Iggy Chapter 54 Esophagus
A client who has been diagnosed recently with esophageal cancer states, "I'm not comfortable going to my father's birthday lunch at our family-owned restaurant because I'm afraid I'll choke in public." What is the nurse's best response? "I understand your concerns, but you can't give up your normal activities. You should go anyway and try not to worry about it." "Could you perhaps invite everyone over to cook at your home? That will allow you to be together and be more relaxed." "Why not take one of your antianxiety pills before going? That will keep you from worrying about everything so much." "You need to talk to your doctor about your concerns. The doctor may recommend that you join a support group for cancer survivors."
"Could you perhaps invite everyone over to cook at your home? That will allow you to be together and be more relaxed." Correct Correct: This response provides psychosocial support to the client and assists the client with finding a solution to the problem.
A client with gastroesophageal reflux disease has undergone a laparoscopic Nissen fundoplication (LNF). What will the nurse include in postoperative home care instructions? "Consume carbonated beverages if you experience stomach upset." "Remain on a soft diet for about a week and avoid raw fruits and vegetables." "You may resume running and weight lifting if you wish." "You may stop taking your anti-reflux medications after 1 week."
"Remain on a soft diet for about a week and avoid raw fruits and vegetables."
The nurse is observing a co-worker who is caring for a client with a nasogastric tube following esophageal surgery. Which actions by the co-worker require the nurse to intervene? (Select all that apply.) Checking tube placement every 12 hours Keeping the bed flat Placing the client upright when taking sips of water Providing mouth care every 8 hours Securing the tube
A, B, D The tube should be checked every 4 to 8 hours. The head of the bed should be elevated at least 30 degrees. Oral hygiene should be provided every 2 to 4 hours.
A client has been diagnosed with terminal esophageal cancer. The client is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? "Haven't you received adequate pain management in the hospital?" "Would you like me to get a nurse from hospice to come talk with you?" "Do you want me to call the hospital chaplain to explain hospice to you?" "Talk to your health care provider about hospice services."
"Would you like me to get a nurse from hospice to come talk with you?" The best way to alleviate the client's concerns would be to have a hospice nurse talk with the client and answer any questions.
A client in the outpatient clinic tells the nurse about experiencing heartburn and nighttime coughing episodes. Which action does the nurse take first? Teach the client about antacid effects and side effects. Ask the client about medications and dietary intake. Suggest that the client sleep with the head elevated 6 inches. Tell the client to avoid drinking alcohol late in the evening.
Ask the client about medications and dietary intake. A. Before client teaching can begin, the nurse needs to elicit more information about the client's symptoms. B. The nurse's initial action should be further assessment of the client's risk factors for GERD. C. Before suggesting interventions, the nurse needs to gather additional data about the client's symptoms. D. The nurse needs additional data before making this determination
A client has been diagnosed with mild gastroesophageal reflux disease and asks the nurse about nonpharmacologic treatments to prevent symptoms. What does the nurse tell this client? "Avoid caffeine-containing foods and beverages." "Eat three meals each day and avoid snacking between meals." "Peppermint lozenges help to reduce stomach upset." "Sleep on your left side with a pillow between your knees
Avoid caffeine
The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associated with a client's hiatal hernia. Which change does the nurse recommend to this client? Eat only two or three meals daily. Sleep flat in a left side-lying position. Drink tea instead of coffee. Avoid working while bent over the computer.
Avoid working while bent over the computer. Correct Correct: The client should avoid working in a bent-over position because this position presses on the diaphragm, causing discomfort.
The nurse is caring for a client with esophageal cancer who has received photodynamic therapy (PDT) using porfimer sodium (Photofrin). What instructions will the nurse include in teaching the client about porfimer sodium? Select all that apply. A. Avoid sunlight for 2 weeks. B. Cover all exposed body areas. C. Follow a full liquid diet for 3 to 5 days after the procedure. D. Monitor for hypertension. E. Tissue particles may be found in the sputum.T
B, C, E Sunlight should be avoided for 1 to 3 months. Side effects are rare and may include nausea, fever, and constipation. Hypertension is not a side effect of porfimer sodium (Photofrin).
A client with gastroesophageal reflux disease (GERD) is newly diagnosed by the nurse practitioner, who prescribes pantoprazole (Protonix) 40 mg. What teaching will the nurse provide for this client about this drug? A. "Be sure to take this drug every day until you feel better." B. "Be aware that this drug can cause anxiety and restlessness." C. "Do not crush the drug because it has a delayed release." D. "Do not take the drug with tomato-based foods or drinks."
C. "Do not crush the drug because it has a delayed release." Protonix is a delayed-release medication; the client should be informed to not crush, break, or chew delayed-release tablets. The client should continue to take the medication even after the GERD-associated symptoms are relieved; if the medication is stopped, the symptoms will return. Although clients with GERD should limit their intake of acidic foods, no specific food-drug interactions have been documented for Protonix. Anxiety and restlessness is not a common adverse effect documented with Protonix
The nurse is reviewing the medication history for a client diagnosed with gastroesophageal reflux disease who has been prescribed esomeprazole (Nexium) once daily. The client reports that the drug doesn't completely control the symptoms. The nurse contacts the provider to discuss which intervention? Adding a second proton pump inhibitor medication Increasing the dose of esomeprazole Changing to a twice-daily dosing regimen Switching to omeprazole (Prilosec)
Changing to a twice-daily dosing regimen The proton pump inhibitors are usually effective when given once daily, but can be given twice daily if symptoms are not well controlled.
The nurse is assessing a client with gastroesophageal reflux disease (GERD). Which findings does the nurse expect to observe? (Select all that apply.) Blood-tinged sputum Dyspepsia Excessive salivation Flatulence Regurgitation
Correct: Dyspepsia, also known as heartburn, is one of the main symptoms of GERD. Correct: Flatulence is common after eating. Correct: Regurgitation (backward flow into the throat) of food and fluids is common. Incorrect Feedback: Incorrect: Blood-tinged sputum is not a symptom of GERD. Incorrect: Excessive salivation is not a symptom of GERD.
The nurse is working with the dietitian to plan a menu for a client who has persistent difficulty swallowing. What is a suitable breakfast selection for this client? Scrambled eggs and toast Oatmeal and orange juice Puréed fruit and English muffin Cream of wheat and applesauce
Cream of wheat and applesauce Correct Correct: Both cream of wheat and applesauce are foods of semi-solid consistency and are appropriate for this client.
The nurse is caring for a client diagnosed with esophageal cancer who is experiencing diarrhea after conventional esophageal surgery. The nurse anticipates that the health care provider will request which medication to manage diarrhea? Loperamide (Imodium) Mesalamine (Pentasa) Minocycline (Minocin) Pantoprazole (Protonix)
Diarrhea can occur 20 minutes to 2 hours after eating and can be symptomatically managed with loperamide (Imodium). Diarrhea is thought to be the result of vagotomy syndrome, which develops as a result of interruption of vagal fibers to the abdominal viscera during surgery
. A client has undergone conventional esophageal surgery. The client's diet has been advanced to semi-solid, and feedings are well tolerated. The client reports experiencing diarrhea about 1 hour after each meal. What is the priority nursing intervention to help prevent further diarrhea? Ensure that the client takes adequate amounts of fluids with meals. Advance the diet to solid food and encourage eating as much as possible at meals. Give the client a dose of magnesium hydroxide (Milk of Magnesia) after each meal. Encourage the client to take fluids between meals rather than with meals.
Encourage the client to take fluids between meals rather than with meals. Correct Correct: Diarrhea is believed to be the result of vagotomy syndrome and can be managed by taking fluids between meals rather than with meals.
The nurse is reviewing orders for a client with possible esophageal trauma after a car crash. Which request does the nurse implement first? Give total parenteral nutrition (TPN) through a central venous catheter. Administer cefazolin (Kefzol) 1 g intravenously. Obtain a computed tomography (CT) scan of the chest and abdomen. Keep the client nothing by mouth (NPO) for possible surgery.
Give total parenteral nutrition (TPN) through a central venous catheter. - Incorrect: Esophageal rest is maintained for about 10 days after esophageal trauma to allow time for mucosal healing, and TPN is prescribed to provide calories and protein for wound healing. Although this is important, it is not a priority for the nurse to implement first. Administer cefazolin (Kefzol) 1 g IV. - Incorrect: Antibiotics may be requested to prevent possible infection, but this is not the priority for the nurse to implement first. Obtain computed tomography (CT) scan of chest and abdomen. - Incorrect: CT of the chest and abdomen will be needed but is not the nurse's initial action. Keep the client nothing by mouth (NPO) for possible surgery. - Correct: Clients with possible esophageal tears should be made NPO until diagnostic testing is completed, because leakage of anything taken orally into the sterile mediastinum could occur. In addition, esophageal rest is maintained for about 10 days after esophageal trauma to allow time for mucosal healing.
Which of these assigned clients does the nurse assess first after receiving the change-of-shift report? Young adult admitted the previous day with abdominal pain who is scheduled for a computed tomography (CT) scan in 30 minutes Adult with gastroesophageal reflux disease (GERD) who is describing epigastric pain at a level of 6 (0-to-10 pain scale) Middle-aged adult with an esophagogastrectomy done 2 days earlier who has bright-red drainage from the nasogastric (NG) tube Older adult admitted with an ileus who has absent bowel sounds and a prescription for metoclopramide (Reglan) on an as-needed (PRN) basis
Middle-aged adult with an esophagogastrectomy done 2 days earlier who has bright-red drainage from the nasogastric (NG) tube
The nurse is reinforcing the instructions on swallowing provided by the speech-language pathologist to a client diagnosed with esophageal cancer. Which instruction to the client is the highest priority? Place food at the back of the mouth as you eat. Do not be overly concerned with tongue or lip movements. Before swallowing, tilt the head back to straighten the esophagus. Do not attempt to reach food particles that are on the lips or around the mout
Place the food at the back of the mouth as you eat. Correct Correct: Placing the food at the back of the mouth when eating will help the client avoid aspirating.
A client with an inoperable esophageal tumor is receiving swallowing therapy. Which task does the home health nurse delegate to an experienced home health aide? Teaching family members how to determine whether the client is obtaining adequate nutrition Assessing lung sounds for possible aspiration when the client is swallowing clear liquids Reminding the client to use the chin-tuck technique each time the client attempts to swallow Instructing family members about symptoms that may indicate a need to call the provider
Reminding the client to use the chin-tuck technique each time the client attempts to swallow
A client is being discharged after a minimally invasive esophagectomy. Which teaching point does the nurse consider to be of the highest priority during the predischarge teaching session? Instruct the client to eat three meals daily. Emphasize the importance of lying down after meals. Encourage the client to ask his or her health care provider for antidepressant medication. Report the presence of fever and a swollen, painful neck incision.
Report the presence of fever and a swollen, painful neck incision. Correct Correct: Wound management and prevention of infection are major concerns because the client who has had an esophagectomy typically has multiple drains and incisions
The nurse is caring for a client with a hiatal hernia who had an open fundoplication yesterday. Which task does the nurse delegate to unlicensed assistive personnel (UAP)? Using a pillow to support the incision when the client coughs Adjusting the position of the nasogastric (NG) tube Assessing the level of postoperative pain using a 0-to-10 scale Giving the client sips of water once bowel sounds are heard
Using a pillow to support the incision when the client coughs Correct Correct: Assisting a client to cough is a task within the education and skill level of a nursing assistant. The other interventions require more knowledge of the potential complications associated with this surgical procedure.
