NORCET 2 - 2021 (shift-1)
Medical & Surgical Nursing
Hard
A client is scheduled for a total gastrectomy. The on-duty nursing officer knows that after surgery, this client may be at risk for what condition?
Appeared in: NORCET 2 - 2021 (shift-1)
Explanation
- A total gastrectomy often involves postoperative nasogastric (NG) suction to decompress the surgical site.
- NG suction and/or vomiting removes large amounts of gastric fluid, which is rich in hydrochloric acid (HCl).
- The loss of hydrogen ions (H+) and chloride ions (Cl−) from the body leads to a relative excess of bicarbonate (HCO3−).
- This increase in bicarbonate raises the blood pH, resulting in metabolic alkalosis.
- This condition is often accompanied by hypokalemia (low potassium) and hypochloremia (low chloride).
Why Other Options Were Wrong
- Option A: Respiratory alkalosis is caused by hyperventilation, which leads to excessive blowing off of carbon dioxide (a respiratory acid). This is unrelated to the loss of gastric fluids.
- Option B: Metabolic acidosis is the opposite of what is expected. It results from a loss of base (bicarbonate) or a gain of acid.
- Option C: Respiratory acidosis is caused by hypoventilation, leading to the retention of carbon dioxide. This is typically related to respiratory depression or lung disease, not gastric surgery.
Related Visual
Clinical Relevance
- Nursing practice connection: Safe nursing care depends on performing Acid-base imbalance as a postoperative complication of total gastrectomy in the correct sequence, documenting the action clearly, and monitoring for the expected response.
- Nurses must meticulously monitor fluid and electrolyte balance in post-gastrectomy patients, paying close attention to the volume and nature of NG tube output.
- Key nursing actions include monitoring arterial blood gases (ABGs), serum electrolytes (especially K+ and Cl−), and assessing for signs of alkalosis like confusion, muscle cramps, and tingling.
- It is crucial to manage NG suction as prescribed (e.g., low intermittent suction) to minimize excessive acid loss and to administer antiemetics to prevent vomiting.
How to Approach the Question
- First, identify the core clinical event in the question: a 'total gastrectomy'.
- Recall the immediate postoperative management and common physiological changes associated with this surgery. A key intervention is often nasogastric (NG) suction.
- Consider the nature of the fluid being removed. The stomach contains gastric acid (HCl).
- Analyze the effect of removing this fluid. Losing acid (H+) from the body will make the blood more alkaline (basic).
- Connect this physiological change to the four types of acid-base imbalances. The loss of metabolic acid leads to 'Metabolic Alkalosis'.
- Evaluate the other options to confirm your choice. Respiratory imbalances involve CO2 changes, and metabolic acidosis involves losing base (like in diarrhea), which is the opposite scenario.
Concept Tested & Keywords
- Concept Tested: Acid-base imbalance as a postoperative complication of total gastrectomy.
- Stem keywords: total gastrectomy, after surgery, at risk
- Lead-in keywords: what condition
Question ID
QAHbAO6H90f4TGhpK0yGSN
Reference Book
E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 2 — Subpart A (pp 1-239 of 478) p. 82-84
E6 Nursing Fundamentals Taylor p. 780-782
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 56-58
Practise the full NORCET 2 - 2021 (shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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