What is the primary role of the nurse when educating a patient about dietary modifications related to gastric health?

B) Explain the potential impact of diet on gastric health

A) Prescribe a specific diet plan

B) Explain the potential impact of diet on gastric health

C) Conduct endoscopic procedures to assess gastric mucosa

D) Diagnose gastric cancer based on dietary habits

What is the most appropriate initial nursing intervention to address the patient's reported decrease in appetite?

B) Suggest the patient keep a food diary to monitor eating patterns

A) Encourage the patient to eat larger meals to improve nutritional intake

B) Suggest the patient keep a food diary to monitor eating patterns

C) Recommend the patient consume high-calorie snacks between meals

D) Advise the patient to drink more fluids with meals to enhance satiety

What nursing intervention is most important for a patient undergoing endoscopic resection for early-stage gastric cancer?

C) Ensuring the patient is NPO (nothing by mouth) 8 hours prior to the procedure

A) Administering antiemetic medication before the procedure

B) Educating the patient about dietary modifications post-procedure

C) Ensuring the patient is NPO (nothing by mouth) 8 hours prior to the procedure

D) Monitoring the patient's vital signs every 2 hours after the procedure

What is the primary nursing intervention for a patient who has been diagnosed with early-stage gastric adenocarcinoma and is scheduled for endoscopic resection?

B) Educating the patient about dietary changes to support gastric health

A) Administering prescribed antiemetics to manage nausea

B) Educating the patient about dietary changes to support gastric health

C) Encouraging the patient to increase physical activity to boost immunity

D) Monitoring vital signs every hour post-procedure

Which nursing intervention is most appropriate to manage the patient's mild discomfort at the site of resection?

A) Administer prescribed analgesics as needed

B) Apply a warm compress to the site

C) Encourage deep breathing exercises

D) Increase the patient's physical activity

After undergoing an endoscopic resection, which of the following vital signs would indicate that a patient is stable?

A) Blood pressure 118/76 mmHg, heart rate 78 bpm, respiratory rate 16 breaths/min

B) Blood pressure 90/60 mmHg, heart rate 100 bpm, respiratory rate 24 breaths/min

C) Blood pressure 150/100 mmHg, heart rate 110 bpm, respiratory rate 30 breaths/min

D) Blood pressure 130/90 mmHg, heart rate 60 bpm, respiratory rate 12 breaths/min

Which follow-up recommendation is most important to reinforce with the patient following an endoscopic resection with no signs of tumor recurrence?

A) Adhering to dietary modifications

B) Avoiding all forms of exercise

C) Discontinuing all medications

D) Eliminating all follow-up appointments

A patient recently underwent a follow-up endoscopy and imaging studies after an endoscopic resection for a gastrointestinal tumor. The findings show no recurrence and normal CBC results. What should the nurse prioritize in patient education at this time?

B) Reinforce the importance of follow-up appointments and lifestyle modifications

A) Encourage resuming a normal diet without restrictions

B) Reinforce the importance of follow-up appointments and lifestyle modifications

C) Advise the patient to avoid any form of physical activity to prevent complications

D) Recommend stopping all medications since the tests are normal

What is the primary purpose of monitoring Carcinoembryonic Antigen (CEA) levels in a patient with a history of cancer?

C) To monitor for possible recurrence of cancer

A) To diagnose new onset of cancer

C) To monitor for possible recurrence of cancer

D) To assess nutritional status

During the patient's follow-up visit, she reports mild nausea and decreased appetite, but her vital signs remain stable. Which nursing action is most appropriate to address these symptoms?

C) Instruct the patient to increase fluid intake

A) Administer antiemetic medication as prescribed

B) Suggest the patient avoid all solid foods

C) Instruct the patient to increase fluid intake

D) Refer the patient to a dietitian immediately

gastric cancer - Nursing Case Study

Pathophysiology

• Primary mechanism: Chronic inflammation from Helicobacter pylori infection can lead to changes in the stomach lining, increasing the risk of cancer by causing DNA damage and promoting abnormal cell growth.

• Secondary mechanism: Dietary factors, such as high salt intake and consumption of smoked or preserved foods, can irritate the stomach lining and further contribute to cellular changes that may lead to cancer.

• Key complication: As gastric cancer progresses, it can cause obstruction or bleeding in the stomach, leading to symptoms like nausea, vomiting, and anemia, which require careful management in clinical practice.

Patient Profile

Demographics:

65-year-old female, retired school teacher

History:

• Key past medical history: Hypertension, occasional GERD

• Current medications: Lisinopril 10 mg daily, Omeprazole 20 mg as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Mild abdominal discomfort

• Key symptoms: Occasional nausea, early satiety

• Vital signs: Blood pressure 128/78 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

Upon conducting a thorough initial assessment, the nurse noted that the patient's abdominal discomfort was localized primarily in the epigastric region, with mild tenderness upon palpation. The patient described the pain as a dull ache that occasionally intensified after meals. She reported a decrease in appetite over the past few weeks, attributing it to feeling full quickly. Despite these changes, her weight remained stable. Her vital signs were within normal limits, with a blood pressure of 128/78 mmHg, a heart rate of 72 bpm, a respiratory rate of 16 breaths per minute, and a temperature of 98.6°F. The patient's skin appeared well-hydrated, and there were no signs of jaundice or pallor, indicating stable hemoglobin levels and no overt signs of anemia at this stage.

During the review of systems, the nurse confirmed that the patient had no recent history of vomiting, melena, or hematemesis, which suggested that any potential bleeding or obstruction was not significant or acute at this point. A mild bloating sensation was reported, but bowel sounds were present and normal in all quadrants, indicating that gastrointestinal motility was not significantly impaired. The nurse also inquired about the patient's dietary habits, noting a preference for salted and preserved foods, which might have contributed to the progression of gastric changes. The nurse emphasized the importance of dietary modifications and continued monitoring for any escalation of symptoms, providing patient education on the potential impact of diet on gastric health.

The findings from this initial assessment provided a baseline for monitoring the patient's condition and highlighted the need for further diagnostic evaluation to rule out any early-stage complications. The nurse recommended follow-up with a gastroenterologist for potential endoscopic examination and biopsy to assess the extent of gastric mucosal changes and to confirm the diagnosis of early-stage gastric cancer. This approach ensured that any interventions could be tailored specifically to the patient's needs, with the goal of managing symptoms effectively and preventing further progression of the disease. The patient was receptive to the plan and expressed understanding of the need for ongoing surveillance and lifestyle modifications.

Section 2

New Diagnostic Results:

Following the initial assessment, the patient underwent an upper gastrointestinal endoscopy as recommended, which revealed mild inflammation and superficial ulcerations in the gastric mucosa, consistent with early-stage gastric cancer. Biopsy samples were taken from the affected areas, and pathology reports confirmed the presence of early gastric adenocarcinoma, classified as stage IA. The cancer was limited to the mucosal layer, with no evidence of lymphatic or distant metastasis. These findings indicated a favorable prognosis due to the early detection and the localized nature of the cancer.

In conjunction with the endoscopy, laboratory tests showed slightly elevated levels of carcinoembryonic antigen (CEA) at 6 ng/mL, which, although above normal, were consistent with early-stage disease. Basic metabolic panel and complete blood count were within normal limits, further corroborating the absence of significant systemic involvement. The patient's liver function tests were also normal, suggesting no hepatic impact from the cancer.

Armed with this information, the healthcare team discussed treatment options with the patient, focusing on endoscopic resection given the early stage and localized nature of the disease. The nurse played a crucial role in educating the patient about the procedure, the importance of dietary changes to support gastric health, and the need for regular follow-up appointments to monitor for recurrence. The patient expressed relief at the potential for a less invasive treatment and was motivated to adhere to the recommended lifestyle modifications to support her recovery and long-term health.

Section 3

Response to Interventions:

Following the decision to pursue endoscopic resection, the patient underwent the procedure successfully. The intervention was uneventful, and the patient tolerated it well, with no immediate complications. Post-procedure, the patient's vital signs remained stable; blood pressure was 118/76 mmHg, heart rate was 78 beats per minute, respiratory rate was 16 breaths per minute, and oxygen saturation was 98% on room air. The patient reported mild discomfort at the site of resection, which was managed effectively with prescribed analgesics. Her pain was rated at 3 out of 10 on the pain scale, indicating manageable levels.

In the days following the procedure, the patient adhered to the recommended dietary modifications, focusing on small, frequent meals and avoiding irritants such as caffeine and spicy foods. The nursing team monitored her nutritional intake and encouraged hydration to promote healing. Follow-up lab tests, including a complete blood count and a basic metabolic panel, continued to show values within normal limits, reinforcing the absence of systemic involvement. The slightly elevated CEA level remained stable, consistent with the expected post-operative course for early-stage gastric cancer.

As part of her recovery, the patient attended several educational sessions provided by the nursing staff, focusing on recognizing signs of potential complications, such as bleeding or infection. She demonstrated understanding by articulating these signs and expressed confidence in managing her care at home. The patient was scheduled for a follow-up endoscopy in three months to ensure complete resection and monitor for any recurrence. Her proactive engagement in her health and adherence to recommendations provided an encouraging outlook for her continued recovery and long-term health maintenance.

Section 4

New Diagnostic Results:

Three months following the successful endoscopic resection, the patient returned for her scheduled follow-up endoscopy to assess the healing process and check for any signs of recurrence. The procedure was completed without complications, and preliminary findings indicated that the resection site had healed well, with no visible evidence of new tumor growth. During this visit, the patient also underwent imaging studies, including a CT scan of the abdomen, which revealed no abnormal findings, further affirming the absence of metastatic disease.

Blood tests were conducted as part of the follow-up assessment, including a complete blood count (CBC) and a carcinoembryonic antigen (CEA) level. The CBC results remained within normal ranges, supporting the patient's stable hematologic status. However, the CEA level, while still slightly elevated, showed a mild decrease compared to previous post-operative measurements, suggesting a positive response to treatment and a decrease in tumor marker activity.

These diagnostic results were discussed with the patient, who expressed relief and optimism about her ongoing recovery. The nursing team reinforced the importance of continued adherence to dietary modifications and routine follow-up appointments. They also provided additional education on lifestyle changes that could further reduce the risk of recurrence, such as maintaining a balanced diet rich in fruits and vegetables, avoiding tobacco and alcohol, and engaging in regular physical activity. The patient left the appointment feeling empowered and committed to her health journey, with a follow-up appointment scheduled for six months to continue monitoring her progress.

Section 5

Six months later, the patient returned for her scheduled follow-up appointment. Upon initial assessment, the nursing team noted that the patient appeared slightly more fatigued than during previous visits. She reported experiencing occasional mild nausea and a decreased appetite over the past few weeks. Despite these symptoms, the patient maintained her weight, and her vital signs remained stable, with blood pressure at 120/80 mmHg, heart rate at 72 beats per minute, respiratory rate at 16 breaths per minute, and an oxygen saturation of 98% on room air. The physical examination revealed no palpable masses or tenderness in the abdominal region, and bowel sounds were normal upon auscultation.

The patient underwent repeat blood tests, including a CBC, liver function tests, and another CEA level. The CBC results were consistent with her previous stable findings, showing no signs of anemia or infection. Liver function tests were within normal limits, ruling out hepatic complications. However, the CEA level, while still higher than average, showed a slight increase compared to the last check. This prompted the healthcare team to consider additional diagnostic imaging to rule out any potential recurrence or progression of disease.

The patient expressed some anxiety about these findings, but the nursing team reassured her by explaining that the slight increase in CEA could be attributable to various factors, not necessarily indicative of cancer recurrence. They emphasized the importance of the upcoming imaging studies to provide a clearer picture and offered support resources to help manage her anxiety. The patient agreed to proceed with the recommended imaging, understanding that these steps were vital in her continued monitoring and care plan. Her commitment to follow-up appointments and lifestyle modifications remained strong, and she left the clinic with a renewed sense of determination to actively participate in her health management.