I.

INTRODUCTION

A. Description of the Disease

Gastroesophageal cancer, comprising esophageal and gastric (stomach) cancers, is a

formidable group of upper digestive tract cancers. These cancers which are distinguished by their

aggressive nature and frequent late-stage diagnosis, pose a substantial worldwide health concern.

Understanding the incidence, risk factors, and demographic differences of gastroesophageal

cancer is critical for healthcare providers, researchers, and policymakers working towards

effective prevention, early detection, and treatment strategies to mitigate its impact.

Gastroesophageal cancer is divided into two types: esophageal cancer and stomach

cancer. Esophageal cancer develops in the esophageal lining, whereas stomach cancer develops

in the mucous-producing cells lining the stomach. These cancers are generally asymptomatic in

their early stages, resulting in a delayed diagnosis and a poorer prognosis. Chronic

gastroesophageal reflux disease (GERD), tobacco use, heavy alcohol use, dietary factors, and

genetic predisposition are all common risk factors for gastroesophageal cancer.

Squamous cell carcinoma and adenocarcinoma are the two main histological forms of

esophageal cancer. Squamous cell carcinoma primarily affects the upper and middle esophagus

and is frequently associated with tobacco and alcohol use. Adenocarcinoma, on the other hand,

often develops in the lower esophagus and is frequently related with persistent GERD, obesity,

and other risk factors.

Stomach cancer, on the other hand, is more common in older adults and is frequently

associated with Helicobacter pylori infection, particular dietary habits, and hereditary

vulnerability.
 B. Statistical Incidence

Huang et al. (2021)

The global incidence of gastroesophageal cancer varies by type and geographic region.

According to the American Cancer Society, an estimated 19,260 new cases of esophageal cancer

were diagnosed in the United States in 2022, leading to 15,530 deaths (American Cancer Society,

2022). The incidence of esophageal cancer can fluctuate by subtype, with adenocarcinoma

becoming more common in Western countries.

Esophageal cancer is the sixth most common cancer in the world, with over 500,000 new

cases diagnosed each year. It is one of the leading causes of cancer death, claiming the lives of

around 500,000 people each year. The 5-year survival rate for patients with esophageal cancer is

less than 20%. The majority of esophageal cancer cases are diagnosed in developing countries.

Its global burden, however, varies widely, ranging from the second most common malignancy in

some countries to one of the least common cancers in others.

Regarding stomach cancer, it remains a major public health concern worldwide. Stomach

cancer was one of the top causes of cancer-related mortality in 2020, accounting for roughly 1.0

million new cases and over 768,000 deaths worldwide (World Cancer Research Fund, 2020). The

incidence of stomach cancer exhibits significant regional disparities, with higher rates in Eastern

Asia and South America.

Esophageal and stomach cancers have a significant global disease burden, emphasizing

the need for improved prevention, early detection, and treatment measures to reduce their impact

on public health.
 C. Current Trends (new approach/method of treatment)

In recent years, the landscape of gastroesophageal cancer treatment has seen tremendous

improvements and developments that provide new hope and improved outcomes for people

dealing with this difficult disease. According to Shitara (2019), Immunotherapy has emerged as

a game-changing treatment, with immune checkpoint inhibitors like pembrolizumab and

nivolumab showing excellent results in clinical trials. These medications function by preventing

cancer cells from evading the immune system, and they have produced long-term responses in

some patients with advanced gastroesophageal cancer.

Precision medicine and targeted therapies have become essential components of

gastric cancer treatment methods. Trastuzumab, a HER2-targeted medication, for example, has

been approved for the treatment of HER2-positive advanced gastric or gastroesophageal junction

cancer. Ramucirumab, a VEGFR2 inhibitor, is also used as second-line therapy in advanced

gastric cancer, demonstrating the trend toward more customized and effective treatment

alternatives (Fuchs, C. S., et al., 2014).

In addition, multimodal techniques have gained prominence in the management of

gastroesophageal cancer. For locally advanced cases, neoadjuvant chemotherapy followed by

surgery and adjuvant chemotherapy has become the usual treatment. Radiation therapy and

proton therapy are also utilized to improve local tumor control while minimizing side effects,

especially in esophageal cancer.

D. Significance of the study

As a student nurse, the case study regarding gastroesophageal cancer is significant because it

provided an opportunity to gain practical insights into the complexities of patient care, develop

critical thinking skills, and apply theoretical knowledge to real-world scenarios. It also highlights

the importance of communication, collaboration, and evidence-based practice, all of which are

crucial aspects of nursing. Moreover, this case study will enable student the nursing student to

prepare for future nursing roles, fostering empathy, competence, and a patient-centered approach

to care while building your self-confidence as a healthcare professional.

II. THE DISEASE PROCESS

A. Definition of the disease

Gastroesophageal cancer refers to malignancies affecting the esophagus or stomach, often

categorized into esophageal or gastric cancer, with varying subtypes. It arises from the

uncontrolled growth of abnormal cells in the gastroesophageal junction, posing significant health

challenges (American Cancer Society, 2021).

Gastroesophageal cancer significantly impacts the digestive system, with the esophagus and

stomach being the primary sites of involvement. Esophageal cancer, for example, may lead to the

formation of malignant tumors along the lining of the esophagus, potentially causing narrowing

(stenosis) and difficulty in the passage of food. This interference with the normal swallowing

process can result in symptoms like dysphagia, impacting the individual's ability to eat and

leading to unintended weight loss.

Similarly, gastric (stomach) cancer can affect the structure and function of the stomach.

Tumors may impede the normal digestive process, leading to symptoms such as persistent

indigestion, bloating, and a feeling of fullness. As the cancer progresses, it may also interfere

with the absorption of nutrients, contributing to nutritional deficiencies and further

compromising the overall health of the individual.

B. Risk Factors

Several risk factors contribute to the development of gastroesophageal cancer. This involves

the following:

 Family History. Genetic factors play a role, and individuals with a family history of

gastroesophageal cancer have a higher predisposition to the disease.

 Chronic GERD (Gastroesophageal Reflux Disease). Persistent exposure of the

esophagus to stomach acid increases the likelihood of cellular changes, contributing

to the development of gastroesophageal cancer (National Cancer Institute, 2020).

 Age. The risk of gastroesophageal cancer increases with age, with most cases

diagnosed in individuals over 55 years old (American Cancer Society, 2021).

  Gender. Men are more likely to develop gastroesophageal cancer than women, with

higher incidence rates observed in males.

 Helicobacter pylori Infection. Chronic infection with Helicobacter pylori, a

bacterium that can infect the stomach lining, is linked to an elevated risk of gastric

cancer.

 Tobacco and Alcohol Use. Both tobacco and alcohol are established carcinogens, and

their combined use synergistically elevates the risk of gastroesophageal cancer.

 Obesity. Excess body weight, particularly around the abdomen, is associated with an

increased risk of gastroesophageal cancer, possibly due to hormonal and metabolic

changes.

 Barrett's Esophagus. Barrett's esophagus, a condition where the normal esophageal

lining is replaced by a different type of tissue, is a precursor to esophageal

adenocarcinoma, increasing the risk of cancer development.

C. Signs and Symptom

Recognizing the signs and symptoms of gastroesophageal cancer is crucial for early

detection and timely intervention. These indicators often manifest as subtle yet progressively

worsening discomforts, affecting the digestive and overall well-being of an individual.

 Dysphagia (Difficulty Swallowing). Gastroesophageal cancer can narrow the esophagus,

leading to difficulty in swallowing solids and liquids (World Cancer Research Fund,

2018).

 Unintended Weight Loss. Advanced stages of gastroesophageal cancer may result in a

reduced appetite and unintentional weight loss (World Cancer Research Fund, 2018).

 Persistent Heartburn or Indigestion. Chronic and unrelenting heartburn or indigestion

may indicate the presence of gastroesophageal reflux disease (GERD) or

gastroesophageal cancer (World Cancer Research Fund, 2018).

 Chest Pain. Discomfort or pain in the chest, especially behind the breastbone, can be a

symptom of gastroesophageal cancer (American Cancer Society, 2021).

 Fatigue. Cancer-related fatigue can result from the body's response to the cancer itself or

the side effects of treatment (World Cancer Research Fund, 2018).

 Chronic Cough. A persistent cough, especially if it worsens over time, may be

associated with irritation of the respiratory tract due to gastroesophageal cancer (Fazio,

2017).

 Regurgitation. The return of stomach contents into the mouth, often accompanied by a

sour taste, can be a symptom of gastroesophageal reflux and, in some cases, cancer

(Yamada et al., 2020).

 Hoarseness or Voice Changes. Gastroesophageal cancer affecting the upper part of the

esophagus can lead to changes in voice quality or persistent hoarseness (Johnson et al.,

2019).

 Nausea and Vomiting. Gastroesophageal cancer may cause nausea and vomiting,

particularly if the tumor obstructs the normal passage of food (Katz, 2018).

 Anemia. Gastroesophageal cancer can lead to bleeding, resulting in anemia characterized

by weakness, paleness, and shortness of breath (Falk, 2018).

 Bloating or Fullness. Some individuals with gastroesophageal cancer may experience a

feeling of abdominal bloating or fullness, often associated with difficulty in eating

(Ginsberg, 2021).

 Change in Bowel Habits. Altered bowel habits, such as constipation or diarrhea, may

occur as a secondary effect of gastroesophageal cancer (Porter, 2017).

III. ANATOMY AND PHYSIOLOGY

National Institute of Health 2023

The digestive system is a complex network of organs that work together to break down

and absorb nutrients from the food we consume. It includes series of organs, including the

mouth, esophagus, stomach, small intestine, large intestine, and associated accessory organs like

the liver and pancreas.

Gastroesophageal cancer, affecting the esophagus and stomach, disrupts this system.

Esophageal cancer, for instance, can lead to narrowing of the esophagus, causing difficulty in

swallowing. Gastric cancer may impact the stomach's normal function, resulting in digestive

discomfort and potential nutritional deficiencies (Yamada et al., 2020). These disruptions

underline the critical need for early detection and intervention to preserve digestive system

functionality. This condition disrupts the following organs and their normal function to the

human body.

Situated in the upper abdomen, just below

the diaphragm, the stomach is positioned

between the esophagus and the small

intestine. Its anatomical location allows it

to receive food from the esophagus and

subsequently pass partially digested food

to the small intestine for further processing. Shaped like a flattened, J-shaped pouch, is lined with

specialized gastric mucosa that secretes digestive enzymes and gastric juices. Its primary

function involves both mechanical and chemical processes to break down ingested food

(Johnson, 2017). Through muscular contractions and gastric acid secretion, the stomach

transforms food into a semi-liquid substance known as chyme. It serves as a reservoir, regulating

the gradual release of processed food into the small intestine for further digestion and absorption.

Furthermore, it initiates the breakdown of proteins and activates digestive enzymes which is a

critical step in nutrient extraction (Richardson, 2016). The stomach is also responsible for the

following:

 Secretes gastric acid to create an acidic environment, aiding in the breakdown of proteins

and activation of digestive enzymes.

 Releases digestive juices containing enzymes like pepsin to further break down food

components.

 Produces mucus to protect its lining from the corrosive effects of gastric acid.

 Acts as a reservoir for food, regulating its controlled release into the small intestine for

optimal digestion.

 Begins the digestive process by breaking down food into chyme, a semi-liquid mixture.

 Facilitates the absorption of certain substances, such as alcohol and certain medications.

 Contains immune cells to defend against ingested pathogens.

 Produces hormones like ghrelin, influencing appetite and food intake.

The esophagus is a muscular tube connecting

the throat to the stomach, forming a vital part

of the digestive system. It spans

approximately 25 centimeters and facilitates

the passage of food and liquids from the

mouth to the stomach through coordinated

muscular contractions. Situated in the thoracic

cavity, the esophagus runs behind the trachea

and heart, connecting the pharynx to the stomach. Its anatomical location allows for the seamless

transfer of food from the mouth to the stomach (Yamada 2020). Its main functions include the

following:

 Facilitates the movement of ingested materials, including food and liquids, from the

mouth to the stomach.

 Utilizes rhythmic muscular contractions (peristalsis) to propel contents forward along its

length.

 Unlike other digestive organs, the esophagus does not participate directly in digestion or

nutrient absorption.

 Plays a crucial role in preventing the backward flow of stomach contents into the throat,

maintaining the integrity of the digestive process.

 Ensures a one-way flow of ingested materials, contributing to the overall efficiency and

health of the digestive system.

 Produces mucus to lubricate and protect the esophageal lining from abrasive food

particles.

 Synchronizes with the swallowing reflex to initiate the movement of food into the

stomach.

 The esophageal wall can stretch to accommodate varying food volumes during

swallowing.

 Maintains a relatively neutral pH environment, in contrast to the acidic stomach,

providing a transitional zone for ingested materials.

 Initiates reflexes, such as the lower esophageal sphincter relaxation, essential for the

passage of food into the stomach.

In summary, the stomach and esophagus are essential components of the digestive system,

with the esophagus facilitating food transport and the stomach playing a key role in digestion.

Gastroesophageal cancer can severely impact these functions, leading to difficulties in

swallowing, disruptions in digestive processes, and discomfort. Recognizing the anatomy and

physiology of these organs is crucial for early detection and effective management of
gastroesophageal cancer, emphasizing the significance of maintaining their normal functionality

for overall digestive health.

IV. MEDICAL MANAGEMENT

a. Diagnostic and Laboratory Procedures

DIAGNOSTIC/
GENERAL INDICATION OR NORMAL ANALYSIS AND
LABORATORY NURSING RESPONSIBILITIES
DESCRIPTION PURPOSE VALUES INTERPRETATION
PROCEDURES
Upper Also known as It is commonly Normal findings Abnormal findings Before the Procedure:
Gastrointestinal esophagogastroduodenoscop indicated for the during upper may include lesions,  Confirm patient identification
Endoscopy y (EGD), is a medical evaluation of endoscopy include a inflammation, ulcers, and consent.
procedure where a flexible gastroesophageal healthy esophagus, or tumors, which  Ensure the patient has been
endoscope is used to examine cancer. It helps in stomach, and require further appropriately prepared, such
the upper part of the the detection, duodenum with no investigation and may as fasting for a specified
gastrointestinal tract, biopsy, and staging signs of lead to the period.
including the esophagus, of tumors in the inflammation, identification of  Assess and document the
stomach, and the first part of esophagus and ulcers, or abnormal conditions such as patient's medical history,
the small intestine stomach, providing growths. The gastroesophageal allergies, and current
(duodenum). This procedure crucial information gastroesophageal reflux disease medications.
is performed for diagnostic for diagnosis and junction should be (GERD), Barrett's  Start an intravenous (IV) line
and therapeutic purposes, treatment planning. well-defined, and esophagus, or cancer. as needed.
allowing direct visualization the mucosa should Biopsies may be  Provide education to the
of the upper digestive system appear normal taken during the patient about the procedure,
to identify and treat various without any procedure for including expectations and
conditions (ASGE, 2020). structural histological potential risks.
abnormalities. examination.
During the Procedure:
 Assist with positioning the
patient for the procedure.
 Monitor vital signs throughout
the procedure.
 Collaborate with the
endoscopy team to ensure a
 smooth process.
 Provide emotional support and
reassurance to the patient.
 Document any adverse events
or complications during the
procedure.

After the Procedure:

 Monitor the patient in the
recovery area until fully
awake.
 Assess vital signs, including
oxygen saturation.
 Monitor for signs of
complications such as
bleeding or perforation.
 Provide post-procedure
instructions to the patient,
including any dietary
restrictions.
 Document and report any
unusual findings or
complications (ASGE, 2020;
Black, Hawks, & Keene,
2020).
Biopsy A biopsy is a medical Biopsy is crucial for In the context of In the case of Before the Procedure:
procedure involving the the diagnosis of biopsy, normal gastroesophageal  Educate the patient about the
removal of a small sample of gastroesophageal values refer to the cancer, the biopsy procedure, including its
tissue or cells from a living cancer. It is absence of pathologist looks for purpose, potential risks, and
organism for microscopic performed to obtain cancerous or abnormal cell benefits.
examination. This diagnostic tissue samples from abnormal cells in morphology, signs of  Confirm patient identification
procedure is commonly used suspicious areas in the examined tissue. dysplasia, and the and consent.
to investigate the nature of the esophagus or The presence of presence of cancer  Ensure that the patient has
abnormalities, lesions, or stomach, allowing normal, healthy cells. The findings been adequately prepared,
suspected diseases within the for histological cells indicates the contribute to the which may include fasting or
body (American Cancer examination to absence of definitive diagnosis other specific instructions.
Society, 2022). confirm the malignancy or and help guide  Provide emotional support and
presence of significant treatment decisions. address any concerns the
cancerous cells, pathology. patient may have.
determine the type
of cancer, and assess During the Procedure:
the degree of  Assist in preparing the patient
malignancy. for the biopsy, which may
involve positioning and
sterilizing the biopsy site.
 Collaborate with the
healthcare team to monitor the
patient's vital signs.
 Offer reassurance and comfort
to alleviate anxiety.
 Ensure that the biopsy
specimens are properly
labeled and sent to the
laboratory for analysis.
After the Procedure:
 Monitor the patient for any
immediate post-procedural
complications.
 Provide post-procedure care
instructions, including
information on potential side
effects or signs of infection.
 Document and report any
unexpected findings or
complications.
 Follow up with the patient to
 address questions or concerns
post-biopsy
Endoscopic It is a medical imaging EUS is commonly Normal findings Abnormal findings Before the Procedure:
Ultrasound technique that combines used in the diagnosis during EUS include may include  Confirm patient identification
endoscopy and ultrasound to and staging of a well-defined and thickening of the GI and consent.
visualize and evaluate the gastroesophageal uniform wall wall, the presence of  Educate the patient about the
gastrointestinal (GI) tract and cancer. It allows for structure of the nodules or masses, EUS procedure, including its
adjacent structures. During detailed imaging of esophagus and and changes in purpose, potential risks, and
EUS, a thin, flexible tube the esophageal and stomach, with no adjacent lymph benefits.
with an ultrasound probe at gastric walls, nearby evidence of nodes. These findings  Ensure that the patient has
its tip is inserted through the lymph nodes, and abnormal masses, contribute to the followed any necessary
mouth or anus to obtain surrounding nodules, or lesions. diagnosis, staging, preparation instructions,
detailed images of the structures, aiding in Lymph nodes and treatment which may include fasting.
digestive organs and the assessment of should appear planning for During the Procedure:
surrounding tissues (Wani et tumor size, invasion normal in size and gastroesophageal  Assist in positioning the
al., 2016). depth, and potential shape, indicating the cancer. patient for the procedure.
spread to adjacent absence of  Monitor vital signs throughout
tissues. metastasis. the procedure.
 Collaborate with the
endoscopy team to ensure a
smooth process.
 Provide emotional support and
reassurance to the patient.
After the Procedure:
 Monitor the patient in the
recovery area until fully
awake.
 Assess vital signs and check
for any signs of complications,
such as bleeding or
perforation.
 Provide post-procedure
instructions to the patient,
 including any dietary
restrictions.
 Document and report any
unusual findings or
complications.
CT Scan This is a medical imaging CT scans are A normal CT scan In the case of Before the Procedure:
(Computed technique that uses X-ray commonly used in finding shows a gastroesophageal  Confirm patient identification
Tomography) technology and computer the evaluation of well-defined cancer, findings may and ensure the patient is aware
processing to create detailed gastroesophageal abdomen and pelvis, include thickening of of the procedure and its
cross-sectional images of the cancer. They help in and symmetrical the esophageal or purpose.
body. The CT scanner rotates identifying the structures, with no gastric walls, the  Assess and document the
around the patient, capturing presence, location, evidence of presence of masses or patient's medical history,
multiple images from and extent of abnormal masses, nodules, and signs of allergies, and current
different angles to produce tumors, as well as lesions, or lymph lymph node medications.
comprehensive, three- detecting potential node enlargement. involvement or  Provide education to the
dimensional images (Mayo metastasis to nearby The esophagus, distant metastasis. patient about the CT scan,
Clinic, 2022). lymph nodes or stomach, and including any necessary
distant organs. CT surrounding organs preparation such as fasting or
scans play a crucial should appear contrast administration.
role in staging the normal in size and  Ensure that the patient is
disease and guiding shape. informed about the importance
treatment decisions of remaining still during the
(NCCN, 2022. scan.

During the Procedure:

 Ensure the patient is
appropriately positioned on
the CT table.
 Collaborate with radiology
technologists to help with
patient comfort and
positioning.
 Monitor the patient's vital
 signs as needed.
 If contrast is used, assess for
allergies and provide
appropriate premedication if
ordered.
After the Procedure:
 Monitor the patient for any
immediate post-procedural
complications.
 Provide post-procedure care
instructions, including
information on potential side
effects of contrast and any
specific post-scan restrictions.
 Document and report any
unexpected findings or
complications.
MRI (Magnetic This non-invasive medical MRI is employed in Gastrointestinal Abnormal findings Before the Procedure:
Resonance imaging technique uses the evaluation of MRI will show may include  Confirm patient identification
Imaging) strong magnetic fields and gastroesophageal well-defined and thickening of the and ensure the patient
radio waves to generate cancer to assess the symmetrical esophageal or gastric understands the purpose and
detailed images of the extent of the structures, with no walls, the presence of process of the MRI.
internal structures of the disease, particularly evidence of masses or nodules,  Assess and document the
body. It provides high- in determining the abnormal masses, and signs of invasion patient's medical history,
resolution images of soft local invasion of lesions, or signs of into nearby tissues. allergies, and current
tissues, making it particularly tumors into local invasion into medications.
useful for visualizing organs surrounding tissues, adjacent tissues. The  Screen for contraindications,
and structures that may not such as the esophagus, stomach, such as the presence of
be as clearly seen with other esophageal wall and surrounding metallic implants, which may
imaging modalities. (Dillman, Gadani, & structures should interfere with the MRI.
Dillman, 2022). appear normal in  Provide emotional support and
size and shape. educate the patient about the
need to remain still during the
 procedure.
During the Procedure:
 Ensure the patient is
comfortably positioned on the
MRI table.
 Collaborate with radiology
technologists to address any
patient concerns.
 Monitor the patient's vital
signs as needed.
 If contrast is used, assess for
allergies, and provide
appropriate premedication if
ordered.

After the Procedure:

 Monitor the patient for any
immediate post-procedural
complications.
 Provide post-procedure care
instructions, including
information on any restrictions
or activities to avoid.
 Document and report any
unexpected findings or
complication
PET-CT It is a medical imaging PET-CT is often Normal PET-CT Areas of increased Before the Procedure:
(Positron technique that combines used in the findings in the metabolic activity on  Confirm patient identification
Emission positron emission diagnosis, staging, context of the PET scan, and ensure the patient
Tomography - tomography (PET) with and monitoring of gastroesophageal indicating potential understands the purpose and
Computed computed tomography (CT) treatment response imaging include cancerous lesions, are process of PET-CT.
Tomography) to provide both functional in gastroesophageal areas of the body correlated with the  Assess and document the
and anatomical information cancer. It helps with typical detailed anatomical patient's medical history,
in a single examination. A identify areas of metabolic activity. information provided allergies, and current
radioactive tracer is injected increased metabolic No abnormal by the CT scan. medications.
into the patient, and the PET activity, such as hypermetabolic foci  Provide education about the
scan detects the emitted cancerous lesions, or areas of increased procedure, including the need
positrons, while the CT scan and provides uptake should be for fasting and potential side
provides detailed anatomical information about observed in the effects.
images. The combination of their location and esophagus, stomach, During the Procedure:
these modalities allows for extent. or surrounding  Monitor the patient during the
better localization and structures. injection of the radioactive
characterization of tracer.
abnormalities.  Ensure the patient is
comfortably positioned for the
PET-CT scan.
 Collaborate with the imaging
team to address any patient
concerns.
 Provide emotional support, as
PET-CT can be an anxiety-
inducing procedure.
After the Procedure:
 Monitor the patient for any
immediate post-procedural
complications.
 Provide post-procedure care
instructions, including
information on hydration and
any restrictions.
 Document and report any
unexpected findings or
complications.
Blood Tests Blood tests involve the Blood tests are used CEA Elevated levels may Before the Procedure:
analysis of blood samples to in the context of (Carcinoembryonic indicate the presence  Confirm patient identification
assess various aspects of gastroesophageal Antigen): Typically of cancer or other and ensure proper informed
health, including the presence cancer to identify less than 5.0 medical conditions. consent.
of certain substances, cellular specific markers nanograms per Abnormalities in  Educate the patient about the
components, and indicators associated with the milliliter (ng/mL). tumor marker levels purpose of the blood tests,
of organ function. These tests disease. Common may suggest the including the specific markers
are crucial for diagnosing and blood tests for CA 19-9 presence of being assessed.
monitoring a wide range of gastroesophageal (Carbohydrate gastroesophageal  Collect a thorough medical
medical conditions (Lab Tests cancer include Antigen 19-9): cancer, but these history, including any
Online, 2022). checking levels of Generally, less than results are not medications or supplements
tumor markers, such 37 units per definitive, and that might affect the results.
as carcinoembryonic milliliter (U/mL). additional imaging or  Ensure proper labeling of
antigen (CEA) and biopsy may be blood samples to prevent
carbohydrate required for errors.
antigen 19-9 (CA confirmation and
19-9), which may be further During the Procedure:
elevated in the characterization of the  Blood tests are relatively
presence of certain disease. quick, and nursing
cancers, including involvement during the
those affecting the procedure is minimal.
esophagus and  Ensure a comfortable and
stomach (Cancer stress-free environment for the
Research UK, patient.
2022).
 Assist with the collection of
blood samples, ensuring
adherence to sterile
procedures.

After the Procedure:

 Monitor the patient for any
immediate post-procedural
complications, such as fainting
or dizziness.
  Provide post-procedure care
instructions, including
information on potential side
effects like bruising at the
needle site.
 Ensure timely and accurate
transmission of blood samples
to the laboratory for analysis.
 Communicate any relevant
findings or abnormalities to
the healthcare team for further
evaluation.
Esophageal Esophageal manometry is a It is not primarily Normal findings in Abnormal findings Before the Procedure:
Manometry diagnostic procedure used to used to detect or esophageal may include  Explain the procedure to the
measure the strength and diagnose manometry include abnormalities in patient, addressing any
coordination of muscle gastroesophageal coordinated and esophageal concerns or questions.
contractions in the cancer. However, it rhythmic muscle contractions, impaired  Confirm patient identification
esophagus. It involves the can be part of the contractions along lower esophageal and obtain informed consent.
insertion of a thin, flexible diagnostic workup the esophagus, with sphincter function, or  Ensure the patient has
tube with pressure sensors for conditions such appropriate signs of motility followed any fasting or
into the esophagus to assess as gastroesophageal relaxation of the disorders. These medication instructions.
the function of the lower reflux disease lower esophageal findings help in  Educate the patient on the
esophageal sphincter and the (GERD) or motility sphincter during diagnosing conditions sensations they may
muscles of the esophageal disorders that may swallowing. These such as achalasia, experience during the
wall (Pandolfino & Kahrilas, contribute to normal values esophageal spasm, or procedure.
2005). symptoms indicate proper ineffective esophageal During the Procedure:
associated with esophageal motility motility.  Assist in positioning the
esophageal cancer. It and function. patient comfortably.
helps in assessing  Collaborate with the
the functionality of healthcare team to insert the
the esophagus and manometry catheter through
its sphincters the nose and into the
(Kahrilas & esophagus.
 Pandolfino, 2008).  Monitor the patient for any
signs of discomfort or
complications during the
procedure.
 Provide emotional support and
reassurance to alleviate
anxiety.
After the Procedure:
 Monitor the patient as they
recover from any sedation or
discomfort.
 Provide post-procedure care
instructions, including any
restrictions on eating or
drinking for a specified
period.
 Document and report any
unexpected findings or
complications.
pH Monitoring It is a diagnostic procedure pH monitoring is not The esophagus is Elevated or prolonged Before the Procedure:
used to measure the acidity primarily used to typically less acidic, acidic pH levels may  Explain the procedure to the
level in the esophagus over a detect or diagnose ranging from indicate abnormal patient, addressing any
specific period. It involves gastroesophageal approximately 4.0 acid reflux, which can concerns or questions.
the placement of a small, cancer. However, it to 7.0. contribute to  Confirm patient identification
flexible tube with a pH is often employed in conditions like and obtain informed consent.
sensor through the nose or the evaluation of GERD.  Ensure the patient has
mouth into the esophagus. GERD, a condition followed any fasting or
This device records the pH that can contribute medication instructions.
levels, helping to assess acid to the development  Educate the patient on the
exposure and evaluate of esophageal cancer sensations they may
gastroesophageal reflux over time. experience during the
disease (GERD) or other Monitoring pH procedure.
esophageal conditions. levels helps assess During the Procedure:
 the extent of acid  Assist in positioning the
reflux and its patient comfortably.
potential impact on  Collaborate with the
the esophagus. healthcare team to insert the
pH monitoring device through
the nose or mouth.
 Instruct the patient on how to
keep a diary of symptoms and
activities during the
monitoring period.
 Monitor the patient for any
signs of discomfort or
complications during the
procedure.
After the Procedure:
 Instruct the patient on
removing the pH monitoring
device at home.
 Review and collect the
symptom diary for correlation
with pH data.
 Provide post-procedure care
instructions, including any
restrictions on eating or
drinking for a specified
period.
 Document and report any
unexpected findings or
complications.
Barium Swallow Also known as an upper A barium swallow Normal findings in a Abnormal findings Before the Procedure:
gastrointestinal (GI) series, is may be indicated to barium swallow may include  Explain the procedure to the
a radiographic imaging evaluate the include a smooth irregularities in the patient, addressing any
procedure used to examine presence of and uniform shape of the concerns or questions.
the esophagus, stomach, and gastroesophageal appearance of the esophagus or  Confirm patient identification
small intestine. During the cancer. It helps in esophagus, stomach, stomach, areas of and ensure informed consent
procedure, the patient ingests identifying and small intestine. narrowing, or is obtained.
a contrast medium containing structural There should be no evidence of  Ensure the patient follows any
barium, which outlines the abnormalities, such evidence of obstruction. These fasting instructions before the
digestive tract on X-ray as tumors or strictures, masses, findings contribute to procedure.
images, allowing for the strictures, and or abnormal the diagnosis of  Assess for allergies,
visualization of structures provides valuable narrowing. The conditions such as particularly to contrast media.
and the detection of information for contrast medium gastroesophageal During the Procedure:
abnormalities. diagnosis and should pass through reflux disease  Assist in positioning the
staging. the digestive tract in (GERD) or the patient for the X-ray
Additionally, it can a coordinated and presence of tumors. examination.
be used to assess the timely manner.  Collaborate with radiology
extent of reflux and technologists to ensure patient
its impact on the comfort and cooperation.
esophagus.  Monitor the patient for any
signs of distress during the
procedure.
 Educate the patient on the
importance of following
instructions during the test.
After the Procedure:
 Monitor the patient for any
immediate post-procedural
complications.
 Provide post-procedure care
instructions, including
information on resuming
normal activities and any
potential side effects related to
the contrast medium.
 Document and report any
unexpected findings or
complications.
 b. IVF, O2 Therapy, Nebulization, NGT

TYPE OF
GENERAL INDICATION OR
MEDICAL NURSING RESPONSIBILITIES
DESCRIPTION PURPOSE
MANAGEMENT
Normal Saline It is a sterile solution of salt Normal saline is not a direct Before the Procedure:
(0.9% NaCl) in water that closely treatment for gastroesophageal  Assess the patient's medical history, including any known
resembles the electrolyte cancer. However, it is often allergies or sensitivities to medications or solutions.
balance of the body. It is used in supportive care for  Verify the healthcare provider's prescription and the correct
commonly used in cancer patients, including those concentration of the normal saline solution.
healthcare for various with gastroesophageal cancer.  Explain the purpose of the normal saline infusion to the patient,
purposes, including Intravenous administration of addressing any concerns or questions.
intravenous (IV) hydration, normal saline may be indicated  Ensure that the IV access site is appropriate and patent.
dilution of medications, and for hydration, especially if the
as a vehicle for certain patient is experiencing During the Procedure:
medical procedures (World dehydration due to cancer-  Prepare the IV infusion set and normal saline solution according
Health Organization, 2013). related symptoms, treatments, to institutional protocols.
or surgery. Adequate hydration  Monitor the patient's vital signs and assess for any signs of
is essential for maintaining adverse reactions, such as swelling or redness at the IV site.
overall health and supporting  Administer the normal saline at the prescribed rate and observe
the body's response to cancer for any signs of fluid overload or complications.
therapies (National  Ensure that the infusion is running smoothly and troubleshoot any
Comprehensive Cancer issues as needed.
Network, 2022).
After the Procedure:
 Monitor the patient for ongoing hydration status and assess for
any signs of improvement or complications.
 Document the administration of normal saline, including the
amount infused and the patient's response.
 Provide post-procedure care instructions, including any
recommendations for oral hydration and follow-up.
Lactated Ringer's It is a sterile intravenous Cancer patients, especially Before the Procedure:
Solution fluid composed of those undergoing treatments  Assess the patient's medical history, including any known
 electrolytes, including like chemotherapy, may allergies or sensitivities to medications or solutions.
sodium chloride, potassium experience dehydration due to  Verify the healthcare provider's prescription and the correct
chloride, calcium chloride, various factors, and concentration of the Lactated Ringer's solution.
and sodium lactate. It is intravenous fluids such as  Explain the purpose of the intravenous hydration to the patient,
designed to closely Lactated Ringer's can help addressing any concerns or questions.
resemble the electrolyte maintain fluid and electrolyte  Ensure that the IV access site is appropriate and patent.
composition of human balance.
plasma and is commonly During the Procedure:
used for fluid resuscitation,  Prepare the IV infusion set and Lactated Ringer's solution
intravascular volume according to institutional protocols.
expansion, and electrolyte  Monitor the patient's vital signs and assess for any signs of
replacement (Baxter adverse reactions, such as swelling or redness at the IV site.
Healthcare Corporation,  Administer the Lactated Ringer's solution at the prescribed rate
2019). and observe for any signs of fluid overload or complications.
 Ensure that the infusion is running smoothly and troubleshoot any
issues as needed.

After the Procedure:

 Monitor the patient for ongoing hydration status and assess for
any signs of improvement or complications.
 Document the administration of Lactated Ringer's solution,
including the amount infused and the patient's response.
 Provide post-procedure care instructions, including any
recommendations for oral hydration and follow-up.

Total Parenteral Total Parenteral Nutrition TPN may be indicated for Before the Procedure:
Nutrition (TPN) (TPN) is a method of patients with gastroesophageal  Assess the patient's nutritional status, including weight, laboratory
providing complete cancer who are unable to values, and any pre-existing nutritional deficiencies.
nutritional support tolerate oral or enteral nutrition  Verify the healthcare provider's prescription for TPN, ensuring it
intravenously. It involves due to complications such as meets the patient's specific nutritional needs.
delivering a balanced obstruction, dysphagia, or post-  Confirm the patient's vascular access for TPN administration,
mixture of nutrients, surgical recovery. In situations such as a central venous catheter.
including carbohydrates, where the gastrointestinal tract  Educate the patient and their family about the purpose of TPN,
 proteins, fats, vitamins, and is compromised or non- potential complications, and the importance of close monitoring.
minerals, directly into the functional, TPN provides a
bloodstream. TPN is used way to maintain adequate During the Procedure:
when patients are unable to nutrition and prevent  Collaborate with the healthcare team to prepare and administer the
meet their nutritional needs malnutrition in cancer patients TPN solution according to the prescribed regimen.
through oral or enteral undergoing treatment.  Monitor the patient's vital signs, fluid balance, and laboratory
routes, often due to values regularly.
conditions affecting the  Ensure the correct placement and functioning of the central
gastrointestinal tract venous catheter used for TPN infusion.
(ASPEN, 2021).  Educate the patient on signs of complications, such as infection or
catheter-related issues.

After the Procedure:

 Continuously assess the patient's response to TPN, including
nutritional status, weight changes, and any signs of complications.
 Monitor for potential TPN-related complications, such as
hyperglycemia or electrolyte imbalances.
 Collaborate with the healthcare team to adjust the TPN
prescription based on the patient's evolving clinical needs.
 Provide ongoing education and support to the patient and their
caregivers regarding TPN management at home if applicable.
Packed Red Blood Packed Red Blood Cells PRBC transfusions may be Before the Procedure:
Cells (PRBCs) (PRBCs) are a blood indicated for individuals with  Assess the patient's vital signs, hemoglobin levels, and overall
product that has undergone gastroesophageal cancer who clinical status to determine the need for a PRBC transfusion.
processing to remove most experience anemia due to  Verify the healthcare provider's prescription for the transfusion,
of the plasma, leaving factors such as gastrointestinal confirming the correct blood product, volume, and any special
concentrated red blood cells. bleeding, cancer-related instructions.
This product is used for treatments, or chronic disease.  Confirm the patient's blood type and crossmatch the blood product
blood transfusions to Anemia can result in fatigue to ensure compatibility.
replace red blood cells in and reduced oxygen-carrying  Educate the patient about the purpose of the transfusion, potential
individuals with anemia, capacity, and PRBC risks, and benefits.
significant blood loss, or transfusions aim to restore
impaired oxygen-carrying hemoglobin levels and improve During the Procedure:
 capacity (American Red overall oxygen delivery to  Verify the patient's identity using two patient identifiers and
Cross, 2021). tissues ensure proper labeling of the blood product.
 Establish intravenous access using a dedicated line for blood
transfusion.
 Administer the PRBC transfusion according to institutional
protocols, monitoring vital signs and the patient's overall
response.
 Observe for signs of transfusion reactions, such as fever, chills, or
allergic reactions, and intervene promptly if needed.
 Document the transfusion details, including the start and end
times, volume administered, and any adverse reactions.

After the Procedure:

 Monitor the patient for continued signs of improvement in
hemoglobin levels and overall clinical status.
 Assess for any delayed transfusion reactions or complications.
 Provide post-transfusion care instructions, including information
on potential symptoms to report.
 Document the patient's response to the transfusion and report any
adverse events to the healthcare team.
Oxygen Therapy Oxygen therapy is a medical Oxygen therapy may be Before the Procedure:
intervention that involves indicated for individuals with  Evaluate respiratory status, vital signs, and medical history.
the administration of gastroesophageal cancer in the  Identify factors influencing oxygen needs.
supplemental oxygen to following situations:  Inform patients and caregivers about the purpose and benefits of
individuals who may have oxygen therapy.
low blood oxygen levels. Respiratory Distress:  Explain the use of delivery devices and potential side effects.
This can be delivered Gastroesophageal cancer,  Ensure availability and functionality of oxygen equipment.
through various devices especially in advanced stages,  Verify prescription details and settings.
such as nasal cannulas, face can lead to respiratory
masks, or ventilators, with complications, including During the Procedure:
the goal of improving difficulty breathing or low  Administer oxygen per the prescribed flow rate and delivery
oxygenation and alleviating oxygen saturation levels. method.
symptoms related to Oxygen therapy is used to  Monitor for signs of respiratory distress or adverse reactions.
 inadequate oxygen supply improve oxygen levels and  Continuously assess vital signs, oxygen saturation levels, and
(British Thoracic Society, relieve symptoms of respiratory effort.
2017). respiratory distress.  Adjust oxygen flow as necessary to maintain target saturation.
 Ensure patient comfort during therapy.
Postoperative Recovery:  Address concerns promptly to enhance compliance.
After surgical procedures for
gastroesophageal cancer, some After the Procedure:
patients may require oxygen  Continue monitoring respiratory status and response.
therapy during the recovery  Document therapy details and any changes in the patient's
period to support respiratory condition.
function and aid in the healing  Provide ongoing education on oxygen therapy importance and
process (National safety.
Comprehensive Cancer  Reinforce recognition of signs indicating the need for medical
Network, 2022). attention.
 Communicate changes or concerns to the healthcare team
promptly.
 Collaborate with other healthcare professionals as needed.
Nasogastric Tube A Nasogastric Tube (NGT) Dysphagia: Used when Before the Procedure:
(NGT) is a flexible tube inserted patients with gastroesophageal  Assess the patient's swallowing ability, nutritional status, and
through the nose and passed cancer experience difficulty overall health.
down the esophagus into the swallowing, providing enteral  Confirm the need for NGT placement based on clinical
stomach. It is commonly nutrition when oral intake is indications.
used for various medical insufficient.  Educate the patient and family about the purpose of the NGT, the
purposes, including feeding, procedure, and potential discomfort.
decompression, and Pre/Postoperative  Obtain informed consent.
medication administration. Management: Employed  Ensure the availability of the appropriate NGT size and necessary
NGTs are available in before surgery for stomach equipment.
different sizes and materials decompression or
(Metheny, 2019). postoperatively to rest the During the Procedure:
gastrointestinal tract.  Position the patient comfortably, usually in a high Fowler's
position.
Aspiration Risk: Utilized in  Collaborate with the healthcare team to insert the NGT through
cases of aspiration risk due to the nose into the stomach.
 impaired swallowing to  Confirm the placement of the NGT by assessing pH and aspirating
prevent the aspiration of gastric gastric contents.
contents into the lungs.  Verify placement using an X-ray if needed.
 Secure the NGT in place to prevent accidental displacement.
 Ensure the tube is free from kinks or obstruction.
After the Procedure:
 Monitor the patient for signs of discomfort, respiratory distress, or
complications.
 Assess and document NGT placement and patency regularly.
 Provide oral and nasal care to prevent irritation and infection.
 Administer medications or enteral nutrition as prescribed through
the NGT.
 Instruct the patient and caregivers on NGT care, signs of
complications, and nutrition administration.
 Address any concerns or questions related to the NGT.
Nebulization Nebulization is a method of Nebulization may be Before the Procedure:
delivering medication in the considered for individuals with  Assess the patient's respiratory status, including the presence of
form of a fine mist or gastroesophageal cancer in the symptoms and baseline lung function.
aerosol, which can be following contexts:  Confirm the prescribed nebulized medication and dosage.
inhaled into the lungs. This  Educate the patient on the purpose of nebulization, the correct use
is achieved using a Respiratory Symptoms: of the nebulizer device, and potential side effects.
nebulizer device that Nebulized medications may be  Ensure the patient understands the importance of adhering to the
converts liquid medication used to manage respiratory prescribed treatment plan.
into a breathable mist symptoms, such as shortness of
(Kerem et al., 2012). breath or coughing, which can During the Procedure:
occur due to cancer-related  Set up the nebulizer equipment according to the manufacturer's
complications or treatments. instructions.
 Measure and prepare the prescribed medication for nebulization.
Palliative Care: Nebulization
 Instruct the patient to inhale the mist through the mouthpiece or
might be employed in
mask.
palliative care to enhance
 Monitor the patient during the procedure for any signs of
comfort and relieve respiratory
respiratory distress or adverse reactions.
distress in advanced stages of
cancer.  Ensure a comfortable and quiet environment to facilitate optimal
inhalation.

After the Procedure:

 Assess the patient for immediate post-nebulization effects and
respiratory response.
 Document the medication administered, dosage, and any observed
changes in symptoms.
 Evaluate the effectiveness of nebulization in alleviating
respiratory symptoms.
 Adjust the treatment plan as needed based on the patient's
response.
 c. Medications

GENERIC
ROUTE, DOSAGE, SIDE EFFECTS AND
NAME & DRUG INDICATION OR
AND FREQUENCY ADVERSE NURSING RESPONSIBILITIES
BRAND CLASSIFICATION PURPOSE
ADMINISTRATION REACTIONS
NAME
Generic Name: Antimetabolite, Indication: Indicated for gastric Side Effects:  Provide patient education on
Fluorouracil Antineoplastic Fluorouracil is indicated adenocarcinoma:  Nause dietary modifications,
chemotherapy agent for the treatment of various  Vomiting including small, frequent
Brand Name: cancers, including 200-1000 mg/m²/day  Diarrhea meals and bland foods.
Adrucil colorectal cancer, breast as a continuous IV  Rash  Monitor daily pattern of
cancer, and certain types of infusion over 24 hr  Chest pain bowel activity, stool
skin cancer (basal cell (as part of a platinum-  Shortness of consistency.
carcinoma and squamous containing regimen) breath  Assess skin for rash.
cell carcinoma). It is used Duration and  Monitor cardiac function.
as part of combination frequency of each Adverse Reactions:  Assess for signs and
chemotherapy regimens in cycle varies based on symptoms of cardiotoxicity,
 Myelosuppression
these cancers dose and regimen. such as chest pain or
 Stomatitis
(Micromedex, 2022). It is shortness of breath.
also used for some cases of  Hand-foot
Syndrome  Monitor complete blood
advanced or metastatic counts (CBC) regularly.
gastroesophageal cancer as
 Assess and manage
part of combination
dermatologic reactions, such
chemotherapy regimens.
as redness, swelling, and
pain in the palms of the
Mechanism of Action:
hands and soles of the feet.
Inhibits the synthesis of
DNA and RNA within
cancer cells. It interferes
with the replication and
repair of DNA, preventing
the growth and division of
cancer cells.
Generic Name: Antineoplastic Indication: Testicular Cancer: Side Effects:  Monitor the patient for signs
Cisplatin chemotherapy agent, For the treatment of 20 mg/m2 by slow IV  Nausea of allergic reactions, such as
Alkylating agent various cancers, including infusion daily for 5  Vomiting rash, itching, or difficulty
Brand Name: testicular, ovarian, bladder, days per cycle in  Hypokalemia breathing, and provide
Platinol and lung cancers, among combination with  Hypomagnesemia emergency care if necessary.
others. It is used in other approved  Bone marrow  Monitor for hypersensitivity
combination with other chemotherapeutic suppression reactions, such as fever,
chemotherapy agents for agents.  Nephrotoxicity chills, or hypotension, and
these indications. provide appropriate
 Ototoxicity
Ovarian Cancer: interventions.
Mechanism of Action: 75 to 100 mg/m2 by  Regularly monitor electrolyte
Adverse Reactions:
Exerts its anticancer slow IV infusion once levels.
 Allergic
effects by binding to DNA every 3 to 4 weeks on  Encourage small, frequent
Reactions
and causing DNA cross- Day 1 meals.
linking. This disrupts DNA  Hypersensitivity
Reactions  Monitor and assess patient’s
replication and Bladder Cancer: hearing.
transcription, leading to 50 to 70 mg/m2 by  Monitor renal function.
cell death and inhibiting slow IV infusion once
 Encourage increased fluid
the growth of cancer cells. every 3 to 4 weeks;
intake.
for heavily pretreated
 Monitor CBC to detect
patients, an initial
myelosuppression.
dose of 50 mg/m2 by
slow IV infusion once
every 4 weeks is
recommended
Generic Name: Antineoplastic Indication: For the Oxaliplatin 85 mg/m² Side Effects:  Monitor body temperature.
Oxaliplatin chemotherapy agent treatment of colorectal IV + leucovorin 200  Diarrhea  Encourage adequate rest.
cancer, both in adjuvant mg/m² IV infused  Fatigue  Inform patient to avoid fatty,
Brand Name: and metastatic settings. It over 2 hr.  Nausea spicy, or acidic foods.
Eloxatin is often used in  Vomiting  Encourage small, frequent
combination with other  Fever meals.
chemotherapy agents, such  Decreased  Advise patient to avoid cold
as fluorouracil and Appetite exposure and drink room
leucovorin, for these temperature fluids.
 Peripheral
indications.  Monitor the patient for signs
Neuropathy
of severe anaphylactic
Mechanism of Action: reactions, such as difficulty
Adverse Reactions:
Exerts its anticancer breathing or a drop in blood
 Anaphylactic
effects by forming pressure and provide
Reaction
platinum-DNA adducts. emergency care if necessary.
These adducts interfere  Renal
Dysfunction  Monitor renal function.
with DNA replication and
transcription, leading to
cell death and inhibiting
the growth of cancer cells
Generic Name: Antineoplastic Indication: Indicated in Side Effects:  Advise patient to avoid
Docetaxel chemotherapy agent For treatment of various combination with  Fatigue activities that requires
cancers, including breast cisplatin and  Diarrhea alertness.
Brand Name: cancer, non-small cell lung fluorouracil advanced  Nause  Encourage small, frequent
Taxotere cancer, prostate cancer, gastric  Vomiting meals.
and certain types of gastric adenocarcinoma,  Hair loss  Monitor body temperature.
and head and neck cancers. including  Neutropenia  Assess skin for rash.
It may be used as a single adenocarcinoma of  Monitor daily pattern of
 Dizziness
agent or in combination the gastroesophageal bowel activity, stool
 Fever
with other chemotherapy junction, in patients consistency.
medications. who have not received  Rash
 Itching  Watch out for any signs of
prior chemotherapy infection.
for advanced disease.  Fainting
 Monitor hypersensitivity
 Mechanism of Action: Adverse Reactions: reactions, such as fever,
Exerts its anticancer Day 1: 75 mg/m IV2
 Hypersensitivity chills, or hypotension.
effects by promoting infusion over 1 hour, Reactions  Monitor for heart rhythm,
microtubule stabilization followed by cisplatin  Cardiotoxicity pattern, and quality.
and inhibiting their 75 mg/m2 as a 1-3 hr  Pulmonary  Report signs of pulmonary
depolymerization during infusion. toxicicity toxicity such as cough,
cell division. This leads to shortness of breath.
cell cycle arrest and
ultimately cell death
Generic Name: Antimicrotubular Indication: Dose: 80 mg/m2 Side effects:  Monitor CBC regularly.
Paclitaxel agent Paclitaxel is used in the  Hypertension Advise the patient to report
treatment of Route: IV infusion  Chest pain any signs of infection
Brand Name: gastroesophageal cancer,  Bradycardia promptly.
Taxol often in combination with Frequency: Days 1,8  Fever  Monitor the following vital
other chemotherapy and 15 of a 28 day  Cough signs: temperature, BP, HR,
agents. It inhibits cancer cycle, until disease  Breathlessness RR, and O2 saturation.
cell growth and division, progression.  Headache  Encourage adequate rest.
contributing to the  Anxiety  Assess mental status.
management of the  Dizziness  Monitor daily pattern of
disease.  Diarrhea bowel activity, stool
Mechanism of Action:  Rash consistency.
Stabilizes microtubules in  Dry skin  Assess skin color, integrity,
the cell during the process  Muscle pain temperature, and texture.
of cell division, disrupting  Mouth sores  Encourage the use of warm
normal microtubule  Hair loss compresses and gentle
dynamics. This exercises.
interference prevents the Adverse reactions:  Provide emotional support
separation of  Hypersensitivity and provide information on
chromosomes, leading to reaction coping with hair loss.
cell cycle arrest and  Peripheral Encourage the use of head
inhibiting cell neuropathy coverings.
proliferation.  Neutropenia  Monitor closely during
infusion for any signs of
 allergic response.
 Assess and manage
symptoms like tingling or
numbness. Educate the
patient on proper foot care
and balance to prevent
injuries.
Generic Name: Topoisomerase I Indication: Regimen 1 (Weekly): Side effects:  Monitor for dehydration and
Irinotecan inhibitor, Cytotoxic Irinotecan is used in the 125 mg/m² IV  Nausea electrolyte imbalance.
antineoplastic agent treatment of various infusion over 90  Vomiting  Encourage small, frequent
Brand Name: cancers, including minutes on days 1, 8,  Breathlessness meals.
Camptosar metastatic colorectal 15, 22, then 2 weeks  Diarrhea  Monitor daily pattern of
cancer. off, then repeat.  Cough bowel activity.
 Fatigue  Encourage adequate rest and
Mechanism of Action: Regimen 2 (Once balance of activity.
 Alopecia
Inhibits topoisomerase I, Every 3 Weeks): 350  Provide emotional support
 Loss of appetite
an enzyme involved in mg/sq.meter IV and information about coping
DNA replication and infusion over 30-90  Anemia
 Mouth sores with hair loss.
repair. By binding to and minutes q3Weeks  Encourage gentle oral
inhibiting this enzyme,  Fever
hygiene with a soft-bristle
irinotecan induces DNA toothbrush or sponge-tipped
damage, preventing cancer Adverse reactions:
 Myelosuppression applicators.
cells from dividing and
 Hypersensitivity  Monitor complete blood
ultimately leading to cell
reactions counts regularly.
death.
 Interstitial Lung  Monitor for signs of
Disease hypersensitivity, such as rash
or difficulty breathing.
 Monitor for signs of dyspnea,
cough, and fever.
Generic Name: Antineoplastic Indication: 100 mg/m² IV q21 Side effects:  Monitor cardiac function
Epirubicin medication, While not a first-line days x 6 cycles  Fast or irregular regularly through
anthracycline treatment for heartbeat echocardiograms or other
Brand Name: chemotherapy drug gastroesophageal cancer, it  Rash cardiac tests.
Ellence may be included in certain  Itching  Encourage small, frequent
chemotherapy regimens  Cough meals.
for advanced or metastatic  Fever  Assess skin color, integrity,
cases. Its use is often part  Chest pain temperature, and texture.
of combination therapies to  Monitor vital signs.
 Sore throat
target cancer cells.  Assess pain level.
 Difficulty
breathing  Provide emotional support
Mechanism of Action: and education about potential
Inhibits DNA and RNA  Weakness
 Nausea hair loss.
synthesis by intercalating
 Vomiting  Encourage adequate fluid
with the DNA helix and
intake to dilute the urine and
interfering with the
Adverse reactions: minimize irritation to the
function of topoisomerase
 Cardiotoxicity urinary tract.
II. It generates free
 Alopecia  Advise the patient to avoid
radicals, causing DNA
 Hematuria excessive pressure on hands
strand breaks and
and feet and to wear
inhibiting cell replication.  Hand-Foot
comfortable shoes.
This mechanism disrupts Syndrome
the cancer cell cycle and
leads to cell death.

Generic Name: Monoclonal Indication: Initial dose of 4 Side Effects:  Monitor temperature
Trastuzumab antibody Trastuzumab is indicated mg/kg as an  Fever regularly.
for the treatment of HER2- intravenous infusion  Nausea  Encourage small, frequent
Brand Name: positive gastroesophageal over 90 minutes then  Vomiting meals.
Herceptin cancer. HER2 (human at 2 mg/kg as an  Diarrhea  Monitor for dehydration.
epidermal growth factor intravenous infusion  Cough  Monitor daily pattern of
receptor 2) is a protein that over 30 minutes  Headache bowel activity, stool
can promote the growth of weekly during consistency.
 Fatigue
cancer cells. Trastuzumab chemotherapy for the  Dyspnea  Encourage deep breathing
specifically targets and first 12 weeks  Rash exercises.
inhibits the activity of (paclitaxel or  Advise pt to have adequate
HER2-positive cancer docetaxel) Adverse Reactions: rest.
cells, making it an  Hypersensitivity  Assess respiratory status
important component of reactions regularly.
treatment for eligible  Anemia  Monitor for signs of
patients with  Left Ventricular anaphylaxis (e.g., rash,
gastroesophageal cancer. Dysfunction respiratory distress).
 Monitor hemoglobin and
Mechanism of Action: hematocrit levels.
 Monitor cardiac function
Trastuzumab is a regularly.
monoclonal antibody that
works by binding to the
HER2 receptor on the
surface of cancer cells.
This binding:
 Inhibits the HER2
signaling pathway.
 Suppresses cancer
cell growth.
 Promotes antibody-
dependent cellular
cytotoxicity
(ADCC), leading to
the destruction of
HER2-positive
cancer cells by the
immune system.
Generic Name: Tyrosine Kinase Indication: 160 mg orally once a Side Effects:  Encourage adequate rest.
Regorafenib inhibitor Used in the treatment of day for the first 21  Fatigue  Provide a therapeutic
advanced gastrointestinal days of each 28-day  Hypertension environment.
Brand Name: stromal tumors (GIST) and cycle until disease  Hand-foot skin  Monitor blood pressure and
Stivarga metastatic colorectal progression or reaction temperature regularly.
cancer. unacceptable toxicity.  Decreased  Assess for signs of urinary
appetite tract infection (UTI).
Mechanism of Action:  Mucositis  Provide oral care before and
Inhibits multiple kinases  Fever after each dose.
involved in angiogenesis 
 Painful urination Advise the patient to avoid
and tumor proliferation. friction and pressure on
Adverse Reactions: hands and feet.
 Hepatotoxicity  Encourage small, frequent
meals and nutritional
supplements.
 Educate the patient on signs
of hepatotoxicity (e.g.,
jaundice, abdominal pain).
Generic Name: Immune checkpoint Indication: IV: 200 mg every 3 Side effects:  Encourage balanced rest and
Pembrolizumab inhibitor (PD-1 Used in advanced or weeks or  Fatigue activity.
inhibitor) metastatic gastric or 400 mg every 6 weeks  Nausea  Encourage small, frequent
Brand Name: gastroesophageal junction  Rash meals.
Keytruda cancer with PD-L1  Chest pain  Assess rash severity and
expression.  Irregular characteristics.
heartbeat  Monitor vital signs and
Mechanism of Action:  Shortness of perform an ECG.
Blocks PD-1, enhancing breath  Assess respiratory status
the immune response regularly.
 Confusion
against cancer cells.  Ensure a safe environment;
 Blurry vision
minimize stimuli.
Adverse reactons:  Advise pt to avoid activities
 Immune related that requires alertness.
 adverse events  Monitor for signs of
autoimmune reactions.
Generic Name: Immune checkpoint Indication: 240 mg IV q2Weeks Side effects:  Monitor daily pattern of
Nivolumab inhibitor (PD-1 Used in advanced or or 360 mg IV  Diarrhea bowel activity, stool
inhibitor) metastatic gastric or q3Weeks plus a  Pruritus consistency.
Brand Name: gastroesophageal junction platinum-containing  Fatigue  Encourage balanced rest and
Opdivo cancer with PD-L1 therapy (eg,  Nausea activity.
expression. oxaliplatin) and a  Weakness  Encourage small, frequent
fluoropyrimidine (eg,  Vomiting meals.
Mechanism of Action: fluorouracil,  Assess respiratory status
 Shortness of
Blocks PD-1, promoting capecitabine) regularly.
breath
an anti-tumor immune Continue until disease  Monitor nutritional status
 Decreased
response. progression, and weight regularly.
appetite
unacceptable toxicity,  Monitor temperature
or up to 2 yr  Fever
 Headache regularly.
 Educate the patient on signs
Adverse effects: of hepatitis (e.g., jaundice,
 Hepatitis abdominal pain).
 Pneumonitis  Monitor for respiratory
symptoms (cough, dyspnea).
Generic Name: Serotonin (5-HT3) Indication: IV: 8 mg started 30 Side effects:  Provide a quiet, dimly lit
Ondansetron receptor antagonist Used for prevention and minutes before  Headache environment.
treatment of chemotherapy, then  Constipation  Monitor bowel habits and
Brand Name: chemotherapy-induced q12hr for 1-2 days  Dizziness stool consistency.
Zofran nausea and vomiting. after chemotherapy  Difficulty  Monitor bowel habits and
breathing stool consistency.
Mechanism of Action:  Irregular  Monitor cardiac rhythm
Blocks serotonin receptors heartbeat continuously.
in the chemoreceptor  Polydipsia  Monitor fluid intake and
trigger zone. output.
 Chest pain
 Decreased urine  Encourage adequate rest.
 Adverse reactions:
 Arrythmias
Generic Name: Opioid analgesic Indication: 1-2 mcg/kg IV bolus Side effects:  Monitor bowel habits and
Fentanyl Used for pain management or 25-100 mcg/dose  Constipation stool consistency.
in cancer patients, PRN or 1-2 mcg/kg/hr  Respiratory  Encourage increased fluid
Brand Name: including those with by continuous IV depression intake and fiber-rich foods.
Duragesic gastroesophageal cancer. infusion or 25-200  Nausea  Monitor respiratory rate and
mcg/hr  Confusion effort regularly.
Mechanism of Action:  Sedation  Encourage small, frequent
Bids to opioid receptors,  Drowsiness meals.
altering pain perception.  Ensure patient safety and
Adverse reactions: minimize environmental
 Overdose stimuli.
 Educate the patient on
avoiding activities requiring
alertness.
 Monitor for signs of
overdose (e.g., respiratory
distress, extreme sedation).
d. Diet

INDICATION(S) OR
TYPE OF DIET GENERAL DESCRIPTION NURSING RESPONSIBILITES
PURPOSE
High-calorie, A high-calorie, high-protein Gastroesophageal cancer and  Regularly assess the patient's nutritional status, dietary
high-protein diet diet is designed to provide its treatments can lead to habits, and weight.
increased energy and protein weight loss and muscle  Work closely with a registered dietitian to individualize the
intake to meet the elevated wasting. A high-calorie, high- dietary plan based on the patient's specific needs,
nutritional needs of protein diet aims to counteract preferences, and treatment regimen.
individuals undergoing cancer these effects, supporting  Provide education on the importance of a high-calorie,
treatment. This diet overall strength and high-protein diet in supporting overall health and treatment
emphasizes foods rich in minimizing malnutrition. outcomes.
calories and protein to Adequate protein and calorie  Assist in developing meal plans that incorporate calorie-
support the body's demands intake are essential for the dense and protein-rich foods, considering any dietary
during the cancer journey. body to heal, recover, and restrictions or preferences.
tolerate cancer treatments.  Monitor the patient's dietary adherence, weight changes,
and any signs of nutritional deficiencies or intolerances.
 Recognize and address potential challenges or concerns
related to dietary changes, offering emotional support to
promote compliance.
Fiber-rich diet A fiber-rich diet emphasizes For individuals with  Evaluate the patient's current dietary habits, fiber intake,
the consumption of foods gastroesophageal cancer, and gastrointestinal symptoms.
high in dietary fiber, incorporating a fiber-rich diet  Work with a registered dietitian to develop an
including fruits, vegetables, proves beneficial in mitigating individualized meal plan that includes a variety of fiber-
whole grains, and legumes. constipation—a prevalent side rich foods, considering the patient's preferences and any
This dietary approach aims to effect of cancer treatments. dietary restrictions.
promote digestive health, Beyond its role in promoting  Provide education on the benefits of a fiber-rich diet for
regulate bowel movements, regular bowel movements, a digestive health and overall well-being.
and support overall well- varied selection of fiber-rich  If the patient is not accustomed to a high-fiber diet,
being. foods contributes to a nutrient- encourage a gradual increase in fiber intake to minimize
dense diet, playing a pivotal gastrointestinal discomfort.
role in maintaining overall  Emphasize the importance of adequate fluid intake along
 nutritional status. with increased fiber consumption to prevent constipation.
 Monitor for any gastrointestinal symptoms and adjust the
fiber intake as needed based on the patient's tolerance.
Low-fat diet A low-fat diet involves A low-fat diet is often  Evaluate the patient's current dietary habits, preferences,
reducing the intake of dietary recommended for individuals and any digestive symptoms related to fat intake.
fats, especially saturated and with gastroesophageal cancer  Collaborate with a registered dietitian to develop a low-fat
trans fats, to support to alleviate digestive meal plan tailored to the patient's individual needs.
cardiovascular health and discomfort commonly  Provide education on identifying and choosing low-fat
manage weight. associated with symptoms like food options, reading food labels, and cooking methods
nausea or reflux during cancer that reduce fat content.
treatment. Additionally,  Assist the patient in planning meals that are low in fat but
embracing a low-fat dietary still nutritionally adequate and palatable.
approach can contribute to  Monitor for any digestive symptoms or changes in weight
supporting cardiovascular and adjust the diet plan as needed.
health, particularly relevant for
patients with pre-existing heart
conditions or concerns.
 e. Activity

TYPE OF ACTIVITY GENERAL DESCRIPTION INDICATION(S) OR PURPOSE NURSING RESPONSIBILITES

Aerobic Exercise It involves continuous and Aerobic exercise can enhance  Collaborate with healthcare providers to
rhythmic activities that elevate cardiovascular health, boost energy determine safe exercise levels.
the heart rate and increase levels, and support overall well-being  Encourage gradual and tailored routines,
oxygen intake, such as brisk for individuals with initial stages of ensuring that exercises are well-tolerated
walking, swimming, or cycling. cancer and undergoing cancer treatment. and adapted to the patient's energy levels.

Bed Rest Bed rest involves limiting Bed rest may be recommended to  Monitor for any signs of complications
physical activity and remaining manage symptoms like fatigue, associated with prolonged bed rest, such
in a supine or semi-supine weakness, or discomfort during periods as muscle atrophy or pressure ulcers.
position. of heightened illness or treatment.  Encourage gentle movements within the
limitations of bed rest to prevent
deconditioning.
Mind-Body Activities Mind-body activities encompass These activities can help manage stress,  Facilitate access to mind-body programs
practices that integrate the mind improve mood, and enhance the overall and resources.
and body, such as yoga, tai chi, quality of life for individuals dealing  Provide guidance on appropriate
or meditation, promoting with gastroesophageal cancer. modifications to accommodate physical
relaxation and holistic well- limitations.
being.  Encourage consistent practice for optimal
benefits.

Meditation Meditation involves techniques This can alleviate stress, anxiety, and  Provide guidance on meditation
that promote mindfulness, enhance coping mechanisms for techniques and resources.
relaxation, and focused attention individuals facing the challenges of  Encourage regular practice and adapt
to foster mental well-being. gastroesophageal cancer. methods based on the patient's preferences
and physical capabilities.
e. Surgical Management

i. Definition of Operation:

Gastroesophageal cancer is a malignancy affecting the esophagus or the junction

between the esophagus and the stomach. It is a complex and challenging condition that

necessitates a multidisciplinary approach for effective management. Surgical interventions play a

crucial role in the treatment of gastroesophageal cancer, aiming to remove or address cancerous

tissue and, when possible, restore normal digestive function. Throughout the surgical process,

nursing considerations focus on preparing patients for surgery, providing postoperative care,

addressing nutritional needs, and offering emotional support to enhance the overall well-being of

individuals facing this diagnosis. Gastroesophageal cancer is often managed surgically, and the

specific surgical approach depends on the location, stage, and characteristics of the cancer.

Common surgical procedures for gastroesophageal cancer include:

 Esophagectomy involves the removal of part or all the esophagus. The remaining

stomach or other tissue is then connected to the remaining portion of the esophagus or to

the small intestine. It is performed to eliminate or reduce the extent of cancerous growth

in the esophagus.

 Gastrectomy entails the removal of a portion or the entirety of the stomach, depending

on the location of the cancer. It may be performed when the cancer affects the upper part

of the stomach or the gastroesophageal junction.

 Esophagogastrostomy involves the removal of both the esophagus and a portion of the

stomach. The remaining stomach is then reconstructed and connected to the remaining

part of the esophagus or the small intestine. It is utilized when cancer involves both the

esophagus and the upper part of the stomach.

 Lymphadenectomy includes the removal of lymph nodes in the surrounding area to

assess the spread of cancer. It helps determine the extent of cancer spread and aids in

planning further treatment.

ii. Procedure (preoperative, intraoperative, and postoperative period)

1. Esophagectomy

Preoperative:

 Conduct a comprehensive preoperative assessment, emphasizing cardiac and respiratory

function.

 Collaborate with a dietitian to address nutritional deficiencies and plan preoperative

nutritional support.

 Administer prophylactic antibiotics to prevent surgical site infections.

 Educate the patient about the procedure, potential complications, and postoperative

expectations.

 Implement deep breathing and coughing exercises to enhance respiratory function.

Intraoperative:

 Monitor vital signs, ensuring hemodynamic stability.

 Assist in patient positioning and preparation for surgery.

 Facilitate communication between the surgical team and the patient's family.

 Collaborate with anesthesia to manage fluid balance and hemodynamic parameters.

 Ensure aseptic technique and adherence to infection control protocols.

Postoperative:

 Monitor for complications such as anastomotic leaks, pneumonia, or respiratory distress.

 Manage pain effectively using a multimodal approach.

 Initiate early ambulation and respiratory exercises to prevent postoperative

complications.

 Collaborate with the dietitian to progress from intravenous to oral nutrition gradually.

 Provide emotional support and education regarding postoperative care and lifestyle

changes.

2. Gastrectomy

Preoperative:

 Assess nutritional status and implement preoperative nutritional interventions.

  Administer preoperative medications, including prophylactic antibiotics and medications

to reduce gastric acidity.

 Educate the patient on changes in dietary habits postoperatively.

 Ensure psychological support and address concerns related to body image.

 Collaborate with the anesthesia team to optimize the patient's overall health.

Intraoperative:

 Monitor and manage intraoperative fluid balance.

 Collaborate with the surgical team to address any intraoperative concerns promptly.

 Communicate with the patient's family regarding the progress of the surgery.

 Implement measures to maintain normothermia.

 Monitor for potential complications, such as bleeding or infection.

Postoperative:

 Monitor for signs of anastomotic leaks, bleeding, or infection.

 Administer pain management and implement strategies to prevent respiratory

complications.

 Gradually reintroduce oral intake, closely monitoring tolerance.

 Facilitate early ambulation and engage in postoperative rehabilitation.

 Provide ongoing nutritional support and education on dietary modifications.

3. Esophagogastrectomy

Preoperative:

 Conduct a thorough preoperative assessment, addressing cardiovascular, respiratory, and

nutritional concerns.

 Collaborate with dietitians to optimize nutritional status and plan preoperative nutritional

support.

 Administer prophylactic antibiotics and other preoperative medications.

 Educate the patient about the surgical procedure, potential complications, and recovery

expectations.
  Implement preoperative respiratory exercises to enhance lung function.

Intraoperative:

 Monitor vital signs and support anesthesia administration.

 Coordinate with the surgical team for patient positioning and preparation.

 Communicate with the patient's family regarding the progression of the surgery.

 Ensure adherence to infection control measures.

 Monitor for intraoperative complications and assist in their management.

Postoperative:

 Monitor for complications, including respiratory distress and anastomotic leaks.

 Administer effective pain management to facilitate early mobilization.

 Gradually reintroduce oral intake, collaborating with the dietitian.

 Implement strategies to prevent postoperative complications such as pneumonia or deep

vein thrombosis.

 Provide emotional support and education on lifestyle modifications postoperatively.

4. Lymphadenectomy

Preoperative:

 Conduct a thorough preoperative assessment to evaluate the patient's overall health,

focusing on cardiovascular and respiratory function.

 Perform imaging studies, such as CT scans or PET scans, to identify and map the lymph

nodes for targeted removal.

 Educate the patient about the purpose of lymphadenectomy, potential risks, and the

importance of postoperative care.

 Obtain informed consent, ensuring the patient understands the procedure, potential

complications, and alternative treatments.

 Collaborate with the healthcare team to optimize the patient's overall health, addressing

any comorbidities or nutritional deficiencies.

Intraoperative:

 Ensure proper positioning of the patient, providing optimal access to the lymph nodes of

interest.

 Coordinate with the anesthesia team to maintain hemodynamic stability and monitor fluid

balance.

 Systematically dissect and remove lymph nodes in the designated areas, guided by

preoperative imaging and surgical landmarks.

 Continuously monitor vital signs and respond to any intraoperative changes promptly.

 Collaborate with pathologists for real-time assessment of lymph nodes to guide the extent

of dissection.

Postoperative:

 Monitor the patient in the post-anesthesia care unit (PACU) for immediate postoperative

recovery, assessing for complications.

 Implement effective pain management strategies to enhance postoperative comfort.

 Monitor fluid and electrolyte balance, addressing any imbalances resulting from surgery.

 Encourage early ambulation to prevent postoperative complications, such as deep vein

thrombosis.

 Collaborate with pathologists for a comprehensive review of excised lymph nodes,

providing valuable information for staging and further treatment planning.

iii. Instruments/equipment and machines/materials needed

 Esophageal Retractors: Used to gently hold and expose the esophagus during surgery.

 Gastric Staplers: Employed for creating anastomoses or closures during resection and

reconstruction.

 Laparoscopic Instruments: Trocars, graspers, and scissors for minimally invasive

procedures.

 Suction and Irrigation Devices: Essential for maintaining a clear surgical field.

 Electrocautery Devices: Used for cutting and coagulating tissues during the procedure.
 Bipolar and Monopolar Electrocautery Devices: Utilized for cutting and coagulating

tissues.

 Gastric Suction Tubes: Essential for maintaining a clear field and evacuating gastric

contents.

 Ligating Instruments: Employed for ligating blood vessels and controlling bleeding

during resection.

 Lymph Node Dissectors: Specialized instruments for precise dissection and removal of

lymph nodes.

 Fine Forceps and Scissors: Used for delicate tissue handling during lymph node

removal.
iv. Overall Nursing Responsibilities for Procedures (Esophagectomy, Gastrectomy,

Esophagogastrectomy, and Lymphadenectomy):

Before the procedure:

1. Assessment and Optimization:

 Conduct a comprehensive preoperative assessment, addressing physical and

psychological needs.

 Optimize the patient's health status, collaborating with the healthcare team.

2. Education and Informed Consent:

 Provide thorough education on the procedure, potential complications, and

postoperative care.

 Confirm informed consent, ensuring the patient's understanding and willingness.

3. Collaboration:

 Collaborate with the surgical team, anesthesia, and other healthcare professionals

for seamless preoperative preparation.

4. Medication Administration:

 Administer prescribed preoperative medications, including antibiotics and pre-

anesthetic medications.

5. Safety Measures:

 Verify safety protocols, including patient identification, correct site, and

procedural details.

 Ensure equipment and supplies readiness.

During the procedure:

1. Monitoring and Advocacy:

 Monitor vital signs continuously, advocating for the patient's safety.

 Communicate effectively with the surgical team, providing updates and

addressing concerns.

2. Aseptic Technique:

 Ensure aseptic technique during the procedure, minimizing the risk of infection.

 Assist in maintaining a clear and organized surgical field.

After the procedure:

1. Complication Monitoring:

 Monitor for postoperative complications, including respiratory distress, infection,

or bleeding.

2. Pain Management:

 Implement effective pain management strategies to ensure patient comfort.

3. Nutritional Support:

 Collaborate with dietitians for nutritional support, considering gradual

reintroduction of oral intake.

4. Recovery Support:

 Support early ambulation and gradual recovery.

 Provide emotional support, addressing the patient's concerns and facilitating

coping.

These overarching responsibilities encompass the entire perioperative process, ensuring

comprehensive care and positive outcomes for patients undergoing esophagectomy, gastrectomy,

esophagogastrectomy, or lymphadenectomy procedures.

V. NURSING MANAGEMENT

a. Nursing Care Plan

Problem #1: Nutritional imbalance less than body requirements

NURSING EXPECTED
ASSESSMENT PLANNING NURSING INTERVENTION SCIENTIFIC RATIONALE
DIAGNOSIS OUTCOME
Subjective Data: Nutritional Short-term goal: Independent: Independent: Short-term goal:
N/A imbalance less
than body After 3 days of nursing 1. Assess the etiological 1. It should be noted that other After 3 days of
Objective: requirements intervention, the patient variables causing the chemotherapeutic drugs nursing intervention,
 Facial related to will be able to help decline in nutrient may suppress appetite. the patient was able to
grimace and abdominal pain keep dietary inputs to intake. help keep dietary
guarding secondary to metabolic needs up and 2. This assessment serves as a inputs to metabolic
behavior stomach cancer running, as well as 2. Monitor weight foundation for nutrient and needs up and running,
noted. as evidenced by increased appetite. accurately and calorie requirements and as well as increased
 Abdominal difficulty of regularly. should thus be correct. appetite.
pain rated at swallowing. Long-term goal:
a scale of 3. Instruct pt to eat small, 3. To prevent nausea and Long-term goal:
8/10 After 1 week of nursing frequent meals. vomiting by keeping the
 Difficulty of intervention, the patient patient’s nutritional status After 1 week of
swallowing will be able to consume 4. Perform good oral care steady. nursing intervention,
observed adequate nutrition for and arrange the patient the patient was able to
when pt was metabolic needs as in the best possible 4. This increases the pt’s consume adequate
instructed to evidenced by position. appetite, and elevating the nutrition for metabolic
demonstrate. acceptable weight or HOB or placing pt on needs as evidenced by
 Inconsistent tissue regeneration, 5. Allow pt to have ample sitting position wile eating acceptable weight or
eating positive nitrogen time to finish the meal offers the optimal posture tissue regeneration,
schedule was balance, muscle-mass and offer help with for food digestion. positive nitrogen
verbalized measures, and increased eating. balance, muscle-mass
energy levels. 5. Allowing adequate time measures, and
 6. Promote the use of makes the meal more increased energy
nutritious supplements enjoyable and encourages pt levels.
and healthful snacks. to consume as much as
possible.
Dependent:
6. Caloric consumption
1. Collaborate with a increased through
registered dietitian. additional food
supplements, such as
2. Administer analgesics nutritional smoothies.
as prescribed.
Dependent:

1. To assess the patient's

nutritional needs, provide
tailored dietary
recommendations, and
suggest modifications such
as texture modification or
the use of liquid
supplements.

2. Adequate pain control

enhances the patient's
ability to tolerate oral
intake, facilitating improved
nutrition and overall
comfort.
b. FDAR (Focus, Data, Action, and Response)

Focus: Data:

Abdominal pain  Pt. received on bed, conscious

and coherent.

 Wincing and guarding behavior

noted.

 Patient reports consistent

abdominal pain rated 8/10 on the

pain scale.

 Patient's medical history includes

a recent diagnosis of stomach

cancer.

Action:

 Assessed pt condition.

 Monitor and document vital

signs.

 Administered pain medication as

prescribed.

 Encouraged deep breathing

exercises.

 Provided comfort measures.

 Reassessed pain after an hour.

Response:

 Pain scale decreased to 4/10.

 For continuity of care.

VI. LEARNING DERIVED

As student nurse, I have learned about the importance of being knowledgeable regarding

the gastroesophageal cancer Gastroesophageal cancer is divided into two types: esophageal

cancer and stomach cancer. These cancers which are distinguished by their aggressive nature and

frequent late-stage diagnosis, pose a substantial worldwide health concern. This case study

underscores the importance of keen observation and effective communication in identifying

subtle symptoms and understanding a patient's history during clinical assessments. Secondly, it

highlights the role of nurses in supporting the diagnostic process, such as facilitating patient

comfort during endoscopy and biopsy procedures.

Additionally, the acquired knowledge from this study has been derived by the student

nurse in accordance with the three aspect of learning and these are as follows:

i. Cognitive Learning

After the completion of the case study on appendicitis, the student nurses shall be able to:

 Define what gastroesophageal cancer is.

 Define various diagnostic and laboratory procedures used for prior to gastroesophageal

cancer.

 Differentiate the medical management and surgical management of the disease.

 Explain the responsibilities of the nurse before, during, and after the procedures.

 Explain the surgical management for gastroesophageal cancer.

 Identify the various surgical instrument used during the surgical procedures.

ii. Psychomotor Learning

After the completion of the case study on appendicitis, the student nurse shall be able to:

 Describe and explain the steps and procedures for the management of gastroesophageal

cancer.

 Describe and explain dietary and activity measures that are indicated for the patient.

 Explain and teach the patient about the procedure to be done.

 Develop a Nursing Care Plan

iii. Affective Learning

After the completion of the case study on appendicitis, the student nurse shall be able to:

 Integrate the proper surgical, medical, and nursing management of the disease for the

prevention of possible complications following treatment

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