Care Management Quiz II

Infectious agents that can cause acute sialadenitis

-Bacteria or viruses (cytomegalovirus, staph, e. coli) -Immunologic compromise (HIV) -Decrease in saliva production

Stomatitis causes

-Infection -Allergy -Vitamin deficiency -Systemic disease -Tobacco -Alcohol -Certain food

Oral cancer non surgical interventions

-Maintain airway -Prevent aspiration -Place patient in semi-fowler to high-fowlers -Radiation -Steroids

GERD contributing factors

-Overweight -Coffee, tea, soda -Caffeinated beverages -Smoking/ tobacco use -Calcium channel blockers -Chocolate -Nitrates -Citrus fruits -Tomatoes and tomato products

Stomatitis health promotion and maintenance

-Poor oral hygiene -Decrease stress level

GERD diagnostic tests

-Upper GI endoscopy -Barium swallow -EGD

Oral cancer risk factors

***Smoking*** -Older age -Alcohol use

What should be a safety priority with stomatitis?

-Airway obstruction -Aspiration pneumonia -Malnutrition

Aspiration nursing safety priority

-Aspiration -Assess patient's LOC, gag reflex, and ability to swallow -Place patient in semi-Fowler or high-Fowlers -Thickened liquids may be needed

Best prevention for acute sialadenitis

Adherence to routine oral hygiene care

EGD

Esophagogastroduodenoscopy

Sialadenitis

Inflammation of a salivary gland

More than 90% of oral cancer is

Squamous cell carcinoma

EGD prep

-Avoid anticoagulants, aspirin, or NSAIDs for several days beforehand -NPO for 6 to 8 hours before -Educate patient on what to expect -Local anesthetic spray is used to inactive the gag reflex

GERD interventions

-Balance nutrition -Lifestyle changes -Eliminate foods that are spicy, acidic, caffeine, carbonated -Smaller meals -Raise head of bed -Don't eat at least 3 hours before bed

Oral cancer key features

-Bleeding from the mouth -Poor appetite -Difficulty chewing or swallowing -Unplanned weight loss -Thick or absent saliva -Painless oral lesion that is red, raised, or eroded -Thickening or lump in cheek

EGD post-procedure care

-Check vital signs ***CHECK GAG REFLEX***

GERD key features

-Dyspepsia -Regurgitation -Dysphagia -Odynophagia (painful swallowing) -Coughing, hoarseness, or wheezing at night -Chest pain -Pyrosis (heartburn) -Epigastric pain -Belching -Flatulence -Nausea

Stomatitis s/s

-Dysphagia -Pain

Erythroplakia

-Precancerous -Red, velvety mucosal lesions on the floor or the mouth, tongue, palate, and mandibular mucosa

Stomatitis patient oral care

-Remove dentures if stomatitis is severe or they have oral pain -Encourage oral hygiene twice a day -Increase oral care to every 2 hours -Use a soft toothbrush or gauze -Use toothpaste free of sodium lauryl sulfate -Avoid commercial mouthwash -Encourage frequent rinsing of the mouth with warm saline, bicarb, or a combination -Help the patient select soft, bland, non-acidic foods -Apply topical analgesics or anesthetics as prescribed

Sialadenitis interventions

-Warm compress -Saliva substitutes (Xylitol) -Massage the gland by sweeping the fingers along the course of the gland with gentle pressure -Pain management

Barrett's esophagus

A condition that occurs when the cells in the epithelial tissue of the esophagus are damaged by chronic acid exposure

A patient who had the Stretta procedure to treat severe GERD is being discharged. Which patient statement requires further nursing teaching? Select all that apply A. "Dysphagia after this procedure is normal" B. "It's important to stop my proton pump inhibitor" C. "I will not take NSAIDs and aspirin for at least 10 days" D. "I might cough up some blood following this procedure" E. "Today I will drink clear liquids and tomorrow I can eat soft food"

A. "Dysphagia after this procedure is normal" B. "It's important to stop my proton pump inhibitor" D. "I might cough up some blood following this procedure"

A nurse is caring for four clients. Which individual does the nurse identify at the highest risk for development of oral cancer? A. 28-year-old with human papilloma virus (HPV) infection B. 30-year-old with recurrent aphthous stomatitis (RAS) C. 55-year-old who quit chewing tobacco 5 years ago D. 76-year-old who is sometimes negligent in denture care

A. 28-year-old with human papilloma virus (HPV) infection

While undergoing radiation treatment for oral cancer, a client develops xerostomia (dry mouth). What collaborative resource does the nurse suggest for this client's care? A. Dentist B. Occupational therapist C. Speech therapist D. Psychiatrist

A. Dentist

A nurse is caring for a 34 year old patient newly diagnosed with GERD. Which lifestyle change will the nurse suggest? Select all that apply A. Lose weight if needed B. Do not eat before bed C. Elevate the foot of your bed by 6 to 12 inches D. Avoid pants with a tight waistband or belt E. Eat fatty foods to minimize ongoing hunger

A. Lose weight if needed B. Do not eat before bed D. Avoid pants with a tight waistband or belt

When providing discharge teaching about mouth care, which substance will the nurse teach the client with oral cancer to avoid? Select all that apply A. Mouthwash B. Lip lubricant C. Warm saline rinses D. Ultra-soft toothbrush E. Disposable foam brushes F. Bicarbonate mouth rinse

A. Mouthwash E. Disposable foam brush

Which food does the nurse teach a patient undergoing chemotherapy with secondary stomatitis to avoid? A. Broiled fish B. Ice cream C. Salted pretzels D. Scrambled eggs

C. Salted pretzels

Which practice does the nurse include when teaching a client about proper oral hygiene? A. Perform self-examination of the mouth every week, and report any unusual findings B. Brush the teeth daily and floss as needed C. Wear dentures that fit a bit loosely for movement when chewing D. Use mouthwash with alcohol unless lesions are present

A. Perform self-examination of the mouth every week, and report any unusual findings

The nurse is teaching a client how to maintain effective oral health. Which measure does the nurse include in the teaching plan? Select all that apply A. Regular dental checkups B. Eating a balanced diet C. Use of mouthwashes containing alcohol D. Managing stress as much as possible E. Ensuring that dentures are slightly loose-fitting

A. Regular dental checkups B. Eating a balanced diet D. Managing stress as much as possible

Untreated infections of the salivary glands can evolve into an

Abscess that can rupture and spread infection into the neck and mediastinum

Acute sialadenitis

Affects the parotid or submandibular glands

Which client statement about GERD triggers requires further nursing teaching? Select all that apply A. "I will decrease my alcohol intake." B. "Smoking 1-2 cigarettes a day won't hurt." C. "My plan is to eat six small meals daily." D. "Tomato-based foods should be avoided."' E. "I love soda but I am going to stop drinking it." F. "Our family eats Mexican dishes several times weekly."

B. "Smoking 1-2 cigarettes a day won't hurt." F. "Our family eats Mexican dishes several times weekly."

A public health nurse is assessing community clients for oral health disorders. Which client is identified at highest risk? A. 23-year old with 3 dental fillings B. 34-year-old with schizophrenia C. 55-year-old with stable angina D. 62-year-old with irritable bowel syndrome

B. 34-year-old with schizophrenia

A nurse is caring for a client with recurrent aphthous stomatitis (RAS) who asks about food choices while healing. Which food will the nurse suggest? A. Half of an orange B. Chocolate pudding C. Chips with hummus D. Glass of tomato juice

B. Chocolate pudding

A client with oral cancer who is to have a radical neck dissection reports being depressed. What is the nurse's priority response? A. Suggest seeking support from a community group B. Listen to the patient's concerns C. Explain the grieving process D. Reassure that it is normal to feel depressed about the diagnosis

B. Listen to the patient's concerns

A client who has undergone surgery and completed radiation therapy to treat oral cancer reports persistent dry mouth. What will the nurse teach this client about managing this symptom? A. This condition is common but is temporary B. Use saliva substitutes, especially when eating dry foods C. This indicates a complication of therapy D. Use lozenges and hard candies to prevent dry mouth

B. Use saliva substitutes, especially when eating dry foods

GERD can cause

Barrett epithelium (esophagus) -Premalignant

A client reports ongoing episodes of "heartburn." Which food will the nurse recommend that the client eliminate from the diet? A. Steak B. Carrots C. Chocolate D. Popcorn

C. Chocolate

When caring for a client with oral cancer who has developed stomatitis as a complication of radiation and chemotherapy, which action does the nurse delegate to the assistive personnel (AP)? A. Instruct how to use nystatin oral rinses B. Assist with making appropriate dietary choices that do not irritate tissues C. Provide oral care using a soft toothbrush D. Inspect the oral mucosa for evidence of oral candidiasis

C. Provide oral care using a soft toothbrush

The nurse is providing instructions to a client with a history of stomatitis. Which instructions does the nurse include in the teaching plan? A. Encourage the patient to eat acidic foods to decrease bacteria B. Mouth care should be performed twice daily at the maximum C. Rinse the mouth frequently with warm saline or sodium bicarbonate D. Use a medium-bristled toothbrush for oral care

C. Rinse the mouth frequently with warm saline or sodium bicarbonate

The nurse is assessing a client who reports having a history of gastroesophageal reflux disease (GERD). Which assessment finding does the nurse report to the primary health care provider? A. "My family likes to eat small meals every 3 to 4 hours throughout the day." B. "When I buy meat, I ask for the leanest cut that is available." C. "I quit smoking 6 months ago." D. "Sometimes I wake up grasping for air in the middle of the night."

D. "Sometimes I wake up grasping for air in the middle of the night."

A client has recently developed acute sialadenitis. Which intervention does the nurse include in this client's care? A. Request a prescription for an opioid to manage pain B. Restrict fluids C. Apply cold compresses D. Massage the salivary gland

D. Massage the salivary gland

Stomatitis

Inflammation within the oral cavity (canker sore)

EGD intra-procedure care

Monitor vitals: Respiratory rate and depth, O2 saturation

GERD

Most Common upper GI Disorder, result of backwards flow of GI contents into esophagus, causing esophageal irritation or inflammation

Primary stomatitis

Occurs most often, and the most common types are aphthous stomatitis or canker sores that present as painful, small oral ulcers, herpes simplex stomatitis, and traumatic ulcers

Secondary stomatitis

Results from infection by opportunistic viruses, fungi, or bacteria in patients who are immunocompromised or as a result of chemotherapy, radiation, or steroid drug therapy -Candidiasis

Leukoplakia

Thickened, white, firmly attached patches on the oral mucosa that cannot be scraped off

What is the highest risk factor for leukoplakia?

Tobacco use