A client scheduled for total gastrectomy. On duty nursing officer know that after surgery this client may risk for?

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

Explanation

A total gastrectomy involves the complete surgical removal of the stomach.
The stomach's parietal cells are the primary producers of hydrochloric acid (HCl), a major acid in the body.
Removal of the stomach eliminates this source of acid, leading to a relative excess of bicarbonate (a base) in the blood.
This shift in the acid-base balance towards a more alkaline state is defined as metabolic alkalosis.

Option A: Respiratory alkalosis is caused by hyperventilation (blowing off too much CO2), which is a respiratory issue, not a direct metabolic consequence of removing the stomach.
Option B: Metabolic acidosis is the opposite of what occurs after a gastrectomy. It involves an accumulation of acid or a loss of bicarbonate.
Option C: Respiratory acidosis is caused by hypoventilation (retaining CO2). While any postoperative patient is at risk for respiratory complications due to anesthesia or pain, it is not the specific metabolic risk associated with the gastrectomy itself.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Acid-Base Imbalance after Total Gastrectomy in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Nurses must monitor post-gastrectomy patients for signs and symptoms of metabolic alkalosis, which include confusion, muscle twitching or cramps, light-headedness, and tingling in the fingers and toes.
Key nursing interventions include monitoring vital signs, assessing neurological status, and reviewing arterial blood gas (ABG) and electrolyte lab results.
What if? If the patient had prolonged vomiting or nasogastric suction before the surgery, they would already be at high risk for metabolic alkalosis due to the loss of gastric acid, and the surgery would exacerbate this risk.

How to Approach the Question

First, identify the key procedure in the question: 'total gastrectomy'.
Recall the primary physiological function of the organ involved. The stomach's main role in acid-base balance is producing hydrochloric acid (HCl).
Analyze the effect of the procedure. Removing the stomach means removing the source of HCl.
Connect this physiological change to acid-base principles. A loss of acid from the body leads to a relative increase in base, causing alkalosis.
Determine if the cause is respiratory or metabolic. Since the cause is the loss of stomach acid (a metabolic factor), not a change in breathing, it is metabolic alkalosis.
Evaluate the options and select the one that matches your reasoning.

Concept Tested & Keywords

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E6 textbook of Applied Biochemistry and Nutrition & DieteticsHarbans Lal (pp 26-464 of 479) p. 158-160

E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 57-59

E6 Nursing Fundamentals Taylor p. 780-782

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.