The nurse is caring for a client following a Billroth II procedure. On review of the post-operative orders, which of the following, if prescribed, would the nurse question and verify?
A. Irrigating the nasogastric tube.
B. Coughing and deep breathing exercises.
C. Leg exercises
D. Early ambulation
Correct Answer: A. Irrigating the nasogastric tube.
In a Billroth II procedure, the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery unless specifically ordered by the physician. In this situation, the nurse would clarify the order.
Option B: The client may do coughing and deep breathing exercises. Discuss and identify stressful situations and how to avoid them. Investigate job-related issues. This can alter gastric motility, interfering with optimal digestion. The patient may require vocational counseling if a change in employment is indicated.
Option C: Leg exercises are allowed to prevent thrombosis. Discuss the importance of eating small, frequent meals slowly and in a relaxed atmosphere; resting after meals; avoiding extremely hot or cold food; restricting high-fiber foods, caffeine, milk products, and alcohol, excess sugars and salt; and taking fluids between meals, rather than with food.
Option D: Early ambulation is recommended after the procedure. Also, discuss the reasons for and importance of cessation of smoking. Smoking stimulates gastric acid production and may cause vasoconstriction, compromising mucous membranes and increasing the risk of gastric irritation and ulceration.
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