Nursing Care Plan A Client with Gastric Cancer
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Nursing Care Plan A Client with Gastric Cancer George Harvey is a 61-year-old estate attorney • Maintain intravenous fluids and total parenteral nutrition as or- who lives with his wife, Harriet. For the last 3 dered until oral food intake is resumed. months, Mr. Harvey has had increasing anorexia and difficulty eat- • Arrange for diet teaching, including strategies to prevent ing. He has lost 10 pounds. His physician has diagnosed gastric dumping syndrome, before discharge. cancer, and Mr. Harvey is admitted for a partial gastrectomy and • Maintain patient-controlled analgesia (PCA) until able to take gastrojejunostomy.The oncologist has recommended postopera- oral analgesics. tive chemotherapy and radiation. Mr. Harvey reports that the • Assess respiratory status including rate, depth, and breath doctor told him “that will give me the best chance for cure.” sounds every hour initially, then every 4 hours. • Assist to cough, deep breathe, and use inspirometer every 2 to ASSESSMENT 4 hours and as needed. Splint abdomen during coughing. On admission before surgery, Mr. Harvey tells his nurse, Lauren • Encourage verbalization of feelings about diagnosis and per- Walsh, that he has eaten very little in the past few weeks. He asks, ceived losses. “What will happen to my wife if something happens to me? I’m • Encourage participation in decision making. afraid this cancer will get me.”Mr.Harvey weighs 147 lb (67 kg) and is 72 inches (183 cm) tall. He is pale and thin; his vital signs are BP EVALUATION 148/86, P 92, R 18, and T 97.8° F PO. A firm mass is palpable in the Mr. Harvey’s weight remained stable through his hospitalization. left epigastric region. The rest of his physical assessment data are On discharge he is taking a high-protein, high-calorie diet in six within normal limits. Mr. Harvey’s hemoglobin is 12.8 g/dL, hema- small feedings per day. He and his wife have reviewed his diet tocrit is 39%, and serum albumin level is 3.2 g/dL, indicating that with the dietitian and are planning on using some dietary sup- he is mildly malnourished. All other preoperative laboratory and plements at home to meet protein needs. He verbalizes an un- diagnostic studies are within normal limits. derstanding of measures to prevent dumping syndrome, includ- ing separating his intake of solid foods and liquids. Mr. Harvey is DIAGNOSES using oral analgesics in the morning and at bedtime to control • Imbalanced nutrition: Less than body requirements, related to his pain. He and his wife have begun to discuss the meaning of anorexia and difficulty eating his diagnosis. Mrs. Harvey tells the discharge nurse, “We are go- • Acute pain, related to surgical incision and manipulation of ab- ing to a support group called ‘Coping with Cancer’ when George dominal organs is stronger.” • Risk for ineffective airway clearance, related to upper abdominal surgery Critical Thinking in the Nursing Process • Anticipatory grieving, related to recent diagnosis of cancer 1. What is the rationale for maintaining nasogastric suction after gastrojejunostomy? EXPECTED OUTCOMES 2. Develop a preoperative teaching plan for a client undergoing • Maintain present weight during hospitalization. an partial gastrectomy. • Resume a high-calorie, high-protein diet by time of discharge. 3. Mr. Harvey calls you just before the initial dose of chemother- • Verbalize effective pain management, maintaining a reported apy and says,“Everyone tells me that chemotherapy will cause pain level of 3 or less on a scale of 1 to 10. vomiting, and I don’t think I can take being sick again.” How • Maintain a patent airway and clear breath sounds. would you respond? • Verbalize feelings regarding diagnosis and participate in deci- 4. Design interventions to ensure adequate nutrition for people sion making. with advanced gastric cancer. PLANNING AND IMPLEMENTATION • Weigh daily. See Evaluating Your Response in Appendix C. • Maintain nasogastric tube placement, patency, and suction as ordered.