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SUBTOTAL GASTRECTOMY/GASTRIC RESECTION Subtotal gastrectomy or gastric resection is indicated for gastric hemorrhage/intractable ulcers, dysfunctional lower esophageal sphincter, pyloric obstruction, perforation, cancer. CARE SETTING Inpatient surgical unit. RELATED CONCERNS Cancer Pancreatitis Peritonitis Psychosocial aspects of care Surgical intervention Total nutritional support: parenteral/enteral feeding Upper gastrointestinal/esophageal bleeding Patient Assessment Database Data depend on the underlying condition necessitating surgery. TEACHING/LEARNING Discharge plan DRG projected mean length of inpatient stay: 3.5 days considerations: Assistance with administration of enteral feedings/total parenteral nutrition (TPN) (if required) and acquisition of supplies Refer to section at end of plan for postdischarge considerations. NURSING PRIORITIES 1. Promote healing and adequate nutritional intake. 2. Prevent complications. 3. Provide information about surgical procedure/prognosis, treatment needs, and concerns. DISCHARGE GOALS 1. Nutritional intake adequate for individual needs. 2. Complications prevented/minimized. 3. Surgical procedure/prognosis, therapeutic regimen, and long-term needs understood. 4. Plan in place to meet needs after discharge. (In addition to nursing diagnoses identified in this CP, refer to CP Surgical Intervention.) NURSING DIAGNOSIS: Nutrition: imbalanced, risk for less than body requirements Risk factors may include Restriction of fluids and food Change in digestive process/absorption of nutrients Possibly evidenced by [Not applicable; presence of signs and symptoms stablishes an actual diagnosis.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Nutritional Status (NOC) Maintain stable weight/demonstrate progressive weight gain toward goal with normalization of laboratory values. Be free of signs of malnutrition.
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ACTIONS/INTERVENTIONS Nutrition Therapy (NIC) Independent Maintain patency of NG tube. Notify physician if tube becomes dislodged. Note character and amount of gastric drainage. Caution patient to limit the intake of ice chips. Provide oral hygiene on a regular, frequent basis, including petroleum jelly for lips. Auscultate for resumption of bowel sounds and note passage of flatus. Monitor tolerance to fluid and food intake, noting abdominal distension, reports of increased pain/cramping, nausea/vomiting. Avoid milk and high-carbohydrate foods in the diet. Note admission weight and compare with subsequent
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