Question

The nurse is caring for a client after a gastrectomy. Which of the following vitamins will the nurse expect to be administered throughout the client's lifespan? A. Phytonadione (vitamin K) B. Cyanocobalamin (vitamin B 12) C. Thiamine (vitamin B1) D. Ascorbic acid (Ascorba-cap)

Short answer

Answer: B. Cyanocobalamin (vitamin B12).

Step-by-step solution

Understanding Gastrectomy

A gastrectomy is a surgical procedure in which a part or the entire stomach is removed. After this procedure, the absorption capacity of nutrients and vitamins is compromised, and therefore, some vitamins may need to be administered throughout the client's lifespan.

Analyzing the Vitamins

Let's analyze the role of each vitamin and its importance after a gastrectomy. A. Phytonadione (vitamin K): Vitamin K is necessary for blood clotting and bone health, and its deficiency could lead to bleeding problems. However, it is mostly absorbed in the small intestine rather than the stomach; thus, supplemental administration is not essential throughout the client's lifespan after a gastrectomy. B. Cyanocobalamin (vitamin B12): Vitamin B12 plays a crucial role in maintaining the nervous system, the production of red blood cells, and DNA synthesis. It is primarily absorbed in the stomach through the intrinsic factor. After a gastrectomy, the production of intrinsic factors will be affected, leading to a deficiency of vitamin B12. This deficiency may cause anemia and neurological problems. Therefore, lifelong supplementation is usually required after a gastrectomy. C. Thiamine (vitamin B1): Vitamin B1 is essential for converting carbohydrates into energy and maintaining the nervous system. Although its deficiency may cause problems, it is primarily absorbed in the small intestine, and lifelong supplementation is not mandatory after a gastrectomy. D. Ascorbic acid (vitamin C): Vitamin C is essential for collagen synthesis, immune function, and antioxidant function, among other roles. The absorption of vitamin C is not affected significantly after gastrectomy, and supplementation throughout the client's lifespan is not mandatory.

Selecting the Correct Vitamin

Based on our analysis in step 2, we can determine that the correct vitamin that should be administered throughout the client's lifespan after a gastrectomy is Cyanocobalamin (vitamin B12).

Answer:

The correct answer is B. Cyanocobalamin (vitamin B12).

Key concepts

Vitamin B12 Supplementation

After a gastrectomy, patients face a unique set of nutritional challenges, especially concerning vitamin B12, scientifically known as cyanocobalamin. This vitamin is vital for numerous bodily functions, including red blood cell formation, nervous system maintenance, and DNA synthesis. Normally, vitamin B12 binds with a protein called intrinsic factor in the stomach before it is absorbed in the small intestine. However, following a gastrectomy, the stomach's ability to produce intrinsic factor is compromised, which results in a reduced capacity to absorb vitamin B12.

Long-term supplementation with vitamin B12 becomes essential after a gastrectomy to prevent deficiency-related conditions such as pernicious anemia and neurological disturbances. The route of administration can vary; some patients may require injections while others might use oral supplements depending on the extent of their surgery and absorption capabilities. Health care providers carefully monitor vitamin B12 levels postoperatively to ensure that supplementation is adequate and effective. This lifelong commitment to supplementation is critical for the well-being of individuals who have undergone gastrectomy.

Nutrition after Gastrectomy

Nutritional care post-gastrectomy is pivotal to ensure a patient's recovery and long-term health. The removal of part or all of the stomach affects not only the absorption of nutrients but also the individual's ability to eat normal-sized meals. Thus, dietary adjustments are crucial. Patients are usually guided to eat smaller, more frequent meals to accommodate their reduced stomach volume. These meals should be balanced and nutrient-dense to support healing and prevent weight loss.

Key Nutritional Considerations:

• Protein intake should be prioritized to aid in tissue repair and muscle maintenance.
• Certain mineral supplements, such as calcium and iron, may be required due to altered digestion and absorption.
• Patients are advised against consuming high-sugar and high-fat foods which may lead to 'dumping syndrome,' causing nausea, cramping, and diarrhea.
• Hydration is essential, but fluids should be consumed between meals to avoid feeling too full.

It's vital for health care providers to offer personalized nutrition plans and to provide ongoing support as dietary needs can change over time.

Long-term Postoperative Care

The importance of long-term postoperative care following a gastrectomy cannot be overstated. This procedure significantly alters the digestive system, necessitating continued medical oversight and lifestyle adjustments. Postoperative care includes regular monitoring for potential complications, such as infections or gastric leaks, and ensuring that nutritional deficiencies are identified and addressed promptly. In addition to vitamin B12 supplementation, patients might require other nutritional supplements based on individual assessments.

Continuous support from multidisciplinary teams, including dietitians, surgeons, primary care providers, and mental health professionals, is essential for optimal recovery. Patients may also benefit from educational resources and support groups to help them adjust to their new dietary habits and understand the importance of adhering to their health care regimen. This comprehensive approach to long-term care is critical for enhancing the patient's quality of life and preventing complications after a gastrectomy.