Gastrointestinal Flashcards
Oral cancer risk factors
-Tobacco/ nicotine
-ETOH
-Men
- HPV infection
-Hx of head & neck cancer
Oral cancer patho
-squamous cells
-Lateral tongue, lips, floor of mouth, oropharynx are most common areas
-70% associated with HPV
Oral cancer CMs
-Few to no symptoms
-painless lesions- may bleed easily
-Leukoplakia -red or white patch in throat or mouth
-tenderness
-difficulty swallowing, chewing, speaking
-Blood-tinged sputum
-Enlarged cervical lymph (not always enlarged)
Oral cancer assessment
-Oral examination
-Palpation of cervical lymph
-PET-CT, MRI, endoscopy, laryngoscopy, biopsy
Oral cancer medical management
-Varies
-Surgical resection
-Chemo & radiation
Oral cancer nursing considerations
-Patent airway (manage secretions)
-Communication (may be impaired w/ surgery due to pain, swelling)
-Nutritional needs (PO vs enteral vs parenteral)
Oral cancer Graft assessment
-is it viable
-monitor both sites (where it came from & where they put it)
-Do not over ice (it restricts blood flow)
Oral Cancer Post surgery
-Pain (meds, liquids, soft foods)
-Mouth care ( soft toothbrush, warm salt water, oral lidocaine)
-Infection prevention( monitor WBCs, redness, swelling, drainage)
-Positive self image (could be disfigured after surgery)
-Education- on self care
Neck dissections
-Radical (removes all cervical lymph, sternocleidomastoid muscle, internal jugualr vein, spinal access. nerve on one side_
-Modified ( perserves one or more)
-Selective
neck resection nursing considerations
- Patent airway ( fowler- prevent aspiration)
-Pain Mgt. (Assess level, PCA edu)
-Wound care ( manage tubes & drainage, Monitor dressings, Assess for infection, Monitor graft site)
Neck resection compications
- loss of mobility ( prevent w/ PT/OT)
-hemorrhage (Monitor)
-Chyke leak ( milk like lymphatic fluid means damaged lymph node-call surgeon) - Nerve injury
Esophageal cancer risk factors
-Chronic irritation
-GERD
-ETOH
-TObacco
-Barrett’s esophagus
Esophageal Cancer CMs
-dysphagia
-sensation of a mass in the throat
-substernal pain
-regurgitation of food
-halitosis (bad breath)
-hiccups
-Eventually it will obstruct airway!
Esophageal Cancer nursing considerations
-Prevention of aspiration pneumonia (IS, fowler, nebulizer)
-Maintaining NG tube (low to intermittent suction, NPO)
-Maintaining adequate Nutrition (diet advance as tolerated, upright 2 hours post meals -prevents dumping syndrome)
Gastric cancer risk factors
-older adults
-men
-Hispanic, African American, Asian/Pacific islander decent
-Diet high in smoked foods, salted or pickled foods; low in fruits & vegetables (Main factor)
Gastric cancer: Reduce anxiety
-Provide safe environment
-Encourage talk therapy
-offer reassurance & support
- Education
Gastric cancer: Nutrition
-Edu on small, frequent meals
-Supplements
-Prevent dumping syndrome (low carb, low sugar meals, 6 small meals, drink after meal)
-Daily weight
- Monitor for dehydration
Gastric cancer: Pain Mgt.
-Assess pain often
-Analgesics
-PCA pump
-Nonpharm methods (reposition, peaceful environment)
Gastric cancer: Psychosocial support
-Communication techniques
-Encourage to express fears, grief
-Be honest
-Emotional support (family, clergy, social work)
Colorectal cancer risk factors
-increasing age
-smoking
-ETOH
-Diet high in fat & protein, low fiber
-Hx of genital cancer, IBD, DM2
-obesity
-previous colon cancer
colorectal cancer CMs
-Change in bowel habits
-Blood in stool
-Anemia
-Anorexia
-Weight loss
-Fatigue
-Dull rt sided pain
-Obstruction (bright red blood in stool. Lft sided)
-Tenesmus, rectal pain, alternating constipation/diarrhea
Colorectal cancer: Medical management
-surgery
-chemo
-radiation
Colorectal cancer: nursing considerations
-Pre-op edu
-Emotional support (assess anxiety level & coping mechanisms)
-Wound care (Assess dressing, encourage splinting, assess for hypovolemia & dehydration)
ulcerative colitis CMs
-LLQ pain
-Chronic diarrhea (mucus, pus, blood)
-Frequent stools >6/day
-Intermittent tenesmus
-Fever, vomiting
-Anorexia, Weight loss
-Intermittent times of exacerbation & no symptoms
Ulcerative colitis complications
-Toxic megacolon -inability to contract the colon- fever, Vomiting, fatigue
-Perforation
-Bleeding
-Malnutrition
-Increased risk for osteoporotic fractures (due to steroids)
- Increased risk for colon cancer
Pharmacological: Ulcerative Colitis
-amino salicylates
-antibiotics
-corticosteroids
-Immunomodulators
-Biological - Remicade, humira, cimziam, tysabri
-Antidiarrheal, antiemetics, sedatives
Ulcerative colitis Nutrition
-Low-residue, high protein, high calorie diet
-Supplements, vitamins, iron replacement
-Avoid: foods that exacerbate diarrhea & IBD symptoms, cold foods, smoking
-apples, beans, broccoli, caffeine, cauliflower, dairy
ulcerative colitis nursing considerations
- Promote rest
-Reduce anxiety
-Coping measures
-Prevent skin breakdown
-Complications (monitor serum electrolytes, Coag studies, dysrhythmias, LOC, bleeding, BP, S/S of perforation & obstruction)
