Chapter 56 Flashcards
Sever stomatitis and edema have the potential to….
Abstruct the airway
Foods that can trigger aphthous ulcers include..
Coffee, potatoes, cheese, nuts, citrus fruits, and gluten
The patient has white plaque-like lesios on the tongue, palate, buccal mucosa, and pharynx. When wiped away the underlying surface is red and sore. What does the nurse document this as?
Oral Candidiasis
If the lesions are seen in the throat, the nusre should expect them to also be in the _________ and should assess for ________
esophagus, dysphagia
The nurse should teach the patient to perform a self-examination of the mouth every _______.
Week
Those at risk for candidiasis include…
Older adults Those on anti-biotics long term Diabetic Malnourished Emotional stress
Dentures can be colonized with _____ contributing to denture stomatitis
Candida albicans
Dysphagia can lead to these problems:
Airway obstruction
Aspiration pneumonia
Malnutrition
True or False: Sodium lauryl sulfate toothpaste is best for patients who need meticulous oral hygeine
False- This type of toothpaste should be avoided
Thep atient should rinse the mouth every _________ with _______ or _________.
2-3 hours, sodium bicarbonate solution, warm saline (may be mixed with hydrogen peroxide)
_____________, __________, and __________ are drug therapies used for stomatitis.
Antimicrobials, Immune modulators, and symptomatic topical agents
Thetracycline should be used ______ times per day and should be used by….
4, swish/swallow
A broad term that refers to inflammation within the oral cavity
Stomatitis
Painful single or multiple ulcerations
Aphthous ulcers (canker sores)
Primary stomatitis is the most common type and includes:
Aphthous stomatitis, herpes simplex stomatitis, and traumatic ulcers
Secondary stomatitis is a result of..
Infection by opportunistic viruses, bacteria, or fungus
Immunocompromised patients
Chemotherapy
Common type of secondary stomatitis common in older adults. caused by long-term antibiotic therapy
Candida Albicans
Causes of candidiasis
Chemotherapy, radiation, steroids
Diseases that can cause stomatitis
HIV, chronic kidney disease, inflammatory bowel disease
Poor oral health is a risk factor for…
ventilator associated pneumonia
Ulcerations can alter _________ status.
Nutritional
When assessing the mouth, the nurse should also palpate the ______ and ______ lymph nodes for swelling
Cervical, submandibular
If the patient reports dysphagia with coughing and food sticking in the throat, the nurse should…
Document and notify the provider
The diet for the patient with stomatitis consists of…
Soft, bland, nonacidic foods
True or False: You should remove the patients dentures if stomatitis is severe.
True
Mouth care should be provided every ___ hours for the patient with uncontrolled stomatitis
2
__________ is typically prescribed for recurrent aphthous ulcers (RAUs)
Tetracycline syrup
May also use minocycline swish/swallow and chlorhexidine mouthwash
________ is prescribed for immunocrompomised patients who contract herpes simplex stomatitis while patients with a normal immune system may be prescribed _________.
IV acyclovir (Zovirax), Oral or topical acyclovir *Ensure normal kidney function
Patients are typically prescribed ____________ for yeast and other fungal infections. It can be taken……
nystatin (Mycostatin)
swish and swallow or ice pop troches
Topical triamcinolone in benzocaine and oral dexamethasone are used as a ____________ preparation and commonly used to treat _____________ .
swish/expectorate, stomatitis (especially RAUs)
Oral levamisole, topical amlexanox (Aphthasol), topical granulocyte-macrophage colony-stimulating factor (GM-CSF) and Thalidomide are all….
Immune modulating agents
OTC benzocane anestetics such as Orabase and Anbesol as well as camphorphenol (Campho-Phenique) and lidocaine mouthwash are used to treat…..
Pain associated with stomatitis
Patients should use extreme caution with lidocaine gargle/mouthwash because…
it is an anesthetizing agent and may cause burns from hot liquids in the mouth. It also makes the patient more susceptible to choking
Dietary changes to help control pain associated with stomatitis include…
Cold liquids (to soothe) Eating foods high in protein and vitamin C (to promote healing) Avoiding hard, spicy, salty, and acidic foods or fluids (that can irritate ulcers)
Which of these foods is appropriate for a breakfast for the patient with RAUs?
- Apples
- Bananas
- Puddings and custards
- Toast
- Scrambled eggs
- Ice cream
- Coffee
- Orange juice
2, 3, 5, 6
The nurse notes raised, thickened, white, sharply rounded patches on the patients tongue. When she tries to scrape them off, they do not remove. what does the nurse document this as?
Leukoplakia
Leukoplakia lesions found on the __________ are more likely to progress to cancer
Tongue or lips
Causes of leukoplakia include…
Chronic cheek biting
Poorly fitting dentures
Broken/poorly repaired teeth
_______ can be found in patients with HIV infection and is associated with ___________ and can be an early manifestation of HIV infection
OHL (oral hairy leukoplakia) , Epstein-Barr virus (EBV)
*OHL is associated with progression of HIV to AIDS
________ is the most common oral lesion in adults.
Leukoplakia
One of the largest risk factors of Leukoplakia is ___________ and it is more likely in people older than _____ years and twice as more likely in ______.
Smoking, 40, men
The patient has a red, velvety mucosal lesion on the surface of the oral mucosa. The nurse documents this as…
Erythroplakia
True or False: Erythroplakia is more malignant than leukoplakia
True- Considered precancerous.
The patient has erythroplakia. The nurse expects the doctor will….
Analyze by biopsy
Prevention strategies for oral cancer….
Minimizing sun/tanning bed exposure
Tobacco cessation
Decreasing alcohol intake
More than 90% of oral cancers are….
Squamous cell carcinomas
__________ is the earliest sign of oral carcinoma. Oral lesions that appear _______________________ are suspicious for cancer. A lesion that does not heal within ___________ or ____________ is a symptom that warrants further assessment
Mucosal erythroplasia/red, raised, eroded/2 weeks/thickening in the cheek
Identify risk factors for oral cancer:
- Heart disease
- Periodontal disease
- Braces
- Poor oral hygeine
- Smoking
- Drinking
2, 4, 5, 6
Identify risk factors for oral cancer:
- HPV
- HIV
- Sun exposure
- Poor nutrition
- Plumbers
- Gum chewing
1, 3, 4, 5
Identify risk factors for oral cancers:
- Soda drinkers
- Coal/metal miners
- Textile workers
- Dentures
- Genetics
- Athletes
2, 3, 5
____________ occurs primarily on the lips
Basal cell carcinoma
Lesion that is asymptomatic and resembles a raised scab
Basal cell carcinoma
Ulcer with a raised pearly border
Evolved basal cell carcinoma
True or False: Basal cell carcinomas do not metastasize
True (can aggressively involve the face)
The biggest risk factor for basal cell carcinoma is…
Excessive sunlight exposure
Second most common type of oral cancer
Basal cell carcinoma
Malignant lesion in the blood vessels
Kaposi’s sarcoma
A painless raised, purple nodule or plaque
Kaposi’s sarcoma
The __________ is the most common site of Kaposi’s sarcoma
Hard palate
Karposi’s sarcoma is most often associated with…
AIDS
Oral bleeding could indicate _________ or ___________
Ulcerative lesion or Periodontal gum disease
____________ may be related to metastasis, heavy alcohol intake, difficulty in eating/chewing, or an underlying health problem.
Weight Loss
Symptoms of oral cancer include:
- Weight Gain
- Thickening of cheek
- Difficulty chewing
- Vomiting
- Thick saliva
- Halitosis
2, 3, 5
Which of these are symptoms of oral cancer?
- Lump in cheek
- Weight loss
- Coughing
- Absent saliva
- Painless, red, raised oral lesion
- Aphthous ulcer
1, 2, 4, 5
Which of these are symptoms of oral cancer?
- Bleeding in the mouth
- Poor appetite
- Dry mouth
- Dysphagia
- White, scrape-able lesion
- Pain
1, 2, 4
The psychosocial affects of oral cancer include an impact on the patient’s…
self-concept
________ is helpful in determining whether a lesion is precancerous
Oral CDx brushing
________ is the definitive method for diagnosis of oral cancer.
Biopsy (needle or incisional)
_______ is useful in detecting perineural involvement and in evaluating thickness in cancers of the tongue
MRI
_______ and ________ can be used to determine spread to liver or lungs
MRI, CT
____________ may be useful for screening high-risk patients.
Toluidine blue
The priority for the nurse with a patient with extensive tumor involvement and copious, tenacious (thick and stringy) secretions is…
Maintaining an open airway
Nursing interventions to manage the patient’s airway include… (3)
Increase air exchange
Remove secretions
Prevent aspiration
Lung sounds:
_________ may be caused by aspiration, ______ may be caused by partial airway obstruction.
The nurse should promote _________ to help produce ______ and to ____________.
Wheezes, Stridor, deep breathing, effective cough, mobilize secretions
To increase air-exchange, the nurse should….
Place patient in semi or high-Fowlers
To liquefy secretions, the nurse should…
Encourage fluids
___________ increases air exchange and promotes effective coughing
CPT (chest physiotherapy)
The remove secretions that obstruct the airway, the nurse should….
Use oral suction (Yankauer catheter) and teach patient and family to use as needed
If edema occurs, the nurse should expect a prescription for…
Steroids (to reduce inflammation)
A cool mist supplied by a face tent helps to assist with ______________ and controls _______
oxygen transport, edema
Aspiration precautions include frequent assessment of the patients _____, _________, and ___________. The patient should be positioned in __________. __________ should be readily available. _______ should be assessed before giving liquids if patient is at high risk. Feed the patient small amounts and teach visitors to speak with nurse before offering food or drink. _________ are given as an aid to prevent aspiration.
LOC, Gag reflex, Ability to swallow, High-fowlers (90*), Suction equipment, Gag reflex, Thickened liquids
Perform oral hygiene every 2 hours for patients with __________, _____, or in the ________ period.
ulcerated lesions, infection, immediate postoperative
*Modifications for oral discomfort, bleeding, or edema
If the platelet count falls below ______/mm^3, switch the patient to a _______.
40,000, chemobrush
__________ can be curative in early-stage lesions in the floor of the mouth or anterior of the tongue. Hospitalization is usually needed for the treatment. A ___________ may be required because of edema and increased oral secretions and the patient will be placed on ___________ precautions while materials are active or in place.
Interstitial radiation therapy (brachytherapy), tracheostomy, radiation transmission
True or False: Patients undergoing radiation and/or chemotherapy should not take any other drugs.
True- decrease ability to tolerate drugs (vitamins, OTCs, herbs, etc.) and they should ask their doctor first.
_________ is a growth factor used to treat oral cancer. This is a new advance known as targeted therapy
EGF (epidermal growth factor)
Smaller lesions may be responsive to _______, _______, or _______ therapies.
Carbon dioxide laser therapy, cryotherapy (extreme cold application), photodynamic therapy
For small, local excisions, postoperative restrictions include…
Liquid diet for a day, then advance as tolerated .
*No activity limitations or postop analgesics
Preoperative teaching for patients undergoing large surgical excisions should have these expectations after surgery
- Tracheostomy, oxygen therapy, and suctioning
- Temporary loss of speech (tracheostomy)
- Frequent monitoring of vitals
- NPO status until sutures are healed
- Need to have IV lines placed (drug therapy, hydration)
- Postoperative drug therapy and surgical drains
- Out of bed first post-op day
- Selecting means of communication for after surgery
Three factors that influence the extent of the surgery performed
Size and location of tumor
Tumor invasion into the bone
Metastasis into neck lymph nodes
Glossectomy
Tongue removal
Mandibulectomy
Jaw removal
Commando procedure
COMbined neck dissection, MANDibulectomy, and Oropharyngeal resection
Metastasis to _________ usually indicates a poor prognosis for patients with cancer of the oral cavity.
Cervical lymph nodes
*Neck dissection may be performed
Nursing interventions for the oral cancer excision postoperative phase focus on…
**MAINTAINING PATIENT’S AIRWAY
Reliving pain and discomfort
Promoting nutrition
The Trachostomy tube may be removed when…
THe patient has an adequate airway and can effectively clear secretions with coughing
*Airtight dressing placed over site
Postoperatively, the priority nursing intervention is for the nurse to…
Remind the patient of the tracheostomy tube and the reason why s/he cannot speak. Provide reassurance that vocal cords are intact (except in laryngectomy)
Postoperatively for the patient who has undergone excision of an oral tumor, the nurse should give oral care every ___ hours.
4
Infection of the oral cavity post-operatively can be detected by….
Unusual odors
To decrease edema, the nurse should…
Elevate the head of the bed.
If skin grafting was done, the nurse should inspect the donor sight every ____ hours for ___________ and __________.
8, bleeding, signs of infection
__________ is usually the initial pain medication given post-operatively for the patient who has had excision of oral cancer
IV morphine
_______ or ________ may be sued for systemic relief of moderate pain after IV medication is discontinued.
Tylox, Percocet
______ or _____ may be needed post-operatively because the patient remains NPO until….
NG feeding, TPN, The surgical incision has healed
When the patient has started oral intake, the nurse should assess for….
Difficulty swallowing
Aspiration
Leakage of saliva/fluids from the suture line
The patient post-operative for excision of oral cancer should be weighed _______ and I&Os should be taken. If the patient is having difficulty maintaining hydration, they may have a ________ placed.
Daily, gastrostomy tube
The patient should perform _____________ with a speech-language pathologist. __________ fluids may be needed to prevent aspiration. Swallowing impairment may be temporary or permanent
Swallowing exercises, Thickened
Acute effects of radiation include….
Treatment-related mucositis, stomatitis, and alterations in taste
Long-term effects of radiation are… and require…
Xerstomia, dental decay
ongoing oral care, use of saliva substitutes, follow-up dental visits
__________ is a common side effect of radiation and chemotherapy
Fatigue
If the tracheostomy tube have been removed before discharge, the patient is placed on a _______ diet.
Soft
Continuing care for the patient with oral cancer includes:
Adding _____ to food, using ________ if dysphagia is present, eating _____ foods if stomatitis occurs, inspecting the mouth _______ for changes (such as redness), clean with __________, and avoid ________.
spices, thickened liquids, soft, daily, non-deodorant soaps (Ivory)
_________ and ______ make nutrition difficult to maintain for the oral cancer patient.
Alterations in taste, dysphagia
*Loss of taste is sometimes permanent
Diet for the oral cancer patient includes..
Use of seasonings and gravies
Liquid supplements (especially for those just beginning to eat)
Soft foods (if bleeding or stomatitis)
Eating high-protein foods (cheeses, milk, eggs, puddings, and legumes)
The patient should use a __________ to provide oral hygiene, wash it with _______ or ________ after each use, and change it _______. It may also be cleaned in the __________
Chemobrush, hydrogen peroxide/water, diluted bleach solution, weekly, dishwasher
If the patient has Xerstomia as a result of radiation, long term consequences may be….
Inability to eat dry foods, use of saliva substitutes
Skin reactions are a common side effect of radiation so the patient should avoid __________, _______, and cleanse the face and neck with ___________. Male patients should use _______ for shaving and avoid _______ to prevent further skin irritation
Sun exposure, perfumed lotions/powders, gentle non-deodorant soap, electric razor, alcohol-based after-shave lotion
The oral surgery patient should be referred to a ______ for continuing care
Case Manager
Inflammation of a salivary gland
Acute sialadenitis
Acute sialadenitis is caused by…
Infectious agents, irradiation, or immunologic disorders
Most common causes of acute sialadenitis are…
Staph, strept, E. coli
Acute sialandenitis commonly affects the ______ or _______ glands in adults
Parotid, submandibular
For the patient with acute sialandenitis the nurse should…..
Administer IV fluids
Apply warm compress
Massage gland
Use saliva substitutes
Use sialagogues (substances that stimulate flow of saliva)
Elevate head of bed to help drain edematous gland
Sialagogues include…
Lemon slices, Citrus-flavored candy, Fruit-flavored candy
Exposure of glands to radiation produces a type of sialadenitis known as ____________ within _________.
Xerostomia, 24 hours
*May be temporary or permanent
For the patient with xerostomia from radiation, the nurse should…
Offer frequent sips of water and frequent mouth care (especially before meals)
Use saliva substitutes (provides moisture for 2-4 hours)
The nurse should assess the patient with salivary gland tumor involvement for….
Facial paralysis or weakness (because of close proximity to facial nerve)
Salivary gland tumors present as….
Localized, firm masses
*May be tender and painful
Treatment of choice for salivary gland cancers is…
Surgical excision
radiation is also used
