Nursing Care Plan (NCP) Gastrectomy | Risk for Imbalanced Nutrition: Less than Body Requirements

Nursing diagnosis: risk for 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; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will

Nutritional Status

Maintain stable weight and demonstrate progressive weight gain toward goal with normalization of laboratory values.

Be free of signs of malnutrition.

Nursing intervention with rationale:

1. Maintain patency of NG, OG, or NI tube when used. Be aware of feeding tube placement—enterostomal or jejunostomal. Notify physician if tube becomes dislodged.

Rationale: Intestinal tubes are inserted to provide rest for gastrointestinal (GI) tract during acute postoperative phase until return of normal GI function. These are attached to suction. Feeding tubes may be inserted at time of surgery or later and are used to provide enteral feedings once gut is functional. Note: Although several methods have been used to identify tube placement at the bedside, such as aspiration of gastric contents, measurement of trypsin, pH, and pepsin levels, abdominal radiographs may be necessary to confirm location of tube, and the physician/surgeon may need to reposition the tube endoscopically to prevent injury to the

operative area.

2. Note character and amount of gastric drainage.

Rationale: Drainage may be bloody for first few hours and then should clear or turn greenish gold. Continued or recurrent bleeding suggest complications and should be reported to physician.

3. Caution client to limit the intake of ice chips.

Rationale: Excessive intake of ice produces nausea and can wash out electrolytes via the NG tube.

4. Provide oral hygiene on a regular, frequent basis, including petroleum jelly for lips.

Rationale: Prevents discomfort of dry mouth and cracked lips caused by fluid restriction and the NG tube.

5. Auscultate for resumption of bowel sounds and note passage of flatus.

Rationale: Peristalsis can be expected to return about the third postoperative day, signaling readiness to resume oral intake.

6. Monitor tolerance to fluid and food intake when resumed, noting abdominal distention, reports of increased pain or cramping, and nausea and vomiting.

Rationale: Complications such as paralytic ileus, obstruction, delayed gastric emptying, or gastric dilation, may occur. Even if the above complications do not occur, “dumping syndrome” is a fairly common aftereffect of stomach surgery. Symptoms include bloating, nausea, weakness, sweating, and rapid heartbeat 30 to 60 minutes after a meal.

7. Note admission weight and compare with subsequent readings.

Rationale: Provides information about adequacy of dietary intake and determination of nutritional needs.

8. Collaborate with nutritional team and dietitian, as indicated.

Rationale: Aids in determining number of calories and types of nutrients for meeting client’s nutritional needs.

9. Administer intravenous (IV) fluids, parenteral or enteral nutrition, as indicated.

Rationale: Meets fluid and nutritional needs until oral intake can be resumed. Note: Early enteral feedings have been found to stimulate gut immunological function and can assist in maintaining gut structure and function. TPN is usually reserved for clients who are critically ill at the time of

surgery or those with total gastrectomy.

10. Monitor laboratory studies: hemoglobin/hematocrit (Hgb/Hct), electrolytes, and total protein and prealbumin.

Rationale: Indicators of fluid and nutritional needs and effectiveness of therapy. Detects developing complications.