Med Surg Chapter 35--Gi

Front 1

What causes tooth decay?

Back 1

bacteria on fermentable carbohydrates, which produces acids that dissolve the tooth enamel

Front 2

What is preventable hygiene?

Back 2

brushing teeth 2x day, flossing, mouth rinse, 2x year visit to dentist, avoid alcohol, tobacco, sugar, starch, replace toothbrush every 2 months

Front 3

What medications can cause dry mouth and increase risk of infection?

Back 3

diuretics, antihypertensives, antidepressants

Front 4

What is a periapical abscess?

Back 4

collection of pus in the apical dental periosteum and tissue surrounding tooth
-oral surgury

Front 5

What is malocclusion?

Back 5

misalignment of teeth when mouth is closed, can cause difficulty in cleaning
-orthodontist

Front 6

What is actinic cheilitis?

Back 6

premalignant squamous, scaling, crusty, fissure of lips
-from sun exposure

Front 7

What is herpes simplix 1?

Back 7

opportunitist infection, contagious, painful vessicle that may rupture
-acyclovir

Front 8

What is chancre?

Back 8

reddend, crusted lesion from syphillis

-antibiotics

Front 9

What is contact dermatitis?

Back 9

red rash, allergric rx to lipstick
-corticosteroids

Front 10

What is leukoplakia?

Back 10

white patches, painless, may progress to cancer
-eliminate tobacco

Front 11

What is hairy leukoplakia?

Back 11

white patches with rough hair-like protections, viral, HIV

Front 12

what is lichen planus?

Back 12

white papules that are ulcerated and painful, may become malignant
-corticosteroids

Front 13

What is candidiasis?

Back 13

(thrush) cheesy white plaque, fungus
-antifungul

Front 14

What is aphthous stomatitis?

Back 14

(canker sore) shallow white ulcer, stress
-antibiodics or corticosteriods is severe

Front 15

What is nicotine stomatitis

Back 15

(smoker's patch) red that turns to creamy thick white mucous, chronic tobacco use
-stop smoking

Front 16

What is krythoplakia?

Back 16

red patch, nonspecific inflammation

Front 17

What is kaposi's sarcoma?

Back 17

red, purple, blue lesion from HIV infection

Front 18

what is stomatitis?

Back 18

redness and edema, painful ulceration, from chemo, radiation therapy or severe drug allergy
-oral hygiene, antibiotic, antiinflamm, anesthetic

Front 19

What is gingivitis?

Back 19

painful, swollen gums, bleeding gums
-oral hygiene

Front 20

What is necrotizing gingivitis?

Back 20

(trench mouth) gray white ulcerations, bleedin gums, foul breath, painful swallowing from poor hygiene, bacterial infection, stress
-oral hygiene, irrigation

Front 21

What is herpetic gingivostamatitis?

Back 21

burning vessicles that form shallow ulcers, from herpes simplex virus, immunosuppression
-topical analgesic, irrigation, antiviral

Front 22

What is periodontitis?

Back 22

bleeding, infection, gum recession from poor oral hygiene and nutrition
-oral hygiene, dentist

Front 23

How are temporomandibular disorders categorized?

Back 23

-myofacial pain
-internal derangement of jaw
-degenerative joint disease

Front 24

How are temporomandibular disorders treated?

Back 24

stress management, ROM ex, NSAIDS, opioids, muscle relax, antidepressants

Front 25

What glands consist of the salivary glands?

Back 25

parotid, submandibular, sublingual, buccal glands

Front 26

How much saliva is produced per day and what is its function?

Back 26

1200 mL/day
lubrication, protection against bacteria, digestion

Front 27

What is parotitis?

Back 27

inflammation of parotid gland or other salivary gland

Front 28

What often causes parotitis?

Back 28

-mumps (epidemic parotitis) which is viral
-staphylococcus aureas
-dehydration or meds

Front 29

What are the s/s of parotitis and the treatment?

Back 29

sudden fever, gland swelling, pain in ear, skin turns red and shiny
-treatment is antibiotics, oral hygiene, nutrition, discont meds, analgesics, maybe parotidectomy to drain gland

Front 30

What is sialadenitis and what causes it?

Back 30

inflammation of salivary glands
-dehydration, stress, radiation, malnutrition, salivary gland calculi, poor oral hygiene
-streptococcus viridans, s. aureas, MRSA, pneumococci

Front 31

What are the s/s of sialadenitis and the treatment?

Back 31

pain, swelling, purulent discharge
-antibiotics, massage, hydration, warm compresses corticosteriods, surgical drainage

Front 32

What is sialolithiasis (salivary calculus)?

Back 32

calcium phosphate build up in submandibular gland duct

Front 33

What are the s/s and treatment of sialolithiasis?

Back 33

no symptoms unless infection, local, colicky pain, gush of saliva
-may spontaneously pass, extracted, lithotripsy (shock waves), surgery

Front 34

Where due neoplasms occur in salivary glands and how are they treated?

Back 34

parotid gland
-radiation, excision, dissection, chemo
*must be careful not to damage 7th cranial nerve

Front 35

Oral cancer is often associated with what?
What type of cancer is it and where is it most oftenly found?

Back 35

alcohol, tobacoo, chronic irritation, dietary deficiency
-squamous cell
-common on lips, tongue, floor of mouth

Front 36

What are the s/s of oral cancer?

Back 36

painless sore that will not heal (2 weeks), hardened with raised edges, may progress to tenderness, difficulty swallowing, speaking, coughing up blood, enlarged cervical lymph nodes

Front 37

What is the diagnostic test and medical management of oral cancer?

Back 37

biopsy
surgical resection, radiation, chem, reconstruction from forearm

Front 38

If a person cannot brush or floss what can they do instead?

Back 38

baking soda and water
hydrogen peroxide and water or
saline and water rinse

Front 39

What is xerostomia, what causes it and how can you manage it?

Back 39

-dryness of the mouth
-radiation, surgery, psychopharm meds, HIV, those that cannot close their mouths
-minimize alcohol, tobacco, dry irritating foods, use humidifier while sleeping, synthetic saliva

Front 40

What is stomatitis (mucositis), what causes it and how can it be managed?

Back 40

-inflamm and breakdown of oral mucosa
-side effect of chemo, radiation
-teeth extraction, fluoride treatments

Front 41

What is leukopenia, what can cause it, how can it be managed with regards to oral cancer?

Back 41

-decreased white blood cells (increase risk for infection)
-radiation, chem, AIDS, HIV, meds, malnutrition, diabetes
-after surgery freq temp checks, strict aseptic tech, skin protection

Front 42

What is included in the malignancies of the head and neck?

Back 42

oral cavity, oropharynx, hypopharynx, nasopharynx, nasal cavity, paranasal sinus, larynx

Front 43

How are malignancies of the head and neck treated?

Back 43

radiation, chemo, surgery-radical neck dissection- removal of all cervical lymph nodes, removal of sternocleidomastoid muscle, interal jugular vein, spinal accessory muscle on one side of the neck

Front 44

What are potential complications of neck dissection surgery?

Back 44

altered respiration, wound infection, hemorrhage, shoulder drop

Front 45

To help maintain airway what should be done?

Back 45

fowler's position- facilitates breathing, increases lymphatic and venous drainage

Front 46

After neck dissection what can cause hemorrhaging, what are the s/s, and what are some nursing interventions?

Back 46

-rupture of carotid artery
-tachycardia, tachypnea, hypotension, high epigastric pain (rupture)
-avoid valsalva, elevate HOB, calm environment

Front 47

What is a chyle fistula and the treatment?

Back 47

milk like drainage from thorasic duct into thorasic cavity from damage of thorasic duct
-pressure dressing, diet of parental nutrition, med chain fatty acids, surgical intervention

Front 48

What nerve damage could occur with neck dissection?

Back 48

lower face paralysis, superior laryngeal nerve- swallowing, speech problems

Front 49

Describe the anatomy of the esophagus.

Back 49

begins at base of pharynx, ends below diapham, mucus lined muscular tube that carries food from the mouth to the stomach

Front 50

What are the two esophageal sphincters?

Back 50

hypopharyngeal sphincter
gastroesophageal sphincter

Front 51

What is achalasia?

Back 51

absent or ineffective peristalis of distal esophagus, with failure of esophageal sphincter to relax in response to swallowing
Narrowing of esophagus just above stomach results in increasing dilation of esophagus in upper chest

Front 52

What are the s/s and secondary complications of achalasia?

Back 52

difficulty swallowing, regurgitation, chest pain, heartburn, discomfort of sensation of food sticking in lower esophagus
-aspiration of gastric contents

Front 53

How is achalasia diagnosed and treated?

Back 53

-x-ray, barium swallow, CT, endoscopy
-eat slowly, drink while eating, botox injections, pneumatic dilation (stretching of esophagus), esophagomyotomy

Front 54

What is diffuse spasm, the cause, s/s, diagnosis and treatment?

Back 54

-motor disorder of esophagus
-unknown cause
-difficulty swallowing, pain on swallowing, chest pain
-esophageal manometry
-nitrates, calcium channel blockers, small freq meals, pneumatic dilation, esophagomyotomy, transhiatal esophagectomy

Front 55

What is a hiatal hernia?

Back 55

upper stomach moves up into lower portion of thorax above diaphram

Front 56

What are the 2 types of hiatal hernias?

Back 56

Type I, sliding- upper stomach and gastroesophageal junction are displaced upward and slide in and out of thorax
Type II, paraesophageal- all or parts of the stomach pass through the diaphragm besides the esophagus

Front 57

What are the s/s, diagnostic tests, and potential complications?

Back 57

-heartburn, regurgitation, dysphagia, asymptomatic, fullness after eating, chest pain
-x-ray, barium swallow, fluroscopy
-hemorrhaging, obstruction, strangulation

Front 58

What is the treatment for hiatal hernias?

Back 58

freq small meals, stay upright for 1 hour after eating, elevate HOB, surgery

Front 59

What is a diverticulum?

Back 59

outpouching of mucosa and submucosa that protrudes thru a weak portion of the musculature, can accure upper, mid or lower esophagus

Front 60

What is the most common type of diverticulum?

Back 60

Zenker's diverticulum, pharyngoesophageal pulsion diverticulum or pharyngeal pouch (thru cricopharyngeal muscle in midline of neck)

Front 61

What are the s/s of pharyngoesophageal pulsion diverticulum, midesophageal diverticula, and epiphrenic diverticula (large lower)?

Back 61

-difficulty swallowing, fullnes in the neck, belching, regurg, gurgling noises (pouch fills with food when pt reclines food in pouch is regurg-coughing, halitosis, sour taste)
-less acute
-asymptomatic

Front 62

What diagnostic test is done for diverticulum?

Back 62

barium swallow
-no esophagoscopy, no blind NG tube insertion

Front 63

What is the treatement for diverticulum?

Back 63

surgical removal

Front 64

What can cause esophagus perforation?

Back 64

stab, bullet wound, trauma, chemical burn, puncture

Front 65

What are s/s and diagnostic test of perforation?

Back 65

pain, dysphagia, infection, fever, leukocytosis, hypotension
-x-ray, fluoroscopy

Front 66

How is perforation of the esophagus treated?

Back 66

broad spectrum antibiotics, NPO, surgery, may heal on own

Front 67

How are swalloed foreign bodies treated?

Back 67

glucagon to relax esophageal muscle, endoscope to remove, sodium bicarb and tartaric acid to increase intraluminal pressure

Front 68

How are chemical burns caused and treated?

Back 68

-acid or base ingestion
-NPO, esophagoscopy, barium swallow, NG tube, antibiotics, corticosteriods, may need reconstruction

Front 69

What is gastroesophageal reflux?

Back 69

excessive regurg into esophagus from incompetent lower esophageal sphincter, pyloric stenosis, or motility disorder

Front 70

What are the s/s of GERD?

Back 70

pyrosis (burning of esophagus), dyspepsia (indigestion), regurg, dysphagia, ordynophagia (pain on swallowing), hypersalivation, esophagitis

Front 71

What are diagnostic tests for GERD?

Back 71

endoscopy, barium swallow, esophageal pH monitoring, bilirubin monitoring

Front 72

How is GERD managed?

Back 72

low fat diet, avoid caffeine, tobacco, beer, milk, pepperment, spearmint, carbonated bev, 2 hours before bed, tight fitting clothes, normal body weight, elevate HOB, antacids, H2 receptors, proton pump inhibitors, surgery

Front 73

What is Barrett's esophagus?

Back 73

untreated GERD causing changes in cell lining the lower esophagus to precancerous cells

Front 74

What are the s/s and diagnostic tests for Barrett's esophagus?

Back 74

GERD, heartburn, peptic ulcer, esophageal stricture
-esophagogastroduodenoscopy, biopsy

Front 75

What is the treatment for Barrett's esophagus?

Back 75

laser thermal ablation, transhiatal esophagectomy, esophageal surgery

Front 76

What is a common benign esophageal tumor, and how are they treated?

Back 76

leiomyoma, which can occlude lumen of esophagus
-excised during esophagoscopy

Front 77

What are risk factors of esophageal cancer?

Back 77

chronic irritation (hot liquid or food), alcohol, tobacco, GERD, Barrett's esophagus, nutritional deficiencies, poor oral hygiene

Front 78

What are the two types of esophageal cancer cells?

Back 78

adenocarcinoma
squamous carcinoma
*spread into lymphatics

Front 79

What are the s/s of esophageal cancer?

Back 79

dysphagia, sensation of mass in the throat, pain or fullness, regurg, foul breath, hiccups, hemorrhaging, weight loss, substernal pain, resp difficulty

Front 80

How is esophageal cancer diagnosed?

Back 80

biopsy, CT, PET, endoscopic ultrasound

Front 81

How is esophageal cancer treated?

Back 81

surgery, radiation, chemo
*surgical resectioning has a high mortality rate from infection, pulm complications, leakage

Front 82

What is the nursing interventions for esophageal surgery?

Back 82

weight gain, high protein/calorie, fowlers position, observed for dyspnea, aspiration, temp monitor, cardiac complications, NG monitor, upright after eating, vagotomy syndrome, oral suctioning

Front 83

What is vagotomy syndrome?

Back 83

dumping syndrome
-interruption of vagal nerve fibers causing pyloric emptying (diarrhea, severe cramping)
-can be caused by Boost and Ensure