Pancreatic Cancer Nursing Diagnosis and Nursing Care Plan

Pancreatic Cancer Nursing Care Plans Diagnosis and Interventions

Pancreatic Cancer NCLEX Review and Nursing Care Plans

Pancreatic cancer is a type of cancer involving the pancreas, an abdominal organ located behind the stomach’s bottom section.

The pancreas secretes digestive enzymes and hormones that contribute to blood sugar regulation. The pancreas can develop a variety of tumors, including malignant and benign (non-cancerous) tumors.

The most prevalent type of pancreatic cancer is known as pancreatic ductal adenocarcinoma, which originates in the cells surrounding the ducts that drain digestive enzymes from the pancreas.

Pancreatic cancer is rarely discovered in its early stages when it is most treatable because it frequently does not manifest symptoms until it has progressed to other organs.

Furthermore, pancreatic cancer treatment options are determined by the degree of the tumor. Surgery, chemotherapy, radiation treatment, or a combination of these may be options.

Stages of Pancreatic Cancer

  • Stage 0. This is the first stage of pancreatic cancer, but it does not always entail malignancy. It simply implies that aberrant cells are present in the pancreas and may develop into malignant cells in the future. There are no symptoms at this time.
  • Stage I. A tumor in the pancreas is all that exists in stage 1 pancreatic cancer. Depending on the size of the tumor, Stage I has two subcategories:
  • Stage IA. The tumor is smaller than 2 cm in diameter.
  • Stage IB. A tumor with a diameter of 2 cm to 4 cm but a smaller size than 2.

Symptoms of stage I pancreatic cancer are usually non-existent. Furthermore, if diagnosed early enough, pancreatic cancer may be cured with surgery.

  • Stage II. Stage II pancreatic cancer is cancer that has progressed to a few surrounding lymph nodes or blood vessels but has not expanded beyond the pancreas. This stage has two sections based on the location of the malignancy and the size of the
    • Stage II A. The tumor is greater than 4 centimeters (cm) but has not disseminated to any lymph nodes or surrounding tissue at this stage.
    • Stage II B. The tumor has progressed to adjacent lymph nodes, but only to three.
  • Stage III. Cancer has progressed to significant blood arteries near the pancreas at this stage. It could potentially have spread to adjacent lymph nodes.
  • Stage IV: Pancreatic cancer has progressed further than the original site to distant locations such as other organs, the brain, or bones. Furthermore, since pancreatic cancer seldom causes symptoms until it has progressed to other locations, it is frequently detected at this late stage.

Signs and Symptoms of Pancreatic Cancer

Pancreatic cancer symptoms do not usually manifest until the disease has progressed. They could include:

  • abdominal discomfort that radiates up to the back
  • loss of appetite or unintentional weight loss
  • blood clots
  • fatigue
  • skin irritation or itching
  • skin discoloration and yellowing of the sclera (jaundice)
  • light-colored stools
  • dark urine
  • current medical history of diabetes

Causes of Pancreatic Cancer

Pancreatic cancer has no recognized cause. Pancreatic cancer develops when aberrant cells begin to proliferate within the pancreas and form tumors, although the cause remains unknown. Healthy cells often develop and die in small quantities. In the event of cancer, the production of aberrant cells increases, and these cells eventually negatively impact healthy cells.

Some genes also regulate cell growth, the division into new cells, and death:

  • Oncogenes are genes that aid cell growth, division, and survival.
  • Tumor suppressor genes help control cell division or induce cells to die at the appropriate moment.

Specific genetic changes and mutations can result in situations that raise the risk of developing pancreatic cancer. Among these conditions are:

  • Peutz-Jeghers disease
  • Lynch’s disease
  • syndrome of hereditary breast and ovarian cancer
  • inherited pancreatitis
  • atypical multiple mole melanoma conditions in a family

Risk Factors to Pancreatic Cancer

While the primary cause of pancreatic cancer is obscure, many risk factors may increase the chances of getting it. These risk factors include:

  • Tobacco consumption. Cigarette smoking may contribute to 20 to 35 percent of pancreatic cancer cases.
  • Excessive alcohol consumption. Drinking three or more alcoholic beverages daily may increase the chances of acquiring pancreatic cancer.
  • Chronic or hereditary pancreatitis. Pancreatitis happens when the pancreas is inflamed and is caused by heavy drinking over a lengthy period. Pancreatitis can also run in families.
  • Weight. Obesity or being overweight, especially in early adulthood, may raise the risk of developing pancreatic cancer.
  • Diet. A diet high in processed foods, red meats, fatty food, carbohydrates, or cholesterol may elevate the risk, but health experts are still working to determine the precise connection between dietary components and pancreatic cancer risk.
  • Gender. Men have a higher possibility than women of having pancreatic cancer.
  • Exposure at work. Working with some chemicals, especially those used in metalworking, and pesticides may play a role in up to 12% of pancreatic cancer occurrences.
  • Age. People aged 65 to 74 are more likely to be diagnosed with pancreatic cancer.
  • Diabetes. Type 1 or 2 diabetes patients may be at an increased risk of getting pancreatic cancer.
  • Race. Black people have the most significant rate of pancreatic cancer in the United States. According to 2018 research, this is attributable to a combination of lifestyle, socioeconomic, and genetic variables, but experts elaborate that additional research into the underlying factors of racial disparity in pancreatic cancer rates is needed.
  • Heredity. Up to 10% of pancreatic cancer patients have a family history.
  • Infections. The presence of H. pylori in the digestive tract may enhance the risk, while the specific relationship to pancreatic cancer is unknown. Hepatitis B can raise the likelihood by up to 24 percent.

Complications of Pancreatic Cancer

As pancreatic cancer spreads, it might lead to consequences like the ones listed below:

  • Weight loss. A variety of circumstances can cause weight loss in persons with pancreatic cancer. Weight loss may occur due to cancer as it consumes the body’s energy. Cancer therapies may produce nausea and vomiting or a tumor pressing on the stomach, making it difficult to eat. Since the pancreas is not producing enough digestive fluids, the body may have problems processing food nutrients.
  • Jaundice. Jaundice can be caused by pancreatic cancer restricting the liver’s bile duct. The yellow complexion, yellow eyes, black urine, and pale feces are all symptoms. Jaundice is commonly accompanied by abdominal discomfort.
  • Pain. A developing tumor may impinge on nerves in the abdomen, causing significant pain. Pain relievers might make the patient feel more at ease. Radiation and chemotherapy treatments, for example, may help limit tumor development and provide some pain relief.
  • Bowel obstruction. Pancreatic cancer that spreads to or presses on the initial segment of the small intestine (duodenum) might obstruct the passage of digested food from the stomach into the intestines.

Diagnosis of Pancreatic Cancer

  • Imaging Test
  • Computed Tomography (CT scan). A scanner obtains several X-ray images, which are then reconstructed by a computer into detailed pictures of the interior of the abdomen. A CT scan assists doctors in making a diagnosis of pancreatic cancer.
    • Magnetic resonance imaging (MRI). A scanner uses magnetic waves to provide detailed images of the abdomen, particularly the area around the pancreas, gallbladder, and liver.
    • Positron Emission Tomography (PET Scan). An imaging test that demonstrates how energy is utilized in the body. This procedure may be used together with other tests to diagnose pancreatic cancer.
    • Endoscopic ultrasound. An endoscopic ultrasound (EUS) creates images of the pancreas inside the abdomen using a piece of ultrasound equipment. The instrument is passed down to the throat and the stomach via a thin, flexible tube (endoscope) to obtain the images.
  • Taking a tissue sample for examination (biopsy). A biopsy is a diagnostic procedure that removes a tiny sample of tissue to be examined under a microscope. Tissue is usually processed during EUS by passing specific tools via the endoscope. A sample of tissue taken from the pancreas is collected less frequently by putting a needle through the skin and into the pancreatic.
  • Blood test (CA19-9 concentrations). This blood test could help doctors determine how cancer responds to treatment. However, the test is not always accurate because some individuals with pancreatic cancer do not have elevated CA19-9 levels, rendering the test ineffective.

If the doctor confirms a pancreatic cancer diagnosis, he or she will try to establish the extent (stage) of the malignancy. The doctor assigns a stage to pancreatic cancer based on information from staging tests, which helps identify treatments most likely to benefit the patient.

Treatment for Pancreatic Cancer

Pancreatic cancer treatment has two primary goals: killing malignant cells and preventing cancer from spreading. The stage of cancer will determine the best treatment option. The following are the primary therapeutic options:

  • Surgery. Pancreatic cancer surgery involves removing sections of the pancreas. While surgery will remove the primary tumor, it will not remove cancer that has spread to other regions. As a result, surgery for advanced-stage pancreatic cancer is rarely advised.
  • Radiation treatment. X-rays and other high-energy beams kill cancer cells.
  • Chemotherapy. Anticancer medications eliminate cancer cells and inhibit their proliferation in the future.
  • Targeted therapy. Medications and antibodies specifically target cancer cells without destroying healthy cells, as chemotherapy and radiation therapy can.
  • Immunotherapy. Several techniques are beneficial to stimulate the immune system to attack cancer cells.
  • Palliative care. Palliative care is specialized medical care that relieves a severe illness’s pain and other symptoms. Palliative care is distinct from hospice care or end-of-life therapy. Teams of doctors, nurses, social workers, and other professionally qualified specialists deliver palliative care. These teams strive to improve the quality of life for cancer patients and their families.

Nursing Diagnosis for Pancreatic Cancer

Nursing Care Plan for Pancreatic Cancer 1

Anticipatory Grieving

Nursing Diagnosis: Anticipatory Grieving related to the predicted loss of physical well-being, changes in lifestyle, and the patient’s perceived death secondary to pancreatic cancer as evidenced by changes in eating patterns, sleeping habits, energy levels, sexual appetite, and communication patterns, denial of future loss, suppressed feelings, and depression.

Desired Outcomes:

  • The patient will recognize and express emotions appropriately.
  • The patient will be able to continue with their regular daily routines, look ahead or plan for the future one day at a time.
  • The patient will be able to verbalize understanding of the dying process and how they feel supported.
Pancreatic Cancer Nursing InterventionsRationale
Expect initial shock and despair from the patient following a pancreatic cancer diagnosis and traumatic procedures.    Only a few patients are genuinely prepared for the reality of what can happen.  
Thoroughly observe the patient for manifestations of mood swings, aggression, and other outbursts. Set limits on the patient’s incorrect behavior and deflect unpleasant thoughts.    Mood swings and aggression are indicators of poor coping, and extra interventions are necessary. Preventing damaging behaviors allows the patient to preserve control and self-esteem.  
Make the environment open and nonjudgmental. The nurses should use active listening, acknowledgment, and other therapeutic communication skills.  This technique fosters and supports honest conversation about one’s feelings and worries.  
Reinforce instruction about disease processes and treatments of pancreatic cancer and provide information about dying as needed. While providing emotional support, be truthful and avoid giving false hope to the patient.  Factual information will benefit both the patient and his or her significant other. Individuals may raise straightforward questions about death, and honest replies foster trust and reassurance that accurate information about pancreatic cancer will be provided.    
Determine the patient’s and significant other’s current stage of sorrow. Explain the grief process as needed.    Knowledge of the grieving process confirms the appropriateness of the sentiments and behaviors being experienced and can help the patient deal with them more effectively.  

Nursing Care Plan for Pancreatic Cancer 2

Situational Low Self-Esteem

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 InterventionsRationale
Encourage the patient to express their worries regarding the effects of pancreatic cancer and treatments on their roles as homemakers, wage workers, or parents.This intervention may aid in reducing issues that impede treatment acceptance or promote illness progression.
If the patient allows it, use touch throughout interactions and maintain eye contact.    Affirmation of individuality and acceptance are vital in lowering patients’ insecure feelings and self-doubt.  
Examine the relevant support networks for the patient and the significant other.  This intervention aids in planning care while in the hospital and after discharge.  
Talk with the patient and significant other about how the diagnosis and therapy affect the patient’s personal life, household, and work activities.    This intervention assists in defining issues in order to begin the problem-solving process.  
During the diagnostic and therapeutic phases, provide emotional support to the patient and significant other.  Although some patients adapt to cancer symptoms or cancer medication side effects, many patients still require additional assistance during this time.  
Recognize any issues the patient may be having. Inform them that counseling is frequently required and essential in the adjustment stage.  This method recognizes the reality of the patient’s feelings and allows them to take whatever measures are required to deal with what is happening.  
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.  Anticipatory guidance can assist the patient and significant other in adjusting to their new state and preparing for some side effects.  
As directed, seek professional counseling.    If the patient and significant other’s support networks erode, this technique may be required to reestablish and sustain a favorable psychosocial structure.

Nursing Care Plan for Pancreatic Cancer 3

Acute Pain

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 InterventionsRationale
Determine the patient’s pain history (pain location, frequency, duration, and intensity using a numeric rating scale (0-10 scale) or a verbal rating scale (“no pain” to “excruciating pain”),    The patient’s information gives baseline data for evaluating the efficacy of interventions. Chronic pain is defined as pain that lasts longer than six months and may influence treatment options.  
When taking around-the-clock agents, whether oral, IV, or patch drugs, determine the onset or precipitants of “breakthrough” pain.      Pain near the end of the dosing interval may indicate the need for a higher or shorter dose interval. Pain can be triggered or develop spontaneously, necessitating short half-life medicines for rescue or additional doses.  
Provide non pharmacological comfort treatments (massage, repositioning, backrub) and diversional activities to the patient.  This method encourages calm and aids in refocusing attention.  
Evaluate the patient and be mindful of any uncomfortable side effects of specific treatments such as surgery, radiation, chemotherapy, or biotherapy.  Depending on the method and substance employed, a wide range of discomforts is typical.    
Encourage the use of stress management strategies or alternative therapies, including relaxation, visualization, and guided imagery.    This method allows patients to participate in nondrug pain management actively and increases their sense of control.

Nursing Care Plan for Pancreatic Cancer 4

Altered Nutrition: Less Than Body Requirements

Nursing Diagnosis: Altered Nutrition: Less Than Body Requirements related to hypermetabolism, side effects of chemotherapy, radiation, surgery, and emotional anguish as evidenced by inadequate food intake, altered taste sensations, a decrease in interest in food, a perceived or actual incapacity to swallow food, diminished subcutaneous fat or muscle mass, and abdominal discomfort.

Desired Outcomes:

  • The patient will exhibit steady or progressive weight gain toward the goal, with laboratory levels normalized, and be free of indications of malnutrition.
  • The patient will participate in specialized initiatives to enhance nutritional intake and stimulate appetite.
Pancreatic Cancer Nursing InterventionsRationale
Observe the patient’s daily dietary intake. Encourage the patient to keep a food journal as directed.  This method determines nutritional strengths and weaknesses.
Encourage the patient to consume a high-calorie, nutrient-rich diet with plenty of fluids. Encourage the use of supplements and frequent or smaller meals spread out throughout the day.  Supplements can help the patient maintain sufficient calorie and protein consumption.
Establish a warm dining environment and encourage patients to share meals with family and friends.  This approach makes mealtime more pleasurable, which may lead to increased consumption.
Examine for pallor, delayed wound healing, and swollen parotid glands on the patient’s skin and mucosal membranes.  This intervention aids in the detection of protein-calorie malnutrition, mainly when weight and anthropometric measurements are lower than expected.  
Take the patient’s height, weight, and tricep skinfold thickness measurements. Determine the amount of recent weight loss. Advise the patient to weigh himself every day or as directed.    If these values go below the standard, the patient’s primary source of stored energy (fat tissue) is depleted.  

Nursing Care Plan for Pancreatic Cancer 5

Risk for Deficient Volume

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 InterventionsRationale
Keep track of the patient’s intake and output. Include all output sources such as emesis, diarrhea, and bleeding wounds.  A continuous fluid imbalance may decrease renal output and urine concentration and may indicate dehydration and the need for additional fluid replacement.  
Examine the patient’s skin turgor and mucous membrane hydration. Take note of the patient’s reports of thirst.    Skin turgor, mucous membrane moisture, and thirst are all indirect indications of hydration status and degree of deficiency.
Provide the pancreatic cancer patient with IV fluids as needed.    IV fluids are administered for general hydration, dilute antineoplastic medications, and decrease undesirable side effects like nausea, vomiting, and nephrotoxicity.  
Thoroughly monitor the patient’s vital signs. Evaluate the patient’s capillary refill and peripheral pulses.  This intervention aims to monitor the patient’s hydration.  
Weigh the patient regularly.  The patient’s weight is a sensitive indicator of fluid balance variations.  

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

1 thought on “Pancreatic Cancer Nursing Diagnosis and Nursing Care Plan”

  1. If all goes well, your well-written page may help me pass LPN Med-Surg. THANK YOU!

    Reply

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