Gastrointestinal

Question 1

Oral cancer risk factors

Answer 1

-Tobacco/ nicotine
-ETOH
-Men
- HPV infection
-Hx of head & neck cancer

Question 2

Oral cancer patho

Answer 2

-squamous cells
-Lateral tongue, lips, floor of mouth, oropharynx are most common areas
-70% associated with HPV

Question 3

Oral cancer CMs

Answer 3

-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)

Question 4

Oral cancer assessment

Answer 4

-Oral examination
-Palpation of cervical lymph
-PET-CT, MRI, endoscopy, laryngoscopy, biopsy

Question 5

Oral cancer medical management

Answer 5

-Varies
-Surgical resection
-Chemo & radiation

Question 6

Oral cancer nursing considerations

Answer 6

-Patent airway (manage secretions)
-Communication (may be impaired w/ surgery due to pain, swelling)
-Nutritional needs (PO vs enteral vs parenteral)

Question 7

Oral cancer Graft assessment

Answer 7

-is it viable
-monitor both sites (where it came from & where they put it)
-Do not over ice (it restricts blood flow)

Question 8

Oral Cancer Post surgery

Answer 8

-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

Question 9

Neck dissections

Answer 9

-Radical (removes all cervical lymph, sternocleidomastoid muscle, internal jugualr vein, spinal access. nerve on one side_
-Modified ( perserves one or more)
-Selective

Question 10

neck resection nursing considerations

Answer 10

• Patent airway ( fowler- prevent aspiration)
  -Pain Mgt. (Assess level, PCA edu)
  -Wound care ( manage tubes & drainage, Monitor dressings, Assess for infection, Monitor graft site)

Question 11

Neck resection compications

Answer 11

• loss of mobility ( prevent w/ PT/OT)
  -hemorrhage (Monitor)
  -Chyke leak ( milk like lymphatic fluid means damaged lymph node-call surgeon)
• Nerve injury

Question 12

Esophageal cancer risk factors

Answer 12

-Chronic irritation
-GERD
-ETOH
-TObacco
-Barrett’s esophagus

Question 13

Esophageal Cancer CMs

Answer 13

-dysphagia
-sensation of a mass in the throat
-substernal pain
-regurgitation of food
-halitosis (bad breath)
-hiccups
-Eventually it will obstruct airway!

Question 14

Esophageal Cancer nursing considerations

Answer 14

-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)

Question 15

Gastric cancer risk factors

Answer 15

-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)

Question 16

Gastric cancer: Reduce anxiety

Answer 16

-Provide safe environment
-Encourage talk therapy
-offer reassurance & support
- Education

Question 17

Gastric cancer: Nutrition

Answer 17

-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

Question 18

Gastric cancer: Pain Mgt.

Answer 18

-Assess pain often
-Analgesics
-PCA pump
-Nonpharm methods (reposition, peaceful environment)

Question 19

Gastric cancer: Psychosocial support

Answer 19

-Communication techniques
-Encourage to express fears, grief
-Be honest
-Emotional support (family, clergy, social work)

Question 20

Colorectal cancer risk factors

Answer 20

-increasing age
-smoking
-ETOH
-Diet high in fat & protein, low fiber
-Hx of genital cancer, IBD, DM2
-obesity
-previous colon cancer

Question 21

colorectal cancer CMs

Answer 21

-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

Question 22

Colorectal cancer: Medical management

Answer 22

-surgery
-chemo
-radiation

Question 23

Colorectal cancer: nursing considerations

Answer 23

-Pre-op edu
-Emotional support (assess anxiety level & coping mechanisms)
-Wound care (Assess dressing, encourage splinting, assess for hypovolemia & dehydration)

Question 24

ulcerative colitis CMs

Answer 24

-LLQ pain
-Chronic diarrhea (mucus, pus, blood)
-Frequent stools >6/day
-Intermittent tenesmus
-Fever, vomiting
-Anorexia, Weight loss
-Intermittent times of exacerbation & no symptoms

Question 25

Ulcerative colitis complications

Answer 25

-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

Question 26

Pharmacological: Ulcerative Colitis

Answer 26

-amino salicylates
-antibiotics
-corticosteroids
-Immunomodulators
-Biological - Remicade, humira, cimziam, tysabri
-Antidiarrheal, antiemetics, sedatives

Question 27

Ulcerative colitis Nutrition

Answer 27

-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

Question 28

ulcerative colitis nursing considerations

Answer 28

• Promote rest
  -Reduce anxiety
  -Coping measures
  -Prevent skin breakdown
  -Complications (monitor serum electrolytes, Coag studies, dysrhythmias, LOC, bleeding, BP, S/S of perforation & obstruction)