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136 Cards in this Set
- Front
- Back
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What is the most common oral problem in the hopital?
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Dry mouth
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What is candida?
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fungal growth in mouth, white, come off when brushed
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What if the white stuff doesn't come off tongue when brushed?
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It may be leukoplaquia- puts pt at risk for cancer (precancerous)
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gastritis
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inflammation of the stomach
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The upper GI tract consists of
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the mouth, oropharynx, esophagus, stomach, and duodenum (small intestine).
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Digestion begins...
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in the mouth.
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What is peristalsis?
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A rhythmic movement of contraction and expansion of the smooth muscle, propels the food toward the stomach.
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Gastric secretions are regulated primarily by the...
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parasympathetic nervous system.
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Vomiting of GI contents is controlled by the....
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vomit center (VC) in the MEDULLA of the brain.
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What is the duodenum?
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The first portion of the small intestine
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Does the esophagus perform peristalsis?
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Yes
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What does the esophagus look like?
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It is flat like a hose
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What accessory organs release gastric secretions?
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salivary, liver, pancreas, gallbladder
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What is the pyloric valve?
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1 way valve that responds to pressure. strong ring of smooth muscle at the end of the pyloric canal which lets food pass from the stomach to the duodenum
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lower esophageal sphincter
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Ileus- Another one way valve that responds to pressure. Sometimes contents can back up through valve
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What foods can weaken the ileus (sphincter)?
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alcohol
coffee chocolate peppermint smoking |
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How do we treat Temporomandibular disorders?
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Try to realign jaw
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Examples of Temporomandibular disorders (Internal derangement of joint)?
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Fractured Jaw, jaw out of alignment
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What is Myofascial pain?
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nerve pain/muscle pain
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How do we treat a fractured jaw?
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wire it shut
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What is a major concern for pts with their jaw wired shut?
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Aspiration! If they vomit!!! Vomit is a comon s/e of anesthesia- this pt needs to come out of surgery with a pair of dedicated wire cutters, These wire cutters go with them EVERYWHERE.
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What is Parotitis?
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Parotid Gland inflammation
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What is Sialadenitis?
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Salivary gland inflammation
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What is Sialolithiasis?
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inflammation from stone in salivary gland
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What are Neoplasms?
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Abnormal growth/tumors
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What is the nurses major role with disorders of the teeth?
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Prevention! We need to practice good oral care for our pts.
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What do dental cavities have to do with nutrition?
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Poor nutrition leads to an increase in cavities
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What is our biggest concern with infection/bacteria in the mouth?
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We are worried about it getting into the blood stream and going to the heart valves. From there it can travel to the brain.
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When should you see a doctor about a sore in your mouth?
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If it persists for more than 2 weeks.
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Actinic cheilitis
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irritated lips- from the sun
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Herpes simplex 1
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Oral cold sore- on lips
Highly Contagious! |
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Chancre
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On lips- red leision from syphilis
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Leukoplakia, hairy leukoplakia, lichen planus
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Can be precancerous- cannot be removed with a toothbrush. Need biopsy to look for cancer
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Candidiasis
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white plaque, associated with tobacco, found more w/ immunocompromised pts
Can be removed with a toothbrush Treat with antifungals |
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When brushing off candidiasis, what is the skin underneath like?
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Very "friable" (fragile, breaks easily)
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Stomatitis
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redness, (from chemotherapy, radiation, bone marrow depression)
Painful, damaged tissue, treat with local anesthetic (lidocaine) |
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What are foods not to eat with stomatitis?
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Spicy food
Alcohol hard food All painful for pt |
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gingivitis
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Gums- painful, swollen, bleed easily
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What medication can cause gingivitis?
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Dilantin- anticonvulsant
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Periodontitis
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Inflammation of gums, causing infection, gum recession, tooth loss
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What foods should be reduced for better oral hygiene?
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Reduce intake of starches and sugars
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Risk factors for oral cancers
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Tobacco use, ALL TOBACCO including smokeless tobacco, chewing tobacco
Alcohol |
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Oral cancers: Increased incidence in ______, persons over age __, and _____ ______
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men
40 African-Americans |
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oral cancer is usually _____ call cancer
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squamous cell
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Where does oral cancer usually occur?
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May occur in any area, but lips, lateral tongue, and floor of the mouth are most frequently affected
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What is important about diagnosing oral cancers?
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Early detection can be curable
Late diagnosis usually ends in death |
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Early manifestation of oral cancer
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Painless mass or sore that does not heal
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Any lesion that is present more than __ _______or that does not heal should be examined and biopsied.
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2 weeks
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Later manifestations of oral cancer
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tenderness; difficulty in chewing, swallowing, or speaking; coughing up blood-tinged sputum; and enlarged cervical lymph nodes.
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Hard lymph nodes are
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abnormal
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Management of oral cancers
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Surgical resection- removal
Radiation therapy Chemotherapy |
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Which of the following conditions is exhibited by a reddened, circumscribed lesion that ulcerates and becomes crusted?
A. Actinic cheilitis B. Chancre C. Leukoplakia D. Candidiasis |
B. Chancre
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What types of foods/substances can lead to oral cancers?
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Processed foods (nitrites)
Charred/BBQ food Alcohol Tobacco |
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Nursing Diagnoses for Oral Disorders?
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Impaired oral mucous membranes
Imbalanced nutrition Disturbed body image Fear of pain and social isolation Pain Impaired verbal communication Risk for infection Deficient knowledge |
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Tell whether the following statement is true or false.
Smokeless tobacco is a potential risk factor for oral cancer. |
True
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If pt cannot tolerate tooth brushing, what would we offer?
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Mouthwashes and other methods of cleaning and rinsing
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If pt has dry mouth, what should the nurse encourage?
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More fluid intake
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If dry mouth persists what can we give?
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Use of synthetic saliva such as Oral Balance or a saliva production stimulant such as Salagen
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If imbalanced nutrition is a concern, what should the nurse assess to confirm?
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Calorie count
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How does the nurse perform a calorie count?
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3 day cal count, take menu and list how much of everything that they ate, give to dietary and they will add it up
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How to promote communication with pts who have difficulty talking
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Assess patient’s writing ability preop.
Plan communication preop. Communication board or pencil and paper Speech therapy |
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Pts that have a radial neck dissection, with removal of all lymph and muscle, will return with a what?
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Tracheostomy
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What to monitor after Radical Neck Disection?
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Airway and breathing
Pain Potential bleeding and wound drainage system Other |
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What is important pt and family teaching for pts with tracheostomy?
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Teach how to suction- airway is the highest priority
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Nursing Diagnoses for radial neck dissection pts?
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Knowledge deficiency
Ineffective airway Acute pain Impaired tissue integrity Imbalanced nutrition Impaired physical mobility secondary to nerve injury |
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HIGHEST priority for pts that have had radial neck dissection?
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AIRWAY
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Following a neck dissection, drainage greater than ___ mL is considered abnormal.
A.50 B.100 C.200 D.300 |
D. 300
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Potential complications after radial neck dissection?
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Hemorrhage
Chyle fistula Nerve injury |
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Purpose of Radical Neck Dissection?
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The purpose of radical neck dissection is to remove lymph nodes and other structures in the head and neck that are likely or proven to be malignant. Variations on neck dissections exist depending on the extent of the cancer. A radical neck dissection removes the most tissue. It is done when the cancer has spread widely in the neck.
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What is the lesser option to Radical Neck Dissection?
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A modified neck dissection
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Chyle fistula
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a leakage of lymphatic fluid from the lymphatic vessels,. A rare but potentially devastating and morbid condition.
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How to manage airway post Radical Neck Dissection?
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Frequent assessment
Place in Fowler’s position. Encourage coughing and deep breathing. If patient has a tracheostomy, provide tracheostomy care as required. |
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What to teach pt and family re home care post Radical Neck Dissection?
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Sign and symptoms to report
Wound care, dressings and drains if present Diet and medications Exercises and activity |
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What type of therapy may be necessary post Radical Neck Dissection?
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Speech therapy
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Post surgery, we are concerned if pts Hb level is lower than __
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10
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Post surgery, we are concerned if pts Hct level is lower than __
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30
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What wil happen for pt if their Hb goes below 9?
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Blood Transfusion
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What can nurse do for pt and encourage pt to do when low Hb?
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Give IV fluids and encourage iron rich foods
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post Radical Neck Dissection, ______________________ when moving the patient.
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Support the head and neck
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Suctioning should be done with great care to protect ____ _______.
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suture lines
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What foods to encourage post surgery?
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Encourage high-density, high-quality intake. (protein esp.)
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What might need to be modified about diet post surgery?
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Diet may need to be modified to liquid diet, or to soft, puréed, and liquid foods.
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What are some disorders of the esophagus?
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Dysphagia
Achalasia Diffuse spasm Hiatal hernia Perforation Foreign bodies Chemical burns GERD (gastroesophageal reflux disease) Esophageal cancer |
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Dysphagia
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Difficulty Swallowing
Most common symptom of esophageal problems |
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Some causes of dysphagia?
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muscle weakness (elderly, paralysis)
Pharyngitis Surgery |
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Odynophagia
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pain on swallowing
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Achalasia
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disorder of the esophagus, which affects the ability to move food toward the stomach
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Treatment for Alcalasia
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Distal esophagus loses motility, so Dr. dilates, and inserts a balloon at this place.
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Diffuse spasm
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Muscle spans that come and go, motor disorder
Difficult or painful swallowing, or chest pain |
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How to Dx diffuse spasms?
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BE swallow, manometry
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Esophageal manometry
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Tube inserted into esophagus, measures peristalsis (muscle contraction), and motion
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Treatment of diffuse spasms?
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Sedatives, long acting nitrates (nitroglycerin), dilation
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Which of the following is the primary symptom of achalasia?
a. Chest pain b. Heart burn c. Difficulty swallowing d. Regurgitation |
c. Difficulty swallowing
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Hiatal hernia
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a condition in which part of the stomach sticks upward into thoracic cavity, through an opening in the diaphragm, d/t a weak ileus
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Are men or women more prone to hernias?
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women
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S/S of hernia?
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Usually Asymptomatic, Can have GERD, heartburn, feeling of fullness, chest pain
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Complications of Hernia?
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Hemorrhage, Obstruction,Strangulation (stomach
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What can pts do to help symptoms of their hernia?
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Small meals, do not lie down for 1 hour after eating, elevate HOB on blocks
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How can hernias be treated?
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Can be surgically treated
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What factors can make a hernia worse?
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obesity
tight clothes pregnancy belts activity- bending/stooping |
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Fundal plication
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wrapping the top of stomach is a popular surgery for hiatal hernia
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What to expect after fundal plication surgery
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Expect to see dark fluid from stomach- old blood from surgery. If bright red blood coming up call Dr., may have beleeding at surgical site.
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After fundal plication, what type of meals and how often to eat?
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6-8 SMALL meals a day
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When does NG tube come out after fundal plication?
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When patient starts passing gas
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Perforation
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Perforated esophagus- a hole through which the contents of the esophagus can pass into the mediastinum, the surrounding area in the chest. This often results in infection of the mediastinum
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What symptoms go along with perforation?
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Severe Pain, dysphagia, fever, leukocytosis, severe hypotension
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Treatment for perforation?
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NPO, percutaneous nutrition, broad spectrum antibiotics, may require surgery
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Foreign bodies
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Something gets impacted in the esophagus
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GERD (gastroesophageal reflux disease)
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Stomach acid coming back up into esophagus
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What do we do if pt cannot swallow?
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TPN or PEG
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What is the max time we want NG tupe in for?
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1-4 weeks
no more than 4 |
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How can NG tubes cause GERD?
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They hold the ileus open and acids can come up past the tube
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Other causes for GERD?Hiatal hernia??
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Gastric distention
NG tubes Obesity Bending over, wearing tight belts, ascites 25-35% population ,more common over 45 years of age, greater incidence in females, caucasians |
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Symptoms of GERD?
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Dyspepsia after meals
Regurgitation no association with nausea or belching Dysphagia and Odynophagia |
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Dyspepsia
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heartburn
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How to relieve dyspepsia?
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antacid
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Diet restrictions GERD?
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Restrict fatty, spicy and acidic foods, Avoid large meals, carbonated beverages, or caffeine. No evening or late night snacks, eat slowly and remain upright after eating for 1-2 hours
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Lifestyle changes for GERD?
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Elevate HOB. Smoking cessation, No alcohol, reduce lifting heavy objects, straining, squatting, or restrictive clothing
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Medications for GERD?
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Antacids, Histamine 2 antagonists, Proton pump inhibitors
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Shat surgeries to relieve GERD?
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Nissen fundoplication, Hill repair , and Belsey repair
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Esophageal Cancer
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a cancerous (malignant) tumor of the esophagus
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Esophageal Cancer more common in men or women?
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Men
Particularly African American, Chinese, Iranian and >50 y/o |
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Adenocarcinoma
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Adenocarcinoma has surpassed squamous cell carcinoma, most common type. Originates in glandular tissue not normally present in the lining of the esophagus. Before adenocarcinoma can develop, glandular cells must replace a section of squamous cells. This occurs in Barrett's esophagus, a pre-cancerous condition in which chronic ACID REFLUX from the stomach stimulates a transformation in cell type in the lower portion of the esophagus.
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What are some causes of Squamous cell carcinoma?
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hot liquids/foods, poor hygiene, smoking, alcohol
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What is important about diagnosing esophageal cancer?
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If stage early can cure, if late, may see death
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Treatment for esophageal cancer?
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radiation, chemotherapy, and or surgery
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What would the nurse be teaching the patient with esophageal cancers:
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To improve nutritional status
To improve pain To prevent respiratory complications |
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Where does H.Pylori love to live?
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In the Pylorus
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What is capsule endoscopy?
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capsule sized camera takes thousands of pictures as it travels through the small intestines 10-50 thousand pictures
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Purpose of the small intestines?
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Absorb nurtients
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Where is the appendix?
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Right next to the iliocecal valve
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Purpose of appendix?
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No purpose anymore
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What is the job of the large intestine?
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Water absorption
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Pts coming from surgery will have serosanguinous bright red blood, and should not bleed more than how much?
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>250 mL in 24 Hours
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Rolling hernias
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when a part of the stomach herniates through the esophageal hiatus and lies beside the esophagus, without movement of the gastroesophageal junction
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Complications of rolling hernias
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the danger is that the stomach can become "strangled", or have its blood supply cut off.
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