care of total gastrectomy pt??????????

tyrese · Jun 27, 2005

please help---total gastrectomy pt?----pt has ngt to low intermit.suction,t-tube to low intermit suction, and 3 jp drains plus j-tube for feeding. surgery complicated by need for trach(40% atm) with mrsa in sputum/nares/ site also surgical incision is gaping in several areas held together with retention sutures which is also positive for mrsa and vre.-----pt bowel function has returned and I was thought that the ngt should be removed after bowel function returns pt's is still to suction ? wouldn't pt be better off on tpn instead of tube feedings? t-tube goes to esophagus right? what is the exact purpose of the t-tube, where is all the drainage being produced at? never seen or worked with t-tube before. plus pt's pain is never being relieved. also seen pt sweating and had loose bm this is symptoms of dumping syndrome right? sorry bout all the questions but i work on a head injury unit and not used to caring for this type of pt -- pt made it to our floor for pick's disease(which is kinda like alzteimers) and cause we had the open bed!!!! any help would be great---thanks :uhoh21: :)

J-tube is usually placed at the jejunum area and not at the esophagus. IT is usually placed at a position after the anastomotic site.

The NGT usually goes into the esophageal region...they might even further introduce it the to the gi...but it is defintely not at a region lower than the J-tube. PUrpose : Fluid collection can occur after such a procedure.....especially bileous fluid....(I have a patient who is at his 183rd post surgery day with the Nasogastric tube still in situ,,,,and still has at least 20- 80 mls of ngt aspirate per day)) and it might take some time before it clears up....NGT also serves as a purpose to monitor for any leakage or bleeding if the anastomotic site gives way..... at present we are giving meds via NGT and feeds via j-tube...purpose to prevent clogging up of jtube.

TPN usually administered only if there is a significant anastomotic leak or fissure that might have fomred post surgery.

He's porbabaly in pain/diaphoresis due to setting in of infection/ gaping wound sites....

pain might pccur due to overactive bowel movements...loose stools/almost diarrhea like is exepected..you are right to say its dumping synddrome...

what kinda feeds is he on?..you might want to refer him to a dietician to review his feeds....fori nstance..instead of full strength supplemnt feeds...change it to half strength...etc...

Although loose watery stools are comoon expected effects of gastrec...do monitor for signs of dehydration....

Care of trachea is utmost impnt...active chest physio is needed to prevent onset of pnuemonia...

PLAN : wound care to prevent further wound breakdown/further infection

Tracheal care to maintain patent airway, minimise infection

MOnitor for signs of sepsis occuring

Active chest physio.

Pain relief ( do u have a pain care team to review analgesias ?)

MObilization as soon as pt is fit to do so.

moniter jp drains for unsuall chyle like fluid - might indicate leak at anastomotic site...

tyrese · Jun 27, 2005

please help---total gastrectomy pt?----pt has ngt to low intermit.suction,t-tube to low intermit suction, and 3 jp drains plus j-tube for feeding. surgery complicated by need for trach(40% atm) with mrsa in sputum/nares/ site also surgical incision is gaping in several areas held together with retention sutures which is also positive for mrsa and vre.-----pt bowel function has returned and I was thought that the ngt should be removed after bowel function returns pt's is still to suction ? wouldn't pt be better off on tpn instead of tube feedings? t-tube goes to esophagus right? what is the exact purpose of the t-tube, where is all the drainage being produced at? never seen or worked with t-tube before. plus pt's pain is never being relieved. also seen pt sweating and had loose bm this is symptoms of dumping syndrome right? sorry bout all the questions but i work on a head injury unit and not used to caring for this type of pt -- pt made it to our floor for pick's disease(which is kinda like alzteimers) and cause we had the open bed!!!! any help would be great---thanks :uhoh21: :)

BTw...in regards to T-tube....my pt has the tube with him for 183 days already.... IT functions like that of a normal drain...just that you could actually flush it....probably for long term useage according to my doctors...

The t-tube might be actually darining at the duodenum/jejunum site...whereby...it is near the bile duct...as such...bile and intestinal fluids are usually drain out form the t-tube....the pt which i am taking care of still has draingage from the t-tube at 300 to 590 mls daily...yeah!!!...

tyrese · Jun 27, 2005

please help---total gastrectomy pt?----pt has ngt to low intermit.suction,t-tube to low intermit suction, and 3 jp drains plus j-tube for feeding. surgery complicated by need for trach(40% atm) with mrsa in sputum/nares/ site also surgical incision is gaping in several areas held together with retention sutures which is also positive for mrsa and vre.-----pt bowel function has returned and I was thought that the ngt should be removed after bowel function returns pt's is still to suction ? wouldn't pt be better off on tpn instead of tube feedings? t-tube goes to esophagus right? what is the exact purpose of the t-tube, where is all the drainage being produced at? never seen or worked with t-tube before. plus pt's pain is never being relieved. also seen pt sweating and had loose bm this is symptoms of dumping syndrome right? sorry bout all the questions but i work on a head injury unit and not used to caring for this type of pt -- pt made it to our floor for pick's disease(which is kinda like alzteimers) and cause we had the open bed!!!! any help would be great---thanks :uhoh21: :)

if you would really like to know where the tube is really located at...why not try asking the doctors in charge???...is there any operative notes in the patients case file which you can actually look up?.....