4068_Ch35_779-808 15/11/14 1:46 PM Page 797

Chapter 35 Nursing Care of Patients With Liver, Pancreatic, and Gallbladder Disorders 797

duodenum. Cancer located in the body of the pancreas
usually spreads farther and more rapidly than do masses in
the head. Cancer of the pancreas may spread by the lymphatic
and vascular systems to distant organs and lymph nodes.
Etiology
The cause of pancreatic cancer is associated most commonly
with smoking, then dietary factors (obesity, especially during
early adulthood; red meat; processed meat), diabetes mellitus,
chronic pancreatitis, and heredity. African American males
have the highest rate of pancreatic cancer. Protection may be
provided with high folate and lycopene fruits and vegetables.
cancer, and gastric or duodenal obstruction. Postoperati ve
complications include infection, breakdown of the surgical
site, fistula formation, diabetes mellitus, and malabsorption
syndrome. If the patient has had chemotherap y or radiation
therapy, complications specific to those therapies can also
occur.
Thrombophlebitis is a common complication of cancer of
the pancreas. As the tumor grows, by-products of the tumor
growth appear to increase the levels of thromboplastic (clotting)
factors in the blood, making clotting easier . The potential for
thrombophlebitis increases if the patient is conf ined to bed or
has surgery.

Signs and Symptoms Diagnostic Tests

The patient with pancreatic cancer e xperiences vague
symptoms early in the disease. Epigastric or back pain,
anorexia, nausea, fatigue, and malaise are early symptoms.
Detection is often dif ficult because of the nonspecif ic
symptoms identified by the patient. Weight loss is the
classic sign of pancreatic cancer . The patient may report
abdominal pain that is worse at night. The pain is described
as gnawing or boring, and it radiates to the back. The pain
may be lessened by a side-lying position with the knees
drawn up to the chest or by bending o ver when walking.
The pain becomes increasingly se vere and unrelenting as
the cancer grows. Pruritus is annoying. Depression may be
experienced. The patient may report a bloated feeling or
fullness after eating. If the cancer obstructs the bile duct,
the patient may ha ve jaundice, dark urine, pruritus, and
light-colored stools. The patient’s health history may
include a recent diagnosis of diabetes mellitus.
Complications
Complications may occur before or after sur gical treatment.
Preoperative complications include malnutrition, spread of the
Serum alkaline phosphatase, glucose, and bilirubin le vels
may be elevated. Amylase and lipase are elevated if the can-
cer has caused a secondary pancreatitis. Blood coagulation
tests, such as clotting time, are done. Carcinoembryonic
antigen is ordered to confirm the presence of cancer (normal:
less than 5 ng/mL).
Abdominal x-rays determine the size of the pancreas and
the presence of masses. CT scan, magnetic resonance imaging
(MRI), or ultrasonography are done to precisely locate masses
in the pancreas. ERCP can be used to visualize the common
ducts and to tak e tissue samples for microscopic analysis.
Pancreatic biopsy is necessary for def initive diagnosis of
pancreatic cancer. A tissue sample may be obtained by needle
aspiration during ultrasonography. This procedure may cause
seeding of the tumor along the needle pathway.
Therapeutic Measures
The prognosis for pancreatic cancer is poor. Survival time is
often 4 to 6 months. If diagnosed early , treatment may
be aimed at cure. If the patient’ s cancer has progressed to
distant involvement of other or gan structures and lymph

NURSING CARE PLAN for the Patient With Acute and Chronic
Pancreatitis

Nursing Diagnosis: Pain related to edema and inflammation

Expected Outcome: The patient will state pain level is less than 2 on a scale of 0 to 10 within 30 minutes of pain
report.

Evaluation of Outcome: Does patient state pain level is less than 2 on a pain scale of 0 to 10?

Intervention Assess the patient every 2 hours for pain by: • Asking the patient to rate pain on a scale of 0 to 10.
Rationale Intense pain is likely to occur with acute pancreatitis. A pain scale allows for a consistent and individual
evaluation of pain. Evaluation Does patient state that pain is tolerable and less than 2 on a pain scale of 0 to 10,
where 0 = no pain and 10 = worst possible pain?

Intervention • Observing the patient for pain behaviors such as grimacing, irritability, reluctance to move, or
inability to lie quietly. Rationale Observation of pain behaviors, such as reluctance to move, shallow respirations,
grimacing, or irritability, may be a reliable indicator of pain. However, the patient in pain may have no observable
pain behaviors. Evaluation Does patient exhibit pain behaviors that differ from his or her report of pain?

Continued