{
  "name": "Subtotal Gastrectomy",
  "slug": "subtotal-gastrectomy",
  "url": "https://nursingplex.com/care-plans/subtotal-gastrectomy",
  "category": "Surgery & Perioperative",
  "summary": "Partial stomach resection with dumping-syndrome prevention and B12/iron follow-up.",
  "nursing_diagnoses": [
    "Imbalanced nutrition",
    "Acute pain",
    "Diarrhea"
  ],
  "overview": [
    "Subtotal (partial) gastrectomy removes a portion of the stomach, with the remnant anastomosed to the duodenum (Billroth I) or jejunum (Billroth II), for gastric cancer or intractable peptic ulcer disease.",
    "A smaller reservoir and loss of pyloric control produce dumping syndrome: hypertonic chyme rushes into the small bowel, drawing fluid into the lumen and causing early cramping, diarrhea, palpitations and diaphoresis, then a later reactive hypoglycemia one to three hours after eating. Loss of intrinsic factor and reduced acid also impair vitamin B12, iron, calcium and folate absorption.",
    "Nursing care focuses on anastomotic protection, nasogastric tube management, a small-frequent low-carbohydrate dry-meal pattern, and lifelong nutritional monitoring."
  ],
  "key_facts": [
    {
      "label": "NG tube",
      "text": "Do not irrigate or reposition an NG tube after gastric surgery without a surgeon's order — it can disrupt the suture line."
    },
    {
      "label": "Expected drainage",
      "text": "Bright red for the first few hours, then darkening to brown-green; persistent bright red bleeding is abnormal."
    },
    {
      "label": "Dumping diet",
      "text": "Small, frequent, high-protein, moderate-fat, low simple-carbohydrate meals; fluids between rather than with meals."
    },
    {
      "label": "B12",
      "text": "Lifelong vitamin B12 supplementation is usually needed to prevent pernicious anemia."
    }
  ],
  "nursing_priorities": [
    "Protect the anastomosis and monitor for bleeding or leak.",
    "Manage the nasogastric tube safely.",
    "Prevent and treat dumping syndrome.",
    "Maintain nutrition, weight and micronutrient levels.",
    "Control pain and prevent pulmonary complications."
  ],
  "assessment": {
    "subjective": [
      "Reports of epigastric pain, fullness or nausea",
      "Reports of cramping, dizziness or palpitations after meals",
      "Complaints of weakness or sweating one to three hours after eating",
      "Reports of unintentional weight loss"
    ],
    "objective": [
      "Nasogastric output volume and color",
      "Vital signs and hemoglobin for bleeding",
      "Abdominal distention, bowel sounds, incision appearance",
      "Weight trend, albumin, B12, iron, folate and calcium levels",
      "Postprandial tachycardia, diaphoresis or hypoglycemia on glucose check"
    ],
    "related_factors": [
      "Reduced gastric reservoir and loss of pyloric sphincter control",
      "Rapid gastric emptying of hyperosmolar contents",
      "Decreased intrinsic factor and gastric acid",
      "Surgical incision and anastomosis"
    ]
  },
  "goals": [
    "The client will remain free of anastomotic leak and significant bleeding.",
    "The client will tolerate prescribed meals without dumping symptoms.",
    "The client will stabilize weight and maintain normal nutritional labs.",
    "The client will describe the post-gastrectomy diet plan accurately."
  ],
  "interventions": [
    {
      "title": "Early postoperative care",
      "points": [
        "Maintain NG suction as ordered; never reposition or irrigate without an order.",
        "Record drainage; report bright red bleeding, sudden cessation of output or severe distention.",
        "Monitor vital signs, temperature and incision for signs of leak or peritonitis.",
        "Provide analgesia, incentive spirometry and early ambulation."
      ]
    },
    {
      "title": "Dumping syndrome management",
      "points": [
        "Serve six small dry meals daily; withhold fluids for 30 minutes before and after eating.",
        "Emphasize protein and complex carbohydrates; limit simple sugars.",
        "Have the patient lie down or recline for 20–30 minutes after meals to slow emptying.",
        "Check glucose if late symptoms occur and treat reactive hypoglycemia."
      ]
    },
    {
      "title": "Long-term nutrition",
      "points": [
        "Weigh regularly and track intake with dietitian involvement.",
        "Administer or teach lifelong vitamin B12 injections or high-dose oral supplementation.",
        "Monitor for iron-deficiency anemia, osteoporosis and calcium deficiency.",
        "Encourage chewing thoroughly and eating slowly."
      ]
    }
  ],
  "patient_teaching": [
    "Explain what dumping syndrome is and how meal composition prevents it.",
    "Review the requirement for lifelong B12 replacement.",
    "Report black stools, vomiting blood, fever or severe abdominal pain.",
    "Keep nutrition follow-up and periodic lab appointments."
  ]
}