Question

​​​​George Smith, a 55-year-old patient is admitted to the intensive care unit after a thoracotomy approach was used for an esophagectomy to remove an early stage adenocarcinoma of the distal esophagus and gastroesophageal junction. The patient has a history of GERD and Barrett’s esophagus. The patient sought medical treatment for dysphagia with solid foods, feeling that there was a lump in his throat and substernal pain with swallowing and subsequent regurgitation of undigested food and the development of hiccups. The patient has no other medical problems. (Learning Objectives 6 and 7)

. What course of cancer treatment should the nurse anticipate that the patient in this case study would have?

2. What nursing care should be provided for the patient in the intensive care unit in the early postoperative period?

3. Explain the care the nurse should provide when the patient begins to eat.

Answer 1

a. Photodynamic therapy may be an alternative for the patient who is considered an operative risk. Studies shows that this therapy shows promise for the patient with the early -stage disease;however it is not recommended for the patient with early-stage disease;however it is not recommended for the patient with late-stage disease accompanied by nodal disease. Prophylactic transhiatal esophagectomy is a recommended therapy for patients with Barrets esophagus and Hirschsprung disease.it is found that they patients undergone prophylactic esophagectomy have shown a significant reduction in invasive adenocarcinoma following the procedure.

bAfter recovering from the effects of anaesthesia, the patient is placed in a low Fowlers position, and later in a Fowlers position, to help prevent reflux of gastric secretions. The patient is observed carefully for regurgitation and dyspnea. A common postoperative complication is aspiration pneumonia. The patient is placed on a vigorous pulmonary plan of care that includes incentive spirometry, sitting up in a chair, and nebulizer treatments. Chest physiotherapy is avoided due to the risk for aspiration. The patient temperature is monitored to detect any elevation that may indicate aspiration or seepage of fluid through the operative site into the mediastinum, which would indicate an esophageal leak

cOnce feeding begins, the nurse encourages the patient to swallow small sips of water. Eventually the diet is advanced as tolerated to a soft, mechanical diet. When the patient can increase his or her food and fluid intake to an adequate amount parenteral fluids are discontinued. After each meal the patient remains upright for at least 2 hours to allow the food to move through the gastrointestinal tract .it is a challenge to encourage the patient to eat, because the appetite is usually poor. Family involvement and home-cooked favourite foods msy help the patient to eat.