Pancreatic cancer nursing diagnosis requires a comprehensive understanding of this complex disease and its impact on patient care. This guide provides healthcare professionals with essential information about nursing diagnoses, interventions, and care plans for patients with pancreatic cancer.
Understanding Pancreatic Cancer
The pancreas is a vital organ located in the upper abdomen. It functions as both an endocrine and exocrine gland. When cancer develops in pancreatic tissue, it often goes undetected until advanced stages, making early nursing intervention crucial for patient outcomes.
Key Clinical Manifestations
Common symptoms that nurses should assess include:
- Unexplained weight loss
- Jaundice (yellowing of skin and eyes)
- Abdominal pain radiating to the back
- Loss of appetite
- New-onset diabetes
- Fatigue
- Changes in stool color and consistency
- Dark urine
Nursing Assessment
Physical Assessment
Nurses should focus on:
Abdominal Examination
- Assess for pain and tenderness
- Check for masses or organ enlargement
- Monitor for ascites
- Evaluate skin color and condition
Nutritional Status
- Track weight changes
- Monitor food intake
- Assess for malabsorption signs
- Document appetite changes
Pain Assessment
- Location and radiation
- Intensity using pain scales
- Timing and duration
- Aggravating and relieving factors
Diagnostic Indicators
Key diagnostic findings include:
- Elevated tumor markers (CA 19-9, CEA)
- Abnormal liver function tests
- Imaging results (CT, MRI, PET scans)
- Biopsy findings
Comprehensive Nursing Care Plans
1. Acute Pain
Nursing Diagnosis Statement:
Acute pain related to tumor growth and tissue invasion as evidenced by verbal reports of pain, guarding behavior, and facial grimacing.
Related Factors:
- Tumor compression of surrounding tissues
- Metastatic disease
- Inflammatory process
- Treatment side effects
Nursing Interventions and Rationales:
- Perform comprehensive pain assessment every shift
Rationale: Enables appropriate pain management and treatment adjustments - Administer prescribed analgesics on schedule
Rationale: Maintains therapeutic pain control levels - Implement non-pharmacological pain management techniques
Rationale: Complements medication therapy and provides additional comfort - Monitor pain relief effectiveness
Rationale: Ensures optimal pain management and identifies the need for adjustments
Desired Outcomes:
- Patient reports pain at an acceptable level (3 or less on a 0-10 scale)
- The patient demonstrates improved functional ability
- Patient uses effective pain management strategies
2. Risk for Impaired Nutrition
Nursing Diagnosis Statement:
Risk for impaired nutrition related to disease process and treatment effects as evidenced by weight loss and decreased appetite.
Related Factors:
- Decreased pancreatic enzyme production
- Nausea and vomiting
- Early satiety
- Treatment-related anorexia
Nursing Interventions and Rationales:
- Monitor daily nutritional intake
Rationale: Identifies nutritional deficits and guides interventions - Administer prescribed pancreatic enzymes
Rationale: Supports proper nutrient absorption - Provide small, frequent meals
Rationale: Maximizes nutritional intake when appetite is poor - Collaborate with dietitian
Rationale: Ensures comprehensive nutritional support
Desired Outcomes:
- The patient maintains a stable weight
- The patient demonstrates improved appetite
- The patient shows normal nutritional lab values
3. Anxiety
Nursing Diagnosis Statement:
Anxiety related to disease prognosis and treatment uncertainty as evidenced by expressed concerns and restlessness.
Related Factors:
- Uncertain prognosis
- Complex treatment regimens
- Fear of death
- Life changes
Nursing Interventions and Rationales:
- Provide active listening and emotional support
Rationale: Creates therapeutic relationship and reduces anxiety - Teach coping strategies
Rationale: Empowers patient to manage anxiety effectively - Include family in care planning
Rationale: Strengthens support system and reduces isolation - Facilitate access to counseling services
Rationale: Provides professional psychological support
Desired Outcomes:
- The patient verbalizes decreased anxiety
- The patient uses effective coping mechanisms
- The patient demonstrates improved emotional well-being
4. Risk for Infection
Nursing Diagnosis Statement:
Risk for infection related to immunosuppression and invasive procedures as evidenced by compromised host defenses.
Related Factors:
- Chemotherapy-induced neutropenia
- Surgical procedures
- Malnutrition
- Chronic disease process
Nursing Interventions and Rationales:
- Monitor vital signs and infection indicators
Rationale: Enables early infection detection - Implement strict infection control measures
Rationale: Prevents healthcare-associated infections - Educate about infection prevention
Rationale: Empowers patient in self-care - Assess wounds and insertion sites
Rationale: Identifies early signs of infection
Desired Outcomes:
- The patient remains free from infection
- The patient demonstrates an understanding of infection prevention
- The patient maintains a normal temperature
5. Fatigue
Nursing Diagnosis Statement:
Fatigue related to disease process and treatment effects as evidenced by decreased energy and increased rest requirements.
Related Factors:
- Cancer-related fatigue
- Treatment side effects
- Nutritional deficits
- Sleep disturbances
Nursing Interventions and Rationales:
- Assess fatigue levels daily
Rationale: Monitors progression and impact - Plan activities during peak energy periods
Rationale: Maximizes patient’s energy resources - Promote adequate rest periods
Rationale: Prevents exhaustion - Implement energy conservation techniques
Rationale: Helps maintain functional status
Desired Outcomes:
- The patient reports improved energy levels
- Patient maintains optimal activity level
- The patient demonstrates effective energy management
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Brunner M, Wu Z, Krautz C, Pilarsky C, Grützmann R, Weber GF. Current Clinical Strategies of Pancreatic Cancer Treatment and Open Molecular Questions. Int J Mol Sci. 2019 Sep 13;20(18):4543. doi: 10.3390/ijms20184543. PMID: 31540286; PMCID: PMC6770743.
- Gupta A, Khalid O, Moravek C, Lamkin A, Matrisian LM, Doss S, Denlinger CS, Coveler AL, Weekes CD, Roeland EJ, Hendifar AE, Nipp RD. Leveraging patient-reported outcomes (PROs) in patients with pancreatic cancer: The Pancreatic Cancer Action Network (PanCAN) online patient registry experience. Cancer Med. 2021 Oct;10(20):7152-7161. doi: 10.1002/cam4.4257. Epub 2021 Sep 3. PMID: 34477302; PMCID: PMC8525124.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
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- Rosenzweig A, Berlin J, Chari S, Kindler H, Matrisian L, Mayoral A, Mills J, Nissen N, Picozzi V, Zelada-Arenas F, Fleming J. Management of Patients With Pancreatic Cancer Using the “Right Track” Model. Oncologist. 2023 Jul 5;28(7):584-595. doi: 10.1093/oncolo/oyad080. PMID: 37043728; PMCID: PMC10322133.
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