Congress Abstracts 2005

45

MANAGEMENT OF PATIENTS EXPERIENCING MALABSORPTION STATUS POST PANCREATIC RESECTION. Marie Riehl, RN, OCN^®, and Linda Schiech, RN, MSN, AOCN^®, Fox Chase Cancer Center, Philadelphia, PA.

Fat malabsorption in patients post pancreatic resection may lead to vitamin and essential fatty acid deficiency in addition to steatorrhea. Patients commonly complain of flatulence, diarrhea, steatorrhea and abdominal discomfort after eating following pancreatic resection and Whipple procedures. Teaching this population of oncology patients on the use of pancreatic enzymes and timing of enzyme administration with meals and snacks resduces symptoms and episodes of malabsorption.

Through patient education, symptom management and instruction of administration of pancreatic enzymes, malabsorption and increased nutritional status are addressed. Increasing the patients awareness of the use of pancreatic enzymes in prevention of malabsorption should increase nutritional status and prevent common gastrointestinal symptoms.

Patients presenting to the outpatient department for their initial post operative visits commonly complain of flatulence, diarrhea, steatorrhea and abdominal discomfort after eating. Reviewing patients medications and the timing of the oral intake of the enzymes showed a relationship to the symptoms they were reporting. Commonly patients took the enzymes prior to sitting down to have a meal. Patients were educated on the importance of taking their pancreatic enzymes with the food they were eating versus prior to that meal or snack. Patients were offered the suggestion of placing the enzymes around their plate in the relation to a clock. It was suggested to take the capsules at 12, 3, 6 and 9 o’clock. Follow up calls to these patients and follow up office visits allowed for assessment of the patients complaints and/or progress.

Continued follow up and education showed marked improvement in patients’ overall understanding and compliance. The patients report changes in diet and symptoms often resulting in the change in the amount of capsules taken with meals. Patients are encouraged to equally disperse the enzymes with fluids before, during and after the meal or snack. Patients reported it helpful to lay the capsules around their plate to remember to dispurse the capsules throughout the meal.

Through effective teaching and assessment of patients’ symptoms of malabsorption, we as nurses can intervene and instruct the patient and caregivers on administration of pancreatic enzymes. The number of capsules taken with meals and snacks should be estimated by assessing which dose minimizes steatorrhea, diarrhea, and flatulence while maintaining good nutritional status. Dosages should be adjusted according to the response of the patient.