J.C is an 82-year-old white man who was evaluated by GI specialist due to abdominal discomfort, loss of appetite, weight lost, weakness and occasional nausea.

Past Medical History (PMH):

Patient is Diabetic, controlled with Metformin 500 mg by mouth twice a day, Lantus 15 units SC bedtime. Hypertensive, controlled with Olmesartan 20 mg by mouth once a day. Atrial Fibrillation, controlled with Rivaroxaban 15 mg by mouth once a day and bisoprolol 10 mg by mouth once a day.

Labs:
Hb 12.7 g/dl; Hct 38.8% WBC 8.2; Glycemia 74mg/dl; Creatinine 0.8 mg/dl; BUN 9.8 mg/dl; AST 21 U/L ALT 17 U/L; Bil T 1.90 mg/dl; Ind 0.69 mg/dl; Dir 1.21 mg/dl.

Diagnostic test:

Endoscopic Ultrasound of the Pancreas. Solid mass in the head of pancreas 4 cms, infiltrating Wirsung duct. The solid mass impress to infiltrate the superior mesenteric vein. Perilesional node is detected, 1.5 cms, metastatic aspect. Fine needle aspiration (FNA) biopsy: Ductal adenocarcinoma.

Case study questions:

One paragraph per question. Total six questions, six paragraphs

1. Describe the potential most common sites for metastasis on J.C and (One paragraph):

a. why?

2. Describe the tumor cell markers and (One paragraph):

a. Why tumor cell markers are ordered for a patient with pancreatic cancer?

3. Classify the tumor based on the TNM Stage classification based on the case study described, and (One paragraph):

a. Why this classification important?

4. Describe characteristics of malignant tumors regarding it (One paragraph):

a.Cells

b. Growth

c. Ability to spread.

5. Describe the carcinogenesis phase when a tumor metastasized  (One paragraph) .

6. Select and describe the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle, or Neural  (One paragraph). 

Part 2: Nursing role transition

 Three paragraphs per question. Total two questions, six paragraphs

1. Describe three barriers that have slowed down the progress of advanced practice nursing (One paragraph per each barrier- Total of six paragraphs)

 2. Describe one strategy for each barrier to help overcome these limits (Three paragraph per each startegy- Total six paragraphs)

Part 3: Psychology

 One paragraph per question. Total three questions, three paragraphs

1. According to psychology, what is a Crisis Intervention and (One paragraph):

a. Describe the types of Crisis

2. Describe the nurse's Interventions during the crisis  (One paragraph).  

3. Name and describe all types of Therapy for Care  (One paragraph).