The pancreas, a flat, pear-shaped gland that is part of the digestive system, is located behind the lower part of the stomach and surrounded by the liver, small intestines, gallbladder, and spleen. It is composed of endocrine cells that secrete hormones like insulin and exocrine cells that secrete enzymes to aid in digestion.
Pancreatic cancer develops in the pancreatic tissues. Most pancreatic tumors are adenocarcinomas that develop in the epithelium of the ductal system. The common bile duct becomes obstructed as the tumor grows and develops, resulting in obstructive jaundice. If the tumor develops in the body or the tail of the pancreas, symptoms may manifest after the tumor growth has already advanced.
Pancreatic cancer often does not produce symptoms until it spreads to other organs. This delay in detection often results in a poor prognosis.
The signs and symptoms of pancreatic cancer are the same as chronic pancreatitis and may include the following:
- Abdominal pain radiating to the back
- Loss of appetite
- Unintentional weight loss
- Jaundice
- Dark-colored urine
- Light-colored stools
- Itchy skin
- Fatigue
Abdominal ultrasound, endoscopic ultrasound, CT scan, MRI and biopsy, and magnetic resonance cholangiopancreatography (MRCP) are often used to diagnose pancreatic cancer.
Nursing Process
Surgery is the most effective treatment for pancreatic cancer. However, only about 20% of patients have resectable tumors at the time of diagnosis. With neoadjuvant chemotherapy, more patients with pancreatic cancer become surgical candidates. If the cancer has metastasized and surgery is not possible, palliative measures like radiation therapy, cholecystojejunostomy, or endoscopically placed biliary stents are indicated.
Nurses provide symptomatic and supportive care to patients diagnosed with pancreatic cancer with interventions like administering medications, providing comfort measures, offering psychological support, ensuring adequate nutrition, and providing patient education and resources.
Nursing Care Plans Related to Pancreatic Cancer
Acute Pain
Acute pain caused by pancreatic cancer is described as a dull pain in the upper abdomen that can radiate to the back. If the tumor has grown and advanced, the pain can become more frequent, last longer, and worsen after eating or lying down.
Nursing Diagnosis: Acute Pain
Related to:
- Disease process
- Effects of cancer treatment
- Effects of chemotherapy
- Nerve damage
- Inflammatory process
- Tumor growth
As evidenced by:
- Expressive behavior
- Positioning to ease pain
- Facial expressions of pain
- Protective behavior
- Guarding behavior
- Diaphoresis
- Reports pain intensity
- Distraction behavior
Expected outcomes:
- Patient will report a significant reduction in pain and discomfort.
- Patient will utilize pharmacologic measures prescribed to control pain.
Assessment:
1. Assess and evaluate the patient’s pain history.
The location, duration, intensity, and frequency of the pain can help determine causative factors of pain and guide appropriate interventions for pain relief in patients with pancreatic cancer.
2. Assess discomfort from side effects of cancer treatments.
Chemotherapy and radiation may damage nerves and tissue, aggravating the patient’s pain experience.
Interventions:
1. Administer pain medications as indicated.
Drug therapy, including long-acting oral morphine and fentanyl patches, is indicated for patients with pancreatic cancer to help reduce discomfort.
2. Evaluate the precipitating factors of breakthrough pain.
Increasing pain intensity and duration that requires a higher dosage of pain medication may indicate a developing complication or progression of cancer.
3. Encourage the use of nonpharmacologic pain relief interventions.
Massage, imagery, and diversional activities can help reduce anxiety, refocus attention, and relieve discomfort in patients with pancreatic cancer. Cognitive-behavioral therapy and other mental health services can teach coping strategies for managing pain sensations.
4. Assist with palliative care measures.
Palliative care is not curative and focuses on managing symptoms and pain for improved quality of life. This can be achieved through surgical procedures, nutritional support, chemotherapy, and more.
Imbalanced Nutrition: Less Than Body Requirements
Pancreatic cancer and its treatments are associated with malnutrition, with significant effects on the patient’s overall well-being and quality of life.
Nursing Diagnosis: Imbalanced Nutrition
Related to:
- Disease process
- Hypermetabolism
- Insufficient pancreatic enzymes
- Side effects of cancer treatment
- Chemotherapy
- Radiation therapy
- Pancreatic resection
As evidenced by:
- Abdominal cramping
- Abdominal pain
- Loss of appetite
- Altered taste sensation
- Food intake less than recommended daily allowance (RDA)
- Hyperactive bowel sounds
- Diarrhea
- Steatorrhea
- Weight loss
Expected outcomes:
- Patient will exhibit a progressive weight gain toward the desired goal.
- Patient will verbalize the causes of malnutrition and strategies to improve deficiencies.
Assessment:
1. Assess the patient’s nutritional status.
Assessing the patient’s current nutritional status through daily intake and weight can help plan appropriate interventions.
2. Assess the pathology of malnutrition.
Surgical procedures can affect the function of the pancreas. Pancreatic cancer may cause insufficient secretion of enzymes for digestion, and the reduced secretion of insulin often results in patients becoming diagnosed with diabetes mellitus.
3. Assess for biomarkers of malnutrition.
The nurse can assess transferrin, albumin, total protein, and specific vitamins for deficiencies.
Interventions:
1. Administer pancreatic enzymes.
If the pancreas can no longer secrete enzymes necessary for digestion, supplemental enzymes can be provided to help break down fats, carbohydrates, and protein.
2. Refer the patient to a dietitian.
A dietitian is vital in planning nutritional interventions for patients with pancreatic cancer and those currently undergoing chemotherapy or radiation therapy.
3. Administer antiemetics and pain medications before meals.
Pain, discomfort, nausea, and vomiting can affect the patient’s appetite.
4. Encourage the patient to avoid alcohol and fried foods.
Alcoholic beverages and greasy, fried foods are to be avoided by patients with pancreatic cancer as these foods are difficult to digest and can result in diarrhea, gas, and bloating.
5. Administer enteral nutrition.
Enteral nutrition is recommended over parenteral nutrition and has been shown to reduce complications and hospital stays while increasing energy.
Death Anxiety
Patients with pancreatic cancer often report symptoms of anxiety, distress, and depression due to the poor prognosis of the condition. The anticipation of death and the process of dying can negatively affect the patient’s quality of life.
Nursing Diagnosis: Death Anxiety
Related to:
- Anticipation of death
- Disease process
- Poor prognosis
- Uncertainty of prognosis
- Anticipation of pain
- Anticipation of suffering
- Awareness of imminent death
- Unpleasant physical symptoms
As evidenced by:
- Expresses concern about the impact of death
- Expresses deep sadness
- Express fear of loneliness
- Expresses fear of pain related to dying
- Expresses fear of premature death
- Expresses fear of the dying process
- Expresses powerlessness
- Expresses fear of the unknown
- Expresses concern over role changes
Expected outcomes:
- Patient will verbalize acceptance of their prognosis and peace with dying.
- Patient will identify and verbalize interventions that can help control anxiety.
Assessment:
1. Assess the patient’s level of anxiety.
Understanding the patient’s anxiety level and the effects on their life can help plan an appropriate approach to providing interventions.
2. Assess for damaging behaviors and set limits on inappropriate behaviors.
Mood swings and aggression can indicate poor coping mechanisms in patients with anxiety.
3. Assess the patient’s knowledge about the current condition, its prognosis, complications, and treatment.
Assessing what the patient knows about pancreatic cancer, its prognosis, and treatment options can help the nurse dispel myths and provide accurate information.
Interventions:
1. Acknowledge the patient’s feelings and concerns.
Shock, anger, and despair are normal responses upon the initial diagnosis of pancreatic cancer. Reassure the patient that their feelings are normal and valid.
2. Educate and reinforce information about the condition, symptoms, and treatment.
Knowing what to expect allows for better self-control, reduced anxiety, and adherence to the treatment regimen.
3. Encourage the patient to plan activities.
Staying busy helps some patients not to focus on their anger or depression. Encourage hobbies like gardening, crafts, time in nature, or anything they are interested in.
4. Instill hope.
Some medical practitioners believe hope and a positive outlook can help heal the body. The nurse can support this belief by reminding the patient to live life like they always have, practice gratitude, and participate in activities that spark joy.
5. Refer the patient to community and support groups.
Peer and community groups can provide additional support for patients with pancreatic cancer.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, In
- Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection. Gilliland TM, Villafane-Ferriol N, Shah KP, Shah RM, Tran Cao HS, Massarweh NN, Silberfein EJ, Choi EA, Hsu C, McElhany AL, Barakat O, Fisher W, Van Buren G. Nutrients. 2017 Mar 7;9(3):243. doi: 10.3390/nu9030243. PMID: 28272344; PMCID: PMC5372906.
- Pancreatic Cancer. Cleveland Clinic. Reviewed: September 7, 2021. From: https://my.clevelandclinic.org/health/diseases/15806-pancreatic-cancer
- Pancreatic Cancer Treatment. National Cancer Institute. Updated: March 17, 2022. From: https://www.cancer.gov/types/pancreatic/hp/pancreatic-treatment-pdq
- What Is Pancreatic Cancer? American Cancer Society. Revised: February 11, 2019. From: https://www.cancer.org/cancer/pancreatic-cancer/about/what-is-pancreatic-cancer.html
- What is pancreatic cancer? NHS. Reviewed: May 5, 2020. From: https://www.nhs.uk/conditions/pancreatic-cancer/
