Gastric cancer and NGT

[tnguy31]

Hi nurses,

I would love to hear your opinion on this issue.

I have an 87 yrs asian female patient with gastric cancer that metastasize to other organs. She was admitted to hospice after having part of her stomach remove. She was doing good for 2 months. Recently, she nauseated and vomited 5-6 times a day, increased the frequency at night, the emesis is coffee ground in small to moderate amount. Pt is on Zofran 4mg dissolve on tongue every 6hr around the clock, reglan 10mg tid 30mins before meals. The meds has no longer effective in controlling her n/v symptoms, it reduced the severity but not very much. Family is extremely anxious, pt looks uncomfortable, visible weight loss, she has no pain, v/s: t 97.4-96.9, pulse 87-94, resp 14-16, o2 >97%, bp 98-118/56-78, BM every day 1-2 times a day.

Dr.order protonix po (i forgot the dosage) and NGT intermittent suction. The patient is a very small lady that weight probably less than 80lbs.

Do you think NGT is a good idea? Why or why not? The dr. insisted on NGT with pediatric size tube; the DON insisted on not too, so I decide I would ask nurses here.

Thank you for your input.

Also, I'm giving out the Hospice Quickflip from Corridor Group (2 of them). Have to buy as a package of 4, and realize they're all the same, so I only need one. :)) so just pm me.

[IdislikeCODEbrowns]

If the NGT is set to suction and used for decompression then I would assume it would be more for the patient's comfort/palliation

[tnguy31]

@ Idis: I'm thinking about the risk of further dehydrate the patient and possibly perforate tumors in her stomach. What do you think?

[tnguy31]

The dr. also order NPO till n/v resolve. Patient still has sense of hunger and desire to eat.

[tewdles, RN]

That is unusual, to restrict nutrition for a dying patient who is hungry and WANTS to eat.

I wonder if something like Reglan may improve gastric emptying and decrease nausea?

Using an NG tube for decompression is not unusual but it sounds sort of like the pt goals to continue eating and drinking my be in conflict with that intervention.

The important element to remember in cases like this is that all interventions should be patient goal driven, not health team goal driven. So is the NGT meeting the goals of the patient or the goals of the health care team?

[salvadordolly]

Our docs do RTC Thorazine before they'd do NGT. Invasive, uncomfortable, not terribly palliative. How do the family and the client view the NGT?

So is the NGT meeting the goals of the patient or the goals of the health care team?

[curiousauntie]

We just had a young patient, Asian also, with stomach cancer with mets. Admitted to us with the NG tube. No pain, no nausea, and did feel hungry all the time, but if he ate, he DID have nausea. (It didn't help that he loved cooking shows and watched them all the time.) The second day after admission, he suddenly developed nausea not relieved with the Compazine supp. Nurse visited and found the jar of the suction full. Once emptied and restarted, the nausea disappeared. He was not able to tolerate any pills/caps, used liquid Ativan for anxiety and liquid Morphine once he did develop pain. Only able to tolerate ice chips orally. We considered the NG/suction to be symptom management. He died within 3 weeks, but never had nausea after the first time.

[tnguy31]

The pt died last night. I feel so sad. She died peacefully, no pain. @curiousauntie: Thank you for sharing. The family is very worry about leaving the pt feel hungry, they think it's a bit cruel to her. I regretted that I didn't pursue this treatment to relieve her symptoms.