Please enable JavaScript.
Coggle requires JavaScript to display documents.
Gastric Cancer - Coggle Diagram
Gastric Cancer
Clinical Manifestations
Abdominal pain
Loss of appetite
Weight loss
Bloating after meals
Early satiety
Nausea and vomiting
Dyspepsia
Risk Factors
Pernicious anemia
Gastric ulcers
Chronic inflammation of stomach
Presence of Helicobacter pylori in early age
Diet ↑smoked/salted/spiced food; food with preservatives e.g. nitrates/nitrites; ↓fruits and vegetables
Hereditary; blood group A
Assessment & Diagnostic
Oesophagogastroduodenoscopy
(OGDS/upper endoscopy)
Laparoscopy
Ascites & hepatomegaly
Barium X-ray
Endoscopic U/S
CT scan abdomen
Medical Management
Subtotal Gastrectomy
Billroth I (limited resection)
Billroth II (75% resection)
Chemotherapy
Radiation therapy
Tumor markers
Total gastrectomy
Self-Management Teaching
Dietary management
Discourage fluid intake with meals; consume 1hr before or after is recommended
Meals content should have more dry items than liquid items
Antispasmodics
Can eat fat as tolerated
Low (concentrated) carbohydrate intake
S/A & frequent meals
Dietary supplements: iron, **Vit B12 (inj), vitamins
Low fowler’s during meals and lie down for 20-30min after meal to delay stomach emptying
Enteral/parenteral feedings
Information about detection and prevention of untoward effects/complications
Care of enteral/parenteral tube
Demonstrate & supervise feeding
Support group
State necessary dietary changes
Promoting self-care at home
Dietitian consultation
Teaching for enteral/parenteral feedings
Pain management
Record of daily I/O, wt
Lifestyle changes
Recognizing signs and symptoms
Treatment regimens-expected side effects
Psychological counseling
Information about diet & nutrition
Follow up appointment
Complications
Postoperative
Abdominal Distention
Atelectasis
Infection
Impaired nutritional status
Hemorrhage
Potential
Bile reflux
Drug agents: Cholestyramine
Dumping syndrome
Fullness, cramping pain, faintness, dizziness, diarrhea, weakness, palpitation, diaphoresis, low BS
Dietary deficiencies
wt loss
Iron, vit B12 (anaemia), Ca2+
Nursing Management
Pre-Op
Assessment
Pain
h/o of H. pylori
Loss of appetite
h/o smoking & alcohol
Changes in eating habit
Family h/o cancer
Food toleration
Psychosocial- support, coping skills, financial resources
Nausea and vomiting, haematemesis
Physical examination - inspection, auscultation, percussion, palpation of the abdomen for tenderness/masses, ascites, bowel sound
Wt loss
Knowledge of pre-op and post-op routines and rationales
Nutritional status
Dietary history
Nursing Diagnosis
Anxiety related to surgical intervention
Deficient knowledge related to surgical procedure & post-op management
Imbalanced nutrition less than body requirements
related to poor nutrition prior to surgery
Post-Op
Nursing Diagnosis
Acute pain related to surgical intervention
Imbalanced nutrition less than body requirements
related to altered GI system after surgery
Deficient knowledge regarding self-care activities
Planning & Goals
Anticipate lifestyle changes
Relief pain
Optimal nutrition
Reduce anxiety
Interventions
Relieving pain
Positioning
Maintain & Secure NGT
Relaxation Exercise
Pain Assessment
Rest Period
IV Opioid
Monitoring complications
Vomiting-bright-red blood
Assess NG drainage for type & amount
Haemorrhage, sign of shock
Assess abdominal dressing for bleeding
Dysphagia, gastric retention, bile reflux, dumping syndrome,
vit B12 & mineral deficiencies
Promoting optimal nutrition
Monitor IV therapy
Monitor nutritional status
Inj vit B12 (if total gastrectomy is done)
Enteral/Parenteral nutrition
Food Supplements
Daily weight
Assess for dehydration
Administer antiemetics
S/A, Frequent portions of food
Definition
Malignant neoplasms found in stomach usually adenocarcinoma
Pathophysiology
Tumor infiltrates surrounding mucosa
Penetrating wall of stomach & adjacent
organs
Metastasis through lymph to peritoneal
cavity