11. Dumping syndrome: hypoglycemic-type episode; occurs postoperatively after gastric resection (may also occur after vagotomy, antrectomy, or gastroenterostomy), when food and fluids that are more hyperosmolar than the jejunal secretions pass quickly into jejunum, producing fluid shifts from bloodstream to jejunum. This is a mild problem for about 20% of patients and will disappear in a few months to a year. Symptoms cause serious problem for about 7% of patients. This discomfort may occur during a meal or up to 30 minutes after the meal and last from 20-60 minutes. The reaction is greatest after the ingestion of sugar.
    1. Assessment:
       1. Subjective data:
          1. Feeling of fullness, weakness, faintness,
          2. Palpitations.
          3. Nausea.
          4. Discomfort during or after eating.
       2. Objective data:
          1. Diaphoresis.
          2. Diarrhea.
          3. Fainting.
          4. Symptoms of hypoglycemia.
    2. Analysis/nursing diagnosis:
       1. Altered nutrition, more than body requirements, related to body’s inability to properly digest high-carbohydrate, high-sodium foods.
       2. Diarrhea related to food passing into jejunum too quickly.
       3. Risk for injury related to hypoglycemia.
       4. Knowledge deficit related to dietary restrictions.
    3. Nursing care plan/implementation:
       1. Goal: health teaching.
          1. Include:
             1. Increased fat, protein to delay emptying.
             2. Rest after meals.
             3. Small, frequent meals.
             4. Fluids between meals.
          2. Avoid:
             1. Foods high in salt, carbohydrate.
             2. Large meals.
             3. Stress at mealtime.
             4. Fluids at mealtime.
    4. Evaluation/outcome criteria:
       1. No complications.
       2. Patient heals.
       3. No further ulcers.
       4. Incorporates health teaching into lifestyle and prevents syndrome.