Documentation Guidelines

• Response to the diagnosis of pancreatic cancer, the diagnostic tests, and recommended treatment regimen

• Description of all dressings, wounds, and drainage collection devices: Location of drain, color and amount of drainage, appearance of incision, color and amount of GI drainage

• Physical findings related to the pulmonary assessment, abdominal assessment, presence of edema, and condition of extremities

• Response to pain medications, oral intake, and activity regimen

• Presence of complications: Hemorrhage, infection, pulmonary congestion, activity intolerance, unrelieved discomfort, absence of return of bowel sounds and function, decrease in urinary output

• Bowel pattern: Presence of constipation, diarrhea, steatorrhea

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