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PRNU 234 Med Surg 2 > Lecture 1 Oral and Esophageal Disorders > Flashcards

Lecture 1 Oral and Esophageal Disorders Flashcards

1
Q

What external factors contribute to oral and esophageal disorders?

A

Smoking and Drinking
Dental Hygiene

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2
Q

What is an EGD?

A

esophagogastroduodenoscopy
vis

visualize esophagus, stomach, upper duodenum

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3
Q

nursing considerations for EGD

A

NPO 8 hours prior
ask about allergies to numbing and sedative agents
monitor vitals and respiratory rate

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4
Q

what is an upper GI tract study?

A

Barium swallow
Visualize structures and movement

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5
Q

Nursing considerations for upper GI tract study

A

NPO prior
Push fluids after to eliminate barium
Can cause constipation and white stools for 24-72 hours

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6
Q

Patient education for oral care

A

Brush teeth BID
Floss daily
Dental visits every 6 months
Avoidance or moderation of alcohol and tobacco

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7
Q

what is xerostomia?

A

dry mouth

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8
Q

what can cause xerostomia?

A

oral cancer
polypharmacy
HIV
inability to close mouth

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9
Q

interventions for xerostomia

A

avoid dry irritating foods
avoid alcohol and tobacco
PO fluid intake
humidified oxygen
chewing gum or lozenges
synthetic saliva

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10
Q

what can cause jaw disorders?

A

congenital malformation
fracture - trauma from bike accident, assault
cancer

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11
Q

clinical manifestations of jaw disorders

A

dull ache to throbbing pain
restricted ROM, locking
misalignment of teeth
popping or clicking noises
swelling
difficulty swallowing

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12
Q

management of jaw trauma

A

maintain airway
control bleeding
surgery

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13
Q

management of non-traumatic jaw disorders

A

NSAIDs
physical therapy

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14
Q

considerations after jaw surgery

A

monitor airway
wire cutters at bedside
diet restriction

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15
Q

risk factors for oral cancer

A

smoking
alcohol
poor oral hygiene
HPV
previous head or neck cancer

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16
Q

clinical manifestations of oral cancer

A

few early symptoms, usually has progressed by the time it is identified
- weight loss
- painless lesion that bleeds and doesn’t heal
- red or white patch in mouth or throat
- tenderness
- difficulty chewing or swallowing
- speech difficulty
- coughing up blood
- enlarged cervical lymph nodes

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17
Q

management of oral cancer

A

radiation, chemo
surgical options
- simple excision
- partial or total glossectomy
- radical neck dissection to remove lymph nodes

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18
Q

what is removed in a radical neck dissection

A

lymph nodes
sternocleidomastoid
internal jugular vein

19
Q

nursing management after radical neck dissection

A

optimize nutrition
establish communication strategy

20
Q

nursing interventions for impaired airway post radical neck dissection

A
  • high fowlers
  • non-rebreather
  • take vitals
  • observe for swelling and drainage
  • racemic epinephrine
  • therapeutic communication
  • call rapid response and notify surgery team
21
Q

maintaining airway clearance after radical neck dissection

A
  • fowlers position
  • pay attention for stridor
  • assess s/s of respiratory distress
  • pulmonary hygiene
  • extremely careful oral suctioning if patient cannot clear secretions
  • humidified oxygen
  • assess and control pain
22
Q

what do you want to check for new graft after radical neck dissection?

A
  • color and temp, look for cyanosis
  • doppler pulse check for tissue perfusion
23
Q

what should we expect for drainage post radical neck dissection?

A

JP drain

notify for excessive drainage

drainage should be serosanguinous

24
Q

wound care post radical neck dissection

A
  • monitor dressing
  • reinforce dressing PRN
  • empty JP drain and document output
  • administer prophylactic antibiotics
  • administer enteral or parenteral nutrition
25
Q

emotional support post radical neck dissection

A
  • coping
  • self image
  • alcohol and nicotine cessation
26
Q

communication strategies for radical neck dissection

A
  • assess communication abilities prior to surgery
  • dry erase board
  • communication board
27
Q

monitoring and avoiding complications post radical neck dissection

A
  • promote physical mobility
  • avoid valsalva maneuver
  • assess and trend VS to monitor for hemorrhage
  • assess facial paralysis or trouble swallowing as signs of nerve injury
28
Q

checkpoints of the esophagus

A
  1. starts at mouth
  2. upper esophageal sphincter
  3. esophageal hiatus - diaphragm
  4. lower esophageal sphincter
  5. ends at stomach
29
Q

risk factors for GERD

A

obesity, pregnancy
alcohol intake
caffeine intake
smoking
diet, large meals
sedentary lifestyle
hiatal hernia
ascites
tight belts
NG tube

30
Q

signs and symptoms of GERD

A
  • abdominal and chest pain
  • burning sensation
  • bad taste in mouth
  • nausea
  • burping
  • difficulty swallowing
  • sensation of something caught in esophagus
  • pulmonary symptoms from acid aspiration (rare, very severe GERD)
31
Q

pre procedure education for upper endoscopy

A
  • NPO after midnight
  • procedure will use sedation
  • no work after procedure, will need ride home
32
Q

complications of GERD

A
  • strictures
  • barret’s esophagus
  • dental carries
  • pulmonary complications
33
Q

preventing GERD symptoms

A

elevate HOB
eat at least 2 hours before bed

34
Q

pharmacologic management of GERD

A

antacids - calcium carbonate
H2 antagonists - famotidine
PPI - omeprazole
Prokinetic Agent - Metoclopramide: accelerate gastric emptying

35
Q

what is barret’s esophagus?

A

uncontrolled GERD alters esophageal mucosa, causing the formation of precancerous cells

36
Q

managing barret’s esophagus

A

EGD
PPIs to manage GERD

37
Q

what is a hiatal hernia?

A

top portion of stomach protrudes upwards

38
Q

describe a Type 1 hiatal hernia

A

sliding hiatal hernia
lower esophageal sphincter/gastroesophageal junction moves upwards from displacement and hiatus has widened

39
Q

describe a Type 2 hiatal hernia

A

paraesophageal or rolling hernia
lower esophageal sphincter/gastroesophageal junction are in normal position, portion of stomach protrudes upwards adjacent to and past the lower esophageal sphincter

40
Q

clinical manifestations of type 1 hiatal hernia

A

pyrosis
regurgitation
dysphagia
can be asymptomatic

41
Q

clinical manifestations of type 2 hiatal hernia

A

feelings of fullness after eating
feeling breathless after eating
feeling of suffocation
angia-like chest pain
increased symptoms when laying flat

42
Q

complications of type 2 hiatal hernia

A

hemorrhage
strangulation of hernia
obstruction

43
Q

management of hiatal hernia

A

frequent small feedings
do not recline 1 hour after eating
elevate HOB

44
Q
A

PRNU 234 Med Surg 2 (7 decks)

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