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 gastrointestinal tract.
NG suction removes large volumes of gastric fluid, which is highly acidic due to its hydrochloric acid (HCl) content.
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.
Typical lab findings include a pH above 7.45, HCO₃⁻ above 28 mEq/L, and often low levels of chloride and potassium.

Option A: Respiratory alkalosis is caused by hyperventilation, where excessive amounts of carbon dioxide (an acid) are exhaled. This is related to respiratory function, not the loss of gastric fluids.
Option B: Metabolic acidosis is the opposite of what occurs with gastric fluid loss. It results from either a loss of base (like bicarbonate) or a gain of metabolic acids.
Option C: Respiratory acidosis is caused by hypoventilation, leading to the retention of carbon dioxide (CO₂). This is a respiratory issue and is not a direct consequence of a gastrectomy.

Visual 1: Flowchart: Gastrectomy → Postoperative NG Suction → Removal of Gastric Acid (HCl) → Loss of H+ and Cl- ions → Increased blood HCO₃⁻ → Metabolic Alkalosis. This visual helps trace the cause-and-effect relationship.
Visual 2: Chart: ABG Interpretation. A chart showing the four primary acid-base disorders with their characteristic pH, PaCO₂, and HCO₃⁻ values would help learners differentiate them.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Acid-Base Imbalances Post-Gastrectomy in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Post-gastrectomy, nurses must meticulously monitor fluid and electrolyte balance. Recognizing the high risk for metabolic alkalosis allows for early detection and intervention.
Key nursing actions include monitoring NG tube output, assessing for signs of alkalosis (e.g., muscle twitching, confusion), and closely watching lab values for pH, bicarbonate, chloride, and potassium.
Patient safety is paramount. Uncorrected metabolic alkalosis can lead to severe complications, including seizures and life-threatening cardiac arrhythmias, often linked to concurrent hypokalemia.

How to Approach the Question

First, identify the key procedure in the question: 'total gastrectomy'.
Next, consider the common postoperative interventions and consequences associated with this surgery. A major one is the use of a nasogastric (NG) tube for suction.
Analyze the physiological effect of NG suction. It removes contents from the stomach.
Recall the nature of gastric contents: they are highly acidic (containing hydrochloric acid, HCl).
Connect the loss of a large amount of acid from the body to its effect on acid-base balance. Losing acid makes the body more alkaline (alkalosis).
Determine the origin of the imbalance. Since it's due to a loss of metabolic components (acid from the stomach), it is classified as 'metabolic' alkalosis.

Concept Tested & Keywords

Concept Tested: Acid-Base Imbalances Post-Gastrectomy
Stem keywords: total gastrectomy, post-surgery, risk
Lead-in keywords: what condition
Clinical cues: The procedure (total gastrectomy) is the key cue, as it implies loss of stomach acid.

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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.