NURSING MANAGEMENT

Before Surgery
 Assess the patient’s and family’s knowledge of preoperative and postoperative surgical
routines and the rationale for surgery
 Assess the patient’s nutritional status:
o Has the patient lost weight? How much? Over how much time?
o Does the patient have nausea and vomiting? Has the patient had hematemesis?
 Assess for the presence of bowel sounds and palpates the abdomen to detect masses or
tenderness
After surgery
 Assess the patient for complications secondary to the surgical intervention, such as
hemorrhage, infection, abdominal distention, atelectasis, or impaired nutritional status
Reducing Anxiety
 Provide a relaxed, nonthreatening atmosphere so that the patient can express fears,
concerns, and possibly anger about the diagnosis and prognosis
 Encourage the family or significant other to support the patient
 Offer reassurance and supporting positive coping measures
 Advise the patient about any procedures and treatments so that the patient knows what to
expect
Promoting Optimal Nutrition
 Encourage the patient to eat small, frequent portions of nonirritating foods to decrease
gastric irritation
 Give food supplements high in calories, as well as vitamins A and C and iron, to enhance
tissue repair
 If the patient is unable to eat adequately prior to surgery to meet nutritional requirements,
parenteral nutrition may be necessary.
 Explain ways to prevent and manage dumping syndrome (six small feedings daily that
are low in carbohydrates and sugar; fluids between meals rather than with meals)
 Inform the patient that symptoms of dumping syndrome often resolve after several
months
 Administer vitamin B12 as prescribed, if a total gastrectomy is performed, to prevent
decreased production of red blood cells, or pernicious anemia
 Monitor the IV therapy and nutritional status and records intake, output, and daily
weights to ensure that the patient is maintaining or gaining weight
 Assess for signs of dehydration (thirst, dry mucous membranes, poor skin turgor,
tachycardia, decreased urine output)
 Review the results of daily laboratory studies to note any metabolic abnormalities
(sodium, potassium, glucose, BUN)
  Administer antiemetic agents as prescribed
Relieving Pain
 Administer analgesic agents as prescribed, such as a continuous IV infusion of an opioid
or a PCA pump set to infuse an opioid
 Assess routinely the frequency, intensity, and duration of the pain to determine the
effectiveness of the analgesic agent.
 Recommend nonpharmacologic methods for pain relief, such as position changes,
imagery, distraction, relaxation exercises (using relaxation audiotapes), backrubs,
massage, and periods of rest and relaxation
Providing Psychosocial Support
Some patients mourn the loss of a body part and perceive their surgery as a type of
mutilation. Some express disbelief and need time and support to accept the diagnosis.
 Help the patient express fears, concerns, and grief about the diagnosis
 Answer the patient’s questions honestly and encourages the patient to participate in
treatment decisions.
 Offer emotional support and involves family members and significant others whenever
possible, including recognizing mood swings and defense mechanisms (e.g., denial,
rationalization, displacement, regression)
 Reassure the patient, family members, and significant others that emotional responses are
normal and expected
 Project an empathetic attitude and spends time with the patient
 The services of clergy, psychiatric clinical nurse specialists, psychologists, social
workers, and psychiatrists are made available, if needed.
Many patients may begin to participate in self-care activities after they have
acknowledged their loss.
Promoting Home and Community-Based Care
Educating Patients About Self-Care
Self-care activities depend on the type of treatments used—surgery, chemotherapy,
radiation, or palliative care.
 Educate the patient and family about diet and nutrition, treatment regimens, activity and
lifestyle changes, pain management, and possible complications
 Consult with a dietitian to determine how the patient’s nutritional needs can best be met
at home.
 Instruct the patient or caregiver about administration of enteral or parenteral nutrition
 Provide explanations to the patient and family about what to expect, including the length
of treatments, the expected side effects (e.g., nausea, vomiting, anorexia, fatigue,
 neutropenia), and the need for transportation to appointments for treatment, if
chemotherapy or radiation is prescribed
 Psychological counseling may also be helpful.
Continuing Care
The need for ongoing care in the home depends on the patient’s condition and treatment.
 Reinforce nutritional counseling and supervises the administration of any enteral or
parenteral feedings
 the patient or caregiver must become skillful in administering the feedings and in
detecting and preventing untoward effects or complications related to the
 Instruct the patient or caregiver to record the patient’s daily intake, output, and weight
 Explain strategies to manage pain, nausea, vomiting, or other symptoms
 Educate the patient or caregiver to recognize and report signs and symptoms of
complications that require immediate attention, such as bleeding, obstruction, perforation,
or any symptoms that become progressively worse
 Explain the chemotherapy or radiation therapy regimen and ensure that the patient and
family or significant other understand the care that will be needed during and after
treatments
 Assist the patient, family, or significant other with decisions regarding end-of-life care
and make referrals as warranted, because the prognosis for gastric cancer is poor

References:
Brunner & Suddarth. (2018). Textbook of Medical-Surgical Nursing. (14th ed). China: Wolters
Kluwer.
NURSING PROCESS
The Patient With Gastric Cancer

Assessment
Obtain a dietary history from the patient, focusing on recent nutritional intake and status:
 Has the patient lost weight? If so, how much and over what period of time?
 Can the patient tolerate a full diet? If not, what foods can he or she eat?
 What other changes in eating habits have occurred?
 Does the patient have an appetite?
 Does the patient feel full after eating a small amount of food?
 Is the patient in pain?
 Do foods, antacids, or medications relieve the pain, make no difference, or worsen the
pain?
 Is there a history of infection with H. pylori?
Obtain the patient’s smoking and alcohol history and family history (e.g., any first- or second-
degree relatives with gastric or other cancer).
Perform psychosocial assessment, including questions about:
 Social support
 Individual and family coping skills
 Financial resources
 Helps the nurse plan for care in acute and community settings
After the interview, the nurse performs a complete physical examination:
 Assess the patient’s abdomen for tenderness or masses
 Palpate and percuss the abdomen to detect ascites

Nursing Diagnosis
Based on the assessment data, major nursing diagnoses may include the following:
 Anxiety related to the disease and anticipated treatment
 Imbalanced nutrition: less than body requirements related to early satiety or anorexia
 Acute pain related to tumor mass
 Grieving related to the diagnosis of cancer
 Deficient knowledge regarding self-care activities