Chapter 53

Question 1

PASS If this dysphagia is suspected

Answer 1

Probable that the patient will have swallowing difficulty

account for the previous one problems

screen for signs and symptoms

speech language pathologist referral

Question 2

Signs and symptoms of dysphagia to be alert for if the patient has stomatitis

Answer 2

Coughing or choking when swallowing
sensation of the food sticking in the pharynx
difficulty initiating the swallow process

Question 3

What to teach patients when using for viscous lidocaine/ magic mouthwash

Answer 3

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

Question 4

What is stomatitis?

Answer 4

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

Question 5

What is primary Somatitis

Answer 5

The most common type includes aPHTHOUS somatitis herpes simplex sOmatitis and traumatic ulcers these are non-infectious.

Question 6

What is secondary stomatitis?

Answer 6

result from opportunistic virus fungi or bacteria in patients with that compromise immune system or drug such as chemotherapy

Question 7

What is a common type of stomatitis

Answer 7

Candida which is present in mouth in small amounts especially older adults

Question 8

Some causes of Candida

Answer 8

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

Question 9

What foods can trigger allergic responses to cause apthous ulcers

Answer 9

Coffee potatoes cheese nuts fruits and gluten

Question 10

Assessment for stomatitis

Answer 10

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

Question 11

What is Oral candidiasis?

Answer 11

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

Question 12

What to document when assessing the mouth

Answer 12

characteristics of the lesions including the location, size, shape, odor, color and drainage.
coating or cracking
difficulty swallowing

Question 13

Patient at risk for candidasis

Answer 13

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

Question 14

Interventions for stomatitis To preserve tissue integrity

Answer 14

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

Question 15

Interventions to minimize alterations and comfort with Stomatitis

Answer 15

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

Question 16

Leukoplakia

Answer 16

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

Question 17

Leukoplakia risk factors

Answer 17

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

Question 18

Erythroplakia

Answer 18

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

Question 19

Prevention strategies for oral cancer

Answer 19

Minimize sun exposure

tobacco cessation

decrease alcohol intake

reduce exposure radiation from x-rays

Question 20

Major risk factors for oral cancer

Answer 20

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

Question 21

Kaposi’s sarcoma

Answer 21

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

Question 22

Nursing intervention for oral cancer treatment

Answer 22

Maintain an open airway is priority of care to promote gas exchange
Second is the focus on restoring and maintaining oral health

Question 23

Non-surgical interventions for oral cancer

Answer 23

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

Question 24

Genetic considerations

Answer 24

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

Question 25

Aspiration precautions Risk factors and prevention

Answer 25

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

Question 26

Teach patients undergoing radiation or chemo therapy treatment

Answer 26

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

Question 27

Intervention actor extensive excision or resection of the oral cavity

Answer 27

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

Question 28

Precautions while restarting oral fluids

Answer 28

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

Question 29

Patient and family education for self management

Answer 29

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

Question 30

Complications side effects from radiation therapy

Answer 30

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

Question 31

Which facial assessment finding any client with a saliva gland tumor prompt the nurse to notify the healthcare provider

Answer 31

Loss of sensation in the Tongue