Exam 3: Assessment of GI, Oral Cavity problems, and Esophageal problems

Question 1

RUQ contents:

Answer 1

liver, gallbladder

Question 2

RLQ contents:

Answer 2

Appendix

Question 3

LLQ contents:

Answer 3

Descending colon

Question 4

LUQ contents:

Answer 4

Spleen, other part of the pancreas, stomach

Question 5

Esophagogastroduodenoscopy (EGD)

Answer 5

Direct visualization of esophagus, stomach, duodenum

Question 6

Esophagogastroduodenoscopy (EGD) teaching

Answer 6

• NPO 6-8 hrs prior, no anticoagulants
• Moderate sedation during procedure
• Topical anesthetic depresses gag reflex
• NPO after until gag reflex returns (1-2 hrs)

Question 7

Esophagogastroduodenoscopy (EGD) nursing care

Answer 7

• Position left, side-lying

- Monitor for signs of perforation: pain, bleeding, fever

Question 8

Esophagogastroduodenoscopy (EGD) complications

Answer 8

• Respiratory rate <12 is a concern
• Base line heart rate, can get attention
• Respiratory arrest
• perforations
• Aspiration
• Respiratory acidosis

Question 9

Colonoscopy

Answer 9

• Entire large bowel
• Clear liquid diet (no red, purple, orange fluids)
• Then NPO to achieve a clean bowel
• No anticoagulants (GI doctor cannot take them off this, must check with primary physician)
• Moderate sedation

Question 10

Candidiasis treatment

Answer 10

• Oral care protocol
• Nystatin oral suspension
• Ice pop troches
• Topical triamcinolone in benzocaine
• oral dexamethasone elixer

Question 11

Oral Cancer treatment

Answer 11

Diagnosis

• Oral CDx
• Biopsy
• Surgical

Nonsurgical
- Oral care
- Radiation therapy
External beam 
Brachytherapy (implantation)

• Chemotherapy
  Risk for stomatitis
• Targeted therapy
  Block EGF receptors

Question 12

Oral cancer: Squamous cell

Answer 12

• 90 % of oral cancers
• Mucosal erythroplasia
• HPV-positive oral cancer (on rise)
  Tonsillar area
  Base of tongue

Question 13

Oral cancer: Basal cell cancer

Answer 13

More common on the lips

- lip balm

Question 14

Oral cancer: Kaposi’s sarcoma

Answer 14

• Malignant lesion in blood vessels

- Common in the hard palate

Question 15

Oral cancer: Symptoms

Answer 15

• Bleeding from the mouth
• Poor appetite
• Difficulty chewing
• Difficulty swallowing (painful swallowing)
• Poor nutritional status, weight loss
• Thick or absent saliva
• Painless oral lesion, red, raised, eroded
• Thickening or lump in cheek

Question 16

GERD Treatment: Lifestyle

Answer 16

• Eat smaller, more frequent meals
• Eat more slowly
• Eat in calm, relaxed environment
• Avoid high fat meals, high fat diary, fried foods, citrus fruits, pastry
• Avoid lying flat after eating
• Lose weight if obese
• Avoid smoking, alcohol

Question 17

Esophageal cancer: Surgical treatment

Answer 17

• MIE or Open
• Esophagectomy
• Esophagogastrostomy

Question 18

Esophagogastrostomy post op

Answer 18

• semi-fowlers
• patency of chest tube and monitor
• hypotension