An exploratory laparotomy is performed on a client with melena, & gastric cancer is discovered. A partial gastrectomy is performed & a jejunostomy tube is surgically implanted. A nasogastric tube to suction is in place. What should the nurse expect regarding the client's nasogastric tube drainage during the first 24 hours after surgery?

Appeared in: BHU NO-2019

Explanation

Following a partial gastrectomy, the surgical site has fresh incisions and suture lines which will ooze some blood.
It is normal and expected for the nasogastric (NG) tube drainage to be sanguineous (bloody) or serosanguineous (blood-tinged) for the first 12-24 hours.
The presence of a small amount of blood and some clots indicates normal postoperative healing and is not a sign of a complication.
This initial bloody drainage should gradually decrease and change in color over the next 1-2 days.

Option B: Green and viscid drainage indicates the presence of bile. This is not expected in the immediate postoperative period when some bleeding is normal.
Option C: Coffee-ground drainage signifies old, digested blood. The primary expectation in the first 24 hours is fresher, red-colored blood from the surgical site.
Option D: Large amounts of frank (bright red) blood indicate active, ongoing hemorrhage, which is a life-threatening postoperative complication, not an expected finding.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Postoperative assessment of nasogastric tube drainage after gastric surgery in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Accurate assessment and documentation of NG tube drainage are critical nursing responsibilities to monitor for postoperative complications like hemorrhage.
A sudden increase in the volume of drainage or a change to bright red blood is a critical finding that must be reported to the surgeon immediately.
Nurses must not irrigate or reposition an NG tube after gastric surgery without a specific order, as this could damage the fresh suture line.

How to Approach the Question

First, identify the key elements of the question: the procedure (partial gastrectomy), the intervention (NG tube), and the timeline (first 24 hours).
Recall the normal physiological response to surgery. Any incision will result in some bleeding.
Evaluate the options based on the expected findings versus complications. A small amount of blood is expected, while a large amount is a complication.
Consider the normal progression of GI drainage. Fresh blood appears first, followed by older blood (brown), and then bile (green/yellow) as healing progresses and motility returns.
Based on this timeline, eliminate options that describe later-stage drainage (green) or a serious complication (large amounts of frank blood).
Conclude that some blood and clots are the most logical and expected finding in the immediate 24-hour postoperative period.

Concept Tested & Keywords

Concept Tested: Postoperative assessment of nasogastric tube drainage after gastric surgery.
Stem keywords: partial gastrectomy, nasogastric tube, postoperative, drainage, first 24 hours
Lead-in keywords: expect
Clinical cues: Surgical procedure: partial gastrectomy
Clinical cues: Timeline: first 24 hours after surgery

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 152-154

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 196-198

Practise the full BHU NO-2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.