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Med Surg 1 > Chapter 56 > Flashcards

Chapter 56 Flashcards

0
Q

Sever stomatitis and edema have the potential to….

A

Abstruct the airway

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1
Q

Foods that can trigger aphthous ulcers include..

A

Coffee, potatoes, cheese, nuts, citrus fruits, and gluten

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2
Q

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?

A

Oral Candidiasis

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3
Q

If the lesions are seen in the throat, the nusre should expect them to also be in the _________ and should assess for ________

A

esophagus, dysphagia

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4
Q

The nurse should teach the patient to perform a self-examination of the mouth every _______.

A

Week

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5
Q

Those at risk for candidiasis include…

A 
Older adults
Those on anti-biotics long term 
Diabetic
Malnourished
Emotional stress
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6
Q

Dentures can be colonized with _____ contributing to denture stomatitis

A

Candida albicans

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7
Q

Dysphagia can lead to these problems:

A

Airway obstruction
Aspiration pneumonia
Malnutrition

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8
Q

True or False: Sodium lauryl sulfate toothpaste is best for patients who need meticulous oral hygeine

A

False- This type of toothpaste should be avoided

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9
Q

Thep atient should rinse the mouth every _________ with _______ or _________.

A

2-3 hours, sodium bicarbonate solution, warm saline (may be mixed with hydrogen peroxide)

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10
Q

_____________, __________, and __________ are drug therapies used for stomatitis.

A

Antimicrobials, Immune modulators, and symptomatic topical agents

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11
Q

Thetracycline should be used ______ times per day and should be used by….

A

4, swish/swallow

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12
Q

A broad term that refers to inflammation within the oral cavity

A

Stomatitis

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13
Q

Painful single or multiple ulcerations

A

Aphthous ulcers (canker sores)

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14
Q

Primary stomatitis is the most common type and includes:

A

Aphthous stomatitis, herpes simplex stomatitis, and traumatic ulcers

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15
Q

Secondary stomatitis is a result of..

A

Infection by opportunistic viruses, bacteria, or fungus
Immunocompromised patients
Chemotherapy

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16
Q

Common type of secondary stomatitis common in older adults. caused by long-term antibiotic therapy

A

Candida Albicans

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17
Q

Causes of candidiasis

A

Chemotherapy, radiation, steroids

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18
Q

Diseases that can cause stomatitis

A

HIV, chronic kidney disease, inflammatory bowel disease

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19
Q

Poor oral health is a risk factor for…

A

ventilator associated pneumonia

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20
Q

Ulcerations can alter _________ status.

A

Nutritional

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21
Q

When assessing the mouth, the nurse should also palpate the ______ and ______ lymph nodes for swelling

A

Cervical, submandibular

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22
Q

If the patient reports dysphagia with coughing and food sticking in the throat, the nurse should…

A

Document and notify the provider

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23
Q

The diet for the patient with stomatitis consists of…

A

Soft, bland, nonacidic foods

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24
Q

True or False: You should remove the patients dentures if stomatitis is severe.

A

True

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25
Q

Mouth care should be provided every ___ hours for the patient with uncontrolled stomatitis

A

2

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26
Q

__________ is typically prescribed for recurrent aphthous ulcers (RAUs)

A

Tetracycline syrup

May also use minocycline swish/swallow and chlorhexidine mouthwash

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27
Q

________ is prescribed for immunocrompomised patients who contract herpes simplex stomatitis while patients with a normal immune system may be prescribed _________.

A 
IV acyclovir (Zovirax), Oral or topical acyclovir 
*Ensure normal kidney function
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28
Q

Patients are typically prescribed ____________ for yeast and other fungal infections. It can be taken……

A

nystatin (Mycostatin)

swish and swallow or ice pop troches

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29
Q

Topical triamcinolone in benzocaine and oral dexamethasone are used as a ____________ preparation and commonly used to treat _____________ .

A

swish/expectorate, stomatitis (especially RAUs)

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30
Q

Oral levamisole, topical amlexanox (Aphthasol), topical granulocyte-macrophage colony-stimulating factor (GM-CSF) and Thalidomide are all….

A

Immune modulating agents

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31
Q

OTC benzocane anestetics such as Orabase and Anbesol as well as camphorphenol (Campho-Phenique) and lidocaine mouthwash are used to treat…..

A

Pain associated with stomatitis

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32
Q

Patients should use extreme caution with lidocaine gargle/mouthwash because…

A

it is an anesthetizing agent and may cause burns from hot liquids in the mouth. It also makes the patient more susceptible to choking

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33
Q

Dietary changes to help control pain associated with stomatitis include…

A 
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)
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34
Q

Which of these foods is appropriate for a breakfast for the patient with RAUs?

  1. Apples
  2. Bananas
  3. Puddings and custards
  4. Toast
  5. Scrambled eggs
  6. Ice cream
  7. Coffee
  8. Orange juice
A

2, 3, 5, 6

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35
Q

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?

A

Leukoplakia

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36
Q

Leukoplakia lesions found on the __________ are more likely to progress to cancer

A

Tongue or lips

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37
Q

Causes of leukoplakia include…

A

Chronic cheek biting
Poorly fitting dentures
Broken/poorly repaired teeth

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38
Q

_______ can be found in patients with HIV infection and is associated with ___________ and can be an early manifestation of HIV infection

A

OHL (oral hairy leukoplakia) , Epstein-Barr virus (EBV)

*OHL is associated with progression of HIV to AIDS

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39
Q

________ is the most common oral lesion in adults.

A

Leukoplakia

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40
Q

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 ______.

A

Smoking, 40, men

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41
Q

The patient has a red, velvety mucosal lesion on the surface of the oral mucosa. The nurse documents this as…

A

Erythroplakia

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42
Q

True or False: Erythroplakia is more malignant than leukoplakia

A

True- Considered precancerous.

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43
Q

The patient has erythroplakia. The nurse expects the doctor will….

A

Analyze by biopsy

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44
Q

Prevention strategies for oral cancer….

A

Minimizing sun/tanning bed exposure
Tobacco cessation
Decreasing alcohol intake

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45
Q

More than 90% of oral cancers are….

A

Squamous cell carcinomas

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46
Q

__________ 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

A

Mucosal erythroplasia/red, raised, eroded/2 weeks/thickening in the cheek

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47
Q

Identify risk factors for oral cancer:

  1. Heart disease
  2. Periodontal disease
  3. Braces
  4. Poor oral hygeine
  5. Smoking
  6. Drinking
A

2, 4, 5, 6

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48
Q

Identify risk factors for oral cancer:

  1. HPV
  2. HIV
  3. Sun exposure
  4. Poor nutrition
  5. Plumbers
  6. Gum chewing
A

1, 3, 4, 5

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49
Q

Identify risk factors for oral cancers:

  1. Soda drinkers
  2. Coal/metal miners
  3. Textile workers
  4. Dentures
  5. Genetics
  6. Athletes
A

2, 3, 5

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50
Q

____________ occurs primarily on the lips

A

Basal cell carcinoma

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51
Q

Lesion that is asymptomatic and resembles a raised scab

A

Basal cell carcinoma

52
Q

Ulcer with a raised pearly border

A

Evolved basal cell carcinoma

53
Q

True or False: Basal cell carcinomas do not metastasize

A

True (can aggressively involve the face)

54
Q

The biggest risk factor for basal cell carcinoma is…

A

Excessive sunlight exposure

55
Q

Second most common type of oral cancer

A

Basal cell carcinoma

56
Q

Malignant lesion in the blood vessels

A

Kaposi’s sarcoma

57
Q

A painless raised, purple nodule or plaque

A

Kaposi’s sarcoma

58
Q

The __________ is the most common site of Kaposi’s sarcoma

A

Hard palate

59
Q

Karposi’s sarcoma is most often associated with…

A

AIDS

60
Q

Oral bleeding could indicate _________ or ___________

A

Ulcerative lesion or Periodontal gum disease

61
Q

____________ may be related to metastasis, heavy alcohol intake, difficulty in eating/chewing, or an underlying health problem.

A

Weight Loss

62
Q

Symptoms of oral cancer include:

  1. Weight Gain
  2. Thickening of cheek
  3. Difficulty chewing
  4. Vomiting
  5. Thick saliva
  6. Halitosis
A

2, 3, 5

63
Q

Which of these are symptoms of oral cancer?

  1. Lump in cheek
  2. Weight loss
  3. Coughing
  4. Absent saliva
  5. Painless, red, raised oral lesion
  6. Aphthous ulcer
A

1, 2, 4, 5

64
Q

Which of these are symptoms of oral cancer?

  1. Bleeding in the mouth
  2. Poor appetite
  3. Dry mouth
  4. Dysphagia
  5. White, scrape-able lesion
  6. Pain
A

1, 2, 4

65
Q

The psychosocial affects of oral cancer include an impact on the patient’s…

A

self-concept

66
Q

________ is helpful in determining whether a lesion is precancerous

A

Oral CDx brushing

67
Q

________ is the definitive method for diagnosis of oral cancer.

A

Biopsy (needle or incisional)

68
Q

_______ is useful in detecting perineural involvement and in evaluating thickness in cancers of the tongue

A

MRI

69
Q

_______ and ________ can be used to determine spread to liver or lungs

A

MRI, CT

70
Q

____________ may be useful for screening high-risk patients.

A

Toluidine blue

71
Q

The priority for the nurse with a patient with extensive tumor involvement and copious, tenacious (thick and stringy) secretions is…

A

Maintaining an open airway

72
Q

Nursing interventions to manage the patient’s airway include… (3)

A

Increase air exchange
Remove secretions
Prevent aspiration

73
Q

Lung sounds:
_________ may be caused by aspiration, ______ may be caused by partial airway obstruction.
The nurse should promote _________ to help produce ______ and to ____________.

A

Wheezes, Stridor, deep breathing, effective cough, mobilize secretions

74
Q

To increase air-exchange, the nurse should….

A

Place patient in semi or high-Fowlers

75
Q

To liquefy secretions, the nurse should…

A

Encourage fluids

76
Q

___________ increases air exchange and promotes effective coughing

A

CPT (chest physiotherapy)

77
Q

The remove secretions that obstruct the airway, the nurse should….

A

Use oral suction (Yankauer catheter) and teach patient and family to use as needed

78
Q

If edema occurs, the nurse should expect a prescription for…

A

Steroids (to reduce inflammation)

79
Q

A cool mist supplied by a face tent helps to assist with ______________ and controls _______

A

oxygen transport, edema

80
Q

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.

A

LOC, Gag reflex, Ability to swallow, High-fowlers (90*), Suction equipment, Gag reflex, Thickened liquids

81
Q

Perform oral hygiene every 2 hours for patients with __________, _____, or in the ________ period.

A

ulcerated lesions, infection, immediate postoperative

*Modifications for oral discomfort, bleeding, or edema

82
Q

If the platelet count falls below ______/mm^3, switch the patient to a _______.

A

40,000, chemobrush

83
Q

__________ 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.

A

Interstitial radiation therapy (brachytherapy), tracheostomy, radiation transmission

84
Q

True or False: Patients undergoing radiation and/or chemotherapy should not take any other drugs.

A

True- decrease ability to tolerate drugs (vitamins, OTCs, herbs, etc.) and they should ask their doctor first.

85
Q

_________ is a growth factor used to treat oral cancer. This is a new advance known as targeted therapy

A

EGF (epidermal growth factor)

86
Q

Smaller lesions may be responsive to _______, _______, or _______ therapies.

A

Carbon dioxide laser therapy, cryotherapy (extreme cold application), photodynamic therapy

87
Q

For small, local excisions, postoperative restrictions include…

A

Liquid diet for a day, then advance as tolerated .

*No activity limitations or postop analgesics

88
Q

Preoperative teaching for patients undergoing large surgical excisions should have these expectations after surgery

A
  • 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
89
Q

Three factors that influence the extent of the surgery performed

A

Size and location of tumor
Tumor invasion into the bone
Metastasis into neck lymph nodes

90
Q

Glossectomy

A

Tongue removal

91
Q

Mandibulectomy

A

Jaw removal

92
Q

Commando procedure

A

COMbined neck dissection, MANDibulectomy, and Oropharyngeal resection

93
Q

Metastasis to _________ usually indicates a poor prognosis for patients with cancer of the oral cavity.

A

Cervical lymph nodes

*Neck dissection may be performed

94
Q

Nursing interventions for the oral cancer excision postoperative phase focus on…

A

**MAINTAINING PATIENT’S AIRWAY
Reliving pain and discomfort
Promoting nutrition

95
Q

The Trachostomy tube may be removed when…

A

THe patient has an adequate airway and can effectively clear secretions with coughing
*Airtight dressing placed over site

96
Q

Postoperatively, the priority nursing intervention is for the nurse to…

A

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)

97
Q

Postoperatively for the patient who has undergone excision of an oral tumor, the nurse should give oral care every ___ hours.

A

4

98
Q

Infection of the oral cavity post-operatively can be detected by….

A

Unusual odors

99
Q

To decrease edema, the nurse should…

A

Elevate the head of the bed.

100
Q

If skin grafting was done, the nurse should inspect the donor sight every ____ hours for ___________ and __________.

A

8, bleeding, signs of infection

101
Q

__________ is usually the initial pain medication given post-operatively for the patient who has had excision of oral cancer

A

IV morphine

102
Q

_______ or ________ may be sued for systemic relief of moderate pain after IV medication is discontinued.

A

Tylox, Percocet

103
Q

______ or _____ may be needed post-operatively because the patient remains NPO until….

A

NG feeding, TPN, The surgical incision has healed

104
Q

When the patient has started oral intake, the nurse should assess for….

A

Difficulty swallowing
Aspiration
Leakage of saliva/fluids from the suture line

105
Q

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.

A

Daily, gastrostomy tube

106
Q

The patient should perform _____________ with a speech-language pathologist. __________ fluids may be needed to prevent aspiration. Swallowing impairment may be temporary or permanent

A

Swallowing exercises, Thickened

107
Q

Acute effects of radiation include….

A

Treatment-related mucositis, stomatitis, and alterations in taste

108
Q

Long-term effects of radiation are… and require…

A

Xerstomia, dental decay

ongoing oral care, use of saliva substitutes, follow-up dental visits

109
Q

__________ is a common side effect of radiation and chemotherapy

A

Fatigue

110
Q

If the tracheostomy tube have been removed before discharge, the patient is placed on a _______ diet.

A

Soft

111
Q

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 ________.

A

spices, thickened liquids, soft, daily, non-deodorant soaps (Ivory)

112
Q

_________ and ______ make nutrition difficult to maintain for the oral cancer patient.

A

Alterations in taste, dysphagia

*Loss of taste is sometimes permanent

113
Q

Diet for the oral cancer patient includes..

A

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)

114
Q

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 __________

A

Chemobrush, hydrogen peroxide/water, diluted bleach solution, weekly, dishwasher

115
Q

If the patient has Xerstomia as a result of radiation, long term consequences may be….

A

Inability to eat dry foods, use of saliva substitutes

116
Q

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

A

Sun exposure, perfumed lotions/powders, gentle non-deodorant soap, electric razor, alcohol-based after-shave lotion

117
Q

The oral surgery patient should be referred to a ______ for continuing care

A

Case Manager

118
Q

Inflammation of a salivary gland

A

Acute sialadenitis

119
Q

Acute sialadenitis is caused by…

A

Infectious agents, irradiation, or immunologic disorders

120
Q

Most common causes of acute sialadenitis are…

A

Staph, strept, E. coli

121
Q

Acute sialandenitis commonly affects the ______ or _______ glands in adults

A

Parotid, submandibular

122
Q

For the patient with acute sialandenitis the nurse should…..

A

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

123
Q

Sialagogues include…

A

Lemon slices, Citrus-flavored candy, Fruit-flavored candy

124
Q

Exposure of glands to radiation produces a type of sialadenitis known as ____________ within _________.

A

Xerostomia, 24 hours

*May be temporary or permanent

125
Q

For the patient with xerostomia from radiation, the nurse should…

A

Offer frequent sips of water and frequent mouth care (especially before meals)
Use saliva substitutes (provides moisture for 2-4 hours)

126
Q

The nurse should assess the patient with salivary gland tumor involvement for….

A

Facial paralysis or weakness (because of close proximity to facial nerve)

127
Q

Salivary gland tumors present as….

A

Localized, firm masses

*May be tender and painful

128
Q

Treatment of choice for salivary gland cancers is…

A

Surgical excision

radiation is also used

Med Surg 1 (5 decks)

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