Ghana Christian University College

Programme: BSc. Nursing

Course Title: Surgical Nursing 2

Lecturer: Mr. Kwame Breko

Date of Submission: 4th March 2025

Student ID: 424142037

 Pre-Operative Nursing Diagnoses for a Patient with Stomach Cancer

1. Imbalanced Nutrition: Less than Body Requirements related to decreased appetite

and difficulty swallowing

Objectives:

1. The patient will maintain or gain weight as evidenced by stable or increased body
weight.

2. The patient will demonstrate improved nutritional intake by consuming small,

frequent meals.

Nursing Orders:

1. Assess the patient’s dietary intake and weight regularly.

2. Encourage high-protein, high-calorie foods and nutritional supplements.

3. Offer small, frequent meals instead of large portions.

4. Collaborate with a dietitian for a personalized meal plan.

5. Provide mouth care before meals to enhance appetite.

2. Acute Pain related to tumor invasion and gastric irritation

Objectives:

1. The patient will report reduced pain levels as measured by a pain scale of 3/10 or
lower.

2. The patient will demonstrate effective pain management using prescribed

analgesics and non-pharmacological interventions.

Nursing Orders:

1. Assess pain level, location, and characteristics using a pain scale.

2. Administer prescribed analgesics and monitor for effectiveness.

3. Encourage relaxation techniques such as deep breathing and guided imagery.

 4. Position the patient comfortably to reduce pain intensity.

5. Educate the patient on the importance of timely pain management.

3. Anxiety related to fear of surgery and prognosis

Objectives:

1. The patient will verbalize reduced anxiety regarding the surgical procedure.

2. The patient will demonstrate coping strategies such as deep breathing and
relaxation exercises.

Nursing Orders:

1. Encourage the patient to express feelings and concerns.

2. Provide accurate information about the surgery and post-operative care.

3. Teach relaxation techniques such as deep breathing and visualization.

4. Offer emotional support and reassurance.

5. Arrange for the patient to speak with a counselor or support group if needed.

4. Risk for Infection related to compromised immune system and malnutrition

Objectives:

1. The patient will remain free from signs of infection, such as fever and increased
white blood cell count.

2. The patient will demonstrate understanding of infection prevention measures.

Nursing Orders:

1. Maintain strict hand hygiene before and after patient contact.

2. Administer prophylactic antibiotics as prescribed.

3. Monitor vital signs and signs of infection (e.g., fever, wound drainage).

4. Educate the patient on proper personal hygiene and handwashing techniques.

 5. Ensure a clean and sterile environment before surgery.

5. Deficient Knowledge related to lack of information about surgical procedure and

post-operative care

Objectives:

1. The patient will verbalize an understanding of the surgical procedure and

expected outcomes.

2. The patient will demonstrate knowledge of post-operative self-care practices.

Nursing Orders:

1. Assess the patient’s level of knowledge and readiness to learn.

2. Provide clear, written, and verbal explanations about the procedure.

3. Use visual aids and videos to enhance patient understanding.

4. Encourage the patient and family members to ask questions.

5. Provide written discharge instructions on post-operative care.

 Post-Operative Nursing Diagnoses for a Patient with Stomach Cancer

1. Acute Pain related to surgical incision and tissue manipulation

Objectives:

1. The patient will report a pain level of 3/10 or lower within 24 hours
postoperatively.

2. The patient will demonstrate effective pain management techniques.

Nursing Orders:

1. Assess pain level regularly using a pain scale.

2. Administer prescribed analgesics as needed.

3. Encourage non-pharmacologic pain relief techniques such as relaxation and

positioning.

4. Monitor for side effects of pain medications.

5. Educate the patient on pain management strategies.

2. Risk for Infection related to surgical incision and decreased immune function

Objectives:

1. The patient will remain free from signs of infection, such as redness, swelling, or
fever.

2. The patient will demonstrate knowledge of infection prevention strategies.

Nursing Orders:

1. Perform proper wound care using sterile techniques.

2. Monitor the surgical site for signs of infection.

3. Encourage early ambulation to promote circulation and healing.

4. Administer prescribed antibiotics as necessary.

 5. Educate the patient on proper wound care and hygiene.

3. Impaired Gastrointestinal Motility related to surgical manipulation of the stomach

Objectives:

1. The patient will report the return of bowel sounds and the ability to tolerate oral
intake.

2. The patient will have regular bowel movements without complications.

Nursing Orders:

1. Assess bowel sounds and monitor for signs of paralytic ileus.

2. Encourage early ambulation to stimulate bowel motility.

3. Gradually introduce oral intake as tolerated, starting with clear liquids.

4. Monitor for nausea, vomiting, and abdominal distension.

5. Administer stool softeners or laxatives as prescribed.

4. Imbalanced Nutrition: Less than Body Requirements related to reduced stomach

capacity and altered digestion

Objectives:

1. The patient will maintain adequate nutritional intake to support healing.

2. The patient will tolerate small, frequent meals without nausea or vomiting.

Nursing Orders:

1. Provide small, frequent meals with nutrient-dense foods.

2. Encourage high-protein and high-calorie foods.

3. Monitor weight and nutritional status regularly.

4. Collaborate with a dietitian for a personalized dietary plan.

5. Educate the patient on dietary modifications to prevent dumping syndrome.

5. Risk for Deficient Fluid Volume related to post-operative fluid loss and decreased
oral intake

Objectives:

1. The patient will maintain adequate hydration as evidenced by normal urine output
and stable vital signs.

2. The patient will demonstrate knowledge of the importance of adequate fluid

intake.

Nursing Orders:

1. Monitor intake and output closely.

2. Administer IV fluids as prescribed to maintain hydration.

3. Encourage small, frequent sips of fluids.

4. Assess for signs of dehydration such as dry mucous membranes and decreased
urine output.

5. Educate the patient on the importance of fluid intake and signs of dehydration.

This comprehensive nursing care plan ensures that the patient receives holistic pre-
operative and post-operative care for stomach cancer.
 REFERENCES

Ameyaw, J. A. O. (2014). Surgical site infections after abdominal surgery: prevalence, causes

and management at the Surgical Wards, Komfo Anokye Teaching Hospital, Ghana
(Doctoral dissertation).

Liu, D., & Li, S. C. (2024). Nursing of a patient with multiple primary cancers: A case report and

review of literature. World Journal of Clinical Oncology, 15(10), 1315.

Stewart-Knight, K. (2016). Pre-operative treatment for oesophageal cancer: perspectives and

experiences (Doctoral dissertation, University of East London).

Yun, M. A., Kim, S. S., Kim, S., & Noh, S. H. (2016). The effects of a standardized preoperative

education program on stomach cancer patients undergoing gastrectomy. Asian Oncology

Nursing, 16(2), 85-93.

Zhang, L., Wang, S., Gao, X., Gao, T., Huang, L., Lian, B., ... & Wang, X. (2022). Poor Pre-

operative Nutritional Status Is a Risk Factor of Post-operative Infections in Patients with

Gastrointestinal Cancer—A Multicenter Prospective Cohort Study. Frontiers in Nutrition,
9, 850063.