Nursing 211

N211: Health Differences Across the Lifespan I • Anxiety and knowledge deficit related to diagnosis and treatments • Altered family processes related to diagnosis and role relationship changes Medical Interventions Include gastric resection to remove the tumor includes subtotal and total gastrectomy; radiation and chemotherapy with antimetabolites such as 5-Fluorouracil (5FU) and, antibiotics such as doxorubicin (Adriamycin) or mitomycin C (Mutamycin). Combination therapy with surgery, radiation and chemotherapy are commonly used. Gastric Resection is when a portion of the stomach is removed. Pre-operatively a nasogastric tube is inserted and connected to suction. Post-operatively monitor vital signs, lung and bowel sounds, I&O including drainage from NG tube. Encourage ambulation to promote peristalsis and prevent postoperative complications such as paralytic ileus and obstruction. Complications include acute gastric dilation which manifests as epigastric pain, fullness, hiccups, tachycardia, and hypotension. Dumping syndrome occurs when eating there is a rapid emptying of food into the jejunum without proper mixing and duodenal digestion. Dumping Syndrome signs and symptoms are vertigo, tachycardia, syncope, sweating, pallor, and palpitations 15 to 30 minutes after eating. This is caused by a rapid shift of extracellular fluid into the bowel to dilute hypertonic chyme, thereby decreasing blood volume. Late manifestations 2 to 3 hours after eating include epigastric fullness, distension, diarrhea, abdominal cramping, nausea and high-pitched bowel sounds. This is caused by an excessive release of insulin in response to a rapid rise in blood glucose due to a high carbohydrate bolus entering the jejunum. This can be minimized with a low CHO, high protein, high fat diet; avoidance of drinking fluids with meals and lying down after eating. Billroth I (gastroduodenostomy) is a partial gastrectomy in which the distal portion of the stomach is removed, and the remainder is anastomosed to the duodenum. Billroth II (gastrojejunostomy) is a partial gastrectomy in which the lower portion of the stomach is removed, and proximal remnant is anastomosed to the jejunum. Nursing Interventions Include monitoring vital signs, administering an antiemetic medication as needed for GI effects; offer bland foods high in nutrients and calories; encourage small frequent meals; avoid producing foods such as cabbage, broccoli, and fruits. Monitor weight and intake and output. Encourage pacing of activities with periods of rest. Allow patient to express feelings regarding diagnosis. Prepare the patient for expected changes in body image such as alopecia, weight loss and decreased appetite. 3.12 Colorectal Cancer


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