Oral and Esophageal Disorders Flashcards
Temporomandibular Joint Disorder (TMJ) S/S
- pain w/ chewing
- jaw pain (morning)
- jaw joint popping/clicking
- limited opening/ROM
- worn, cracked, chipped teeth
- loose, sore teeth
- unstable tooth position
- headaches
- sinus pressure
- neck/shoulder tension
- sense of water in ears
Non-Surgical Treatment for TMJ
- stress management
- mouth guards for nights
- ROM exercises
- pain meds
Surgical Treatment for TMJ Fractures
- insertion of metal plates and screws for stabilization
- wiring of jaw shut for several weeks
- may be stabilized using rubber bands
What are the 2 most common causes for TMJ?
Osteoarthritis or Dislocation of jaw
TMJ Nursing Management Post-OP
- liquid/pureed diet
- no chewing up to 4 weeks
- keep wire cutters/scissors at bedside
- may need straw
- keep mouth clean-soft sponge or child sized tooth brush
- report any ulcerations to provider
Parotitis
inflammation of parotid gland
Risk factors for Parotitis
- decreased salivary flow
- dehydration
- meds
- infections (mumps, flu, staph)
Parotitis S/S
- primary condition
- swollen, hardened, tender glands
- ear pain
- difficulty swallowing
Nursing Management for Parotitis
- assist w/ adequate oral/dietary intake
- oral hygiene
- hold/DC meds r/t problems
- antibiotics/pain meds
- I&D
S/S for Oral cancers
- asymptomatic until late stages
- painless sore that is difficult to or will not heal
- indurated (hard) w/ raised edges
Treatment for Oral Cancers
- radiation therapy
- chemotherapy
- surgery
Radical Neck Dissection
all tissue on side of neck from jawbone to collar bone is removed
all muscle, nerve, salivary gland, and major blood vessel is removed
Modified Radical Neck Dissection
- MOST COMMOM
- all lymph nodes are removed
- less neck tissue taken
- may spare nerves and sometimes blood vessels or muscle
Selective Neck Dissection
if cancer has not spread far, fewer lymph nodes are removed
muscle, nerve, and blood vessel may be saved
Laryngectomy
permanent laryngeal stoma
Concerns for Laryngectomy
- airway
- communication
- nutrition
- body image
Nursing Management for Laryngectomy
- dietary consult
- assess swallowing
- suctioning
- monitor graft site
- assess for excessive dry mouth
- assess for stomatitis
- dentistry may be needed
- assess support system
Airway Considerations
- semi-fowlers position
- assess for respiratory distress
- auscultate lung sounds (stridor=call provider ASAP)
- coughing/deep breathing
- suction prn
- assess swallowing
- consult speech patho
Wound Care
- JP drain may remain for 3-5 days
- drainage should decrease after 1st 24 hrs
- reinforce dressing but do not remove
- assess graft
- assess for swelling
- assess for infection
Nutrition
- assessment begins pre-operatively
- enteral/parenteral feedings
- diet modifications based on chewing/swallowing
- oral care
Communication and Mobility
- pencil & paper
- white board
- communication board
- PT/OT after drains removed and incision healing
- early ambulation
Monitor for Complications
- hemorrhage
- chyle fistula
- nerve damage
Chyle Fistula
- assess for milky odorless discharge
- corrected through monitoring and diet or surgery
Hiatal Hernia
part of stomach pushes upward through the opening in the diaphragm that the esophagus passes through
S/S of Hiatal Hernia
- asymptomatic
- heartburn/chest pain
- dysphagia
- regurgitation
- incarceration (strangulation) w/ obstruction
- sudden severe pain
- n/v
Management for Hiatal Hernia
- frequent small meals
- sit up for 1 hr after meals
- keep HOB elevated while sleeping
- antacids
- H2 antagonist
- PPIs
- surgery
Diverticulum
abnormal sac/pouch that forms at weak point on the esophagus
Diverticulum S/S
- dysphagia
- chronic bleeding
- regurgitation
- chronic bad breath
- chest pain
Management for Diverticulum
- surgery
- NPO until after non-leakage verified
- CL advance as tolerated
Causes of Esophageal Perforations
- surgery
- trauma
- severe retching/vomiting
S/S of Esophageal Perforations
- persistent pain
- dysphagia
- trouble speaking/breathing
- fever/leukocytosis
- hypotension
Management for Esophageal Perforations
- broad spectrum antibiotics
- minor wound symptoms: NPO, enteral, parenteral feedings up to 1 month or more, barium swallows, clear liquids
- surgery
Barium Swallow
- patient drinks a preparation containing the solution and an x-ray is used to track its path through GI tract
- 30-60 mins to complete
- increase fluid and fiber intake to prevent constipation
Gastroesophageal Reflux (GERD)
gastric and/or duodenal contents backflow into esophagus
GERD may result from what?
- obesity
- weak lower esophageal sphincter
- pyloric stenosis
- motility disorder
S/S of GERD
- dyspepsia (indigestion)
- regurgitation
- dysphagia
- odynophagia
- excessive salivation
- patient believes they are having MI
- Barret’s Esophagus
What is Barret’s Esophagus?
normal tissue lining in the esophagus changes to tissue that resembles the lining of the intestines
Barret’s Esophagus increases your risk for developing what?
esophageal adenocarcinoma
S/S of Barret’s Esophagus
- narrowing of esophagus caused by inflammation and scar tissue
- difficulty swallowing
- coughing when eating or drinking
- full feeling in throat
- frequent belching
- treatment w/ esophageal dilation
Management of GERD/Barret’s Esophagus
- low fat diet
- avoid caffeine, alcohol, tobacco, milk, carbonated drinks
- stop eating at least 1 hr before bed
- sit up for 1 hr after eating
- sleep with HOB elevated
- meds: antacids, gastric emptying accelerators
