Nursing Interventions for Gastric Cancer

Nursing Care Plan for for Gastric Cancer

Nursing Diagnosis : 1. Pain ( acute / chronic ) elated to the presence of abnormal epithelial cells, nerve impulse disorders of the stomach.

Goal : Pain is reduced, controlled.
Expected outcomes :

• The patient was not seen grimacing.
• Pain scale of 0 (no pain).
• The patient seemed more relaxed.

Intervention :

1. Assess characteristics of pain and discomfort ; location, quality, frequency, duration, etc.
Rational : provide a basis for assessing changes in the level of pain and evaluate interventions.

2. Reassure the patient that you know, the pain is real and that you will assist the patient in reducing the pain.
Rational :
Fear can increase anxiety and reduce pain tolerance.

3. Collaboration in analgesic administration to improve circulation within the optimal pain prescription.
rational :
Tend to be more effective when given early in the cycle of pain.

4. Teach the patient new strategies to relieve pain and discomfort with distraction, imagination, relaxation.
rational :
Improving alternative pain relief strategies appropriately.



Nursing Diagnosis : 2. Imbalanced Nutrition : less than body requirements related to anorexia.

Goal : Nutritional needs of clients are met.
Expected outcomes :

• The client will maintain nutrient inputs to the metabolic needs.
• Increased appetite.
• No weight loss.

Intervention :

1. Teach the patient the following things : avoid the sight, smell, sounds unpleasant in the environment during meal times.
Rational :
Anorexia can be stimulated or enhanced by noxious stimuli.

2. Suggest eating preferred and well tolerated by the patients, better food with high content of calories / protein. Respect the patient's food preferences based on ethnicity.
Rational :
A food that is well tolerated and high in calories and protein will maintain nutritional status during periods of increased metabolic needs.

3. Encourage adequate fluid intake, but limit fluids at mealtime.
Rational :
Fluid level is necessary to eliminate waste products and prevent dehydration.

4. Increase fluid levels with food can lead to a state of satiety. Consider the cold food, if desired.
Rational :
Cold foods high in protein can often be well tolerated and does not smell than hot food.

5. Collaborative provision of commercial liquid diet by way of enteral feeding through a tube, elemental diet.
Rational :
Feeding through a tube may be necessary in the patient with very weak gastrointestinal system is still functioning.



Nursing Diagnosis : 3. Anxiety related to malignancy advanced disease.

Goal : Anxiety clients decreased.
Expected outcomes :

• Clients are more relaxed.
• The normal pulse.
• No increase in respiration.

Intervention :

1. Provide a relaxed environment and non-threatening.
Rational :
The patient can express fear, problems, and the possibility of anger due to the diagnosis and prognosis.

2. Encourage active participation of the patient and family in care and treatment decisions.
Rational :
To maintain independence and control of the patient.

3. Instruct the patient to discuss personal feelings with the supporters of such clergy if desired.
Rational :
Facilitating the process of grieving and spiritual care.

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Gastric Cancer - Assessment and 5 Nursing Diagnosis

Assessment for Gastric Cancer

Nurses get a history of the patient's diet that focuses on issues such as high food intake and input smoked or marinated fruits and vegetables are low. Is the patient experiencing weight loss, if so how much.

Does the patient smoke ? If yes how much a day and how long ? Is the patient complained of stomach discomfort during or after smoking ? Does the patient drink alcohol ? If so how much ? The nurse asks the patient if there is a family history of cancer. If such a close family member or immediate or distant relatives affected ? Is the patient's marital status ? Is there someone who can provide emotional support ?
During the physical examination is possible to palpate a mass. Nurses must observe the presence of anxiety. Organs examined for tenderness or masses. Pain is usually the symptoms are slow. (Brunner & Suddart, 2001).

1. Anamnesis (Hamsafir, 2010) :

• Pain.
• Weight loss.
• Vomiting.
• Anorexia.
• Dysphagia.
• Nausea.
• Weakness.
• Hematemesis.
• Regurgitation.
• Easily satisfied.
• Ascites (abdominal bloating).
• Abdominal cramps.
• Real or faint blood in the stool.
• The patient complained of discomfort in the stomach, especially after eating.

2. Physical Examination (Hamsafir, 2010) :

• Hemodynamic Status : blood pressure, pulse, acral and breathing.
• Less weight, cachexia, conjunctiva sometimes anemic.
• Abdominal examination may be palpable mass epigastric region, epigastric pain. In malignancy can be found hepatomegaly, ascites.
• If there are complaints of melena, do a digital rectal examination.
• Malignancy = search enlargement supraclavicular (Virchow's node), axillary nodes left (Irish 's node), to the umbilicus (Sister Mary Joseph's nodes), palpable tumors pelvic cul - de - sac on the digital rectal examination (Blumer's shelf), enlarged ovaries (Krukenberg's tumor).

Nursing Care Plan for Gastric Cancer

Nursing Diagnosis for Gastric Cancer

1. Pain ( acute / chronic ) related to the presence of abnormal epithelial cells , nerve impulse disorders of the stomach .

2. Imbalanced Nutrition : less than body requirements related to anorexia .

3. Anxiety related to malignancy advanced disease .

4. Risk for Infection related to the surgical incision .

5. Risk for ineffective airway clearance related to the buildup secret .

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Nursing Care Plan for Gastric Cancer

Definition of Gastric Cancer

Gastric cancer is a malignant form of gastrointestinal neoplasms. Gastric carcinoma is a form of gastric neoplasms are the most common and causes about 2.6 % of all deaths from cancer (Cancer Facts and Figures, 1991).

Gastric cancer occurs in the small curvature or gastric antrum and adenocarcinoma. Other factors, in addition to high- acid foods that cause the incidence of gastric cancer include inflammation of the stomach, pernicious anemia, aclorhidria (no hydrochloride). Gastric ulcer, bacteria H. plylori, and offspring. (Suzanne C. Smeltzer).

Cancer of the stomach or abdominal malignant tumor is an adenocarcinoma. This cancer spreads to the lungs, lymph nodes and liver. Risk factors include chronic atrophic gastritis with intestinal metaplasia pernicious anemia, high alcohol consumption and smoking. (Nettina sandra, nursing practice guidelines).

Gastric cancer is a malignancy that occurs in the stomach, most are of the type adenocarcinoma. Other types of gastric cancer are leiomyosarcoma (smooth muscle cancer) and lymphoma. Gastric cancer is more common in the elderly. Less than 25 % of certain cancers occur in people under the age of 50 years (Osteen, 2003).


Etiology of Gastric Cancer

The exact cause of stomach cancer is unknown, but there are several factors that can increase the development of gastric cancer, include the following matters :

1. Predisposing Factors

a. Genetic factors
Approximately 10 % of patients with gastric cancer have a genetic link. Although still not fully understood, but the mutation of the E - cadherin gene was detected in 50 % of gastric cancer types. The presence of a family history of pernicious anemia and adenomatous polyps was also associated with a genetic condition in gastric cancer. (Bresciani, 2003).

b. Age factor
In this case found to be more common in the age of 50-70 years, but about 5 % of gastric cancer patients aged less than 35 years and 1 % less than 30 years. (Neugut, 1996)


2. Precipitation Factors

a. Consumption of pickled food, smoked or preserved.
Several studies explain the dietary intake of pickled food becomes a major factor increase in gastric cancer. The content of salt that goes into the stomach slows gastric emptying, thereby facilitating the conversion of nitrates into carcinogenic nitrosamines group in the stomach. Combined condition of delayed emptying of stomach acid and an increase in the composition of nitrosamines in the stomach contributed to the formation of gastric cancer (Yarbro, 2005).

b. H.pylori infection.
H. pylori is a bacterium that causes more than 90 % of duodenal ulcers and 80 % of gastric ulcers (Fuccio, 2007). These bacteria on the surface of the gastric ulcer, through the interaction between the bacterial membrane lectins, and specific oligosaccharides from glycoproteins membranes of gastric epithelial cells (Fuccio, 2009).

c. Socioeconomic.
Low socioeconomic conditions are reported to increase the risk of gastric cancer, but not specific.

d. Consume cigarettes and alcohol.
Patients with cigarette consumption of more than 30 cigarettes a day and combined with chronic alcohol consumption increases the risk of gastric cancer (Gonzalez, 2003).

e. NSAIDs.
Inflammatory gastric polyps can occur in patients taking NSAIDs in the long term and this (gastric polyps) may be a precursor of gastric cancer. Gastric polyps conditions will increase the risk of gastric cancer (Houghton, 2006).

f. Pernicious anemia.
This condition is a chronic disease with failure of absorption of cobalamin (vitamin B12), caused by a lack of intrinsic factor gastric secretion. The combination of pernicious anemia with H.pylori infection provides an important contribution to tumorigenesis in the stomach wall formation. (Santacrose, 2008).


Clinical Manifestations of Gastric Cancer

Early symptoms of gastric cancer is often uncertain because most of these tumors in the small curvature, which is only slightly causing interference function of the stomach. Several studies have shown that early symptoms such as pain that is relieved by antacids may resemble symptoms in patients with benign ulcer. Symptoms may include a progressive disease can not eat, anorexia, dyspepsia, weight loss, abdominal pain, constipation, anemia and nausea and vomiting (Harnawati).

Clinical symptoms were found among others (Davey, 2005) :

• Anemia , vague gastrointestinal bleeding and resulted in an iron deficiency may be a presenting symptom of gastric carcinoma is the most common.
• Weight loss, common and further illustrates metastatic disease.
• Vomiting, an indication of the occurrence of gastric outflow obstruction.
• Dysphagia.
• Nausea.
• Weakness.
• Hematemesis.
• Regurgitation.
• Easily satisfied.
• Enlarged abdominal ascites.
• Abdominal cramps.
• Real or faint blood in the stool.
• The patient complained of discomfort in the stomach, especially after eating.

Complications of Gastric Cancer

1. Perforation

Perforation can occur acute and chronic perforation :

• Acute Perforation. Perforation often occurs in : ulceration type of cancer that is located in the minor curvature, diantrum near the pylorus. Usually have symptoms similar to perforation of peptic ulcer. These perforations are often found in men (Hadi, 2002).
• Chronic perforation. Perforations that occur frequently covered by the adjacent tissue, for example by omentum or is penetration. Usually more rare when compared with the complications of benign ulcer. Penetration may be found between layers or layer of omentum gastrohepatic bottom of the liver. What often happens is perforated and covered by the pancreas. With the penetration it will form a fistula, for example gastrohepatic, gastroenteric and gastrocolic fistula. (Hadi , 2002).

2. Haematemesis.
Massive hematemesis and melena occurred ± 5 % of carcinomas ventrikuli whose symptoms are similar as in massive bleeding so much blood is lost, causing hypochromic anemia. (Hadi, 2002).

3. Obstruction.
Can occur in the lower part of the stomach near the pylorus region are accompanied by complaints of vomiting (Hadi, 2002).

4. Adhesion.
If a tumor of the stomach wall can occur adhesion and infiltration of the surrounding organs and cause abdominal pain (Hadi , 2002)



Gastric Cancer - Assessment and 5 Nursing Diagnosis

Nursing Interventions for Gastric Cancer

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