2 Subtotal Gastrectomy Nursing Care Plan

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Subtotal gastrectomy or gastric resection is the removal of a portion of the stomach indicated for gastric hemorrhage/intractable ulcers, dysfunctional lower esophageal sphincter, pyloric obstruction, perforation, cancer. During subtotal gastrectomy, the surgeon removes only the portion of the stomach affected by cancer.

Nursing Care Plans

Here are two (2) nursing care plans (NCP) and nursing diagnosis for patients who underwent subtotal gastrectomy.

  1. Risk for Imbalanced Nutrition: Less Than Body Requirements
  2. Deficient Knowledge
  3. Other Possible Nursing Care Plans
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Risk for Imbalanced Nutrition: Less Than Body Requirements

Nursing Diagnosis

  • Imbalanced Nutrition: 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 for risk diagnosis. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

  • Maintain stable weight/demonstrate progressive weight gain toward the goal with normalization of laboratory values.
  • Be free of signs of malnutrition.
Nursing InterventionsRationale
Maintain patency of NG tube. Notify the physician if the tube becomes dislodged.Provides rest for GI tract during the acute postoperative phase until the return of normal function. Note: The physician or surgeon may need to reposition the tube endoscopically to prevent injury to the operative area.
Note character and amount of gastric drainage.Will be bloody for first 12 hr, and then should clear and turn greenish. Continued or recurrent bleeding suggests complications. A decline in output may reflect the return of GI function.
Caution patient to limit the intake of ice chips.Excessive intake of ice produces nausea and can wash out electrolytes via the NG tube.
Provide oral hygiene on a regular, frequent basis, including petroleum jelly for lips.Prevents discomfort of dry mouth and cracked lips caused by fluid restriction and the NG tube.
Auscultate for resumption of bowel sounds and note passage of flatus.Peristalsis can be expected to return about the third postoperative day, signaling readiness to resume oral intake.
Monitor tolerance to fluid and food intake, noting abdominal distension, reports of increased pain, cramping, nausea, and vomiting.Complications of paralytic ileus, obstruction, delayed gastric emptying, and gastric dilation may occur, possibly requiring reinsertion of NG tube.
Avoid milk and high-carbohydrate foods in the diet.May trigger dumping syndrome.
Note admission weight and compare with subsequent readings.Provides information about the adequacy of dietary intake and determination of nutritional needs.
Administer IV fluids, TPN, and lipids as indicated.Meets fluid and nutritional needs until oral intake can be resumed.
Monitor laboratory studies (Hb and Hct, electrolytes, and total protein, prealbumin).Indicators of fluid and nutritional needs and effectiveness of therapy, and detects developing complications.
Progress diet as tolerated, advancing from clear liquid to bland diet with several small feedings.Usually, the NG tube is clamped for specified periods of time when peristalsis returns to determine tolerance. After NG tube is removed, intake is advanced gradually to prevent gastric irritation and distension.
Administer medications as indicated:
Controls dumping syndrome, enhancing digestion and absorption of nutrients.
  • Fat-soluble vitamin supplements, including vitamin B12, calcium
Removal of the stomach prevents absorption of vitamin B12 (owing to loss of intrinsic factor) and can lead to pernicious anemia. In addition, rapid emptying of the stomach reduces the absorption of calcium.
  • Iron preparations
Corrects and prevents iron deficiency anemia.
  • Protein supplements
Additional protein may be helpful for tissue repair and healing.
  • Pancreatic enzymes, bile salts
Enhances digestive process.
Promotes the absorption of fats and fat-soluble vitamins to prevent malabsorption problems.
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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses as reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of it’s evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions show how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

More nursing care plans related to gastrointestinal disorders:

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Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
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