Disorders in the

Pancreas and Ovaries

Presented by Group 3
Pancreas
Anatomy
• Elongated and tapered organ
• Pale grey gland weighing about 60
grams about 12-15 cm long
• Situated in the epigastric and left
hypochondriac region
Parts
• Head - widest part of the organ;
lies in the curve of duodenum
• Body - the tapered left side
extends slightly upward that
lies behind the stomach
• Tail - narrowed end part that
lies in front of the kidney and
just reaches the spleen
Physiology
Endocrine Functions:
- Islet of Langerhans
- Alpha cells: Glucagon (20%)
- Beta cells: Insulin (75%)
Exocrine Functions:
- amylase
- protease
- lipase
 - Known as “lifestyle” diabetes.

Diabetes - The body does not produce enough insulin or

the cells ignore the insulin that is produced.

Mellitus - Insulin is required by the body in order to use

sugar.
- Insulin takes the sugar from the blood into the
Type II cells.
- When glucose builds up in the blood instead
of going into cells, it can cause some
problems.
Diabetes - 3 cardinal signs of
- Polyuria (huge urine output)

Mellitus - Polydipsia (excessive thirst)

- Polyphagia (excessive hunger and food

Type II consumption)
SYSTEMIC EFFECTS
INTEGUMENTARY CARDIOVASCULAR CNS REPRODUCTIVE
- Alopecia - Hypertension - Tremor - Gential Dysfunction
- Dry skin - Chest pain - Memory Loss - Impotence
- Bristle - Palpitations - Decrease in sensation - Loss of libido
- Cold clammy skin - Headache - Vaginitis
- Sweating - Peripheral Neuropathy - Amenorrhea
- Gangrenous feet
GENITO-URINARY GASTRO-INTESTINAL EENT RESPIRATORY MUSCULOSKELETAL
- Polyuria - Polyphagia - Poor eyesight - Kussmaul Breathing - Body weakness
- Nocturia - Polydipsia - Cataract - Acetone Breathing - Body ache
- Dysuria - N/V - Glaucoma - Fruity smell
- Hesitancy - Loss of body weight
- UTI
 Conditions that can arise:

● Hypoglycemia

● Hyperglycemia
 HYPOGLYCEMIA
● low blood glucose (sugar)
● below 70 mg/dl
 TREATMENT OF HYPOGLYCEMIA
● The quickest way to raise blood glucose or treat hypoglycemia is with
some form of sugar, such as:
■ 3 glucose tablets
■ ½ cup of fruit juice
■ 5-6 pieces of hard candy
● Once you have checked your blood glucose and treated the
hypoglycemia, wait 15 to 20 minutes and then recheck your blood
again.
● If your blood sugar is still low and symptoms of hypoglycemia
haven’t went away, repeat treatment.
 TREATMENT OF HYPOGLYCEMIA
● If you pass out from hypoglycemia, people should:

○ NOT inject insulin

○ NOT give you food or fluids

○ Inject glucagon

○ Call for emergency help

 HYPERGLYCEMIA
- high blood glucose
- the body has too little or not
enough insulin; when the
body can not use insulin
properly
 HYPERGLYCEMIA
Factors:
- Eating more than planned
- Exercising less than planned
- The stress of an illness, such as a cold
or flu
- Other stresses, such as family conflicts
or dating problems
 SYMPTOMS OF HYPERGLYCEMIA
● Ketoacidosis occurs when the body
doesn’t have enough insulin. Without
insulin, the body can’t use glucose for
fuel, so it is left breaking down fats for
energy.
SYMPTOMS:
○ SOB
○ breath that smells fruity
○ n/v
○ very dry mouth
 TREATMENT OF HYPERGLYCEMIA
- Exercise is often effective in lowering blood glucose
levels.
- However, if your blood glucose is above 240 mg/dl,
check your urine for ketones.
- If they are present, do NOT exercise.
- This can actually lead to higher blood glucose
levels than prior to beginning the exercise.
- You will need to work with your doctor on finding
the best way to lower your blood glucose level.
LABORATORY EXAMINATIONS
HBA1C,
FASTING BLOOD GLUCOSE,
LIPID PROFILE,
MICROALBUMINURIA TEST,
SERUM CREATININE LEVEL,
URINALYSIS
ECG
 DIABETES MEDICATIONS
1. SULFONYLUREAS
- It stimulates the beta cells of the pancreas to release
insulin
- Sulfonylureas are oral medications that help lower
blood sugar (glucose) levels in people living with Type
2 diabetes.
- i.e., Amaryl (glimepiride)
- Taken 1 to 2 times a day, before meals
 DIABETES MEDICATIONS
2. BIGUANIDES
- Lower blood glucose by decreasing amount of glucose
made
- helps to lower blood glucose levels by making muscle
tissue more sensitive to insulin so that glucose can be
absorbed.
- i.e., Metformin (Glucophage)
- Usually taken 2 times a day
NURSING DIAGNOSIS, GOALS, AND INTERVENTIONS
1. Risk for Unstable Blood Glucose Level as evidenced by inadequate blood glucose monitoring
and inability to follow diabetes management
Goal: Normalize insulin activity and blood glucose levels to prevent or reduce the development of
complications that are neuropathic and vascular in nature
Interventions:

Teach the patient how to perform home glucose monitoring.

Stress the importance of achieving blood glucose control.
Explain the importance of weight loss to obese patients with diabetes.
 NURSING DIAGNOSIS
2. Deficient Knowledge related to unfamiliarity with information, lack of recall, or misinterpretation.

GOAL: Providing complete information and proper education to patients with diabetes can dramatically increase

adherence to the treatment regimen.

INTERVENTIONS:

1. Explain that insulin dosages may need to be adjusted.

2. Explain the importance of inserting the needle perpendicular to the skin.

3. Teach the patient to follow a low in simple sugars, low in fat, and high in fiber and whole grains.

4. Teach the patient and/or SO to recognize the signs and symptoms

 NURSING DIAGNOSIS
3. Imbalanced Nutrition: Less Than Body Requirements

Desired Outcomes
Ingest appropriate amounts of calories/nutrients.

Display usual energy level.

Demonstrate stabilized weight or gain toward usual/desired range with normal laboratory values.

INTERVENTIONS

Educate the patient on the dangers of consumption of alcohol with diabetes mellitus

Provide liquids containing nutrients and electrolytes as soon as the patient can tolerate oral fluids, then progress to a portion of

more solid food as tolerated.

Include SO in meal planning as indicated.

Administer other medications as indicated

 ● occurs when changes (mutations) in the pancreas cells
lead them to multiply out of control.

PANCREATIC
CANCER
The Stages of Pancreatic Cancer
 MEDICATION
Gemcitabine

The recommended dose of Gemcitabine is 1000 mg/m² over 30 minutes

intravenously. The recommended treatment schedule is as follows:

Weeks 1-8: weekly dosing for the first 7 weeks followed by one week
rest.

After week 8: weekly dosing on Days 1, 8, and 15 of 28-day cycles.

Contraindications
Indications
Gemcitabine Injection is
Gemcitabine is indicated as first-line treatment for patients with locally contraindicated in patients with a
advanced (nonresectable Stage II or Stage III) or metastatic (Stage IV) known hypersensitivity to
adenocarcinoma of the pancreas. gemcitabine.
5-Fluorouracil
The recommended dose of 5-Fluorouracil is 400 mg/m² IVP on
Day 1, followed by 2400 mg/m² IV as a continuous infusion over
46 hr q2Weeks.
Indications

5-Fluorouracil (5-FU) is one of the standard chemotherapy drugs

used to treat pancreatic cancer. However, treatment only extends
survival modestly, and disease recurrence is typical due to drug
resistance.
Contraindications
Fluorouracil, 5-FU is contraindicated in patients with known
hypersensitivity to the drug, or any product components.
Nursing Diagnosis:

Situational Low Self-Esteem related to painful surgeries, chemotherapy or radiation treatment side
effects, exhaustion, intractable pain, death threat, worry, and anxiety secondary to pancreatic cancer as
evidenced by verbalization of lifestyle change, obsession with change or loss, and failure to accept
responsibility for self-care.

Desired Outcomes:

● The patient will explain how his/her body is changing.

● The patient will begin developing coping techniques to deal with difficulties.
● The patient will demonstrate adaptation to changes or events by setting achievable objectives and
actively participating in work, activities, or personal relationships as necessary.
Pancreatic Cancer Nursing Interventions
● Encourage the patient to express their worries
regarding the effects of pancreatic cancer and
treatments on their roles as homemakers, wage
workers, or parents.
● If the patient allows it, use touch throughout
interactions and maintain eye contact.
● Examine the relevant support networks for the
patient and the significant other.
● Talk with the patient and significant other about
how the diagnosis and therapy affect the patient’s
personal life, household, and work activities.
● During the diagnostic and therapeutic phases,
provide emotional support to the patient and
significant other.
● Recognize any issues the patient may be having.
Inform them that counseling is frequently required
and essential in the adjustment stage.
● Examine the potential side effects of a specific
treatment, such as impacts on sexual activity and
feelings of attractiveness and desire. Inform the
patient that not all side effects will occur and that
others can be avoided or controlled.
Nursing Diagnosis:

Acute Pain related to the illness process, as well as the unwanted outcomes of different cancer therapy
methods secondary to pancreatic cancer as evidenced by complaints of pain, changes in muscular
tone, pain masking on the face, distracted behaviors, and restlessness.

Desired Outcomes:

● The patient will report maximum pain relief/control with minimum impairment with activities of
daily living (ADLs).
● The patient will adhere to the pharmaceutical regimen suggested.
● The patient will use relaxation strategies and diversional activities as directed for the unique
situation
Pancreatic Cancer Nursing Interventions

● Determine the patient’s pain history (pain

● Evaluate the patient and be mindful of any
location, frequency, duration, and intensity
uncomfortable side effects of specific treatments
using a numeric rating scale (0-10 scale) or a
such as surgery, radiation, chemotherapy, or
verbal rating scale (“no pain” to “excruciating
biotherapy.
pain”),
● Encourage the use of stress management strategies
● When taking around-the-clock agents, whether
or alternative therapies, including relaxation,
oral, IV, or patch drugs, determine the onset or
visualization, and guided imagery.
precipitants of “breakthrough” pain.

● Provide non pharmacological comfort

treatments (massage, repositioning, backrub)
and diversional activities to the patient.
Nursing Diagnosis:
Risk for Deficient Volume related to excessive losses by regular routes (vomiting or diarrhea) or
pathological routes (indwelling tubes or wounds), hypermetabolic condition, and decreased fluid
intake secondary to pancreatic cancer.

Desired Outcome: The patient will exhibit stable vital signs, moist mucous membranes, excellent
skin turgor, fast capillary refill, and adequate urine output.
Pancreatic Cancer Nursing Interventions

● Keep track of the patient’s intake and output. ● Thoroughly monitor the patient’s vital signs.
Include all output sources such as emesis, Evaluate the patient’s capillary refill and peripheral
diarrhea, and bleeding wounds. pulses.

● Examine the patient’s skin turgor and mucous ● Weigh the patient regularly.
membrane hydration. Take note of the patient’s
reports of thirst.

● Provide the pancreatic cancer patient with IV

fluids as needed.
DISORDERS IN THE OVARIES
 - Ovaries produce an abnormal amount of androgens
- numerous small cysts (fluid-filled sacs)
- can cause missed or irregular menstrual periods,
POLYCYSTIC excess hair growth, acne, infertility, and weight gain.
- Higher risk for type 2 diabetes, high blood pressure,
OVARY heart problems, and endometrial cancer.
- The types of treatment for PCOS may depend on
SYNDROME whether or not a woman plans to become pregnant.

(PCOS)
 SIGNS AND SYMPTOMS
- Missed periods, irregular periods, or very light periods
- Ovaries that are large or have many cysts
-
-
Excess body hair, including the chest, stomach, and back (hirsutism)
Weight gain POLYCYSTIC
- Acne or oily skin
-
-
Male-pattern baldness or thinning hair
Infertility
OVARY
-
-
Small pieces of excess skin on the neck or armpits (skin tags)
Dark or thick skin patches on the back of the neck, in the armpits,
and under the breasts
SYNDROME
(PCOS)
 DIAGNOSIS

POLYCYSTIC - Disturbed body image related to changes in physical

appearance as evidenced by refusal to verify actual
OVARY change/loss
- Risk for ineffective childbearing process related to

SYNDROME hormonal dysfunction as evidenced by irregular

menstruation
- Ready for enhance health management
(PCOS)
 PCOS MANAGEMENT
GENERAL MODIFICATION: MEDICAL MANAGEMENT:
Lifestyle modification Prescribed drug to treat PCOS

DIET & EXERCISE: SURGICAL MANAGEMENT:

500-1000 calorie deficit Laparoscopic Ovarian Drilling
MEDICATION
CLOMIPHENE ( clomid )
Mechanism of action:
- it helpful for the induction of ovulation.
- this oral anti-estrogen medication is taken during the
first part of menstrual cycle.

Dose: 50 to 100 mg per day

Adverse effects:
- Multiple pregnancy/ovarian hyperstimulation,
thromboembolism, visual disturbances
MEDICATION
METFORMIN (Glucophage, Fortamet, )
- Oral medication for type 2 diabetes improves insulin
resistance and lowers insulin levels.
- If women have prediabetes, metformin can also slow the
progression to type 2 diabetes and help with weight loss
- it can improves menstrual irregularities (e.g.,
oligomenorrhea).
-
Starting dose: 500 mg given orally twice a day
Target dose: 1500-1800 mg/day

Adverse effects:
- Dairrhoea, Nausea, Vomiting, Flatulence, Indigestion,
Abdominal discomfort.
INTERVENTION
1. Provide rapport with the patient.
2. Monitor vital signs.
3. Provide therapeutic environment.
4. Encourage verbalization of feelings.
5. Encourage to do diversional activities.
6. Encourage rest and sleep.
7. Provide for individualized physical .
ENDOMETRIOSIS

- Endometriosis is a condition where tissue

similar to the lining of your uterus grows on other
parts of your body.
- Endometrium is the inner lining of your uterus.
- This tissue is what you shed during a menstrual
period
- Major cause of chronic pain and Infertility
SIGNS AND SYMPTOMS

- Dysmenorrhea
- Pelvic pain
- Pain during intercourse
- Pain during urination or bowel
movements
- Too much bleeding
- Infertility
PATHOPHYSIOLOGY
MEDICATION
Hormone Birth Control

- Birth control pills, patches, and vaginal rings

- Include both estrogen and progestin.
- Progestin-only contraceptives. These include pills,
shots, and an IUD (intrauterine device). These
medicines can cut down on pain, as most women
don’t have a period while taking these medicines, or
at least have fewer periods.
MEDICATION
Gonadotropin-Releasing Hormone (GnRH) Analogues
- Gonadotropin-releasing hormone (GnRH) analogs
include GnRH "agonists" and GnRH "antagonists."
- Both types of medication cause the ovaries to
temporarily stop producing estrogen. This causes the
endometriosis tissue to shrink.
- GnRH Agonists:
Nafarelin (Synarel)
○ Leuprolide (Lupron)
○ Goserelin (Zoladex)
- GnRH Antagonists:
○ Elagolix (Orilissa)
 SURGICAL MANAGEMENT
● Hysterectomy
major surgery with permanent effects, and it's
not always a cure — the condition and related
pain can return.

● Laparoscopy
Laparoscopy is less invasive than open surgery
(in which a larger incision is made in the
abdomen) and is often associated with a
shorter recovery time

● Laser therapy
Another option made possible by laparoscopy.