INTRODUCTION

Gastric cancer
The stomach is part of the digestive system. It is located in the upper abdomen, between the esophagus
and the small intestine. Stomach cancer is also called gastric cancer.
The stomach is a J-shaped organ in the upper abdomen. It is part of the digestive system, which
processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) in foods that are eaten and
helps pass waste material out of the body. Food moves from the throat to the stomach through a hollow,
muscular tube called the esophagus. After leaving the stomach, partly-digested food passes into the small
intestine and then into the large intestine.
The wall of the stomach is made up of 3 layers of tissue: the mucosal (innermost) layer, the muscularis
(middle) layer, and the serosal (outermost) layer. Gastric cancer begins in the cells lining the mucosal layer and
spreads through the outer layers as it grows.
Gastric cancer is a disease in which malignant (cancer) cells form in the lining of the stomach. Age, diet,
and stomach disease can affect the risk of developing gastric cancer. There are three ways that cancer spreads in
the body. Most (85%) cases of gastric cancer are adenocarcinomas that occur in the lining of the stomach
(mucosa). Approximately 40% of cases develop in the lower part of the stomach (pylorus); 40% develop in the
middle part (body); and 15% develop in the upper part (cardia). In about 10% of cases, cancer develops in more
than one part of the organ.
Stomach cancer can spread (metastasize) to the esophagus or the small intestine, and can extend through
the stomach wall to nearby lymph nodes and organs (e.g., liver, pancreas, colon). It also can metastasize to other
parts of the body (e.g., lungs, ovaries, bones).Stomach cancer occurs twice as often in men and it is more
common in people over the age of 55.Stomach cancer is cancer that occurs in the stomach — the muscular sac
located in the upper middle of your abdomen, just below your ribs. Your stomach is responsible for receiving
and holding the food you eat and then helping to break down and digest it.

Risk factors for gastric cancer include the following:

• Eating a diet high in salted, smoked foods and low in fruits and vegetables.
• Eating foods that have not been prepared or stored properly.
• Being older or male.
• Smoking cigarettes.
• Having a mother, father, sister, or brother who has had stomach cancer.

The three ways that cancer spreads in the body are:

• Through tissue. Cancer invades the surrounding normal tissue.
o Through the lymph system. Cancer invades the lymph system and travels through the
lymph vessels to other places in the body.
o Through the blood. Cancer invades the veins and capillaries and travels through the blood
to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other
places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary
(metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the
bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not
bone cancer.

Stages
In stage 0, abnormal cells are found in the inside lining of the mucosal (innermost) layer of the stomach wall.
These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma
in situ.
In stage I, cancer has formed. Stage I is divided into stage IA and stage IB, depending on where the cancer has
spread.
• Stage IA: Cancer has spread completely through the mucosal (innermost) layer of the stomach
wall.
• Stage IB: Cancer has spread:
o Completely through the mucosal (innermost) layer of the stomach wall and is found in up
to 6 lymph nodes near the tumor; or
o To the muscularis (middle) layer of the stomach wall.

Stage II In stage II gastric cancer, cancer has spread:

• Completely through the mucosal (innermost) layer of the stomach wall and is found in 7 to 15
lymph nodes near the tumor; or
• To the muscularis (middle) layer of the stomach wall and is found in up to 6 lymph nodes near
the tumor; or
• To the serosal (outermost) layer of the stomach wall but not to lymph nodes or other organs.

Stage III gastric cancer is divided into stage IIIA and stage IIIB depending on where the cancer has spread.
• Stage IIIA: Cancer has spread to:
o The muscularis (middle) layer of the stomach wall and is found in 7 to 15 lymph nodes
near the tumor; or
o The serosal (outermost) layer of the stomach wall and is found in 1 to 6 lymph nodes near
the tumor; or
o Organs next to the stomach but not to lymph nodes or other parts of the body.
• Stage IIIB: Cancer has spread to the serosal (outermost) layer of the stomach wall and is found in
7 to 15 lymph nodes near the tumor.

Stage IV
In stage IV, cancer has spread to:
• Organs next to the stomach and to at least one lymph node; or
• More than 15 lymph nodes; or
• Other parts of the body.

CURRENT TREND

Cancer is the third leading cause of morbidity and mortality in the Philippines. Leading cancer
sites/types are lung, breast, cervix, liver, colon and rectum, prostate, stomach, oral cavity, ovary and leukemia.
There is at present a low cancer prevention consciousness and most cancer patients seek consultation only at
advanced stages. Cancer survival rates are relatively low a recent assessment revealed shortcomings in the
Cancer Control Program and urgent recommendations were made to reverse the anticipated ‘cancer epidemic’.
There is also today in place a Community-based Cancer Care Network which seeks to develop a network of
self-sufficient communities sharing responsibility for cancer care and control in the country. Those cancers
whose major causes are known (where action can therefore be taken for primary prevention), such as cancers of
the lung/larynx (anti-smoking campaign), liver (vaccination against hepatitis B virus), cervix (safe sex) and
colon/rectum/stomach (healthy diet). DOH–RCR was evaluated as the first population-based survival data for
Filipinos. Lung cancer had the lowest survival and breast cancer had the highest .Five-year survival in excess of
40% was observed for only three cancer sites: oral cavity, colon and breast. For all other sites, survival was less
than 30%. Owing to the small number of cases in each category, no distinct impact of age on relative survival
could be perceived for most cancer sites.
REASONS FOR CHOOSING THE TOPIC

Our group chose this case because it is our first time to encounter this kind of illness and we are fond of
knowing the important things to be considered, terms to be discussed, appropriate nursing interventions and
medical management for this case. And as much as possible, we want to explore on different kinds of cases
within our every exposure so we can expand and enhance our knowledge, skills, and understanding of different
diseases to our subject.

IMPORTANCE OF THE STUDY CASE

The important of this case study is for student to be familiar with the gastric cancer, how it starts, and
what are the signs and symptom; especially how to prevent, treat and manage patients by giving nursing
interventions, medication for treatment, and providing rapport. Conducting this case study is also important to
be able to incorporate concept and enhance manage in medical-surgical nursing, and apply appropriate nursing
management for patients with gastric cancer accurately and efficiently.

MAJOR GOALS OBJECTIVE

Our major goals for this may include attaining an optimal level of nutrition, preventing infection,
maintaining skin integrity, enhancing coping mechanism, adjusting to changes in body image, acquiring
knowledge of and skills in self care, and to prevent further complications.
NURSING PROCESS
ASSESSMENT
PERSONAL DATA
Name: Mr. X

Age: 59 yrs. old

Sex: Male

Civil Status: Married

Address: Sitio Pangulo Carangian Tarlac city

Occupation: Truck Driver

Religious Affiliation: Roman Catholic

Role in the Family: Father

Date of Birth: January 14, 1950

Place of Birth: Pangasinan

Nationality: Filipino

Health Care Financing: Through the helped of his children

Usual source of medical care: PHILHEALTH

Date of Admission: January 20, 2010

LIFESTYLE AND ENVIRONMENT STATUS

Mr. X lives in a two storey house with his wife at Carangian Tarlac City. He has 3
children and all of them have their own family and still helping their father for hospitalization.
He is a truck driver of a lumber store here in Tarlac. According to him as a driver there was an
instance that sometimes when the “call of nature” called him, he can’t stop the truck right away
especially when he’s in the middle of the road. According to his wife, he loves to drink soda and
coffee. Sometimes he eats his meals not on time because of his work. He also eats foods rich in
cholesterol. He has no vices at all.

FAMILY HISTORY OF HEALTH AND ILLNESS

Great grand parents

 3rd Degree

Grandparents
2nd Degree

Parents

1st Degree

Siblings

HISTORY OF PAST ILLNESS

He does not suffer to any chronic disease. During his past years he only have cough, flu,
and fever that last only for 3-7 days only. His vaccination was completed during his younger
years. He only had intermittent abdominal pain that was started early 2009. During the
occurrences of his abdominal pain he consulted some clinics and the doctor told him that he only
had gastritis ulcer so that they prescribed him ranitidine and cefuroxime. And sometimes he only
bought over the counter medicines as needed.

December 22, 2009 he was admitted at Talon General Hospital because he can’t tolerate
his abdominal pain. In the said hospital X-ray was performed in the same date. The next day, he
was undergone endoscopy at Central Luzon Doctors Hospital, they stated that gastric mass
poorly differentiated adenocarcinoma with signet ring features. Then, January 07, 2010 CT- Scan
was performed at Ramos General Hospital. The result stated that the gastric mucosa on the
fundus and proximal body is thickened and irregular indicative of infiltrating gastric mass lesion.

He was not involved in any accidents.

HISTORY OF PRESENT ILLNESS

 He was apparently well until July 2009 when he felt abdominal pain almost every day but
tolerable. He lost 9kg within 6 months. His condition then progressed to recognizable vomiting
undigested non bilious food after meals especially with solids. Ever since then, he experienced
anorexia and was afraid to eat but he could still tolerate fluids. Blood in his stool also found out.
He could tolerate fluid and small amount of soft diet. He was treated by medication when he
consults his doctor but still he felt intermittent abdominal pain.

On December 2009, Abdominal Ultra sound and X-ray was performed and the result
revealed that he has gastric mass. CT- Scan was performed as well and endoscopy for the second
opinion and the result was he had gastric adeno carcinoma.

Last January 20, 2010 he was admitted at Tarlac Provincial Hospital. Exploratory
laparotomy also performed for jejunostomy for feeding of the patient last January 31, 2010.
Ever since diagnosed with the disease although he really don’t know his whole condition, it has
affected his quality of life and peace of mind. He has been having insomnia and feels he is a
burden to his family financially and emotionally.

PHYSICAL ASSESSMENT
 EVALUATIO
ASSESSMENT TECHNIQUE ACTUAL FINDING NORMAL FINDINGS
N
Inspection and Pale, Xerosis as evidence Uniform whitish pink to brown color
palpation by flaking, generalized according to race, dry with a
Skin Abnormal
skin tenderness , poor minimum of perspiration, skin should
skin turgor not be tender
Inspection and black thick and evenly Hair varies from dark to pale blonde
palpation distributed, brittle hair based on the amount of melanin
dull hair, with no present should not be brittle and
parasites noted absent from any parasite, may feel
Hair Abnormal
thin, straight, coarse, thick, or curly; it
should be shinny and resilient when
traction is applied and should not
come out in clumps in your hand
Inspection Smooth absent from Pale white to pink to light skinned
Scalp nodules and masses no individuals no infestations or lesions Normal
parasites dandruff (seborrhea) may be present
Inspection Pale, Beau’s line noted Have pink cast in light skinned
individuals and are brown I dark
skinned individuals. Capillary refill of
2-3 sec. the nail surface should be
Nails smooth and slightly rounded or flat. Abnormal
Curved nails are a normal variant.
Nail thickness should be uniform
throughout, with no splintering or
brittle edges
Inspection Oval, symmetrical; The facial features should be
cachexia noted symmetrical. Both palpebral fissures
should be equal and the nasolabial
fold should present bilaterally. The
Face Abnormal
shape of the face can be oval, round,
or slightly square. There should be no
edema, disproportionate structures, or
involuntary movements.
Inspection Pale conjunctiva The bulbar conjunctiva is transparent
with small blood vessels visible in it.
It should appear white except for a
Eyes Abnormal
few small blood vessels w/c are
normal. No swelling, exudates,
foreign bodies, or lesions are noted
Inspection Centrally positioned, The ear should be match the flesh
pale color, proportion to color of the rest of the patients skin
the head, dry cerumen and should be positioned centrally and
in proportion to the head. Cerumen
Ears should be moist and not obscure the Abnormal
thympanic membranes. There should
be no foreign bodies, redness,
drainage, deformities nodules or
lessions
Inspection Symmetrically, no The shape of the external nose can
swelling, bleeding, vary greatly among individuals.
lesions, and masses normally, it is located symmetrically
Nose (external) Normal
in the midline of the face and is
without swelling, bleeding, lesions, or
masses
Inspection Pale ,dry, flaccid The lips and membranes should be
Palpation pink and moist with no evidence of
Lips lesions or inflammations. Lips should Abnormal
not be flaccid an lesions should not be
present
Mouth Inspection Acetony breath The breath should smell fresh Abnormal
DIAGNOSTOC AND LABORATORY PROCEDURE

ABDOMINAL ULTRASOUND
HOSPITAL: Talon General Hospital (TGH)
DATE PERFORMED: 12/22/09
FINDINGS:
The stomach is distended with a homogenous echoic structure caudally and posteriorly suggestive of a mass in
the stomach measuring 15.6cm in thickness. A gastric neoplasm sarcoma? May be considered. Clinical
correlation and upper G.I. series or gastroscopy may be help.
IMPRESSION: Suggestive of a gastric mass.

CHEST X-RAY
HOSPITAL: Talon General Hospital (TGH)
DATE PERFORMED: 12/22/09
IMPRESSION: The lung fields are essentially clear

ENDOSCOPY
HOSPITAL: Central Luzon Doctors Hospital (CLDH)
DATE PERFORMED: 12/23/09
FINDINGS: Gastric mass poorly differentiated adenocarcinoma with signet ring features.

CT SCAN
DATE PERFORMED: 01/07/10
HOSPITAL: Ramos General Hospital (RGH)
PROCEDURE: Whole abdomen CT scan
FINDINGS: The gastric mucosa on the fundus and proximal body is thickened and irregular indicative of
infiltrating gastric mass lesion.
IMPRESSION: Consider gastric tumor lesion most likely neoplasm unremarkable liver, gallbladder, pancreas,
spleen, kidney and urinary bladder.
LABORATORY RESULTS

CBC
DATE: 01/27/10

NORMAL VALUE FINDINGS INTERPRETATION

WBC 4.1-10.4 11.8 HIGH
LYM 0.6-4.1 0.4 LOW
GRAN 2.0-7.8 10.0 HIGH
RBC 4.20-6.30 4.05 LOW
HGB 120-180 107 LOW
HCT .37-.51 .32 LOW
MCV 80.0-97.0 80.7 NORMAL
MCH 26.0-32.0 26.4 NORMAL
MCHC 310-360 327 NORMAL

BLOOD CHEMISTRY (ELECTROLYTES)

DATE: 01/20/10

ELECTROLYTES NORMAL VALUE FINDINGS INTERPRETATION

SODIUM 136-142 130.8 LOW
POTASSIUM 3.8-5.0 3.69 LOW
CHLORIDE 45-103 102 NORMAL

TPAG DETERMINATION
DATE: 01/27/10
NORMAL VALUE FINDINGS INTERPRETATION
TOTAL PROTEIN 60-78 57.37 LOW
ALBUMIN 32-45 23.37 LOW
GLOBULIN 23-35 34 NORMAL
ANATOMY AND PHYSIOLOGY

The pylorus is the region of the stomach that connects to the duodenum

It is divided in two parts:

The pyloric antrum, which connects to the body of the stomach.
The pyloric canal, which connects to the duodenum.

The pyloric sphincter, or valve, is a strong ring of smooth muscle at the end of the pyloric canal and lets food
pass from the stomach to the duodenum.
PATHOPHYSIOLOGY

Book based:
Gastric mass metastasis
ETIOLOGIC PREDISPOSING
- Chemicals - Age

- Viruses - Sex

- Genetic - Stress

- Physical - Occupation

Malignant Cell

“Cancer Cell”

Adenocarcinoma Gastro intestinal tract

Obstruction PYLORUS

CANCER CELL

Break, Spill from Lymphatic and Blood vessel

primary tumor

Deposited within normal cell

METASTASIS
Patient based:

PATIENT
Lifestyle Hereditary
History of cancer (1st Degree)

On and Off Abdominal pain

Anorexia and vomiting

Gastric mass Cancer Cell (Adeno carcinoma)

Gastric outlet obstruction Gastric biopsy

GASTRIC MASS METASTATIC

 NURSING SCIENTIFIC
CUES PLANNING INTERVENTIONS RATIONALE EVALUATION
DIANOSIS EXPLANATION

S-“Nahihirapan Ineffective In ability to clear After 1-2˚ of -Monitor the -Secretion in After 1-2˚ nursing
akong airway secretions or nursing respiratory pattern the airway the interventions, the
huminga.” As clearance obstructions as interventions, respiratory rate patient was able
verbalized by related to from the the patient will will to demonstrated
the patient presence of respiratory tract to be able to -Place patient in -To maintain absence of
secretion maintain a clear demonstrate semi-fowlers O2 in blood and reduction
O-Pale in airway absence of position. to help patient congestion and
appearance secretion and to established improve oxygen
improved the normal exchange
-DOB oxygen breathing
exchange -Administer O2 -Facilitate
-(+)cough inhalation via nasal effective
cannula. breathing
-w/ O2 via
nasal canula -Place pt. to a -Facilitate
comfortable position effective
- V/S as follows breathing
BP-100/70
mmHg -Teach the patient -This technique
PR-82bpm deep breath and can help
RR-22bpm perform controlled increase sputum
TEMP-39.1’C coughing. clearance and
decrease cough
spasms.
-
-Administer Bronchodilators
bronchodilators as decrease airway
prescribed by the resistance.
doctor.
 CUES NURSING SCIENTIFIC PLANNING INTERVENTIONS RATIONALE EVALUATION
DIANOSIS EXPLAINATION

S-“Nilalagnat Hyperthermia Body temperature After 1-2˚ of -Asses the history of -To know the After 1-2˚of
ako.” As related to elevated above nursing the patient. other possible nursing
verbalized by present illness normal range interventions, causes in intervention, the
the patient (gastric the patient temp acquiring kind patient latest
metastasis) will be back of disease. temp is 37.5
O-weak in from the normal
appearance range from -Monitor the vital -Use for -continued TSB
39.1C to 37.5 sign. baseline data
-flushed skin
-Performed tepid -Tepid sponge
-warm to touch sponge bath. bath minimizes
the heat of the
-dry skin patient by way
of evaporation.
-V/S as follows
BP-90/60 -Instruct the patient -To prevent
mmHg to increase fluid dehydration.
PR-82bpm intake.
RR-22bpm
TEMP-39.1’C -Administer -To lower the
paracetamol as heat of the
prescribe by the patient faster.
Physician.
 NURSING SCIENTIFIC RATIONALE
CUES PLANNING INTERVENTIONS EVALUATION
DIAGNOSIS EXPLANATION

S- “Sumasakit Chronic pain r/t Unpleasant After 4-8˚ of -Assessed for -To identify pt. -After 4-8˚ of
yong tiyan ko” ulceration and sensory and proper nursing conditions With potential proper nursing
As verbalized necrosis emotional intervention the associated with long to pain lasting intervention the
by the patient. experience arising pain will be term pain beyond normal patient pain is
from actual decrease from healing now decrease to
potential tissue pain scale of tolerable level
O- Weak in damage resulted 8/10 to 2/10. AEB pain scale
appearance from the tumor of 4/10
-P.S. of 8/10 that erodes blood -Used pain rating -To obtain
-With O2 vessels and scale patient -Goal partially
inhalation pressure on tissue assessment of met
-Swollen that causes tissue pain
stomach damage.
-With -Encouraged pt. To -To limit
jejunostomy use positive focusing on
tube feeding affirmation Ex. “Iam pain
-With IFC healing”
intact
-With -Encouraged used of -To promote
surgical non- relaxation
incision on pharmacological
abdomen methods of pain
-Poor muscle control Ex. “Deep
tone-assume in breathing”
supine position
most of the -Administered pain -It may help to
time reliever as ordered reduce the pain
 CUES NURSING SCIENTIFIC
PLANNING INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS EXPLANATION

S- “ Hopelessness r/t Subjective state in After 2-3˚ of -Established a -Client may After 2-3˚of
Nawawalan na prolonged w/c an individual proper nursing therapeutic then feel safe proper nursing
ako ng pag activity sees limited or no interventions, relationship showing to disclose interventions, pt.
asang restriction alternatives or patient will be positive regard for feelings and was able to
gumaling” as creating personal choices able to the client feel understood participated in
verbalized isolation available and is participate in and listened to diversional
unable to mobilize diversional activities of own
O-Weak and energy on own activities of -Expressed hope to -Client may choice
pale behalf own choice client and not identify in
appearance encouraged so to do own situation
-Lack of so
initiative
-W/ oxygen -Assisted -Provides
inhalation client/family to opportunity to
-W/ become aware of avoid/ modify
jejunostomy factors/situation situation
tube feeding leading to feelings of
-W/ IFC intact hopelessness
-W/ surgical
incision on -Provided positive -Encouraged
abdomen feedback for actions continuation of
-Assume in taken to deal w/ desired
supine position overcome feelings of behavior
most of the hopelessness
time
 NURSING SCIENTIFIC
CUES PLANNING INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS EXPLANATION

S- “Hindi ako Activity Insufficient After 4˚ of -Noted reports of -Symptoms After 4˚ of

masyado intolerance r/t physiological or proper nursing weakness, pain and may be result proper nursing
makagalaw.”A generalized psychological interventions, fatigue of contributing interventions, pt.
s verbalized by body weakness energy to endure pt. will be able intolerance of was able to
the patient. or complete to eliminate or activity eliminate or
required or desired reduce the reduced the
O- Weak and daily activities negative factors -Plan carefully -To reduce negative factors
pale affecting balance rest period fatigue affecting activity
appearance activity w/ activities intolerance
-W/ oxygen intolerance
inhalation -Promote com fort -To promote
-W/ surgical measures relaxation
incision on
abdomen -Passive ROM -Provide
-W/ rendered muscle
jejunostomy strength and
tube feeding promote blood
-Swollen flow
stomach -Changed position -To promote
-Poor muscle from side to side and risk of
tone-assume semi-fowlers developing
supine position position alternately pressure ulcer
most of the every 2 hr. -To prevent the
time development
-Kept back dry of other
complication
like(pneumoni
a)
MEDICAL MANAGEMENT
IVF

IV FLUIDS DARE ORDERED CLASSIFICATION INDICATION

5% Dextrose in January 20-23,2010 HYPERTONIC Intravenous solution for replacement

Lactated Ringers January 25-27,2010 therapy particularly in extra cellular fluid
Solution and electrolyte deficit and acid base
balance of the patient

Plain Lactated Ringers January 24,2010 ISOTONIC Fluid and electrolytes balance
Solution
NURSING RESPONSIBILITIES:
PRIOR:
 Verify with the doctors order

 Explain the indication to the patient

DURING:
 Label the IVF bottles and indicating the date and time it was started with the ordered regulation

 Maintain and regulated at the rate prescribed

 Handle IVF aseptically

 Changed solution and IVF tubing as per hospital policy

AFTER:
• Check the site for any signs/symptoms of infection
BLOOD TRANSFUSSION

TYPE OF BLOOD DATE ORDERED/ DATE GENERAL DESCRIPTION INDICATION OR

PERFORMED/ DATE PURPOSE
CHANGE/

Packed Red Blood Cells January 23,2010 This increased the amount of
(PRBCs) January 25,2010 hemoglobin in the blood that can carry
January 26,2010 oxygen per fused from alveoli of the
lungs to tissue. One unit of PRBCs
typically will raise the hematocrit by 3-
4% and the blood hemoglobin
concentration by 1 gm/dl. PRBCs last
in refrigeration for up to 42 days, but
under the right condition they can be
frozen for up to the decade.
 Restore blood components
and promotes homeostasis
 Volume replacement in
case with massive blood
loss.
 Use to increased the
oxygen carrying capacity
of blood in anemia’s,
surgery or trauma.
 To treat acute and chronic
anemia

NURSING RESPONSIBILITIES

PRIOR:

 Check doctors order.

 Verify consent

 Explain the procedure

  Check the serial number of the blood type

DURING:

 Label the bottle date, time started and regulated

 Monitor vital signs

 Check for any signs of adverse reaction

AFTER:

 Checked the site for any sign and symptoms of infection

 MEDICAL DATE ORDERED/DATE GENERAL INDICATIONS/
MANAGEMENT PERFORMED/ DESCRIPTION PURPOSES

Jejunostomy feeding Jan.31, 2010 A surgical procedure in Typically recommended for

which a hole is made in the patients who have pancreatic
small intestine in order to disease, have difficulty
insert feeding tube. A patient emptying the stomach, or
may receive jejunostomy if have problem with the
he has difficulty in pulmonary aspiration of
maintaining a healthy body gastric contents, which occurs
weight consuming food when the stomach contents
through the mouth. A are inhaled into the lungs. As
jejunostomy tube may be an alternative to a
used to introduce nutritious gastrostomy, in which the
liquids and medicines to the feeding tube is inserted into
body when the stomach is not the stomach, a jejunostomy
fit for a feeding tube or in may also be used when the
order to drain unwanted gases stomach needs to be kept
and liquids from the stomach. strong for further surgeries.
 MEDICAL DATE ORDERED/DATE GENERAL INDICATIONS/
MANAGEMENT PERFORMED/ DESCRIPTION PURPOSES

NASOGASTRIC TUBE Jan.20, 2010 An alternative feeding • For lavage

method to ensure
adequate nutrition • Empty the stomach
includes enteral after a drug overdose
(through the or accidental
gastrointestinal poisoning
system) methods. • Drain the stomach
Enteral Nutrition after major trauma, so
(EN), also referred to the person can't inhale
as total enteral stomach contents into
nutrition (TEN), is the lungs
provided when the
client is unable to • Keep the stomach
ingest foods or the relaxed after major
upper gastrointestinal surgery to the
tract is impaired and abdomen, such as an
the transport of food abdominal exploration
to the small intestine
• Prevent distension of
is interrupted.
the stomach when the
person has a bowel
obstruction.
 NURSING RESPONSIBILITIES:

 Explain the procedure, benefits, risks, complications, and alternatives to the patient or the patient's
representative.
DRUG STUDY

ROUTE/DOSAGE
NURSING
DRUG NAME / ACTION INDICATION CONTRAINDICATION
RESPONSIBILITIES
FREQUENCY

Generic Name: 750mg Inhibits cell- Serious Contraindicated in patient -Check first the patient
CEFUROXIME IVP wall synthesis, infection of the hypersensitive to drugs allergic to drugs
q 8˚ promoting lower
Brand Name: osmotic respiratory and -Use cautiously in patient
Zinacef instability; urinary tracts, have hypersensitivity to
usually skin and skin penicillin because of
Classification: bactericidal structures possibility of cross
ANTIBIOTICS infection bones sensitive with other Beta
and joints Lactam Antibiotics
infections
septicemia -Absorption of cefuroxime
meningitis, is enhance by food
gonorrhea and
preoperative
prophylaxis
 DOSAGE
NURSING
DRUG NAME /ROUTE/ ACTION INDICATION CONTRAINDICATION
RESPONSIBILITIES
FREQUENCY

Generic Name : 50 mg Inhibits Used in the Hypersensitivity. History of -Assess knowledge/teach pt.
RANITIDINE IVP histamine H2 management of acute porphyria. Long appropriate use, possible side
q 8hrs receptor site in various therapy. effects/appropriate
Brand Name : the gastric gastrointestinal interventions and adverse
Zantac parietal cell, w/c disorders such as symptoms to report
inhibits gastric peptic ulcer.
Classification: acid secretions. -Use caution in presence of
H2 receptor renal and hepatic
antagonist impairement

-Assess potential for

interventions w/ other
pharmacological agents, pt.
may be taking (e.g
increasing and decreasing
levels/effects and toxicity)
 DOSAGE
NURSING
DRUG NAME /ROUTE/ ACTION INDICATION CONTRAINDICATION
RESPONSIBIITIES
FREQUENCY

Generic Name : 50 mg/tab Centrally acting Moderate to Hypersensitivity. Acute -Assess pt’s pain (location,
TRAMADOL P.O analgesic not severe pain intoxication w/ alcohol type, character) before
q 6˚ chemically hypnotics, centrally acting therapy and regularly
Brand Name : related to opiods analgesics, opiods, or thereafter to monitor drug
Ultram but binds o mu- psychotropic agents effectiveness (give before
opiod receptor pain become extreme)
Classification: and inhibits
Centrally active reuptake of -Assess hypersensitivity
analgesic norepinephrine reactions : pruritus, rash, and
and serotonin urticaria

-Monitor input-output ratio

and check for decreasing
output w/c may indicate
retention
 DOSAGE
NURSING
DRUG NAME /ROUTE/ ACTION INDICATION CONTRAINDICATION
RESPONSIBILITIES
FREQUENCY

Generic Name : 300 mg Decrease fever Relief of mild to Hypersensitivity ; -Assess pt’s fever or pain :
PARACETAMOL IVP by inhibiting the moderate pain ; intolerance to tartazine, type of pain, location,
q 4˚ effectiveness of treatment of fever alcohol, table sugar, intensity, duration,
Brand Name : (PRN for temp : 38 pyrogens on the saccharin temperature
Tylenol C) hypothalamic
heat regulating -Assess allergic reactions :
Classification: centers and by rash, urticaria, : if these
Antipyretics hypothalamic occur, drug may have D/C
action leading to
sweating and -Check I&O ratio :
vasodilation. decreasing output may
indicate renal failure (long
term therapy)
 DOSAGE/
NURSING
DRUG NAME ROUTE/ ACTION INDICATION CONTRAINDICATION
RESPONSIBILITIES
FREQUENCY

Generic Name: 30 mg Primary Indicated for Pt’s w/ a -Primary mechanism of

KETOROLAC IVP mechanism of short-term previous demonstrated action responsible for
q 8hrs action management of hypersensitivity ketorolac’s anti-
Brand Name : responsible for moderate to to ketorolac, inflammatory, antipyretic
Toradol ketorolac’s severe and in pt’s w/ and analgesic effects is the
anti- postoperative the complete or partial inhibition of prostaglandin
Classification: inflammatory, pain syndrome of nasal polyps, synthesis by competitive
Anti- antipyretic and or other allergic blocking of the enzyme.
inflammatory analgesic manifestations to aspirin or
effects is the other non-steroidal anti- -Ketorolac therapy should
inhibition of inflammatory drugs (due to always be given initially
prostaglandin possibility of severe by the IM or IV route.
synthesis by anaphylaxis Oral therapy should be
competitive used only as a
blocking of the continuation of parenteral
enzyme. therapy.

-Advise pt to consult if
rash, itching, visual
disturbances, tinnus, wt.
gain, edema, block stools,
or influenza like
syndromes (chills, fever,
muscles aches, pain)
occur.
DIET

TYPE OF GENERAL
DATE PURPOSE FOOD TAKEN
DIET DESCRIPTION

Jan.20,2010 DAT Any foods and drinks can To provide essential nutrient to Crackers, noodles, water
(Diet as be given by mouth the body, and to help maintain
tolerated) body energy

TYPE OF GENERAL
DATE PURPOSE FOOD TAKEN
DIET DESCRIPTION

Jan.31,2010 NPO No foods or drink should Preparation for surgery and also NONE
(Nothing per be given by mouth done after surgery to prevent
Orem) pulmonary aspiration

TYPE OF GENERAL
DATE PURPOSE FOOD TAKEN
DIET DESCRIPTION

Feb.01,2010 Soft diet A diet that is soft in It provide essential nutrients in Milk
texture low in residue the form of liquids like milk, and (ENSURE)
easily digested and, well it help to sustain body nutrient
tolerated
EXERCISE

TYPE OF EXERCISE GENERAL DESCRIPTION PURPOSE/INDICATION

Passive ROM Passive ROM exercise are done for a person by
helper. The helper d0oes the ROM exercise because
the person cannot do them by himself
• This exercise helps keep the joint and
muscles as healthy as possible.
• This can help to promote good blood
low and flexibility of the extremities.

NURSING RESPONSIBILITIES:

• Explain the purpose of the procedure

• Raise the patient bed to a height that is comfortable for him

• Do all ROM exercise smoothly and gently

• Stop ROM exercise if the person fells pain

• Take note of any complain of the patient about his physical condition after doing the procedure
SURGICAL MANAGEMENT

DATE SURGICAL GENERAL

PURPOSE
PERFORMED PROCEDURE DESCRIPTION

January 31, 2010 Exploratory Is a large incision made Is used to visualize

Laparotomy into the abdomen. and examine the
structures inside of
the abdominal
cavity.

January 31, 2010 Gastric mass biopsy The removal of a small Is an important
piece of living tissue means of diagnosing
from an organ or part cancer from
of the body for examination of
microscopic fragment of tumor.
examination.

January 31, 2010 Jejunostomy A surgical operation in For jejunostomy

which the jejunum is feeding
brought through the
abdominal wall and
openend.

January 31, 2010 Jejunotomy A surgical incision into In order to inspect

jejunum the interior or
remove something
within it.

NURSING RESPONSIBILITIES
PRIOR: AFTER:
-Secure consent. -Flat on bed
-Keep on NPO -Monitor vital signs
-Explain the procedure -Keep on NPO for 8º
SOAPIE

S- “Nahihirapan pa akong huminga” As verbalized by the patient

O -Received on lying position

-Conscious, coherent conversant
-With O2 via nasal Cannula at 3LPM
-with IVF DSLR IL @ 550 ml level reg. @ 30gtts/ min @ regulated hand
-with productive cough
-initial V/S as follows:
BP-100/70mmHg RR-18cpm
PR-80bpm TEMP-37.5’C
-Slowed movement noted
-With intact IFC connected to urine bag at 300cc level of yellowish color of urine.
-Pale in appearance.

A -Ineffective airway clearance r/t presence of secretion

P -After 1-2 of nursing interventions, the patient will be able to demonstrate absence
reduction of congestion with respiration and improved 02 exchanges.

I -Elevated head of the bed and change position every 2’.

-Emphasized deep breathing exercises.
- Administered 02 inhalation via nasal cnnula.
-Promoted surface cooling by means of undressing
-Placed patient to a comfortable position
-place patient in semi fowler position.

E -After 1-2’ of nursing interventions, the patient was able to demonstrated absence
reduction of congestion with respiration of improved oxygen exchanged.
CONCLUSIONS

Therefore, effective student nursing care and client teaching to achieve outcome goals
require that we understand the pathophysiology of the gastric cancer. We should know the
natural history of the disease, such as; the normal course of disease progression, likely sites of
metastasis, potential for effective treatment, side effects and the treatments. With a basic
understanding of gastric cancer, we can build on that knowledge base by listening to the client’s
history, reviewing the information provided in the medical record, consulting with colleagues,
including student nursing peers and student nursing leaders.

RECOMMENDATION

We firmly believe, therefore, that the risk of gastric cancer and its mortality rate can be
reduced, we need aggressive education regarding the signs and symptoms of gastric cancer. One
of the major risk factors is diet — in particular, diets high in smoked foods, salted fish and
meats, and pickled foods. Because the need for smoking, salting, and pickling foods decreased
once refrigeration became readily available, the way in which food is consumed may also impact
the risk of gastric cancer; for example, very hot-temperature foods and rapid food consumption
may be detrimental, we advice him to avoid that kind of food!!. To our dear patient, we must
recommend to eat a diet high in fresh fruits and yellow and green vegetables when he finally get
home.

We recommend to our patient that providing tube care and preventing infection can be
applied over the tube insertion site, to protects the skin around the incision from leakage and of
gastric acid and spillage of feedings and also to prevent skin breakdown.

EVALUATION

At the end of this case study and proper nursing interventions provided the student nurses
were able to achieved our expected outcomes such as; reports less anxiety, express fears and
concerns about surgery, attains optimal nutrition by eating a small frequent meals high in
calories, iron and vitamin C & A and also complies with enteral or parenteral nutrition as needed,
performs self care activities and adjust to lifestyle changes.