5.3.1: FRAME 1- Recognize Cues
- Page ID
- 90252
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Question Type: Matrix Multiple Choice
Scoring: 0/1
NCSBN Item Type and Scoring: https://www.ncsbn.org/public-files/p...main_stage.pdf
What symptoms are associated with pancreatic cancer?
| Symptom | Associated | Not Associated |
|---|---|---|
| Nausea | X | |
| Confusion | X | |
| Bloating | X | |
| Fatigue | X | |
| Edema | X | |
| Jaundice (Icterus) | X | |
| Sudden onset of diabetes | X | |
| Light colored stools | X | |
| Dark colored urine | X |
RATIONALE
Pancreatic cancer affects your pancreas, a gland in your abdomen that aids in digestion. Early stages of pancreatic cancer often have no symptoms, however, if symptoms are present, they can include nausea, bloating, fatigue, jaundice, lack of appetite, stomach pain, back pain, sudden onset of diabetes, light colored stool, and dark colored urine.
FOCUSED GUIDE
Pancreatic cancer survival rates are low because the disease is difficult to detect in the early stages (Cleveland Clinic, 2023). The most common type of pancreatic cancer is ductal adenocarcinoma, which begins in the cells that line your organs. Pancreatic ductal adenocarcinoma is poised to become the second leading cause of cancer-related death by 2030, and the median overall survival for clients with advanced, metastatic disease remains only about 12 months (Pishvaian et al., 2020). Treatment for pancreatic cancer includes surgery, chemotherapy, and radiation therapy.
Early stages of pancreatic cancer often do not have symptoms. Jaundice or icterus is one of the first symptoms of pancreatic cancer. Jaundice generally manifests first in the sclerae and/or mucous membranes, and skin. Icterus (jaundice), also known as hyperbilirubinemia, is defined as a yellow discoloration of the body tissue resulting from the accumulation of excess bilirubin. Deposition of bilirubin happens only when there is an excess of bilirubin, and this indicates increased production or impaired excretion. The normal serum levels of bilirubin are less than 1 milligram per deciliter (mg/dL).
However, the clinical presentation of jaundice with peripheral yellowing of the eye sclera, also called scleral icterus, is best appreciated when serum bilirubin levels exceed 3 mg/dl. With further increase in serum bilirubin levels, the skin will progressively discolor ranging from lemon yellow to apple green, especially if the process is long-standing; the green color is due to biliverdin (Abel & Samant, 2023). The sclerae are often the first tissue to develop jaundice. If the bilirubin level is only mildly high, then this might be the only part of the body where you can detect a yellow color. With higher levels of bilirubin, the skin and mucous membranes may also become jaundice.
Clinical considerations for inspecting common changes to the skin (pallor, cyanosis, jaundice, flushing) are not easily detectable when assessing people who have dark skin tones. Skin tone and pigmentation are regulated by melanogenesis, a complex process directly linked to genetics. Melanocyte cells in the skin produce melanin pigment (Pusey-Reid et al., 2023). Skin tone is best assessed in areas of the body that are not frequently exposed to UV radiation. For clients with darker skin tone, the nurse should inspect the oral mucosa, especially the hard palate, for yellow discoloration. For a more accurate determination of jaundice, examine the sclera closest to the cornea. Be aware that if the palms and soles have callouses, they may appear yellow even when jaundice is not present (Pusey-Reid et al., 2023).