Upper GI Flashcards
Oral and pharynx cancer
-most common: leaps, lateral tongue, floor of mouth
-increased in men
Mgmt of oral cavity dx
-mouth care: increase fluid, synthetic saliva
-adequate food and fluid
-positive self image
-minimize pain: avoid hot, spicy, hard food; oral care; lidocaine or pain med
-prevent infection
Radical neck dissection
Remove all of just about everything
Modified neck dissection
Preserves one or more non lymphatic structure
Nursing interventions for neck dissection
-airway clearance
-pain mgmt
-adequate food/fluid
-communication
-physical mobility
Complication of neck dissection—hemorrhage
-hypovolemic shock
-avoid valsalva
-impending rupture: high epigastric pain
-pressure at site call MD and HOB elevated
Complication of neck dissection—chyle leak
-duct dmg during surgery
-post op when oral fluids begin
-F/E replacement, restrict activity, HOB elevated, stool softener
-octreotide: reduce flow
Complication of neck dissection—nerve injury
-lower facial paralysis
-dysphagia, impaired tongue mvt, vagus nerve injury
-shoulder dysfunction is most common
Measuring NG tube
-placement positioning semi Fowler
-xray after placement or pull back residual
-tip of nose —> ear —> xiphoid process
PEG tube sites and dressing
meticulous skin care
keep clean and dry
Delivering nutrition enterally
-functioning GI tract***
-safe/cheap
-preserves GI, intestinal and hepatic and fat meta, lipoprotein syn
-maintain normal insulin and glucose ratio
-NEVER MIX ANYTHING WITH FEEDING**
Enteral feedings
- check residual and start with 30mL water
-give feeling flush again
-after feeding clamp for 30-6pm in then back on suction
Parenteral nutrition
-inadequate food/fluid within 7 days
-1-3L over 24hrs (needs new order q 24hrs)
-never piggyback into IV fluid
-filter prevents admin of precipitate
-monitor labs
-PPN via peri IV or CPN via CVAD (watch infection)
Complication of PN
-pneumothorax
-air embolus
-clot or displace catheter
-sepsis
-hyperglycemia/rebound hypoglycemia
-fluid overload
Esophagus hiatal hernia
-persistent heartburn, dysphagia, SOB, suffocation feeling after eat
-worsen after eating or lying flat
-rf: high fat diet, tobacco, obese, anti-cholingerics
