Recognize Cues
Mr. Alvarez, 54, presents to the clinic with complaints of persistent fatigue and feeling “full quickly” after eating. He reports a 20-lb unintentional weight loss over three months and occasional dark-colored stools. On exam, his skin and conjunctiva are pale. His stool test is guaiac-positive. He denies alcohol use or NSAID consumption. Which cues are most concerning for gastric cancer rather than gastritis, and what underlying pathophysiology explains them?
Unintentional weight loss, early satiety, and occult GI bleeding suggest tumor infiltration reducing gastric capacity and chronic mucosal bleeding.
Ms. Robinson, 63, diagnosed with gastric cancer, presents with vomiting and dizziness. Vitals: BP 86/58 mmHg, HR 118 bpm, RR 22, and dry mucous membranes. What is the nurse’s priority action, and why?
Assess for hypovolemia and initiate IV fluids per provider order to restore intravascular volume and prevent shock.
Mr. Nguyen, 45, was diagnosed with H. pylori gastritis and started on triple therapy (omeprazole, amoxicillin, clarithromycin). After two days, he reports nausea and wants to stop. What teaching should the nurse provide to ensure effective treatment?
Complete the full antibiotic regimen to eradicate infection and prevent resistance.
Ms. Taylor, 47, on omeprazole for gastritis, reports improved appetite and no burning pain. Which finding indicates effective therapy?
Absence of pain and hematemesis indicates reduced acid and mucosal healing.
Mr. Lee, 42, newly diagnosed with gastritis, drinks coffee daily and takes aspirin for headaches. What lifestyle modifications should the nurse teach?
Avoid caffeine, alcohol, and NSAIDs; eat small, frequent, bland meals.
Mrs. Morales, diagnosed with gastric cancer, presents with anorexia, fatigue, and black stools. Labs show Hgb 8.4 g/dL, albumin 2.8 g/dL. She expresses fear about surgery and recovery. Which three preoperative nursing priorities should be addressed?
Ms. Chen, 38, reports burning epigastric pain and nausea that worsens after drinking coffee or wine. She has taken ibuprofen daily for back pain. On exam, mild tenderness is noted in the upper abdomen, with no palpable mass. Which cue supports a diagnosis of acute gastritis, and what is the likely etiology?
Epigastric burning after irritant ingestion indicates acute gastritis caused by mucosal erosion from NSAID and alcohol use.
Mr. Gomez, 59, with chronic gastritis, takes ibuprofen 600 mg twice daily for arthritis. He reports worsening stomach pain and black, tarry stools. Which action should the nurse take first?
Notify the provider to discontinue NSAIDs and evaluate for GI bleeding; monitor Hgb/Hct and initiate PPI therapy.
Mrs. Johnson, 62, receiving cisplatin chemotherapy for gastric cancer, reports flank pain and decreased urine output. What nursing intervention is essential to prevent complications?
Assess renal function and ensure pre- and post-hydration; cisplatin is nephrotoxic.
Mr. Hernandez, 60, post–gastrectomy, tolerates small meals but experiences dizziness after eating sweets. How should the nurse interpret this finding?
Dumping syndrome; modify diet to smaller, high-protein meals and avoid simple sugars.
Mrs. Davis, 66, is scheduled for a gastrectomy next week and worries about nutrition.
What preoperative teaching is essential?
Explain small meal portions, avoiding fluids with meals, and lifelong vitamin B12 supplementation.
Mr. Patel, 67, has a history of chronic gastritis. He reports fatigue, numbness in his fingertips, and a sore tongue. Labs reveal hemoglobin 9.2 g/dL and vitamin B12 level of 120 pg/mL (low). What is the underlying process responsible for these findings, and what complication should the nurse anticipate?
Autoimmune destruction of parietal cells causes loss of intrinsic factor, leading to vitamin B12 deficiency and pernicious anemia.
Mrs. Fields, 70, underwent partial gastrectomy two weeks ago. She reports dizziness, palpitations, and sweating 30 minutes after meals. What complication should the nurse suspect, and what immediate action is required?
Dumping syndrome; instruct her to lie down after meals and avoid fluids with food.
Mr. Rivera, 58, on metoclopramide for nausea, develops facial twitching and lip smacking. What should the nurse do next?
Hold the medication and notify the provider immediately; this may indicate tardive dyskinesia.
Ms. Ahmed, 65, treated for chronic gastritis, continues to feel fatigued. Labs show low B12 despite therapy. Which intervention is required?
Initiate monthly vitamin B12 injections due to intrinsic factor loss.
Mr. Thompson, 70, post-gastrectomy, says, “I’ll drink water with my meals to help digestion.”
What should the nurse clarify?
Advise avoiding fluids with meals to prevent dumping syndrome; drink 30–60 minutes after eating.
Ms. Rivera, 59, reports progressive bloating, early satiety, and vomiting undigested food hours after eating. She denies alcohol use but notes unintentional weight loss. An abdominal X-ray shows gastric distention. Which cue pattern supports gastric outlet obstruction secondary to gastric cancer?
Persistent vomiting of undigested food and visible gastric distension indicate delayed gastric emptying from tumor obstruction.
Mr. Ortiz, 61, with gastric cancer, reports severe nausea and vomiting. Labs show potassium 2.9 mEq/L. He appears weak and restless. What is the nurse’s highest priority?
Replace potassium per order and monitor ECG; hypokalemia increases arrhythmia risk.
Ms. Delgado, 70, with gastritis, reports persistent pain despite PPI therapy and herbal supplement use. What is the nurse’s best response?
Assess for supplement–drug interactions and notify provider; herbal agents like St. John’s Wort may reduce PPI efficacy.
Mr. Lewis, 57, post-chemotherapy for gastric cancer, has stable weight but reports mild nausea. What does this outcome indicate?
Partial improvement; antiemetic regimen may need adjustment.
Ms. Parker, 52, recovering from gastritis, asks why she must avoid smoking. What education should the nurse provide?
Smoking decreases gastric mucosal blood flow and delays healing, increasing recurrence risk.
Mr. Kim, 72, presents with fatigue, pale skin, and mild epigastric discomfort. He denies overt bleeding. Stool test is positive for occult blood, and Hgb is 8.8 g/dL. Which findings should lead the nurse to suspect occult gastric bleeding, and what condition might this signify?
Low hemoglobin, positive fecal occult blood, and fatigue suggest chronic bleeding from gastric carcinoma or erosive gastritis.
Ms. Franklin, 68, post–gastrectomy, suddenly develops severe abdominal pain, rigid abdomen, and tachycardia. What is the nurse’s immediate action based on these cues?
Suspect gastric perforation; notify the surgeon immediately, keep NPO, and prepare for emergency surgery.
Mr. Wallace, 65, with advanced gastric cancer, reports severe pain unrelieved by oral opioids. He appears restless and tachycardic. What nursing intervention demonstrates advanced clinical judgment?
Assess pain pattern, administer breakthrough IV analgesia as ordered, and notify provider to adjust pain regimen.
Mrs. Brooks, 62, two months post–gastrectomy, reports fatigue and pallor. Hgb is 8.0 g/dL. What does this finding indicate, and what intervention is required?
Iron-deficiency anemia from malabsorption; initiate iron supplementation and assess dietary intake.
Mr. Johnson, 72, recently treated for gastric cancer, is starting home care and expresses anxiety about fatigue and diet. What should the nurse prioritize in home health education?
Nutritional planning, emotional support, and monitoring for anemia or cancer recurrence.