Physiological Adaptation Q 173
A client has cancer of the pancreas. The nurse should be most concerned about which nursing diagnosis?
A. Alteration in nutrition
B. Alteration in bowel elimination
C. Alteration in skin integrity
D. Ineffective individual coping
Correct Answer: A. Alteration in nutrition
Cancer of the pancreas frequently leads to severe nausea and vomiting and altered nutrition. Weight loss occurs in about 90% of patients. Abdominal pain occurs in about 75% of patients. Weakness, pruritus from bile salts in the skin, anorexia, palpable, non-tender, distended gallbladder, acholic stools, and dark urine.
Option B: Patients with adenocarcinoma of pancreas typically present with painless jaundice (70%) usually due to obstruction of the common bile duct from the pancreatic head tumor. Lab findings will include elevation in liver function tests, direct and total bilirubin levels, elevated amylase and lipase, and elevated pancreatic tumor markers (CA 19-9 and CEA).
Option C: Neoadjuvant first approach in resectable pancreatic adenocarcinoma is implemented more and more frequently at high-volume centers nationwide and internationally. The rational behind neoadjuvant first approach is that the patient is in their best shape to receive chemotherapy and at best odds of completing chemotherapy for 4-6 months. In addition, tissue is thought to be still well-oxygenated having not gone through a large procedure such as the Whipple.
Option D: For patients with metastatic, stage IV, pancreatic cancer, discussions with the patient regarding treatment are essential. One can receive chemotherapy. However, the life prolongation will be at best months, yet affect the toxicity and effects of the chemotherapy. It is important to keep nutrition on the forefront of the patient’s care as nutrition can affect wound healing.