A client scheduled for total gastrectomy. On duty nursing officer know that after surgery this client may ris… - NORCET 2 - 2021 (shift-1)

NORCET 2 - 2021 (shift-1)

Medical & Surgical Nursing

Hard

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

A total gastrectomy involves the complete removal of the stomach, which is the body's primary organ for producing hydrochloric acid (HCl).
The removal of this acid-producing organ leads to a net loss of acid from the body.
This loss results in a relative excess of bicarbonate (a base) in the blood, leading to an increase in pH.
This state of primary bicarbonate excess is defined as metabolic alkalosis.
Post-operative nasogastric suction, which is common after this surgery, can further exacerbate the condition by removing more acidic gastric contents.

Option A: Respiratory alkalosis is caused by hyperventilation, leading to an excessive loss of carbon dioxide (an acid). This is a respiratory issue, not a metabolic one related to the stomach.
Option B: Metabolic acidosis is the opposite of what occurs after a gastrectomy. It involves a gain of acid or a loss of base (bicarbonate). Removing the stomach causes a loss of acid.
Option C: Respiratory acidosis is caused by hypoventilation, leading to the retention of carbon dioxide. This is a primary respiratory problem and is not a direct consequence of removing the stomach.

Visual 1: Diagram: An illustration showing the stomach's parietal cells secreting HCl, and a 'before and after' visual of body pH balance with and without the stomach.
Visual 2: Flowchart: A flowchart demonstrating the pathway: Total Gastrectomy → Decreased HCl production/loss of gastric fluid → Relative increase in serum HCO₃⁻ → Increased pH → Metabolic Alkalosis.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Acid-base imbalance following total gastrectomy in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Nurses must diligently monitor patients post-gastrectomy for signs and symptoms of metabolic alkalosis, which include confusion, dizziness, muscle cramps, tingling in the extremities, and cardiac dysrhythmias.
Key nursing interventions include monitoring vital signs, assessing neurological status, and closely tracking serum electrolytes (especially potassium and chloride) and arterial blood gas (ABG) results.
What if? If the patient had a procedure that resulted in severe, prolonged diarrhea (e.g., a colectomy), the primary risk would shift to metabolic acidosis. This is because diarrhea causes a significant loss of bicarbonate-rich fluid from the lower gastrointestinal tract.

How to Approach the Question

First, identify the key procedure in the question: 'total gastrectomy'.
Next, recall the primary physiological function of the organ being removed. The stomach's main role in this context is producing a large amount of acid (HCl).
Analyze the direct consequence of the procedure. Removing the stomach eliminates a major source of acid from the body.
Connect this physiological change to the principles of acid-base balance. A loss of acid results in a relative excess of base (bicarbonate).
Categorize the resulting imbalance. A primary excess of bicarbonate is termed 'metabolic alkalosis'.
Finally, review the options and select the one that matches your conclusion.

Concept Tested & Keywords

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