Oral and Esophageal Disorders Flashcards
Oral Cancer causes
HPV, head and neck cancer, cigarette (nicotine), cigar, pipe, tobacco (smokeless),
Oral Cancer interventions
- promoting mouth care: magic mouthwash (numb and infection prevention), chlorhexadine, 1/2 tsp baking soda + salt+ warm water
-food/nutrition: TF r/t oral discomfort, cal count, liquid diet
-body image- social worker, spiritual advisor, emotional grieving
-pain/discomfort
-infection prevention
1 post-op priority for oral cancer
maintain patent airway
- increased oral secretions
- look for tracheal deviation (swelling, edema)
- upper airway sounds
Aggressive Neck Dissection
removal of sternocleidomastoid muscle
- internal jugular vein
- spinal accessory nerve – shoulder drop/dysfunction, neck depression
Modified neck dissection
preserves more anatomy
- internal jugular vein
- sternocleidomastoid
- spinal accessory nerve
Neck dissection priority problems
Hemorrhage: carotid artery rupture #1 culprit
warnings: tachycardia, tachypnea, hypotension, diminished carotid pulse (DOPPLER, DONT PALPATE), airway mgmt, increased neck drainage = CALL SURGEON
neck dissection patient education (post hemorrhage)
- no valsalva
- HOB > 45
- report increased pain/pressure on neck
- report epigastric pain
Nerve injury assessments
spinal- shrug shoulders, move head left and right
marginal mandibular (facial)- puff cheeks, smile big, raise eyebrows
vagus- uvula midline, voice quality
hypoglossal- (tongue mvmd)- stick your tongue straight out, move it side to side
brachial plexus- bilateral/unilateral arm flexion
Delivering nutrition with tube feeds
implementing orders: dietician orders rate and nutritional makeup based on pt nutritional needs,
common complications: mechanical prob/displacement, aspiration, GI issues (cramping, v/d), hyperglycemia, dehydration (flush tube with water), formula-drug interactions
s/sx of GERD
pyrosis (heartburn), regurgitation, dyspepsia (indigestion), dysphagia, hyper salivation, esophagitis, dental erosion, ulcerations and adenocarcinomas in severe cases
GERD pt education
- tobacco cessation
- limiting alcohol
- weight loss
- HOB after eating
- avoid eating before bed
GERD Rx options
Antacids/acid neutralizers:
- calcium carbonate (tums)
- simethicone (gas X)
H2 antagonists:
- famotidine (pepcid)
PPIs:
- pantoprazole (protonic)
- omeprazole (prilosec)
- lansoprazole (preVacid)
Surface agents (barriers)
- sucralfate
Esophageal sphincter relaxer
- baclofen
Hiatal hernia
diaphragm opening enlarged- upper stomach passes up to thorax cavity
Sliding esophagus (A) - Hiatal Hernia s/sx
GERD, hemorrhage, obstruction (volvulus)
Paraesophageal hernia (B) s/sx
pyrosis (heartburn), n/v, regurgitation, dysphagia, (can be asymptomatic) - strangulation
-pt reports fullness quickly during meals (epigastric pain)
