SCIENTIFIC EXPLANATION PLANNING
>Due to mass in the abdomen, the patient may experience, >After 1hr of nursing intervention,
severe pain and discomfort even with minimal the clients level of pain will be
movement. minimized.
Pseudocyst and abscesses in & around the pancreas
may occur as a result of localized necrosis, & may exert
pressure on the stomach or colon.
Medical-Surgical Nursing Brunner and Suddarath’s 6th
edition
INTERVENTION RATIONALE EVALUATION
>Obtained pain history from >Pain is specific to each individual and >The client’s level
patient/ family and patient’s each person has their own coping of pain is
ability to handle pain. strategies to deal with their comfort. minimized as
>Assessed patient for pain >Helps to establish plan of care and evidenced by
level. shows concern for the patient. pain scale
>Instructed patient to report >Efficiency of comfort measures and decreases 2/6.
pain as it develops rather medication is improved with timely
than visualization level is intervention.
severe.
>Encouraged verbalization of >Can reduce anxiety and for there by
feeling. reduce perception of intensity of pain.
>Determined the location, >Information provides baseline data and
frequency , duration and evaluate needed for effectiveness of
intensity of pain. intervention.
>Encouraged to use of >Enables client to participate actively in
relaxation techniques like non-drug treatment of pain and
deep breathing exercise. enhances sense of control.
>Performed palliative >May relieve pain and enhance
measures (e.g. circulation.
repositioning)
INTERVENTION RATIONALE
Ojective:
>restless
>irritable
>unsuccessful social interaction behavior
SCIENTIFIC EXPLANATION PLANNING
It is always a factor that trigger the mood of a person. After 2 hours of nursing intervention the
patient will be able to cope with her
present condition.
INTERVENTION RATIONALE EVALUATION
>Conveyed attitude of acceptance and >To avoid threatening client’s self-concept, preserve
respect. existing self-esteem.
>Encouraged control in all situation >To preserve autonomy.
possible, include client in decision
and planning.
>Instructed family to assist with >Involves family in care. Patient may be more trusting
reorientation as needed. of family members.
>Encouraged client to learn relaxation
techniques, use guided imagery an >In order to incorporate and practice new behavior.
positive affirmation of self.
NANDA
Objective:
>happy
>calm
>relax
>sitting comfortably
SCIENTIFIC EXPLANATION PLANNING
Acceptance of the condition may help for fast After 2 hours of nursing intervention the
recovery patient will verbalized the understanding
of own sense of self-concept.
INTERVENTION RATIONALE EVALUATION
O
Encouraged to have a follow-up check-up after one week to
Dr. Arellano, Dr. Gonzales and Dr. Reyes.
D
Advised the patient to eat foods rich in protein ,
carbohydrates and calcium. Avoid eating sour and salty
foods. Avoid also too much soft drinks and increase fluid
intake.
S
Advised whole family to keep their faith in GOD and never
forget to ask guidance and support from our Lord.
ACKNOWLEDGEMENT
I would like to extend my heartfelt thanks to the following people
that with their presence, the accomplishment of this case study and
presentation will not be possible.
To the Almighty One for giving me the strength, knowledge and
power.
To my parents and friend for continuously supporting me
financially and emotionally.
I. Assessment
II. Nursing diagnosis
III. Planning
IV. Implementation
V. Evaluation
ASSESSMENT
ASSESSMENT
Subjective-Client Interview
• Interview the client
• An interview is an organized conversation with the clients to obtain
the client’s health history and information about the current illness
Phases of the interview-orientation, working, and termination
• Schedule interviews around interruptions if possible, and in a
conducive atmosphere
• Use open-ended questions, back channeling, problem seeking
interview techniques, and close ended questions for symptom
clarification
Nursing Health History
• Biographical Information
• Reason for Seeking Health Care
• Client Expectations
• Present Illness or Health Concerns
• Health History
• Family History
• Environmental History
• Psychosocial History
• Spiritual Health
• Review of Systems
PHYSICAL EXAM
• Vital signs are taken
• Other objective measurements are taken
• (ht, wt, VS, general survey)
Planning
• Short term goal: an objective that is expected to be achieved within
a short time frame, usually less than a week
• Long term goal: an objective that is expected to be achieved over a
longer time frame, usually over weeks or months
• Expected outcome: specific measurable change in a client’s status
that is expected to occur in response to nursing care
GUIDELINES FOR WRITING GOALS
• Client centered
• Singular goal or outcome
• Observable
• Measurable
• Time-limited
• Mutual factors
• Realistic
NURSING
INTERVENTION
INTERVENTION
• Nursing students learn to write and use a nursing care plan as part
of their education
• By using a nursing care plan, students can apply the knowledge
gained from nursing and medical literature and the classroom to a
practice situation
• The nurse enters a scientific rationale for a specific intervention
• Scientific rationale: the reason that, based on supporting literature,
a specific nursing action was chosen
THANK YOU MAM
GOD BLESS