oral and esophageal disorders Flashcards
periodontal disease is conencted to systemic diseases like…
- CVD
- DM
- RA
what is the most common cause of tooth loss among adults
periodontal disease
who is at greater risk for periodontal disease
- increased age
- balck or hispanic
- current smokers
- lack of dental care (low SES)
what are some dental health considerations for the older adult
meds
poor dentition can exacerbate:
- decreased food intake, loss of appetite
- social isolation
- increased susceptibility to systemic infection
- trauma to oral cavity secondary to thinner, less vascular oral mucous membranes
what is plaque
- sticky layer of bacteria
- eating foods high in sugar
what si tartar
plaque but mineralized on your teeth
what are some keys to oral care in the inpatient
- healthy teeth must be cleaned on a daily basis
- mastication and saliva aid in keeping teeth clean: not eating or dry mouth -> bad
- nurse must brush teeth -> if you cant brush, wipe em with gauze pad and swish
- prevent drying lips, coat with water soluble gel
- promote good diet low in sugar and starch
what are some causes of esophageal perforation
- boerhaave syndrome (75%) - forceful emesis
- procedures (NG/EGD/ET)
- chemical ingestion
- foreign bodies
- stab/gunshot
whats happening with esophageal perforation
- opening in esophagus
- contets into mediastinum (systemic inflammatory response)
- can lead to sepsis
how will a client with esophageal perforation present
- neck/shoulder/upper and lower back issues
- cannot lie flat
- tachypnea and tachycardia
- severe hypotension
- fever and chills
- dysphagia and vomiting
- PAIN
- might aspirate blood
what are some labs and diagnostics for esophageal perforation
- fluoroscopy (be careful)
- CT
- EGD (not during acute phase)
what meds can help with esophageal perforation
- pain control meds
- broad spectrum antibiotics
what are some surgical interventions for esophageal perforation
from no surgery to minimal surgery to major surgery
what are some complications of esophageal perforation
- pneumonia
- sepsis
- death
- ARDS
describe nursing focus and education for esophageal perforation
- discuss risks and signs of perforation prior to procedures
- NPO x 1 month (TPN/PPN)
- add liqs back in first and progress
- if major surgery = no food x 6mo
- if no food provide good oral care
- discuss reperforation
what are some causes of foreign bodies in the esophagus
- not properly chewing food
- dumbass kids shoving things in their mouth
- fish bones
- grapes, peanuts, candies, hot dogs (HA)
how will the client present with foreign bodies in the esophagus
- acute dysphagia
- complete = increased saliva/dysphagia
- odynophagia (painful swallowing)
- gagging and choking
- CP
what are some labs and diagnostics for foreign bodies in the esophagus
- xray
- fluoroscopy/EGD
whats a complication of foreign bodies in the esophagus
obstruction and perforation
what med may help with foreign bodies in the esophagus
glucagon
no idea why tho
whats a surgical intervention for foreign bodies in the esophagus
EGD
how can nurses help with foreign bodies in the esophagus
- teach perent about small shit and their dumbass kids
- follow up with GI
what are some causes of chemical burns of esophagus
- acid/base
- intentional/unintentional
- meds
how will the client present with chemical burns of esophagus
- dysphagia
- stridor, wheezing, dyspnea, tachypnea
- abdominal tenderness and guarding
- bleeding and shock
- may need intubation
what are some labs and diagnostics for chemical burns of esophagus
- chest and abdominal xray
- eventual EGD when healed
what are some meds that can help with chemical burns of esophagus
- corticosteroids
- antibiotics if infection
what are some acute interventions for chemical burns of esophagus
- DO NOT induce vomiting
- prepare for emergent intubation
- neutralizing chemicals
how can nurses help with chemical burns of esophagus
- talk to parents about possible toxins
- know poison control number 1-800-222-1222
- discuss long term complications
- if suicide attempt to refer to couneling
- enteral feedings (G/J tube)
- pneumatic dilation (fix scar tissue)
what are some causes of GERD
- incompetent LES (little sphincter guy)
- hiatal hernia
- pregnancy
- motility disorder
whats happening with GERD
backflow of acid = esophagitis
how will the clint present with GERD
- pyrosis (heartburn)
- CP
- dysphagia
- dyspepsia/regurgitation
- sensation in throat
- disrupted sleep
what are some complications of GERD
- esophageal stricture
- esophaheal ulcer
- barrett’s esophagus (precancerous change)
what are some labs and diagnostics for GERD
- EGD
- fluoroscopy
what are some surgical interventions for GERD
- Nissen fundoplication
- LINX
what meds can help with GERD
- anatacids (tums)
- H2s (famotidine): as neesed, reduce stomach acid, can inhibit B12 absorption
- PPIs (omeprazole): daily, can inhibit B12 absorption
- prokinetics (metoclopramide): if caused by slow motility
how can nurses help with GERD
- maintain a healthy weight
- stop smoking
- elevate HOB
- stay upright after meals
- avoid triggers
- avoid tight fitting clothes
- herbal and relaxtion therapies
- follow up if worsened
- twizzlers
name the two major types of esophageal cancer
- adenocarcinoma
- squamous cell carcinoma
what are some risk factors for adenocarcinoma
- GERD
- alcohol/tobacco
- barretts esophagus
what are some risk factors for squamous cell carcinoma
- chronic ingestion hot/cold foods
- poor oral hygiene
- alcohol/tobacco
- nutritional deficiencies
- caustic injury to esophagus
what is esophageal cancer primarily found
- distal esophagus
- gastroesophageal junction
describe treatment of esophageal cancer
- if detected early = curable
- late = treat symptoms
- surgery, radiation, chemo
- esophagectomy
