Which of the following would be an expected nutritional outcome for a client who has undergone a subtotal gastrectomy for cancer?
A. Regain weight loss within 1 month after surgery.
B. Resume normal dietary intake of three meals per day.
C. Control nausea and vomiting through regular use of antiemetics.
D. Achieve optimal nutritional status through oral or parenteral feedings.
Correct Answer: D. Achieve optimal nutritional status through oral or parenteral feedings.
An appropriate expected outcome is for the client to achieve optimal nutritional status through the use of oral feedings or total parenteral nutrition (TPN). TPN may be used to supplement oral intake, or it may be used alone if the client cannot tolerate oral feedings. Maintain patency of NG tube. Notify the physician if the tube becomes dislodged. This provides rest for the GI tract during the acute postoperative phase until the return of normal function.
Option A: The client would not be expected to regain lost weight within 1 month after surgery. Note admission weight and compare with subsequent readings. This provides information about the adequacy of dietary intake and determination of nutritional needs.
Option B: The client would not be expected to tolerate a normal dietary intake of three meals per day. Monitor tolerance to fluid and food intake, noting abdominal distension, reports of increased pain, cramping, nausea, and vomiting. Complications of paralytic ileus, obstruction, delayed gastric emptying, and gastric dilation may occur, possibly requiring reinsertion of the NG tube.
Option C: Nausea and vomiting would not be considered an expected outcome of gastric surgery, and regular use of antiemetics would not be anticipated. Progress diet as tolerated, advancing from clear liquid to bland diet with several small feedings. Usually, the NG tube is clamped for specified periods of time when peristalsis returns to determine tolerance. After the NG tube is removed, intake is advanced gradually to prevent gastric irritation and distension.
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