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154 Cards in this Set
- Front
- Back
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Inflammation of the mouth (lips, tongue, & mucous membranes)
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STOMATITIS
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Causes:
• Trauma • Pathogens • Irritants • Disease of the renal, liver & hematologic • Side effects of chemo drugs & radiation |
STOMATITIS
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Clinical Manifestations
Excessive salivation Halitosis Sore mouth |
STOMATITIS
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Diagnostic Test
Usually diagnosed by visual assessment and symptoms HSV (herpes simplex virus) can be diagnosed with direct • fluorescent antibody staining • rapid enzyme immunoassay • viral culture of the lesion. |
STOMATITIS
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can be cultured from stool, nasopharyngeal, throat, CSF and blood specimens.
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Enteroviruses
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Treatment
•Removal or treatment of cause •Oral hygiene with soothing solutions •Topical medications •Soft bland diet |
STOMATITIS
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(normal saline or 1 tsp of table salt mixed with 16 oz of tepid water or 1 tsp of baking soda with 32 oz of water) q1–2 h while ulcers are present may aid in reducing pain and shortening the duration of the ulceration.
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Salt-water rinses
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Equal parts of diphenhydramine and MaaloxTM or KaopectateTM. In s evere cases, 2% viscous lidocaine can be added in an equal amount, but care must be taken to limit the application of lidocaine on ulcerated mucosa, as it may be absorbed and possibly resultin arrhythmias. In addition, when applied to the posterior pharynx, lidocaine can decrease the gag reflex, increasing the risk of aspiration.
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Magic mouthwash:
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in a single application for recurrent aphthous (small ulcer) stomatitis--reduces the severity of pain without altering healing time.
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Silver nitrate
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can be given orally for herpes simplex infections to decrease the length of infection, but in order to be effective it needs to be given within the 1st 48 hours of development of oral lesions.
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Acyclovir
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is a corticosteroid. It helps to reduce swelling and mouth ulcers not caused by herpes
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Triamcinolone
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Nutritional Considerations
•Soft bland diet •Be sure to assess intake, pain may cause decreased intake |
STOMATITIS
Nutritional Considerations |
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Nursing interventions
•Assessment of lips and oral cavity •Assessment of pain & medicate for pain •Assess for decreased intake •Keep oral cavity & lips moist •Provide mouth care |
STOMATITIS
Nursing interventions |
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Teach patient to:
◦ avoid commercial mouth washes, citrus fruit juices, spicy foods, extremes in food temperature, crusty or rough foods ◦ use straw to facilitate fluids bypassing inflamed lesions (if indicated) ◦ use soft tooth brush or toothettes for oral care ◦ check for proper fit of dentures |
STOMATITIS
Teach patient to: |
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Expected Outcomes
•Decreased or absent pain •Oral intake WNL •Moist oral cavity & lips •Provide mouth care |
STOMATITIS
Expected Outcomes |
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Patient will:
◦ avoid commercial mouth washes, citrus fruit juices, spicy foods, extremes in food temperature, crusty or rough foods ◦ use straw to facilitate fluids bypassing inflammed lesions (if indicated) ◦ use soft tooth brush or toothettes for oral care ◦ check for proper fit of dentures |
STOMATITIS
Patient will: |
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Resolution of Stomatitis is the overall goal.
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May take 1-2 wks depending of causative factor
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Inflammation of the stomach or gastric mucosa
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GASTRITIS
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◦ ingestion of food contaminated with disease causing microorganiasms
◦ food that is irritating or too highly seasoned ◦ Overuse of aspirin or other NSAIDs ◦ Excessive alcohol intake ◦ Bile reflux |
Acute gastritis is caused by:
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◦ Caused by the bacteria H. Pylori and also may be caused by auto immune diseases, dietary factors, medcations, alcohol, smoking to reflux
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Chronic gastritis
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Abdominal discomfort
Anorexia Nausea Vomiting Headache Hiccupping |
Assessment findings in Gastritis -ACUTE
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Heartburn after eating
Anorexia Nausea Vomiting Belching Sour taste in mouth Vitamin B12 deficiency Pain in abdomen |
Assessment findings in Gastritis -CHRONIC
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Interventions
In acute gastritis food & fluid may be withheld until symptoms subside ◦ Afterward by order ice chips can be given followed by clear liquids and then solid foods Monitor for hemorrhagic gastritis ◦ Hematemesis, tachycardia, hypotension ◦ Notify physician for these symptoms Instruct to avoid irritating foods/fluids & other ◦ Spicy/highly seasoned ◦ Caffeine, alcohol & nicotine Instruct to take prescribed medications ◦ Antibiotics & antacids Provide information about the importance of Vitamin B12 injections if a deficiency is present |
Interventions In acute gastritis
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◦ Hematemesis, tachycardia, hypotension
◦ Notify physician for these symptoms |
Monitor for hemorrhagic gastritis
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◦ Spicy/highly seasoned
◦ Caffeine, alcohol & nicotine |
In acute gastritis Instruct to avoid irritating foods/fluids & other
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a. Vitamin A
b. Vitamin B12 c. Vitamin C d. Vitamin E |
The nurse is caring for a client with a diagnosis of gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency?
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Condition characterized by erosion of the GI mucosa resulting from the digestive action of HCL acid and pepsin
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Peptic Ulcer Disease (PUD)
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can be acute or chronic depending on degree & duration of mucosal involvement
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Peptic Ulcer
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Increased acid and pepsin release
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further mucosal erosion
Destruction of blood vessels Bleeding Then Ulceration |
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Histamine
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Increase vasodilation
Increase Capillary permeability then Loss of plasma proteins into gastric lumen and then Mucosal edema |
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Burning or gaseous pressure in high left epigastrium and back and upper abdomen
Pain 1-2 hr after meals; if penetrating ulcer, aggravation of discomfort with food Occasional nausea and vomiting, weight loss |
Gastric Ulcers
Clinical manifestations |
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Burning, cramping, pressure-like pain across midepigastrium and upper abdomen; back pain with posterior ulcers
Pain 2-4 hr after meals and midmorning, midafternoon, middle of night, periodic and episodic Pain relief with antacids and food; occasional nausea and vomiting |
DUODENAL ULCERS
Clinical manifestations |
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Recurrence rate: High
Complications: Hemorrhage, perforation, gastric outlet obstruction, intractability |
Gastric Ulcers
Complications: |
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Recurrence rate: High
Complications:Hemorrhage, perforation, obstruction |
DUODENAL ULCERS
Complications: |
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is the most common complication of Ulcers
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Hemorrhage
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What ulcer is more likely to hemorrhage
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Duodenal ulcers
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a person may feel weak, dizzy, faint, short of breath, or have crampy abdominal pain or diarrhea...Vomiting blood or “coffee ground” emesis
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MUST know S/S of hemorrhage
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'Stomach ulcers usually cause pain when they are exposed to gastric acid...but when an ulcer starts bleeding, your blood will
lessen the effect of your stomach acids, and mask any pain you would normally feel.' |
'Stomach ulcers usually cause pain when they are exposed to...
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Bleed is in upper GI tract so most likely old blood in stool…..dark tarry stools
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Blood in stool for Upper GI would be ...
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•Changes in vital signs, ↑ in amount and redness of aspirate
•Signal massive upper GI bleeding •↑ amount of blood in gastric contents •↓ pain because blood neutralizes acidic gastric contents •Maintain patency of NG tube. •Prevent blood clot blockage. •If blocked, distention results. |
ULCERS Hemorrhage
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Which is worse for an ulcer?
Location or Depth |
Depth
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•Sudden onset
•Sudden & severe upper abdominal pain that quickly spreads over abdomen •Tachycardia, weak pulse •Shoulder pain…if spillage irritates phrenic nerve •Abdominal muscles contract. Abdomen firm and boardlike in attempt to protect abdomen •Bowel sounds usually present, but could be diminished or absent May have nausea and vomiting •Bacterial peritonitis may occur within 6-12 hours…can die from peritonitis |
ULCER Perforation Clinical Manifestations
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•Shallow, grunting respirations
•Vital signs every 15 to 30 minutes •Stop all oral, NG feeds/drugs until health care provider notified. •IV fluids may be increased to replace volume lost. •Ensure any known allergies are reported on chart. •Antibiotic therapy is usually started. •Surgical or laparoscopic closure may be necessary if perforation doesn’t heal spontaneously. |
ULCER Perforation
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•Edema, inflammation, spasm & scar tissue causes narrowing
•Pain worse at end of day. Stomach fills and dilates •Relief with belching/vomiting (may be projectile) •Weight loss, constipation & dehydration •Loud peristalsis •May have visible peristaltic waves |
ULCER Gastric Outlet Obstruction
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•Stomach to regain its normal muscle tone
•Ulcer to begin to heal •Inflammation and edema to subside •ACCURATE I & O |
Tx of Gastric Outlet Obstruction:
NG tube inserted in stomach, attached to continuous suction Continuous decompression allows |
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Common to clamp tube overnight for 8 to 12 hours and measure residual in morning
When aspirate below 200 mL •Within normal range •Oral intake of clear liquids can begin |
After several days, NG clamped and residual volumes checked....
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Watch patient carefully for signs of distress or vomiting.
As residual ↓, solid foods added and tube removed IV fluids and electrolytes •Administered according to degree of dehydration, vomiting, electrolyte imbalance Pyloric obstruction: Endoscopically treated with balloon dilations Surgery may be necessary to remove scar tissue. |
Tx of Gastric Outlet Obstruction:
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Endoscopically treated with balloon dilations
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Pyloric obstruction:
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NG tube inserted in stomach, attached to continuous suction Continuous decompression allows
•Stomach to regain its normal muscle tone •Ulcer to begin to heal •Inflammation and edema to subside •ACCURATE I & O After several days, NG clamped and residual volumes checked Common to clamp tube overnight for 8 to 12 hours and measure residual in morning When aspirate below 200 mL •Within normal range •Oral intake of clear liquids can begin Watch patient carefully for signs of distress or vomiting. As residual ↓, solid foods added and tube removed IV fluids and electrolytes •Administered according to degree of dehydration, vomiting, electrolyte imbalance Pyloric obstruction: Endoscopically treated with balloon dilations Surgery may be necessary to remove scar tissue. |
Tx of Gastric Outlet Obstruction:
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Most often used
Allows for direct viewing of mucosa •Determines degree of ulcer healing after treatment •During procedure, tissue specimens can be obtained to identify H. pylori and rule out gastric cancer. |
ULCERS Diagnostic Test
Endoscopy with biopsy (EGD: Esophagastroduodenoscopy |
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Directly visualizes stomach with flexible endoscope. Biopsies may be taken and bleeds can be cauderized
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EGD
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◦ NPO for 8 hours
◦ Make sure consent signed before preop meds ◦ Explain local anesthetic is sprayed to numb throat & pt will be sedated |
Pre EGD
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◦ Keep NPO until gag reflex returns!!!
◦ May gently tickle back of throat to check gag reflex ◦ Check temperature every 15-30 minutes…sudden temperature spike is a sign of perforation |
Post EGD
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a. Monitoring the temperature
b. Monitoring complaints of heartburn c. Giving warm gargles for a sore throat d. Assessing for the return of gag reflex |
The client has undergone esophagogastroduodenoscopy (EGD). The nurse places the highest priority on which item as part of the client’s care plan?
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Noninvasive tests
Serum or whole blood antibody tests Immunoglobin G (IgG) Will not distinguish between active and recently treated disease Urea breath test Can determine active infection Stool antigen test Not as accurate as breath test Invasive tests Endoscopic procedure Biopsy of stomach Rapid urease test |
ULCERS Diagnostic Test
Tests for H. pylori |
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XRAY with fluoroscopy with contrast medium
Used to diagnose structural abnormalities of the esophagus, stomach, duodenum |
Barium Swallow (Upper GI)
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◦ Explain need to drink contrast medium and various positions placed for XRAY
◦ NPO 8-12 hours before ◦ After XRAY prevent contrast impaction…drink plenty of fluids and may need laxative ◦ Tell patient stool may be white for up to 72 hours after test |
Barium Swallow (Upper GI)Nursing responsibilities:
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Contrast medium is ingested and films taken every 30 minutes until medium reaches terminal ileum
Nursing responsibility same as Upper GI |
Small Bowel Series
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•Ineffective in distinguishing a peptic ulcer from a malignant tumor
•Do not show degree of healing |
X‐ray studies
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•Analyze gastric contents for acidity and volume
•NG tube is inserted, and gastric contents are aspirated. •Contents analyzed for HCl acid (pH, pepsin & electrolytes may be analyzed) •Fasting normal acidity should be 2.5 mEq/L |
Gastric analysis
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◦ NPO 8-12 hours
◦ Explain NG tube insertion ◦ Withhold drugs affecting gastric secretions 24-48 hours before test ◦ Ensure NO smoking morning of test |
Prep for Gastric Analysis
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Anemia
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CBC
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(IDs liver problems that complicate Treatment)
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Liver enzyme studies
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•Pancreatic function
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Serum amylase determination
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•Presence of blood
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Stool examination
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Acute phase
◦ May be NPO ◦ IVF Replacement ◦ May have NG tube connected to LIWS |
ULCERS Treatments Acute phase
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Important Health Information
Past health history: Chronic kidney disease, pancreatic disease, chronic obstructive pulmonary disease, serious illness or trauma, hyperparathyroidism, cirrhosis of the liver, Zollinger-Ellison syndrome Medications: Use of aspirin, corticosteroids, nonsteroidal antiinflammatory drugs Surgery or other treatments: Complicated or prolonged surgery Functional Health Patterns Health perception–health management: Chronic alcohol abuse, smoking, caffeine use; family history of peptic ulcer disease Nutritional-metabolic: Weight loss, anorexia; nausea and vomiting, hematemesis; dyspepsia, heartburn, belching Elimination: Black, tarry stools Cognitive-perceptual: Duodenal ulcers—burning, midepigastric or back pain occurring 2-4 hr after meals and relieved by food; nocturnal pain common; gastric ulcers—high epigastric pain occurring 1-2 hr after meals; pain may be precipitated or aggravated by food Coping–stress tolerance: Acute or chronic stress |
NURSING ASSESSMENT Peptic Ulcer Disease
Subjective Data |
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General
Anxiety, irritability Gastrointestinal Epigastric tenderness Possible Diagnostic Findings Anemia; guaiac-positive stools; positive blood, urine, breath, or stool tests for H. pylori; abnormal upper gastrointestinal endoscopic and barium studies |
NURSING ASSESSMENT Peptic Ulcer Disease Objective Data
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•Food and beverages irritating to patient are avoided or eliminated.
•Bland diet may be recommended. •Six small meals a day during symptomatic phase |
ULCERS Nutritional Considerations
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•Uncommon because of antisecretory agents
•Indications for surgical interventions •Unresponsive to medical management •Concern about gastric cancer |
ULCERS Surgical Therapy
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Gastroduodenostomy Partial gastrectomy with removal of distal 2/3 stomach and nastomosis of gastric stump to duodenum
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Billroth I:
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Gastrojejunostomy Partial gastrectomy with removal of distal 2/3 stomach and nastomosis of gastric stump to jejunum
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Billroth II:
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removal of the stomach with attachment of the esophagus to the jejunum or duodenum
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Gastrectomy:
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Monitor VS
Place in Fowler’s position for comfort and to promote drainage Administer IV fluid & Electrolyte replacement Monitor I & O Assess bowel sounds Monitor NGT suction for proper function ◦ If does not drain contents put pressure on gastric suture line ◦ Contact Dr. if tube is not functioning properly Maintain NPO status as prescribed for 1-3 days until peristalsis returns Progress diet per order from sips of clear liquids to 6 small meals QD when bowel sounds return |
Gastric Surgery Postop Care
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Following gastric surgery DO NOT irrigate or remove NG unless prescribed (risk of
disruption of gastric sutures) |
Following gastric surgery DO NOT irrigate or remove NG unless prescribed (risk of
disruption of gastric sutures) |
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◦ Hemorrhage
◦ Dumping syndrome ◦ Diarrhea ◦ Hypoglycemia ◦ Vitamin B12 deficiency |
Monitor for postop complications:
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Severing of vagus nerve
Can be total or selective Eliminates vagal impulses that stimulate hydrochloric acid secretion in the stomach |
Vagotomy
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Surgical enlargement of pyloric sphincter
Commonly done after vagotomy ↓ gastric motility and gastric emptying If accompanying vagotomy, ↑ gastric emptying |
Pyloroplasty
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Dumping syndrome
Postprandial hypoglycemia Bile reflux gastritis |
ULCERS Postoperative Complications
Most common |
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20% of patients experience after surgery.
Direct result of surgical removal of a large portion of stomach and pyloric sphincter ↓ ability of stomach to control amount of gastric chyme entering small intestine Large bolus of hypertonic fluid enters intestine ↑ fluid drawn into bowel lumen Occurs at end of meal or 15 to 30 minutes after eating Symptoms include Weakness, sweating, palpitations, dizziness, abdominal cramps, borborygmi, urge to defecate Last no longer than an hour |
Dumping syndrome
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Symptoms include Weakness, sweating, palpitations, dizziness, abdominal cramps,
borborygmi, urge to defecate Last no longer than an hour |
Dumping syndrome
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To control symptoms of the dumping syndrome (dizziness, sense of fullness, diarrhea, tachycardia), which sometimes occur following a partial or total gastrectomy... are divided into six small feedings to avoid overloading intestines at mealtimes and avoid fluids with meals
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Postgastrectomy dumping syndrome (test question)
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Concentrated sweets (e.g., honey, sugar, jelly, jam, candies, sweet pastries, sweetened fruit) are avoided because they sometimes cause dizziness, diarrhea, and a sense of fullness.
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Simple sugars
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Protein and fats are increased to promote rebuilding of body tissues and to meet energy needs. Meat, cheese, and eggs are the specific foods to increase in the diet.
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Proteins
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Variant of dumping syndrome
Result of uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into small intestine ↑ blood sugar Release of excessive amounts of insulin into circulation Secondary hypoglycemia occurs with symptoms ~2 hours after meals. Symptoms include sweating, weakness, mental confusion, palpitations, tachycardia, and anxiety. |
Postprandial hypoglycemia
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Symptoms include sweating, weakness, mental confusion, palpitations, tachycardia, and
anxiety. |
Postprandial hypoglycemia
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Surgery can result in reflux alkaline gastritis.
Prolonged contact of bile causes damage to gastric mucosa. May result in back diffusion of H+ ions through gastric mucosa PUD may reoccur. Continuous epigastric distress that ↑after meals Administration of cholestyramine (Questran) relieves irritation. Questram binds with bile acid forming and insoluable complex Give other drugs 1 hour before or 4‐6 hours after. Capable of binding with drugs in GI tract. |
Bile reflux gastritis
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Start as soon as immediate postoperative period has successfully passed.
Patient should be advised to reduce drinking fluid (4 oz) with meals. Diet should consist of Small, dry feedings daily Low carbohydrates Restricted sugar with meals Moderate amounts of protein and fat 30 minutes of rest after each meal |
ULCERS Postoperative Nutritional Therapy
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•NG tube used to decompress and decrease pressure on suture line
•Ensure NGT working properly to ensure decompresses pressure inside stomach and decreases pressure on suture line |
Ulcers Postoperative care
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• Color
Bright red at first with darkening within first 24 hours Color changes to yellow‐green within 36 to 48 hours. • Amount • Odor • NG suction must be in working order, and patency maintained. • Observe for signs of ↓ peristalsis and lower abdominal discomfort. Intestinal obstruction Accurate I/O essential Vital signs every 4 hours Frequent position changes IV therapy Observe for signs of infection. |
Aspirate observed for
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Is a result of a deficiency of intrinsic factor necessary for intestinal absorption of Vitamin B12 (can result from gastric DZ or surgery)
May need B12 injections |
Long‐term complication—pernicious anemia
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• Citrus Fruits
• Dried beans • Green leafy vegetables • Liver • Nuts • Organ meats • Brewer’s yeast |
Diet high in B12:
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Not a disease but a syndrome
Secondary to reflux of gastric contents into lower esophagus |
Gastroesphageal Reflux Disease - GERD
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No single cause
Results when ◦ Defenses of lower esophagus are overwhelmed by reflux of gastric contents into esophagus Predisposing factors ◦ Hiatal hernia ◦ Incompetent lower esophageal sphincter (LES) |
GERD Etiology and Pathophysiology
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cause irritation and inflammation
Intestinal proteolytic enzymes and bile salts add to irritation |
HCl acid and pepsin secretions reflux—
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◦ Primary factor in GERD
◦ Results in ↓ in pressure in distal portion of esophagus |
Incompetent LES
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Obesity is a risk factor.
Pregnant women are at increased risk. Cigarette and cigar smoking can contribute to GERD. Hiatal hernia is a common cause of GERD. |
Risk factors of GERD
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◦ Heartburn (pyrosis)
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Clinical Manifestations
Symptoms of GERD |
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◦ Heartburn after a meal
◦ Occurs once a week ◦ No evidence of mucosal damage |
Most individuals have mild symptoms of GERD
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◦ Mild symptoms for period of 5 years or longer
◦ Symptoms associated with difficulty swallowing ◦ Heartburn occurring more than once a week, rated as severe, or occurring at night and waking patient ◦ Older adults with recent onset of heartburn |
Health care provider should evaluate
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Clinical Manifestations
of GERD |
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Esophagitis
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◦ Barrett’s esophagus
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May occur on lips or anywhere within the
mouth |
Oral Cancers
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Important Health Information
Past health history: Recurrent oral herpetic lesions, syphilis, exposure to sunlight Medications: Immunosuppressants Surgery or other treatments: Removal of prior tumors or lesions |
Oral Cancer
NURSING ASSESSMENT Subjective Data |
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Health perception–health management: Use of alcohol and tobacco, pipe smoking; poor oral hygiene
Nutritional-metabolic: Reductions in oral intake, weight loss; difficulty in chewing food; increased salivation; intolerance to certain foods or temperatures of food Cognitive-perceptual: Mouth or tongue soreness or pain, toothache, earache, neck stiffness, dysphagia, difficulty speaking |
Oral Cancer
NURSING ASSESSMENT Functional Health Patterns |
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Integumentary
Indurated, painless ulcer on lip; painless neck mass Gastrointestinal Areas of thickening or roughness, ulcers, leukoplakia, or erythroplakia on the tongue or oral mucosa; limited movement of the tongue; increased salivation, drooling; slurred speech; foul breath odor Possible Diagnostic Findings Positive exfoliative smear cytology (microscopic examination of cells removed by scraping); positive biopsy |
Oral Cancer
NURSING ASSESSMENT Objective Data |
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PREDISPOSING FACTORS
Constant overexposure to sun, ruddy and fair complexion, recurrent herpetic lesions, irritation from pipe stem, syphilis, immunosuppression CLINICAL MANIFESTATIONS Indurated, painless ulcer TREATMENT Surgical excision, radiation |
ORAL CANCER
TYPES AND CHARACTERISTICS OF Lip |
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PREDISPOSING FACTORS Tobacco, alcohol, chronic irritation, syphilis
CLINICAL MANIFESTATIONS Ulcer or area of thickening; soreness or pain; increased salivation, slurred speech, dysphagia, toothache, earache (later signs) TREATMENT Surgery (hemiglossectomy or glossectomy), radiation |
ORAL CANCER
TYPES AND CHARACTERISTICS OF Tongue |
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PREDISPOSING FACTORS
Poor oral hygiene, tobacco usage (pipe and cigar smoking, snuff, chewing tobacco), chronic alcohol intake, chronic irritation (jagged tooth, ill-fitting prosthesis, chemical or mechanical irritants, human papillomavirus [HPV]) CLINICAL MANIFESTATION Leukoplakia; erythroplakia; ulcerations; sore spot; rough area; pain, dysphagia, difficulty in chewing and speaking (later signs) TREATMENT Surgery (mandibulectomy, radical neck dissection, resection of buccal mucosa), internal and external radiation |
ORAL CANCER
TYPES AND CHARACTERISTICS OF Oral Cavity |
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partial removal of tongue
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HEMIGLOSSECTOMY
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called “smoker's patch,” is a white patch on the mouth mucosa or tongue
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Leukoplakia
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malignant neoplasm=
a tumor that tends to grow, invade, and metastasize; usually has an irregular shape and is composed of poorly differentiated cells |
Esophageal Cancer
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Esophageal Cancer
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◦ Arise from glands lining esophagus
◦ Resemble cancers of stomach and small intestine |
Adenocarcinomas
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Esophageal Cancer
Etiology and Pathophysiology |
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◦ Smoking
◦ Excessive alcohol intake ◦ Barrett’s esophagus ◦ Central obesity ◦ Diet low in fruits and vegetables ◦ Exposure to lye, asbestos, and metal ◦ History of achalasia (failure of smooth muscles between esophagus and stomach to relax) |
Esophageal Cancer
Etiology and Pathophysiology |
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in middle and
lower portions of esophagus |
Majority of tumors located
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◦ Usually appears as ulcerated lesion
◦ May penetrate muscular layer and outside wall of esophagus ◦ Obstruction in later stages |
Malignant tumor
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Esophageal Cancer
Clinical Manifestations |
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Esophageal Cancer
Complications |
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Esophageal Cancer
Diagnostic Studies |
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Esophageal Cancer
Collaborative Care |
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Esophageal Cancer
Collaborative Care |
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Porfimer (Photofrin): Photosensitizer
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◦ Removes superficial lesions or submucosal
neoplasms |
Endoscopic mucosal resection (EMR)
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◦ Esophagectomy
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Esophageal Cancer
Collaborative Care |
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Esophageal Cancer
Collaborative Care |
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Esophageal Cancer
Collaborative Care |
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◦ After surgery, parenteral fluids given
◦ Jejunostomy feeding tube may be used. ◦ Swallowing study may be done before patient can have oral fluids. ◦ When permitted, water (30 to 60 mL) is given hourly. ◦ Gradual progression to small, frequent, bland meals ◦ Maintain upright position. ◦ Observe for intolerance of feeding. |
Esophageal Cancer
Collaborative Care |
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◦ Past medical history
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Esophageal Cancer
Nursing Management |
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◦ Imbalanced nutrition: Less than body
requirements ◦ Chronic pain ◦ Deficient fluid volume ◦ Risk for aspiration ◦ Anxiety ◦ Anticipatory grieving ◦ Ineffective health maintenance |
Esophageal Cancer
Nursing Management |
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◦ Have relief of symptoms.
◦ Achieve optimal nutritional intake. ◦ Understand prognosis of disease. ◦ Experience quality of life appropriate to disease progression. |
Esophageal Cancer
Nursing Management |
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◦ Maintain regular follow-up evaluations.
◦ Eliminate smoking and excessive alcohol intake. ◦ Maintain good oral hygiene and dietary habits. ◦ Encourage to seek medical attention for any esophageal problems. |
Esophageal Cancer
Nursing Implementation |
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Esophageal Cancer
Nursing Implementation |
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Esophageal Cancer
Nursing Implementation ◦ Preop care |
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◦ Postoperative care
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Esophageal Cancer
Nursing Implementation |
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Esophageal Cancer
Nursing Implementation ◦ Ambulatory and home care |
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Esophageal Cancer
Nursing Implementation |
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GASTROSTOMY TUBE
Reinsertion & Management |
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GASTRTIC BY-PASS SURGERY
AKA Bariatric Surgery |
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EGD
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What is used to esophageal cancer?
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Barrett's esophagus
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Complication of Gerd
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table 41-9
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study pg 954
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GASTRIC BY-PASS POSTOP CARE
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Dietary Measures Post Bariatric
Surgery |
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Mandible Fracture
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Mandible Fracture
Postoperative Care |
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◦ Observe for respiratory distress
◦ Suction at bedside ◦ Place on side with HOB slightly elevated immediately after surgery ◦ Wire cutters or scissors (wires vs rubber bands) must be taped to HOB and with patient at all times when not in room ◦ Wires/bands only cut at last resort….physician gives instructions postop for which ones to cut in emergency |
Prevent aspiration/airway obstruction:
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FOOD POISONING
causes and symptoms |
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FOOD POISONING
2 types |
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PREVENTION is the focus of interventions
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FOOD POISONING
prevention |
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Bacterial food poisoning
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study table 42-27
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1.Cook all ground beef and hamburger thoroughly.
•Use a digital instant-read meat thermometer to ensure thorough cooking (ground beef can turn brown before disease-causing bacteria are killed). •Cook ground beef until a thermometer inserted into several parts of the patty, including the thickest part, reads at least 160° F. •Persons who cook ground beef without using a thermometer can decrease their risk of illness by not eating ground beef patties that are still pink in the middle. 2.If you are served an undercooked hamburger or other ground beef product in a restaurant, send it back for further cooking. Also ask for a new bun and a clean plate. 3.Avoid spreading harmful bacteria. Keep raw meat separate from ready-to-eat foods. Wash hands, counters, and utensils with hot soapy water after they touch raw meat. Never place cooked hamburgers or ground beef on the unwashed plate that held raw patties. Wash meat thermometers in between tests of patties that require further cooking. 4.Drink only pasteurized milk, juice, or cider. Commercial juice with an extended shelf-life that is sold at room temperature (e.g., juice in cardboard boxes, vacuum-sealed juice in glass containers) has been pasteurized. Juice concentrates are also heated sufficiently to kill pathogens. 5.Wash fruits and vegetables thoroughly, especially those that will not be cooked. 6.Do not eat raw food products that are supposed to be cooked. Follow package directions for cooking at proper temperatures. 7. Persons who are immunocompromised or elderly should avoid eating alfalfa sprouts until the safety of the sprouts can be ensured. |
PATIENT AND CAREGIVER TEACHING GUIDE Prevention of Food Poisoning
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