Reference no: EM133250195

Case: A 76-year-old woman was seen in the oncology unit for treatment of an adenocarcinoma of the body of the stomach. The patient presented to her primary care physician with a four-week history of intermittent chest pressure radiating to her back. Extensive evaluation for a cardiac source was unremarkable, including a normal stress test and abdominal ultrasound. She then developed epigastric abdominal pain, and given that she carried a history of prior H. pylori infection in 2003, there was concern that she might have a peptic ulcer. An upper endoscopy was obtained and showed a large ulcerated tumor in the body of the stomach. Pathological examination of biopsy specimens of the stomach ulcer showed moderately to poorly differentiated adenocarcinoma. Staging computed tomography (CT) scans of the chest, abdomen and pelvis only showed prominent lymph nodes adjacent to the lesser curvature of the stomach within the gastrohepatic ligament and no evidence of metastatic disease.

She reported intermittent upper abdominal discomfort that was worse without food but was typically relieved with eating. She denied any change in appetite or weight. She had no nausea, vomiting, early satiety or change in her bowel habits. Her past medical history was notable for type II diabetes mellitus, hypertension, elevated lipids, gastroesophageal reflux disease (GERD), diverticulosis, endometriosis, kidney stones, anxiety and osteopenia. Her medications included atorvastatin, Inderal, lisinopril, metformin, omeprazole and Paxil. She had allergies to dyazide, morphine, intravenous contrast dye, aspirin and triamcinolone cream. She was a retired research assistant and was married with two children. She never smoked and did not drink alcohol. There was no family history of stomach cancer, but her older brother died of colon cancer metastatic to the liver and lung at the age of 90.

On examination, the weight was 182 pounds, the blood pressure 182/90 mm Hg, the pulse 90 beats per minute and the temperature 97.2 degrees Fahrenheit. There was mild epigastric tenderness without a palpable mass nor an enlarged liver. Results of a complete blood count, plasma electrolytes and tests of kidney and liver function were normal.

The patient was felt to be at high risk for complications from either ECF chemotherapy or even a milder regimen of 5-FU, leucovorin and oxaliplatin (FOLFOX) chemotherapy, and thus she was scheduled for subtotal gastrectomy and D2 lymphadenectomy.

Answer the following:

Question 1: What could have been the predisposing/ major risk factors that could have contributed to the patient's development of gastric cancer?

Question 2: What is your priority Nursing Diagnosis for this patient at this moment? Why?

Question 3: What are the major cues that support your priority Nursing Diagnosis?