Week 1 & 2 Slide Notes Flashcards
Barium Swallow or Upper GI tract study
Patient drinks barium
Used to evaluate disorders through the GI tract
Barium Swallow Nursing Considerations
NPO
Fluids to aid in excretion of barium
White stools 24-72 hours until barium clears
Oral Careq
Brush BID
Floss daily
No ETOH
Q6Month Dental visits
Xerostomia
Known as dry mouth, caused by oral cancer multiple medications, HIV and lockjaw
Interventions for Xerostomia
Avoid dry bulky foods
Avoid alcohol and tobacco
Use humidified oxy
Use chewing gum and lozenges or synthetic saliva
Clinical manifestations of Jaw trauma/disorders are
Dull ache
Restricting jaw motion and locking of the jaw
misalignment of the upper and lower teeth,
Popping, clicking, and grating sound when mouth is opened
and swelling id trauma has occured
Management of Jaw trauma/disorders
Physical therapy
NSAIDS
Oral appliances
Various Diet restrictions and Edu.
* The main goal is to maintain the airway, controlling bleeding is second*
You should almost always have wires cutters at the bedside in order to cut through oral appliances like braces so they do not choke
Oral Cancer and Pharynx cancer RF and locations
Rates are increasing and RF include
Tobacco/nicotine
HPV
Previous history of head and neck CA
Located around the Lips, tongue, buccal mucosa, floor of
mouth, hard palate, upper and lower
gingiva
Clinical manifestations for Oral Cancer and Pharynx cancer
few or no early symptoms
painless sore/lesion that does not heal
Harneded spot with raised edges
Red or white patch in the mouth or throat
Later stages involve tenderness, difficulty swallowing, coughing up blood and wt loss
Management of Oral Cancer and Pharynx cancer
Radiation
Chemo
Surgical options (simple excision, or radical neck dissection)
Select the assessment finding that the nurse should report
immediately post radical neck dissection.
A. Temperature of 100.8 degrees
B. Pain
C. Stridor
D. Localized wound tenderness at the incision site
C
Post Radical Neck Dissection Care
Keep in Fowler position, and maintain airway clearance.
Look for strido and s/s of distress
Use humidified oxy VIA FACE TENT and suction.
Post Op Graft chekc
Assess color, and temp.
Use a doppler for a pulse check
Difficult to assess grafts in the mouth
Wound Care and Nutrition Post RND
Wound care:
You’ll need a drainage tube (Jackson Pratt)
Should be within 80-120 ml/24 hours.
Reinforce PRN and change as prescribed
Nutrition
Start liquid the move to soft.
Will be enteral or parenteral
Things to avoid post RND
Hemorrhage
Valsava maneuver
And avoid sedentary (Move ASAP)
Esophagus GERD
GERD is Gastroesophageal Reflux Disease.
Results from incompetent LES
Can lead to strictures and Barrets Esophagus
GERD RF
Motility dysfuntion
Excessive intraabdominal pressure
HIatal hernia large meals and NGT presence
GERD Clinical Manifestations
Pyrosis
Regurg
Dyspepsia
Dysphagia and odyndophagia
Hypersalvitation
Carries, Barrets and can lead to pulmonary complications
Management of Gerd
Lifestyle modications
Food
Smoking cessation
No tight fitting clothing
Maintain normal body wt
No eating or drinking 2 hours before bedtime
Diet management of GERD
Low fat food
Avoid caffiene tobacco, beer, milk, minty food, carbonated beverages, and acidic foods/drinks
Pharmacological management of GERD
Antacids
Histamine-2 receptors antagonist (Famotidine)
Prokinetic Agent (Metroclopromide)
PPI
Pantorazole and omeprazole
Tums info
Neutralizes acid. Supresses protective flora
Pepcid info
Decreases acid production
monitor qt interval prolongation in kidney injury
Reglan
Accelerate gastric emptying
can cause tardive dyskinesia
Prilosec and protonix
Decrease gastric acid production, can interfer in vitamin absorption (B12 and Mag)
Barrets Esophagus
Uncontrolled GERD
Managed via PPI
They are precancerous cells
Hiatal Hernia
Portion of the stomach produces upward. Type ! and Type 2
Type 1 is in the esophagus while type two is completely outside the stomach and the esophagus
Sliding hernia
Pyrosis Regurg and Dysphagia
Rolling
Feeling full after eating
Breathless after eating
Feeling of suffocation
Angina like pain
Management of Hernia
Diagnostic procedures to identify (Barium, EGD, CT)
Frequent small feedings
Do not recline 1 hour after eating
Elevate HOB 4-8 inches
Management of GERD
Surgical Repair
