The nurse anticipates that the client who has had a subtotal gastrectomy will need supplemental:

Subtotal gastrectomy involves surgical excision of a significant portion of the stomach, drastically reducing the population of parietal cells. These specialized cells secrete intrinsic factor, a glycoprotein mandatory for the absorption of cobalamin in the terminal ileum. Absence of this factor leads to pernicious anemia and progressive neurological deterioration due to demyelination of the spinal cord. A. vitamin B12 due to the loss of the intrinsic factor.: Post-gastrectomy patients lose the physiological capacity to bind dietary B12 for intestinal transport. This necessitates lifelong parenteral supplementation or high-dose oral therapy to prevent megaloblastic hematopoiesis. This intervention is critical to maintain erythrocyte integrity and nervous system function. B. protein due to the loss of some of the digestive processes.: While the stomach initiates proteolysis via pepsin, the majority of protein digestion and absorption occurs efficiently within the small intestine. Pancreatic enzymes compensate for the loss of gastric churning and acid. Protein deficiency is not an inevitable outcome if oral intake remains adequate. C. vitamin A due to the loss of the gastric lining.: Vitamin A is a fat-soluble nutrient primarily absorbed in the duodenum and jejunum with the assistance of bile salts. The stomach does not play a unique role in the metabolic processing or absorption of this specific vitamin. Gastric resection does not typically induce a primary vitamin A deficiency. D. bulk to prevent constipation.: Gastric surgery is more frequently associated with dumping syndrome and increased transit speed rather than constipation. Adding excessive bulk might exacerbate abdominal discomfort in the reduced gastric pouch. Bowel habits post-surgery are managed through specific dietary pacing rather than fiber supplementation.