Ward Class

An Online Resource Site For Student Nurses

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Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

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The December 2012 PRC Nursing Board Exam Result is already available here at Ward Class and at Pinoy R.N.




Gastrointestinal Disorders: Stomach Cancer


  • also called gastric cancer is cancer that forms in tissues lining the stomach; most often develops in the distal third and may spread through the walls of the stomach into adjacent tissues, lymphatics, regional lymph nodes, other abdominal organs, or to the lungs and bones
  • affects men twice as often as women; more frequent in African Americans and Orientals; commonly occurs between ages 50 and 70
  • causes
    • excessive intake of highly salted or smoked foods
    • diet low in quantity of vegetables and fruits
    • atrophic gastritis (chronic inflammation of the stomach mucosa)
    • achlorhydria (lack of hydrochloric acid in the digestive juices in the stomach)
    • H. pylori infection
Assessment Findings
  • fatigue, dizziness, weakness, shortness of breath, pallor, lethargy
  • nausea and vomiting, hematemesis, weight loss, indigestion, epigastric fullness, feeling of early satiety when eating, epigastric pain (late symptom)
  • palpable epigastric mass
Medical Management
  1. chemotherapy -->may use combinations of mitomycin, cisplatin, 5FU, doxorubicin, methotrexate, and eprubicin ; capecitabine or uracil (oral tablet forms of 5FU)
  2. radiation therapy
  3. treatment for anemia, gastric decompression, fluid and electrolyte maintenance
Surgical Management
  • surgery depends on the location and extent of the lesion:
    • subtotal gastrectomy (Billroth I or II) --> part of the stomach is removed; for early stages
    • total gastrectomy--> total removal of the stomach and nearby lymph nodes; may also include the duodenum, spleen, and part of the pancreas
Nursing Management
  1. give consistent nutritional assessment and support
  2. provide care for client receiving chemotherapy
    • monitor IV site for extravasation and stop if it occurs (if using IV chemotherapeutic drugs)
    • administer antiemetic as ordered prior to chemotherapy and up to 48 hours afterwards
    • monitor CBC
    • monitor I&O (diarrhea is expected)
    • monitor liver and renal function tests
    • inspect oral cavity daily for sores and signs of infection
    • discharge teaching:
      • intake of frequent, small portions of high-calorie, high-protein, low-residue foods
      • increase liquid intake and frequent rest periods
      • expect hair loss and purchase scarves and wigs
      • prevent infection: good handwashing technique, avoid crowds, individuals with infection
      • minimize stomatitis by using soft-bristled toothbrush and baking soda rinse
      • use relaxation techniques to cope with nausea
  3. provide care for the client with gastric surgery
    • provide routine post-operative care
    • ensure adequate function of nasogastric tube: measure drainage accurately (notify physician if there is no drainage, anticipate frank, red bleeding for 12-24 hours
    • provide adequate ventilation:
      • place client in mid- or high-Fowler's position to promote chest expansion
      • teach client to splint abdominal incision before turning, coughing, deep breathing
    • promote adequate nutrition : clear liquids to small amounts of bland food after NG tube removal, monitor weight daily, assess for regurgitation (if present, instruct patient to eat small amounts of food at a slower pace)
    • provide discharge planning concerning:
      • gradual increase of food until 3 meals/day is tolerated
      • daily monitoring of weight
      • stress-reduction measures
      • report signs of complications to physician: hematemesis, vomiting, diarrhea, pain, melena, weakness, weakness, feeling of abdominal fullness/distension)
      • controlling symptoms associated with dumping syndrome (rapid gastric emptying) such as weakness, diarrhea, faintness, feeling of fullness, and diaphoresis
        1. avoidance of concentrated sweets
        2. taking six, small, dry meals per day
        3. refraining from taking fluids during meals
        4. lying flat on bed for 20-30 mins. after meals
Prognosis

Stomach (Gastric) Cancer is readily treated when diagnosed in its early stages. Unfortunately, symptoms often manifest when this type of cancer is in its advanced stage and has spread beyond the stomach.

Prevention

The following practices may reduce the risk of stomach (gastric) cancer:
  • Incorporating fruits and vegetables into the diet (high in vitamin C and beta-carotene)
  • Avoidance of foods high in nitrites and nitrates (e.g. cured meats)
  • Limited intake of smoked, heavily salted, or pickled foods
  • Avoidance of tobacco smoke
  • Limited consumption of alcohol
  • Limited intake of red meat
  • Early treatment of gastritis and ulcers
Related Link:
Sample NCP for Stomach Cancer


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