Chapter 53 Flashcards
PASS If this dysphagia is suspected
Probable that the patient will have swallowing difficulty
account for the previous one problems
screen for signs and symptoms
speech language pathologist referral
Signs and symptoms of dysphagia to be alert for if the patient has stomatitis
Coughing or choking when swallowing
sensation of the food sticking in the pharynx
difficulty initiating the swallow process
What to teach patients when using for viscous lidocaine/ magic mouthwash
Use extreme caution because it’s anesthetizing in effect may cause burns from hot liquids in the mouth and or increase the risk of choking
What is stomatitis?
Inflammation within the oral cavity it may present as painful single or multiple ulcerations, called apthous or canker sores.
Inflammation and erosion of the protective lining of the mouth is one of the most common forms
What is primary Somatitis
The most common type includes aPHTHOUS somatitis herpes simplex sOmatitis and traumatic ulcers these are non-infectious.
What is secondary stomatitis?
result from opportunistic virus fungi or bacteria in patients with that compromise immune system or drug such as chemotherapy
What is a common type of stomatitis
Candida which is present in mouth in small amounts especially older adults
Some causes of Candida
long-term antibiotic therapy
immunosuppressive therapy:chemotherapy radiation or steroids
Infection allergy
vitamin deficiency;vitamin B or iron folate zinc
systematic disease o
irritatants: such as tobacco and alcohol
hyperactivity of the immune system
What foods can trigger allergic responses to cause apthous ulcers
Coffee potatoes cheese nuts fruits and gluten
Assessment for stomatitis
History of recent infections nutrition changes
hygiene habits or trauma stress drug history including OTC
nutrition and herbal supplements
course of outbreaks
If lesions interfere swallowing eating or communicating
What is Oral candidiasis?
White plaquelike lesions appear on the tongue palette pharynx cheek when there are wiped away the tongue is red and sore
patients report alterations in comfort or dry hot lesion
down the esophagus patient may have difficulty swallowing/dysphasia
throat pain
What to document when assessing the mouth
characteristics of the lesions including the location, size, shape, odor, color and drainage.
coating or cracking
difficulty swallowing
Patient at risk for candidasis
Older adults due to decreased immune function
Diabetes malnourished
emotional stress
multiple medications that contribute to or dryness and decrease salvation
Dentures
older adults with poor oral hygiene
Older intubated patients in critical care settings
Interventions for stomatitis To preserve tissue integrity
Remove the dentures
oral hygiene after each meal or more frequent
Mouth care every two hours or more frequently
Soft toothbrush/gauge
Rinse with warm Saline or sodium bicarbonate or combination
avoid mouthwash with alcohol and lemon
Select soft bland no acidic foods
apply tropical analgesics or anesthetics
Interventions to minimize alterations and comfort with Stomatitis
hot or cold liquids can be soothing
Avoid Hard spicy salty acidic foods
Chose foods high in protein and vitamin C such a scramble eggs bananas custards pudding and ice cream
over-the-counter medication such as a benzocaine anesthetic: orabase
lidocaine may also be prescribed as a gargle or mouthwash
Leukoplakia
Slowly develop remember it’s causing thickening and white firmly attached patches they cannot easily be scraped off they are slightly raise and Sharply round which are benign
Leukoplakia risk factors
Poor fitting dentures chronic cheek nibbling , Broken teeth HIV infection Or Epstein bar virus tobacco People over 40 years old higher in men than women
Erythroplakia
Read a velvety Makossa lesions on the surface of the oral Macosa these are malignant or pre-cancerous and a biopsy should be performed most commonly found on the floor of the mouth tongue palate and mandibular mucosa
Prevention strategies for oral cancer
Minimize sun exposure
tobacco cessation
decrease alcohol intake
reduce exposure radiation from x-rays
Major risk factors for oral cancer
Increasing in age older than 40 years old
alcohol use
tobacco use
Highest risk the person using alcohol and tobacco together
Textile workers plumbers coal metal workers
periodontal gum disease
sun exposure
poor nutrition poor oral hygiene infection of HPV 16
Kaposi’s sarcoma
a malignant lesion and blood vessels appear as raise purple/ reddish Nigel or plaque usually painless is found in the hard palate and his
most common site also can be found in the gums and tongue or the tonsils it it also is often associated with aids
Nursing intervention for oral cancer treatment
Maintain an open airway is priority of care to promote gas exchange
Second is the focus on restoring and maintaining oral health
Non-surgical interventions for oral cancer
Increase gas change removing secretions prevent aspiration
Asses RR for quality rate and depth. Stridor is obstruction
promote deep breathing exercises and effective coughing mobilize secretions
To promote gas exchange place the patient in semi flowers or high flowers encourage fluids if gas reflexes intact chest physiotherapy increases exchange and promotes effective coffee collaborate with the respiratory therapist use oral suction equipment
Genetic considerations
Genetic variations in patients with orange cats are having fun especially in imitation of the TP53 is nicknamed the guardian of the genome because two more protein P 53 is essential for cell division regulation and prevention of tumor formation always ask family history of any type of cancer oh yeah a session patience for organic
Aspiration precautions Risk factors and prevention
Assess LOC gag reflex
ability to swallow to prevent aspiration
place the patient sitting upright at 90° high Fowlers position
Keep suction equipment nearby
access to gas reflex before giving fluids, UAP to feed patients
teach visitors to speak with you before offer any type of food or liquid
Thicken liquids as an aid to prevent aspiration
Refer to speech and language pathologist I
swallow study may be needed
Teach patients undergoing radiation or chemo therapy treatment
They may experience a decrease in ability to tolerate prescribed or over-the-counter medications as a result of being immunocompromise teach patients about expected side effects and remind them NOT to take any medication without first discussing them with their healthcare provider
Intervention actor extensive excision or resection of the oral cavity
Most important nursing intervention is maintain a patent airway to promote gas exchange
upon awakening from anesthesia the patient may not recall or realize that a tracheotomy is in place
panic because of the inability to speak remind the patient right here she cannot speak
provide reinsurance that the vocal cords are intact or your voice as long as permanent
Precautions while restarting oral fluids
Assess and document the size of difficulty swallowing, aspiration leakage of saliva or fluids from the suture line monitor
daily weights and hydration
nutrition supplementation may improve the patient’s quality of life.
patients who have weight loss or who have difficulty maintaining hydration may be candidate for the placement of a Gastrostomy
Patient and family education for self management
Follow the treatment plan for cancer therapies
taste maybe degrees offer nonspicy seasoning to food to better enjoy
use a thickening agent, eat soft foods stomatitis occur
Inspect mouth every day for changes such as redness on the agents
continue meticulous oral hygiene with the chemo brush frequency clean
brush after each use use the lava substitutes as prescribed
Avoid sun or tanning bed exposure if radiation is a part of therapy
clean with a gentle manual and soap such as Ivory
Complications side effects from radiation therapy
Treat related to mucositis, stomatitis, alterations in taste
long-term effects are xerostomia
dental decay
use of saliva substitute follow up dental visits and ongoing dental care
Fatigue is common
Which facial assessment finding any client with a saliva gland tumor prompt the nurse to notify the healthcare provider
Loss of sensation in the Tongue
