2 Subtotal Gastrectomy Nursing Care Plan

Use this nursing care plan and management guide to provide care for patients who underwent subtotal gastrectomy. Enhance your understanding of nursing assessment, interventions, goals, and nursing diagnosis for this condition.

What is Subtotal Gastrectomy?
Nursing Care Plans and Management
Recommended Resources
See also

What is Subtotal Gastrectomy?

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, or cancer. During subtotal gastrectomy, the surgeon removes only the portion of the stomach affected by cancer.

Nursing Care Plans and Management

Nursing Problem Priorities

The following are the nursing priorities for patients with #:

Manage pain and discomfort post-gastric resection.
Promote wound healing and prevent surgical site infections.
Monitor and manage complications, such as leaks or bleeding.
Provide nutritional support and guidance for diet modifications.
Educate patients on postoperative care and lifestyle adjustments.
Address concerns related to digestion and absorption of nutrients.
Monitor and manage dumping syndrome or other gastrointestinal symptoms.
Schedule regular follow-up appointments for monitoring and adjustment of treatment plans.

Nursing Assessment

Assess for the following subjective and objective data:

See assessment cues under nursing interventions

Nursing Diagnosis

Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with # based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.

Nursing Goals

Goals and expected outcomes may include:

The client will verbalize understanding of the procedure, and disease process/prognosis.
The client will verbalize understanding of functional changes.
The client will identify necessary interventions/behaviors to maintain an appropriate weight.
The client will correctly perform necessary procedures, explaining reasons for actions.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with undergoing subtotal gastrectomy may include:

1. Promoting Adequate Nutrition Balance

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, and 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 the NG tube.

Note the character and amount of gastric drainage.
Will be bloody for the 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.

Note admission weight and compare with subsequent readings.
Provides information about the adequacy of dietary intake and determination of nutritional needs.

Monitor laboratory studies (Hb and Hct, electrolytes, total protein, prealbumin).
Indicators of fluid and nutritional needs and effectiveness of therapy, and detects developing complications.

Maintain patency of the NG tube. Notify the physician if the tube becomes dislodged.
Provides rest for the 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.

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.

Avoid milk and high-carbohydrate foods in the diet.
May trigger dumping syndrome.

Administer IV fluids, TPN, and lipids as indicated.
Meets fluid and nutritional needs until oral intake can be resumed.

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 the NG tube is removed, intake is advanced gradually to prevent gastric irritation and distension.

Administer medications as indicated:

Anticholinergics: atropine, propantheline bromide (Pro-Banthine)
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.
Medium-chain triglycerides (MCT)
Promotes the absorption of fats and fat-soluble vitamins to prevent malabsorption problems.

2. Initiating Patient Education and Health Teachings

Identify foods that can cause gastric irritation and increase gastric acid (chocolate, spicy foods, whole grains, raw vegetables).
Limiting or avoiding these foods reduces the risk of gastric bleeding and ulceration in some individuals. Note: Ingesting fresh fruits to reduce the risk of dumping syndrome should be tempered with the adverse effect of gastric irritation.

Identify symptoms that may indicate dumping syndrome, (weakness, profuse perspiration, epigastric fullness, nausea and vomiting, abdominal cramping, faintness, flushing, explosive diarrhea, and palpitations occurring within 15 min to 1 hr after eating).
Can cause severe discomfort or even shock, and reduces the absorption of nutrients. Usually self-limiting (1–3 wk after surgery) but can become chronic.

Identify signs and symptoms requiring medical evaluation such as persistent nausea and vomiting or abdominal fullness; weight loss; diarrhea; foul-smelling fatty or tarry stools; bloody or coffee-ground vomitus or presence of bile, fever. Instruct the patient to report changes in pain characteristics.
Prompt recognition and intervention may prevent serious consequences or potential complications such as pancreatitis, peritonitis, and afferent loop syndrome.

Discuss and identify stressful situations and how to avoid them. Investigate job-related issues.
Can alter gastric motility, interfering with optimal digestion. Note: The patient may require vocational counseling if a change in employment is indicated.

Review surgical procedures and long-term expectations.
Provides a knowledge base from which informed choices can be made. Recovery following gastric surgery is often slower than may be anticipated with similar types of surgery. Improved strength and partial normalization of the dietary pattern may not be evident for at least 3 mo, and full return to usual intake (three “normal” meals per day) may take up to 12 mo. This prolonged convalescence may be difficult for the patient and SO to deal with, especially if he or she has not been prepared.

Review dietary needs and regimen (low-carbohydrate, low-fat, high-protein) and the importance of maintaining vitamin supplementation.
May prevent deficiencies, enhance healing, and promote cooperation with therapy. Note: Low-fat diet may be required to reduce the risk of alkaline reflux gastritis.

Discuss the importance of eating small, frequent meals slowly and in a relaxed atmosphere; resting after meals; avoiding extremely hot or cold food; restricting high-fiber foods, caffeine, milk products, alcohol, excess sugars, and salt; and taking fluids between meals, rather than with food.
These measures can be helpful in avoiding gastric distension, irritation or stress on surgical repair, dumping syndrome, and reactive hypoglycemia. Note: Ice-cold fluids and foods can cause gastric spasms.

Instruct in avoiding certain fibrous foods, and discuss the necessity of chewing food well.
The remaining gastric tissue may have a reduced ability to digest such foods as citrus skin or seeds, which can collect, forming a mass (phytobezoar formation) that is not excreted.

Recommend foods containing pectin (citrus fruits, bananas, apples, yellow vegetables, and beans).
Increased intake of these foods may reduce the incidence of dumping syndrome.

Discuss signs of hypoglycemia and corrective interventions, (ingesting cheese and crackers, orange or grape juice).
Awareness helps patients take action to prevent the progression of symptoms.

Instruct the patient to weigh on a regular basis.
Change in dietary pattern, early satiety, and efforts to avoid dumping syndrome may limit intake, causing weight loss.

Review medication purpose, dosage, schedule, and possible side effects.
Understanding rationale and therapeutic needs can reduce the risk of complications ( anticholinergics or pectin powder may be given to reduce the incidence of dumping syndrome; antacids and histamine antagonists reduce gastric irritation).

Caution patient to read labels and avoid products containing ASA, and ibuprofen.
Can cause gastric irritation and bleeding.

Discuss the reasons for and importance of cessation of smoking.
Smoking stimulates gastric acid production and may cause vasoconstriction, compromising mucous membranes and increasing the risk of gastric irritation and ulceration.

Stress the importance of regular checkups with a healthcare provider.
Necessary to detect developing complications (anemia, problems with nutrition, and recurrence of disease).

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its 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 showing 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 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.