Exam 2- Upper GI Disorders Flashcards
Lip disorders
- Actinic cheilitis
- Herpes simplex 1- “cold sore”
- Chancre
Mouth disorders
- Leukoplakia
Hairy leukoplakia - Lichen planus
- Candidiasis
- Stomatitis
Gum disorders
- Gingivitis
- Periodontitis
Periapical abscess
Root canal/abstraction
Malocclusion
Incorrect placement of teeth with jaw closed
Parotitis
Sialadenitis
Inflammation of the salivary glands (common with radiation therapy and dehydration)
Neoplasm
Potential for cancer
Achalasia
Ineffective peristalsis (failure of the esophageal sphincter) to relax (for ppl with this, their food doesn’t move through the upper GI like it should)
Medications that cause dry mouth in elderly
- Anti-depressants
- Antihypertensives
- Anti-inflammatory
- Diuretic
Poor dentation can exacerbate problems of aging such as…
- Decreased food intake
- Increased risk of infection
- Loss of appetite
- Social isolation
- Trauma to oral cavity
Nursing management for upper GI
- Promotion of mouth care
- Ensure adequate food and fluid intake
- Support positive self image
- Support communication
- Minimize pain and discomfort
- Prevention of infection
- Education
Impaired Oral Mucous Membranes- Nursing Interventions (9)
- Oral care
- Dental care prior to surgery or radiation therapy
- Frequent gentle brushing and flossing
- Pt education related to oral hygiene
- Encourage fluid intake
- Use of synthetic saliva (Oral Balance, saliva production stimulant - Salagen)
- Avoid hot or spicy foods
- Vicious Xylocaine or other pain meds
- Anti-fungal medications for candidiasis, antibiotics, or corticosteroids for infection or stomatitis, topical
Anti-fungal medications
Nystatin
Synthetic saliva example
Oral Balance
Saliva production stimulant example
Salagen
Oral Cancer risk factors
Tobacco use
HPV infection
Excessive use of alcohol
Previous history of head/neck cancer
Oral cancer increased risk for what gender and what race?
Men, Caucasian
5 year survival rate for oral cancer
66%
Who is at a higher risk for oral cancer?
Smokers and drinkers
Manifestations of oral cancer
- Painless mass or sore that does not heal
When should you get an exam on a sore?
Is lesion is present for more than 2 weeks
Later manifestations of oral cancer
- Tenderness
- Difficulty in chewing, swallowing, or speaking
- Coughing up blood-tinged sputum
- Enlarged cervical lymph nodes
Assessment for oral cancer
- Examination of oral and cervical lymph nodes
- Health history
- Inspect and palpate the structures of the mouth and neck
Diagnostic for oral cancer
Biopsy on suspicious lesions
Prevention of oral cancer
HPV vaccination (children 11-21 for males and 26 for females)
Medical management of oral cancer
- Surgical resection
- Radiation therapy
- Chemotherapy
Nursing management of oral cancer
- Nutritional status assessment
(enteral feedings) - Communication
- Airway management post-op
- Oral care
- Body image
Malignancy of head and neck is what percent of all cancers?
5%
Treatment of malignancy of head and neck
- Chemo
- Radiation
- Surgery
Biggest procedure for head and neck cancer
Radical neck dissection
Problems related to radical neck dissection
- Hemorrhage
- High epigastric pain
- Chyle fistula
- Nerve injury
Early signs of potential complications of a radical neck dissection
Tachycardia
Tachypnea
Late sign of a radical neck dissection
Hypotension
Biggest complication with hemorrhage
High epigastric pain
What do we do for high epigastric pain?
- Call for help immediately
- Apply pressure
What do we avoid and observe regarding complications of a radical neck dissection?
- Avoid valsalva maneuver
- Observe dressing for s/s
What is high epigastric pain a sign of?
Carotid artery rupture
What is a chyle fistula?
Leakage of lymphatic fluid
Nursing care: What do we do for airway following a neck dissection?
- Fowler’s position
- C & DB
- Trach care
- Assess for stridor & s/s respiratory distress
Nursing care: Main actions following a neck dissection
- Assess airway
- Pain
- Bleeding
- Wound care
- Nutrition & communication
- Education, self esteem
- Physical mobility
How often do we do VS after neck dissection?
Q 15x4 x2 hours, then Q4 hours once stable
Wound care to assess/monitor after neck dissection
Drainage tubes
Dressing changes
What do nurses implement for physical mobility following neck dissection?
- Rehab exercises (done to promote maximum function after surgery)
- PT/OT consult
- Home or transitional care referral
Hiatal hernia
Opening in the diaphragm through which the esophagus passes, becomes enlarged, and part of the upper stomach tends to move up into the lower portion of the thorax
Hiatal hernia manifestations
- 50% are asymptomatic
- Heart burn
- Regurgitation
- Dyspepsia
Hiatal hernia management
- H2 receptor blockers
- Surgery to tighten cardiac sphincter
- Small, frequent meals
- Do NOT lie down for 1 hour after meals (elevate HOB)
What are the H2 receptor blockers used for a hiatal hernia?
Tagamet
Zantac
MOM
“Carafate”
Hiatal hernia nursing management
- Teaching
- Correct taking of meds
- Diet
- Lifestyle
Guidelines for diet with hiatal hernia
- Avoid spicy foods
- Avoid late night meals
- Avoid ETOH
- Frequent small meals
Hiatal hernia lifestyle is the same as…
GERD
Hiatal hernia lifestyle
- Do not recline for 1 hour after eating
- Elevate HOB on blocks 4-8 inches
Gastroesophageal reflux (GERD)
Occurs as a result of the backward flow (reflux) of gastrointestinal contents into the esophagus
Incidence of GERD increases with…
Age
(or if pt has a hiatal hernia)
GERD is associated with…
Barrett’s Esophagus
GERD manifestations
- Pyrosis
- Dyspepsia
- Regurgitation
- Dysphagia
- Painful swallowing
Pyrosis
Burning sensation
Dyspepsia
Indigestion
Diagnostic findings for GERD
- Endoscopy or barium swallow
(12-36 hour ambulatory esophageal pH monitoring to evaluate degree of acid reflux (wireless capsule))
Management of GERD
Diet therapy
What do we avoid with GERD
Peppermint
ETOH
Caffeine
Beer
Milk
Soda
SMK
Education for GERD
- Lifestyle changes
- Avoid eating or drinking 2 hours before bed
- Weight management, HOB elevated
Medications for GERD
- Anatacids
- H2 blocker
- Proton pump inhibitor
- Prokinetic medications
H2 Blockers (histamine receptor antagonists) used for GERD
Pepcid
Zantac
Axid
Tagamet (interferes w other drugs and is short acting)
Proton pump inhibitors used for GERD
Prevacid
Prilosec
Protonix
Nexium
Prokinetic meds used for GERD
Reglan
Antacids for GERD
- Maalox
- MOM
- Sodium bicarbonate
- Tums
When should you take antacids for GERD?
Before and 2-3 hours after meals
Concerns with taking antacids for GERD
- Concern with altering acid-base balance if used excessively
- Concern with getting too much magnesium, sodium, or calcium
What do H2 blockers do for GERD?
Decrease acid production
Which H2 blocker interferes with other drugs and is short acting?
Tagamet
What meds are often used OTC for GERD?
Histamine receptor antagonists
Which meds are prescribed for GERD?
Proton pump inhibitors
Proton pump inhibitor action
Reduces gastric acid production for up to 24 hours
When should you take proton pump inhibitors for GERD?
Before meals or at bedtime
What meds are used with more severe GERD?
PPIs
Which type of med do we NOT crush when giving for GERD?
PPIs
What do prokinetics do?
Accelerate gastric emptying
Which meds are not used for long term use because they cause extrapyramidal (tremors, muscle contractions, seizures) s/s?
Prokinetics
Cancer of the esophagus may be caused by…
Chronic irritation
This diagnosis is typically advanced at diagnosis
Esophageal cancer
What increases risk for esophageal cancer?
Smoking and drinking
(even secondhand smoke)
Esophageal cancer and what, go hand in hand?
GERD
Most common complaint for esophageal cancer
Dysphagia
What confirms esophageal cancer diagnosis?
EGD
Esophageal cancer treatment
Resection versus palliative care
Usually, how long is life expectancy for esophageal cancer?
Less than 6 months because of late diagnosis
