14558810 Stomach Cancer

8/3/2019 14558810 Stomach Cancer

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Stomach Cancer


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Anatomy and Physiology


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Anatomy and Physiology

The stomach, stimulated by the vagus nerves is where proteindigestion begins. It is most dilated part of the alimentary tract,

situated between the oesphagus and duodenum and lying in the

epigastrium and left hypochondrium. It is roughly J-shaped, with

the upper opening at the level of the T9 vertebra and the loweropening at the pylorus or gastroduodenal junction to the right of

the midline at the level of the L1 vertebra (transpyloric plane).

The stomach has three parts: the fundus (the part above the level

of entry of the oesophagus), the body (main part), and thepyloric part (pyloric antrum, with the pyloric sphincter at the

junction with the duodenum)


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Pathophysiology

Most gastric cancers are adenocarcinomas andcan occur in any portion of the stomach. The tumorinfiltrates the surrounding mucosa. Penetrating the

wall of the stomach and adjacent organs andstructures. The liver, pancreas, esophagus, andduodenum are often affected at the time of

diagnosis. Metastasis through lymph to theperitoneal cavity occurs later in the disease.


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Assessment

The nurse elicits a dietary history from the patient, focusing onrecent nutritional intake and status. Has the patient lost weight?If so, how much and over what period of time? Can the patienttolerate a full diet. If not, what foods can he or she eat? What

other changes in eating habits have occurred. Is there a historyof infection with H. pylori bacteria? Other health information toobtain includes the patients smoking and alcohol history andthe family history (any first or second degree relatives withgastric or other cancer). A psychosocial assessment, includingquestions about social support, individual and family copingskills, and financial resources, will help the nurse plan for carein acute and community settings. After the interview, the nurseperforms a complete physical examination, carefully assessesthe patients abdomen for tenderness or masses, and alsopalpates and percusses to detect ascites.


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Sign and Symptoms

Anorexia

Dyspepsia (Indigestion)

Weight loss

Abdominal Pain

Constipation

Anemia

Nausea and Vomiting


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Nursing Diagnosis

Anxiety related to the disease and anticipatedtreatment

Imbalanced nutrition, less than body requirements,

related to anorexiaPain related to tumor mass

Anticipatory grieving related to the diagnosis of cancer

Deficient knowledge regarding self-care activities


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Imaging Studies

Endoscopy for biopsy and cystologic washings is the

usual diagnostic study

Barium x-ray examination of the upper GI tract may

also be performed.

CT Scan, Bone scan, and Liver scan are valuable in

determining the extent of metastasis.

Complete X-Ray Examination


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Lab Test

Fecal Occult Blood Test is used to detect microscopic blood in thestool, which may indicate stomach or other gastrointestinal (GI)

cancers

Complete Blood Count (CBC) is a simple blood test used to measure

the concentration of white blood cells, red blood cells, and platelets. In an upper GI series, or Barium Swallow, the patient drinks a thick,

chalky liquid that coats the esophagus and stomach and makes it

easier to detect abnormal areas on r-ray. InDouble-Contrast Barium

Swallow, air is blown into the esophagus and stomach to help theliquid coat the wall of the organs more thoroughly.


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Pictures


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Planning

Reduced anxiety

Optimal nutrition

Relief pain

Anticipated lifestyles changes
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Nursing Intervention

The nurse encourages the family in their efforts to support the patient, offeringreassurance and supporting positive coping measures.

The nurse advises the patient about any procedures and treatment so that the patientknows what to expect.

The nurse encourages the patient to eat small, frequent portions of nonirritating foods todecrease gastric irritation.

The nurse monitors the IV therapy and nutritional status and records intake, output, anddaily weights to ensure that the patient is maintaining or gaining weight.

The nurse works with patient to manage pain by suggesting non pharmacologic methodsfor pain relief, such as position changes, imagery, distraction, relaxation exercises,backrubs, massage and periods of rest and relaxation.

The nurse explain manage pain, nausea, vomiting or other symptoms. Self care activities will depend on the mode of treatment used surgery, chemotherapy,

radiation, or palliative care.

The nurse also teaches the patient or caregiver to recognize and report signs andsymptoms of complications that require medical attention, such as bleeding, obstruction,perforation, or any symptoms that become progressively worse.
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Evaluation

Reports less anxiety

a. Expresses fears and concerns about surgery

b. Seeks emotional supports

Attains optimal nutrition

a. Eats small, frequent meals high in calories, iron, and vitamins Aand C

b. Complies with enteral or parenteral nutrition as needed

Has less pain

Performs self-care activities and adjusts to lifestyle changesa. Resumes normal activities within 3 months

b. Alternates periods of rest and activity

c. Manages tube feedings
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Thank You!!!
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14558810 Stomach Cancer

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