Chapter 55: Care of Patients with Stomach Disorders

A client has been discharged home after surgery for gastric cancer, and a case manager will follow up with the client. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? A. Schedule of the client's follow-up examinations and x-ray assessments B. Information on family members' progress in learning how to perform dressing changes C. Copy of the diet plan prepared for the client by the hospital dietitian D. Detailed account of what occurred during the client's surgical procedure

A Because recurrence of gastric cancer is common, it will be a priority for the client to have follow-up examinations and x-rays, so that a recurrence can be detected quickly. It may take family members a long time to become proficient at tasks such as dressing changes. Although the case manager should be aware of the diet, family members will likely be preparing the client's daily diet, and they should be provided with this information. It is not necessary for the case manager to have details of the client's surgical procedure unless a significant event has occurred during the procedure.

An older female client is diagnosed with gastric cancer. Which statement made by the client's family demonstrates a correct understanding of the disorder? A. "This may be related to her recurring ulcer disease." B. "This is probably curable with surgery." C. "Gastric cancer has a strong genetic component." D. "Thank goodness she won't have to undergo surgery."

A Infection with Helicobacter pylori is the largest risk factor for gastric cancer because it carries the cytotoxin-associated antigen A (CagA) gene. Clients with chronic ulcers are probably infected with this organism. Surgery is not curative; most gastric cancers do not present with symptoms until late in the disease and have a high fatality rate. There is no strong genetic predisposition to gastric cancer. Surgery is part of the treatment.

A client has been diagnosed with terminal gastric cancer and is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? A. "Pain control is a major component of the care provided by hospice and its staff members." B. "What has your provider told you about participating in hospice?" C. "I can speak to your provider about requesting adequate pain medication." D. "You don't want to become too dependent on pain medication and become an addict."

A Telling the client that pain control is a major component of hospice care correctly describes the services provided by hospice and its staff members, and reassures the client about their expertise in pain management. Asking the client what the provider has said is an evasive response by the nurse and does not address the client's concerns. The nurse does not need to speak to the provider because pain control is an integral part of hospice services. It is inappropriate to tell a terminally ill client in need of pain control that he or she may become too dependent on pain medication.

The nurse has placed a nasogastric (NG) tube in a client with upper gastrointestinal (GI) bleeding to administer gastric lavage. The client asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? A. "Saline goes down the tube to help clean out your stomach." B. "Medication goes down the tube to help clean out your stomach." C. "The provider requested the tube to be placed just in case it was needed." D. "We'll start feeding you through it once your stomach is cleaned out."

A. Gastric lavage involves the instillation of water or saline through an NG tube to clear out stomach contents and blood clots.

A client is scheduled to be discharged after a gastrectomy. The client's spouse expresses concern that the client will be unable to change the surgical dressing adequately. What is the nurse's highest priority intervention? A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the provider B. Asking the provider for a referral for home health services to assist with dressing changes C. Asking the spouse whether other family members could be taught how to change the dressing D. Trying to determine specific concerns that the spouse has regarding dressing changes

A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the provider

The nurse working during the day shift on the medical unit has just received report. Which client does the nurse plan to assess first? A. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy B. Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal C. Middle-aged client with gastric cancer who needs to receive omeprazole (Prilosec) before breakfast D. Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy

A. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy

The student nurse learns about risk factors for gastric cancer. Which factors does this include? (Select all that apply.) a. Achlorhydria b. Chronic atrophic gastritis c. Helicobacter pylori infection d. Iron deficiency anemia e. Pernicious anemia

ANS: A, B, C, E Achlorhydria, chronic atrophic gastritis, H. pylori infection, and pernicious anemia are all risk factors for developing gastric cancer. Iron deficiency anemia is not a risk factor.

A client who had a partial gastrectomy has several expected nutritional problems. What actions by the nurse are best to promote better nutrition? (Select all that apply.) a. Administer vitamin B12 injections. b. Ask the provider about folic acid replacement. c. Educate the client on enteral feedings. d. Obtain consent for total parenteral nutrition. e. Provide iron supplements for the client.

ANS: A, B, E After gastrectomy, clients are at high risk for anemia due to vitamin B12 deficiency, folic acid deficiency, or iron deficiency. The nurse should provide supplements for all these nutrients. The client does not need enteral feeding or total parenteral nutrition.

A client had an upper gastrointestinal hemorrhage and now has a nasogastric (NG) tube. What comfort measure may the nurse delegate to the unlicensed assistive personnel (UAP)? a. Lavaging the tube with ice water b. Performing frequent oral care c. Re-positioning the tube every 4 hours d. Taking and recording vital signs

ANS: B Clients with NG tubes need frequent oral care both for comfort and to prevent infection. Lavaging the tube is done by the nurse. Re-positioning the tube, if needed, is also done by the nurse. The UAP can take vital signs, but this is not a comfort measure.

A client has a recurrence of gastric cancer and is in the gastrointestinal clinic crying. What response by the nurse is most appropriate? a. "Do you have family or friends for support?" b. "I'd like to know what you are feeling now." c. "Well, we knew this would probably happen." d. "Would you like me to refer you to hospice?"

ANS: B The nurse assesses the client's emotional state with open-ended questions and statements and shows a willingness to listen to the client's concerns. Asking about support people is very limited in nature, and "yes-or-no" questions are not therapeutic. Stating that this was expected dismisses the client's concerns. The client may or may not be ready to hear about hospice, and this is another limited, yes-or-no question.

A client is scheduled for a total gastrectomy for gastric cancer. What preoperative laboratory result should the nurse report to the surgeon immediately? a. Albumin: 2.1 g/dL b. Hematocrit: 28% c. Hemoglobin: 8.1 mg/dL d. International normalized ratio (INR): 4.2

ANS: D An INR as high as 4.2 poses a serious risk of bleeding during the operation and should be reported. The albumin is low and is an expected finding. The hematocrit and hemoglobin are also low, but this is expected in gastric cancer.

A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important? a. Alcohol intake of 1 to 2 drinks per week b. Family history of H. pylori infection c. Former smoker still using nicotine patches d. Willingness to adhere to drug therapy

ANS: D Treatment for this infection involves either triple or quadruple drug therapy, which may make it difficult for clients to remain adherent. The nurse should assess the client's willingness and ability to follow the regimen. The other assessment findings are not as critical.

When teaching a patient about pernicious anemia, which statement does the nurse include? A. Patients with pernicious anemia are not able to digest fats B. Pernicious anemia results in a deficiency of vitamin B12 C. all patients with gastrointestinal bleeding will eventually develop pernicious anemia D. Oral iron supplements are an effective treatment for pernicious anemia

B. Pernicious anemia results in a deficiency of vitamin B12

The nurse finds a client vomiting coffee-ground emesis. On assessment, the client has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority? A. Administering a histamine2 (H2) antagonist B. Initiating enteral nutrition C. Administering intravenous (IV) fluids D. Administering antianxiety medication

C Administering IV fluids is necessary to treat the hypovolemia caused by acute gastrointestinal (GI) bleeding. Administration of an H2 antagonist will not treat the basic problem, which is upper GI bleeding. Enteral nutrition will not be part of the treatment plan for acute GI bleeding. Administration of antianxiety medication will not treat the basic problem causing the client's change in mental status, which is hypovolemia.

The nurse is monitoring a client with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is most indicative of bleeding related to cancer? A. Respiratory rate from 24 to 20 breaths/min B. Apical pulse from 80 to 72 beats/min C. Temperature from 98.9° F to 97.9° F D. Blood pressure from 140/90 to 110/70 mm Hg

D A decrease in blood pressure is the most indicative sign of bleeding. A slight decrease in respiratory rate, apical pulse, and temperature is not the primary indication of bleeding.

A client with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 pounds of body weight has been regained. The client is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this client? A. Explain to the client the importance of drinking the enteral supplements prescribed. B. Ask the client's family to try to persuade the client to drink the supplements. C. Inform the client that a nasogastric tube may be necessary if he or she fails to comply. D. Ask the client if a change in flavor would make the supplement more palatable.

D Asking the client if a change in flavor would help shows that the nurse is attempting to determine why the client is not drinking the supplements. Many clients don't like certain supplement flavors. The nurse should not assume that the client does not understand the importance of drinking the supplements or that the client requires persuasion to drink the supplements. The problem may be entirely different. Telling the client that a nasogastric tube may be necessary could be construed as threatening the client.

The nurse is caring for a patient who vomited coffee ground blood. Where does the nurse suspect the patient is bleeding? a. colon b. rectum c. small intestine d. upper GI system

D. upper GI system

The student nurse is performing a gastric lavage on a patient with an active upper GI bleed. Which action by the student requires intervention by the supervising nurse? a. Using an ice-cold solution to perform lavage of the stomach b. instilling the lavage solution in volumes of 200 to 300 mL c. continuing the lavage until the solution returned is clear or light pink without clots d. positioning the patient on his left side during the procedure

a. Using an ice-cold solution to perform lavage of the stomach

The nurse is providing discharge teaching for a patient after gastrectomy. Which teaching points will the nurse include to help the patient minimize dumping syndrome? (select all that apply) a. eat small frequent meals b. drink an 8 ounce glass of water with each meal c. eliminate alcohol and caffeine from you diet d. lie flat for a short time after eating e. take B12 injections as prescribed by your health care provider.

a. eat small frequent meals c. eliminate alcohol and caffeine from you diet d. lie flat for a short time after eating e. take B12 injections as prescribed by your health care provider.

When performing an assessment on a patient with an active upper GI bleed, which conditions does the nurse identify as common causes of upper GI bleeding? (select all that apply) a. esophageal cancer b. esophageal varices c. gastroesophageal reflux disease d. dudoenal ulcer e. gastritis f. gastric cancer

a. esophageal cancer b. esophageal varices d. dudoenal ulcer e. gastritis f. gastric cancer

A patient develops an active upper GI bleed. Which are the priority actions the nurse takes for caring for this patient? (select al that apply) a. provide oxygen b. start 1 and 2 large-bore IV lines c. Prepare to infuse 0.9% normal saline solution d. monitor serum electrolytes e. prepare for nasogastric tube insertion

a. provide oxygen b. start 1 and 2 large-bore IV lines c. Prepare to infuse 0.9% normal saline solution e. prepare for nasogastric tube insertion

Which drug would the health care provider prescribe to treat H. pylori infection? a. Ranitidine (Zantac) b. Omperazole (Prilosec) c. Clarithromycin (Biaxin) d. Pantoprazole (Protonix)

c. Clarithromycin (Biaxin)

An older adult patient is admitted with an upper GI bleed. Which finding does the nurse expect to assess in the patient? A. decreased pulse b. increased hemoglobin and hematocrit c. acute confusion d. increased blood pressure

d. increased blood pressure

An older client has gastric cancer and is scheduled to have a partial gastrectomy. The family does not want the client told about her diagnosis. What action by the nurse is best? a. Ask the family why they feel this way. b. Assess family concerns and fears. c. Refuse to go along with the family's wishes. d. Tell the family that such secrets cannot be kept.

ANS: B The nurse should use open-ended questions and statements to fully assess the family's concerns and fears. Asking "why" questions often puts people on the defensive and is considered a barrier to therapeutic communication. Refusing to follow the family's wishes or keep their confidence will not help move this family from their position and will set up an adversarial relationship.

A client has been recently diagnosed with gastric cancer. What signs and symptoms suggest that the cancer is at an advanced stage? Select all that apply. Indigestion Nausea and vomiting Retrosternal pain Feeling of fullness Enlarged lymph nodes Iron deficiency anemia

In advanced gastric cancer, nausea and vomiting is often present and the lymph nodes may be enlarged. Vomiting may occur due to excessive dilation or thickening of the stomach wall, or may be due to pyloric obstruction. Lymph node enlargement is due to metastasis. Iron deficiency anemia is also a sign of advanced gastric cancer that may be due to the reduction of iron or vitamin B12 absorption. Indigestion, retrosternal pain, and a feeling of fullness are symptoms of early gastric cancer.