1. Linda S. Williams / Paula D. Hopper Copyright © 2011. F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 33 Nursing Care of Patients with Upper Gastrointestinal Disorders

2. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nausea and Vomiting  Nausea: Urge to Vomit  Vomiting: Expelling Stomach Contents Through Esophagus and Mouth

3. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  None  Protect Airway  Medications  IV Fluids  NG Tube  Clear Liquids, Dry Toast

4. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Nausea  Risk for Aspiration  Deficient Fluid Volume

5. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anorexia  Lack of Appetite

6. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Eating Disorders  Anorexia Nervosa  Bulimia Nervosa

7. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anorexia Nervosa  Females  Age 12 to 18 Years  Treatment goal  Restore Nutritional Health  18% Die

8. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anorexia Nervosa (cont’d)  Symptoms  Severe Weight Loss  Low Self-esteem  Compulsive Dieting  Disturbed Body Image

9. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anorexia Nervosa (cont’d)  Nursing Care  Therapeutic Relationship  Vital Signs  Daily Weights  Intake/Output of Food and Fluids

10. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anorexia Nervosa (cont’d)  Complications  Poor Nutrition, Electrolyte Imbalances  Decreased Vital Signs  Osteoporosis  Muscle Loss  Diabetes

11. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Bulimia Nervosa  Compulsive Eating, Self-induced Vomiting  Laxatives  “Binge–purge”  Young Women  Enamel Erosion of Front Teeth  Metabolic alkalosis

12. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Bulimia Nervosa (cont’d)  Treatment Goal  Restore Nutritional Health  Nursing Care  Therapeutic Relationship  Vital Signs, Daily Weights  Intake/Output of Food and Fluids

13. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Eating Disorders  Imbalanced Nutrition: Less Than Body Requirements  Body Image, Disturbed

14. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Obesity  Weight 20% or Greater Than Ideal Body Weight  BMI  Overweight: 25 to 29.9 Kg/m 2  Obese: >30 Kg/m 2

15. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Body Mass Index (BMI)

16. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Obesity (cont’d)  Caloric Intake Exceeds Energy Expenditure  Comorbidites: Diseases Associated with Obesity  Morbid Obesity: BMI >40

17. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Weight Loss Through Exercise and Calorie Restriction  Support Groups  Behavior Modification

18. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Surgical Management  Types of Bariatric Surgery  Restrictive  Limits How Much Stomach Can Hold  Malabsorption  Decreases Calorie/Nutrient Absorption  Combination  Restrictive and Malabsorption

19. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Surgical Management (cont’d)  Restrictive  Laparoscopic Adjustable Gastric Banding  Vertical Banded Gastroplasty (VBG)  Combination  Roux-en-Y Gastric Bypass

20. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Roux-en-Y Gastric Bypass Vertical Banded Gastroplasty

21. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications of Gastric Restrictive Surgeries  Vomiting  Erosion of the Gastric Tissue  Breakdown of Staple Line  Leaking of Stomach Secretions  Infection or Death

22. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Postoperative Care  Clear, Liquid Diet  Progresses to Full Liquids, Pureed Foods  Regular Foods at 6 Weeks

23. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnosis: Obesity  Imbalanced Nutrition: More Than Body Requirements

24. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Oral Health Care  Important to Overall Health  Often Neglected in Daily Care  Oral Hygiene with Chlorhexidine Gluconate  Prevents Pneumonia  Reduces Ventilator-associated Pneumonia

25. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Oral Health Care (cont’d)  Prophylactic Antibiotics  Xerostomia (Dry Mouth)  Artificial Saliva Substitute  Dentures  Gingival Recession  Fluoride Gel or Rinse

26. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Oral Health Care (cont’d)  Gingivitis  Flossing Daily  Candida Albicans (Yeast Infection)  Nystatin  Angular Cheilosis

27. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Stomatitis  Inflammation of Oral Cavity  Causes  Aphthous Stomatitis (Canker Sores)  Herpes Simplex Virus Type I (Cold Sores)

28. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Oral Cancer  Risk: Alcohol or Tobacco Use  Detected Early, Curable  Painless  Difficulty in Chewing, Swallowing, Speaking  Biopsies  Radiation, Chemotherapy, Surgery

29. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Radical Neck Dissection

30. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Oral Cancer Nursing Care  Referral: Alcohol/Tobacco Cessation  Preoperative Teaching  Postoperative  Airway  Communication  Nutrition

31. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Esophageal Cancer  Risk: Alcohol or Tobacco Use  Detected Late, Metastasizes  Difficulty Swallowing, Feeling Full, Pain in Chest, Foul Breath, Food Regurgitation  EGD, Biopsy

32. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Esophageal Cancer (cont’d)  Radiation  Chemotherapy  Surgery  Esophagogastrostomy  Dacron Esophageal Replacement  Esophagoenterostomy

33. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Esophageal Cancer (cont’d)  Nursing Diagnoses  Pain  Risk for Deficient Fluid Volume  Imbalanced Nutrition: Less Than Body Requirements

34. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia Lower Esophagus/Stomach Slides up Through Hiatus of Diaphragm into Thorax

35. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia (cont’d)  Occurs In  Women  Those over 60  Obesity  Pregnancy

36. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia (cont’d)

37. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia (cont’d)  Signs and Symptoms  None  Pain  Heartburn  Fullness  Reflux

38. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia (cont’d)  Diagnosis  X-Ray  Fluoroscopy

39. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Antacids  Small Meals  No Reclining 1 Hour After Eating  Raise Head of Bed 6 to 12 Inches  No Bedtime Snacks, Spicy Foods, Alcohol, Caffeine, Smoking

40. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia (cont’d)  Surgical Management  Fundoplication

41. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Fundoplication

42. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hiatal Hernia (cont’d)  Nursing Care  Teaching  Preoperative Care  Postoperative  Dysphagia with Eating

43. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastroesophageal Reflux Disease (GERD)  Pathophysiology  Gastric Secretions Reflux into Esophagus  Esophagus Damaged  Lower Esophageal Sphincter Does Not Close Tightly

44. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastroesophageal Reflux Disease (GERD) (cont’d)  Signs and Symptoms  Heartburn  Regurgitation  Dysphagia  Bleeding

45. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastroesophageal Reflux Disease (GERD) (cont’d)  Complications  Aspiration  Scar Tissue  Diagnosis  Barium Swallow  Esophagoscopy

46. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Lifestyle Changes  Medications  Antacids  H 2 Receptor Antagonists  Proton Pump Inhibitors  Prokinetic Agents

47. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastroesophageal Reflux Disease (GERD) (cont’d)  Esophy X  Endoscopic Procedures  Fundoplication

48. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition GERD Complications  Esophagitis  Barrett's Esophagus (Precancerous)  Esophageal Cancer  Bronchospasm  Larygeospasm  Aspiration Pneumonia

49. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Barrett's Esophagus  Precancerous  Radiofrequency Ablation

50. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastroesophageal Reflux Disease (GERD) (cont’d)  Nursing Diagnosis  Acute Pain

51. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastroesophageal Reflux Disease (GERD) (cont’d)  Nursing Care  Education  Lose Weight  Low-fat, High-protein Diet  Avoid Caffeine, Milk Products, Spicy Foods

52. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Mallory-Weiss Tear  Pathophyisiology  Longitudinal Tear in Mucous Membrane of Esophagus at Stomach Junction  Tears from Sudden, Powerful, or Prolonged Force  Hiatal Hernia Present

53. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Mallory-Weiss Tear (cont’d)  Signs and Symptoms  Bright Red, Bloody Emesis  Bloody or Tarry Stools

54. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Mallory-Weiss Tear (cont’d)  Diagnosis  EGD  Hemoglobin and Hematocrit

55. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Mallory-Weiss Tear (cont’d)  Therapeutic Interventions  Self-heal  PPI  Anti-emetic  Avoid Alcohol

56. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Mallory-Weiss Tear (cont’d)  Nursing Care  Report Bleeding  Teaching  Avoid Alcohol  Medications

57. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Esophageal Varices  Dilated Blood Vessels in Esophagus  Portal Hypertension  Rupture Life-threatening

58. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastritis  Inflammation of the Stomach  Acute or Chronic  Abdominal Pain, Nausea, Anorexia  Remove Irritating Substance  Bland Diet of Liquids/Soft Foods  Antacids

59. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastritis (cont’d)  Inflammation of Stomach Mucosa  Acute  Chronic

60. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastritis (cont’d)  Pathophysiology  Protective Mucosal Barrier Broken Down  Autodigestion  Severe  Perforation  Scarring

61. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastritis (cont’d)  Signs and Symptoms  Abdominal Pain  Nausea, Vomiting  Anorexia  Abdominal Tenderness  Feeling Of Fullness

62. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastritis (cont’d)  Signs and Symptoms (cont’d)  Reflux  Belching

63. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastritis (cont’d)  Therapeutic Interventions  Treat Cause  Bland Diet  Antacids  Anti-emetics

64. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Chronic Gastritis Type A  Autoimmune Gastritis  Fundus  Asymptomatic  Leads to Pernicious Anemia

65. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Chronic Gastritis Type B  Pathophysiology  From Infection with Helicobacter pylori  Lower Stomach

66. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Chronic Gastritis Type B (cont’d)  Signs and Symptoms  Anorexia, Heartburn, Belching, Sour Taste, Nausea/Vomiting  Treatment  Antibiotics

67. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease  Erosion of GI lining  Primary Cause: Bacterium H. pylori  Curable  Influenced by Smoking

68. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d)  Gastric  High Left Epigastric/Upper Abdominal Burning/Gnawing Pain  Increased 1 to 2 Hours After Meals or with Food

69. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d)  Duodenal  Midepigastric/Upper Abdominal Burning/Cramping Pain  Increased 2 to 4 Hours After Meal/ Middle of Night  Relieved with Food or Antacids

70. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d)  Signs and Symptoms  Anorexia  Nausea/Vomiting  Bleeding

71. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d)  Diagnosis  Helicobacter pylori  Upper GI Series  EGD

72. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Antibiotics  Proton Pump Inhibitors  Histamine H 2 Antagonists  Bismuth Subsalicylate  Sucralfate (Carafate)  Antacids

73. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d)  Treatment  Bland Diet  Avoid Irritants: Smoking, Caffeine, Alcohol

74. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d)  Complications  Bleeding  Perforation  Obstruction

75. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Peptic Ulcer Disease (cont’d)  Nursing Diagnoses  Acute Pain  Risk for Injury  Deficient Knowledge

76. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Stress Ulcers  Ischemia Damaging Mucous Barrier  Acid Secretions Create Ulcers

77. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Stress Ulcers (cont’d)  Preventive Treatment  Quick Trauma Care  Early Feeding  Testing Gastric Ph – Keep Above 5  Antacids, Histamine Blockers, Sucralfate

78. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Bleeding  From Ulcer Perforation, Tumor, Gastric Surgery  Occult or Observable  Symptoms Vary by Severity  Treat Hypovolemic Shock if Present  NPO, IV Fluids, Blood, NG Tube, Oxygen

79. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Bleeding (cont’d)  Nursing Diagnosis  Deficient Fluid Volume

80. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Cancer  Malignant Lesion in Stomach  Second Most Common Cancer  Men Greater Than Women  H. Pylori Infection Risk Factor  Poor Prognosis as Metastasizes

81. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Cancer (cont’d)  Signs and Symptoms  No Early Symptoms  Late Symptoms  Indigestion  Anorexia  Pain Relieved by Antacids

82. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Cancer (cont’d)  Late Symptoms (cont’d)  Weight Loss  Nausea and Vomiting  Anemia

83. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Cancer (cont’d)  Diagnosis  X-Ray  Gastroscopy  Gastric Fluid Analysis  Serum Gastrin

84. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastric Cancer (cont’d)  Surgery  Chemotherapy  Radiation

85. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Subtotal Gastrectomy  Partial Removal of Stomach  Gastroduodenostomy (Billroth I)  Distal Stomach Removed  Anastomosed to Duodenum  Treats Gastric Problems

86. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Subtotal Gastrectomy (cont’d)

87. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Subtotal Gastrectomy (cont’d)  Gastrojejunostomy (Billroth II)  More Distal Stomach Removed  Anastomosed to Jejunum  Treats Duodenal Problems

88. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Total Gastrectomy  Total Stomach Removal  Extensive Gastric Cancer  Anastomosis of Esophagus to Jejunum

89. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Total Gastrectomy (cont’d)

90. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Gastric Surgery  Acute Pain  Fear

91. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Care After Gastric Surgery  Monitor Vital Signs  Respiratory Status  Control Pain  Intake and Output  Incisional Site

92. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Care After Gastric Surgery (cont’d)  NG Tube Care  Ambulate Early  Monitor Abdominal Status  Education

93. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications of Gastric Surgery  Hemorrhage  Gastric Distention  Dumping Syndrome  Nutritional Problems  Pernicious Anemia

94. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications of Gastric Surgery (cont’d)  Steatorrhea  Pyloric Obstruction