Stomach Disorders: Gastric cancer, Gastrectomy, & Bariatric surgery Post-op

Question 1

Gastric cancer

Risk factors diseases?

Answer 1

H. Pylori
Gastric polyps
Pernicious anemia

Question 2

Gastric cancer

Risk factor foods?

Answer 2

Pickled foods
Nitrates
Added salt to food

Question 3

Gastric cancer

Risk factor if lack of what foods?

Answer 3

Lac of fruits and veg

Question 4

Gastrectomy is the main tx for what?

Answer 4

Gastric cancer

Question 5

Gastrectomy post op

NG tube is connected to ____

Answer 5

Low suction to empty stomach

*if whole stomach removed, the NG tube put in small intestine until bowel function returns

Question 6

Gastrectomy post op

NPO until when? Then what?

Answer 6

Stomach wakes up then
Clear liquids after audible bowel sounds/pt has BM
Then liquids, then soft food, then solid food

Question 7

Gastrectomy post op

Eat what once starting to eat?

Answer 7

Small meals
More protein
Less sugar

Question 8

Gastrectomy post op

When to get pt up?

Answer 8

Out of bed day after surgery

*abdominal binder/splinting may be needed to reduce pain

Question 9

Gastrectomy post op

What could happen–dumping or refeeding?

Answer 9

Dumping

Question 10

Bariatric post op

Priority?

Answer 10

Airway

• Postion
• SaO2 monitor
• note: pt. with thin and short neck veins often have compromised airways and need aggressive support

Question 11

Bariatric post op

T/F: Need abdominal binder

Answer 11

T

Question 12

Bariatric post op

How to control pain?

Answer 12

PCA with mophine for first 24 hr then oral opioids (liquid form preferred) after PCA d/c

Question 13

Bariatric post op

Pt still large after this surgery?

Answer 13

Yes focus on your safety and theirs!!

Question 14

Bariatric post op

How to be safe with big pt?

Answer 14

• Extra wide bed (bed rails shouldn’t touch pt)
• Beds need to have adequate weight maximums
• Extra personnel for moving/turning pt

Question 15

Bariatric post op

Should pt lift anything post op

Answer 15

No

Question 16

Bariatric post op

How to do skin assessment?

Answer 16

• Monitor between skin folds and around tubes/catheters
• Skin kept clean and dry
• Use absorbent padding between folds
• Turn q2h

Question 17

Bariatric post op

NG tube management?

Answer 17

• May be placed, if so monitor tube for potency
• NEVER reposition tube bc movement can disturb suture line
• Will be removed 2nd day after pt. passes gas

Question 18

Bariatric post op

Diet order?

Answer 18

1. Clear liquid slowly introduced after surgery in small 1 oz cup
2. Pureed, foods, juice, thinned soups, milk for 24-48 hours later and on this for SIX weeks!!!
3. 6 small feeds to prevent dehydration

Question 19

Bariatric post op

Observe for what-dumping or refeeding?

Answer 19

DUmping syndrome

Question 20

Dumping can occur especially after?

Answer 20

Gastric bypass

Question 21

Symptoms of dumping?

Answer 21

Tachycardia
Nausea
Diarrhea
Ab. cramping

Question 22

When to remove catheter?

Answer 22

Within 24 hours to prevent UTI