Gastric Cancer Nursing Care Plan & Management

Notes

Description
  • It is also called malignant tumor of the stomach.
  • It is usually an adenocarcinoma.
  • It spreads rapidly to the lungs, lymph nodes, and liver.
  • Risk factors include chronic atrophic gastritis with intestinal metaplasia; pernicious anemia or having had gastric resections (greater than 15 years prior); and adenomatous polyps.
  • This cancer is most common in men older than age 40 and in blacks.
  • Complications are hemorrhage and dumping syndrome from surgery or widespread metastasis and death.

gastric cancer

Causes/ Risk Factors

No one knows why some people develop stomach cancer and others don’t. The number of people affected varies widely between different countries. For example, stomach cancer is far more common in Japan than in the UK. There is also evidence that people from poorer backgrounds are at increased risk.

There are a many other factors that increase the risk of developing stomach cancer.

  • Age. Stomach cancer is most common around the age of 60. It’s rare under the age of 40.
  • Gender. Men are around twice as likely to develop stomach cancer as women.
  • Helicobacter pylori infection. These bacteria live in the stomach lining of many people, and don’t usually cause any symptoms. However, the infection sometimes causes inflammation of the stomach lining (gastritis), indigestion and stomach ulcers. It is known to increase the risk of stomach cancer.
  • Diet. A diet high in salt and foods that are smoked or cured may increase the risk of stomach cancer. In particular, certain food preservative chemicals known as nitrosamines, which are found cured meats such as bacon and ham, may increase your chance of developing stomach cancer.
  • Family history. Some people inherit an increased risk of developing stomach cancer.
  • Type A blood group. Some research indicates that people who have type A blood are at higher risk of developing stomach cancer.
  • Smoking. When you smoke, you swallow small amounts of tobacco smoke, which increases your risk of getting stomach cancer.
  • Atrophic gastritis. This condition causes the lining of the stomach to waste away. It has also been linked with an increased risk of stomach cancer.
  • Pernicious anaemia. This is type of anaemia raises your risk of stomach cancer.
Assessment
  1. Most often, the patient presents with the same symptoms as gastric ulcer. Later, evaluation shows the lesion to be malignant.
  2. Gastric fullness (early satiety), dyspepsia lasting more than 4 weeks, progressive loss of appetite are initial symptoms.
  3. Stool samples are positive for occult blood.
  4. Vomiting may occur and may have coffee-ground appearance.
  5. Later manifestations include pain in black or epigastric area (often induced by eating, relieved by antacids or vomiting); weight loss; hemorrhage; gastric obstruction.
Diagnostic Evaluation
  1. Upper GI X-ray with contrast media may initially show suspicious ulceration that requires further evaluation.
  2. Endoscopy with biopsy and cytology confirms malignant disease.
  3. Imaging studies (bone scan, liver scan, CT scan) helps determining metastasis.
  4. Complete blood count (CBC) may indicate anemia from blood loss.
Primary Nursing Diagnosis
  • Pain (acute) related to gastric erosion
Therapeutic Intervention / Medical Management
  • The only successful treatment of gastric cancer is gastric resection, surgical removal of part of the stomach with involved lymph nodes; postoperative staging is done and further treatment may be necessary.
  • Surgical options include proximal or distal subtotal gastric resection; total gastrectomy (includes adjacent organs such as tail of pancreas, portion of liver, duodenum); or palliative surgery such as subtotal gastrectomy with gastroenterostomy to maintain continuity of the GI tract.
  • Surgery may be combined with chemotherapy to provide palliation and prolong life.
Pharmacologic Intervention
  • Chemotherapeutic agents used as adjuvant (in addition to) or neoadjuvant (before surgery) often in combination: fluorouracil, doxorubicin, methyl-CCNU, cisplatin, methotrexate, etoposide to treat cancer that has metastasized to organs beyond stomach; shrink tumors before surgery.
  • B vitamin complex tablet Combat vitamin B12deficiency and megaloblastic anemia from lack of intrinsic factor
  • Narcotic analgesics manage pain, side effects of treatment drugs such as morphine, meperidine which increase patient comfort during end-stage disease
  • Other Medications: Antiemetics may be used to control nausea, which increases as the tumor enlarges. In the advanced stages, the physician may prescribe sedatives, narcotics, and tranquilizers to increase the patient’s comfort. Antispasmodics and antacids may also help relieve GI discomfort.
Nursing Intervention
  1. Monitor nutritional intake and weigh patient regularly.
  2. Monitor CBC and serum vitamin B12 levels to detect anemia, and monitor albumin and prealbumin levels to determine if protein supplementation is needed.
  3. Provide comfort measures and administer analgesics as ordered.
  4. Frequently turn the patient and encourage deep breathing to prevent pulmonary complications, to protect skin, and to promote comfort.
  5. Maintain nasogastric suction to remove fluids and gas in the stomach and prevent painful distention.
  6. Provide oral care to prevent dryness and ulceration.
  7. Keep the patient nothing by mouth as directed to promote gastric wound healing. Administer parenteral nutrition, if ordered.
  8. When nasogastric drainage has decreased and bowel sounds have returned, begin oral fluids and progress slowly.
  9. Avoid giving the patient high-carbohydrate foods and fluids with meals, which may trigger dumping syndrome because of excessively rapid emptying of gastric contents.
  10. Administer protein and vitamin supplements to foster wound repair and tissue building.
  11. Eat small, frequent meals rather than three large meals.
  12. Reduce fluids with meals, but take them between meals.
  13. Stress the importance of long term vitamin B12 injections after gastrectomy to prevent surgically induced pernicious anemia.
  14. Encourage follow-up visits with the health care provider and routine blood studies and other testing to detect complications or recurrence.
Documentation Guidelines
  • Physical findings related to gastric cancer:Epigastric discomfort,dyspepsia,anorexia,nausea, sense of fullness, gas pains, unusual tiredness, abdominal pains, constipation, weight loss,
  • vomiting,hematemesis,blood in the stool,dysphagia,jaundice,ascites,bone pain
  • GI decompression data: Irrigation and patency of tube, assessment of bowel sounds and passage of gas,complaints of nausea,amount and description of gastric fluid output
  • Presence of postoperative complications: Hemorrhage, obstruction, anastomotic leaks, infection,peritonitis
  • Presence of postoperative dumping syndrome and associated patient symptoms
Discharge and Home Healthcare Guidelines
  • Teach the patient the importance of compliance with palliative and follow-up care. Be sure the patient understands all medications, including the dosage, route, action, and adverse effects.
  • Teach the patient the signs and symptoms of infection and how to care for the incision. Instruct the patient to notify the physician if signs of infection occur.
  • Encourage the patient to seek psychosocial support through local support groups (e.g.,I Can Cope),clergy,or counseling services. If appropriate,suggest hospice services.
  • Teach the patient methods to enhance nutritional intake to maintain ideal body weight. Several small meals a day may be tolerated better than three meals a day. Take liquid supplements and vitamins as prescribed. Refer the patient to the dietitian for a consultation. Teach family members and friends prevention strategies. Strategies include increasing the intake of fresh fruits and vegetables that are high in vitamin C; maintaining adequate protein intake; and decreasing intake of salty, starchy, smoked, and nitrite- preserved foods.

 


Sources:

http://hcd2.bupa.co.uk/
Marilyn Sawyer Sommers, RN, PhD, FAAN , Susan A. Johnson, RN, PhD, Theresa A. Beery, PhD, RN , DISEASES AND DISORDERS A Nursing Therapeutics Manual, 2007 3rd ed
Nursingcrib.com

Exam

Welcome to your MSN Exam for Gastric Cancer! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 10 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Our nutritional habits greatly impact our health, and often, the relationship is inverse. Foods that are a feast for our taste buds can sometimes be a menace to our health. Smoked foods, for instance, might add flavor to our meals, but they're not quite as beneficial when it comes to our risk of certain diseases. Meanwhile, fruits and vegetables, those colorful allies of health, can often have a protective effect against numerous conditions.

1 / 10

1. In reference to gastric cancer, can you determine which statement holds true?

💡 Hint

Consider the symptom that directly suggests an issue with the stomach's ability to empty its contents. This could be a reaction to the body's inability to properly digest food.

2 / 10

2. Which symptom might suggest that an enlarging cancer is causing stomach drainage?

💡 Hint

In the realm of microscopic warriors, Helicobacter pylori holds a unique position. Its fascinating ability to survive in the harsh acidic environment of the stomach and its role in certain health conditions have intrigued scientists for years. For anyone diving into this micro world, it's worth noting that the name of the bacteria provides a hint to its preferred territory - 'Helicobacter', meaning spiral-shaped, and 'pylori', referring to the pylorus or the lower part of the stomach.

3 / 10

3. Which type of cancer is believed to have a connection with the bacterium Helicobacter pylori?

💡 Hint

It's intriguing how our habits and choices can influence our health landscape. Cigarettes, for instance, contain over 7,000 chemicals that harm our bodies, leading to various health problems, including an increased risk for cancers. Likewise, our culinary preferences, such as a penchant for overly salty or pickled foods, could also play a part in shaping our health outcomes. As we age, our bodies undergo changes that might make us more susceptible to certain conditions. It all underlines the importance of maintaining a balanced lifestyle and making informed choices.

4 / 10

4. Which of the following could potentially increase the likelihood of developing stomach cancer?

💡 Hint

The role of Helicobacter pylori in the onset and development of peptic ulcers is well established, thus necessitating its elimination. For anyone intrigued by the tiny, spiral-shaped bacterium, a fascinating fact is that it can survive in the highly acidic environment of the stomach, an ability not possessed by many other microorganisms. The management of H. pylori often involves a "triple therapy" strategy, an interesting combination of medications aimed at eradicating the bacteria.

5 / 10

5. A male patient, diagnosed with a Peptic ulcer, presents with a high concentration of Helicobacter pylori bacteria as revealed by laboratory tests. Can you identify the most accurate interpretation of this information?

💡 Hint

The human body is a complex symphony of signals, and at times, it might speak in distressing notes such as unexplained pain, unusual bloating, or alarming signs like blood in stools. These could potentially be indicators of serious conditions like stomach cancer. Always remember that health is the melody of well-being, and any discordant note deserves immediate attention.

6 / 10

6. What other symptoms might be indicative of stomach cancer?

💡 Hint

The covert nature of stomach cancer often mirrors the quiet, yet significant, role our stomachs play in digestion. Much like the subtle operations within our stomach that convert food into energy, the early stages of stomach cancer may go unnoticed, quietly progressing without any discernible symptoms. This emphasizes the importance of regular health check-ups and the value of maintaining a lifestyle that reduces the risk of such diseases.

7 / 10

7. The diagnosis of stomach cancer may not be accompanied by noticeable symptoms for an extended period.

💡 Hint

While diet plays a significant role in stomach cancer risks, certain types of foods, particularly those preserved in specific ways, might pose a higher risk. Consider the food choices that often contain nitrates and nitrites used for preservation.

8 / 10

8. A patient suffering from persistent indigestion is hospitalized and later diagnosed with stomach cancer. Which item from the following list is associated with a heightened risk of developing this type of cancer?

💡 Hint

The game of life is one of balance and moderation. Adopting certain lifestyle choices and being mindful of our health can tilt the scale in favor of disease prevention. For example, eating a healthy diet, exercising regularly, avoiding tobacco, and reducing alcohol intake can all contribute to a healthier life, possibly reducing the risk of various diseases, including stomach cancer. This is not a guarantee, as various factors play into cancer development, but it's a step towards creating a healthier environment for our bodies.

9 / 10

9. Is it possible to prevent the onset of stomach cancer?

💡 Hint

Listening to our bodies is a form of self-care. Sometimes, our bodies whisper their discomfort in ways that may seem ordinary or even benign — such as a persistent heartburn, an unexplained fatigue, or a sudden disinterest in food. It's crucial not to ignore these whispers, as they might be early signs of something more significant, such as stomach cancer. Remember, the earlier a problem is detected, the more likely it is that it can be effectively managed or treated.

10 / 10

10. What signs might a person initially exhibit if they are developing stomach cancer?

Nursing Care Plan

Nursing Care Plan for Gastric Cancer

Nursing Diagnosis

Pain ( acute / chronic )related to the presence of abnormal epithelial cells, nerve impulse disorders of the stomach.

Goal

Pain is reduced, controlled.

Expected outcomes
  • The patient was not seen grimacing.
  • Pain scale of 0 (no pain).
  • The patient seemed more relaxed.
Intervention
  • Assess characteristics of pain and discomfort ; location, quality, frequency, duration, etc.
    • Rationale : provide a basis for assessing changes in the level of pain and evaluate interventions.
  • Reassure the patient that you know, the pain is real and that you will assist the patient in reducing the pain.
    • Rationale : Fear can increase anxiety and reduce pain tolerance.
  • Collaboration in analgesic administration to improve circulation within the optimal pain prescription.
    • Rationale :Tend to be more effective when given early in the cycle of pain.
  • Teach the patient new strategies to relieve pain and discomfort with distraction, imagination, relaxation.
    • Rationale : Improving alternative pain relief strategies appropriately.

Nursing Diagnosis
Imbalanced Nutrition : less than bodyrequirements related to anorexia.

Goal

Nutritional needs of clients are met.

Expected outcomes
  • The client will maintain nutrient inputs to the metabolic needs.
  • Increased appetite.
  • No weight loss.
Intervention
  • Teach the patient the following things : avoid the sight, smell, sounds unpleasant in the environment during meal times.
    • Rationale : Anorexia can be stimulated or enhanced by noxious stimuli.
  • Suggest eating preferred and well tolerated by the patients, better food with high content of calories / protein. Respect the patient’s food preferences based on ethnicity.
    • Rationale : A food that is well tolerated and high in calories and protein will maintain nutritional status during periods of increased metabolic needs.
  • Encourage adequate fluid intake, but limit fluids at mealtime.
    • Rationale : Fluid level is necessary to eliminate waste products and prevent dehydration.
  • Increase fluid levels with food can lead to a state of satiety. Consider the cold food, if desired.
    • Rationale :Cold foods high in protein can often be well tolerated and does not smell than hot food.
  • Collaborative provision of commercial liquid diet by way of enteral feeding through a tube, elemental diet.
    • Rationale : Feeding through a tube may be necessary in the patient with very weak gastrointestinal system is still functioning.

Nursing Diagnosis
Anxiety related to malignancy advanced disease.

Goal

Anxiety clients decreased.

Expected outcomes
  • Clients are more relaxed.
  • The normal pulse.
  • No increase in respiration.
Intervention
  • Provide a relaxed environment and non-threatening.
    • Rationale : The patient can express fear, problems, and the possibility of anger due to the diagnosis and prognosis.
  • Encourage active participation of the patient and family in care and treatment decisions.
    • Rationale : To maintain independence and control of the patient.
  • Instruct the patient to discuss personal feelings with the supporters of such clergy if desired.
    • Rationale : Facilitating the process of grieving and spiritual care.