Pancreatectomy
In pancreatectomy, various resections, drainage procedures, and anastomoses may be used to treat pancreatic diseases in which more conservative techniques have failed. It’s indicated for palliative treatment of pancreatic cancer as well as chronic pancreatitis, which commonly stems from prolonged alcohol abuse. It’s also used to treat islet cell tumors (insulinomas).
The type of procedure used depends on the patient’s condition, the extent of the disease and its metastasis, and the amount of endocrine and exocrine function the pancreas retains. In many cases, the procedure is determined only after surgical exploration of the abdomen.
Procedure
After the patient is anesthetized, the surgeon makes an abdominal incision. He selects the procedure based on evaluation of the pancreas, liver, gallbladder, and common bile duct. If the disease is localized, he may resect a portion of the pancreas and the surrounding organs. If the surgeon detects either metastatic disease in the liver or lymph nodes or tumor invasion of the aorta or superior mesenteric artery, he may decide to bypass the obstruction to lessen the patient’s pain.
Complications
Major complications of pancreatectomy include hemorrhage (during and after surgery), fistulas, abscesses (common with distal pancreatectomy), common bile duct obstruction, and pseudocysts. Subtotal resection sometimes causes insulin dependence, whereas total pancreatectomy always causes permanent and complete insulin dependence.
Key nursing diagnoses and patient outcomes
Imbalanced nutrition: Less than body requirements related to malabsorption of nutrients caused by loss of digestive enzymes. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
receive an adequate nutritional intake with enteral feedings (or total parenteral nutrition when enteral feedings can’t be given)
show no signs of intolerance to enteral feedings, such as nausea and vomiting
have an adequate intake and output
not exhibit signs and symptoms of malnutrition.
Risk for injury related to potential coagulation abnormalities. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
exhibit normal coagulation studies
show no signs of bleeding from the incision site
maintain hemodynamic stability, as evidenced by stable vital signs, output that equals intake, and normal mental status.
Ineffective breathing pattern related to guarded respirations caused by abdominal incision. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:
maintain adequate ventilation and stable respiratory status
comply with measures to prevent respiratory complications, such as turning, coughing, and deep breathing every 2 to 4 hours and using an incentive spirometer correctly
not exhibit respiratory complications, such as pneumonia or atelectasis.
Nursing interventions
When preparing for or managing a patient with a pancreatectomy, expect to implement these nursing interventions.
Before surgery
Explain to the patient that the specific procedure will be selected by the surgeon during abdominal exploration. (See Understanding types of pancreatectomy, pages 654 and 655.)
Provide emotional support and encourage the patient to express his feelings.
Give analgesics as ordered.
Arrange for necessary diagnostic studies, as ordered, to help the surgeon determine the existing endocrine and exocrine structure of the pancreas and any anatomic anomalies.
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