Med surg exam 2: Oral esophageal disorders

CBC

Assess this lab with GERD because erosion of esophagus can cause bleeding

Strictures

Clinical manifestation where the esophagus narrows

Ambulatory pH monitoring, EGD

Diagnostic tests used to dgx GERD

low sugar, high protein and fat

Dietary needs for esophageal cancer in their 6 small meals a day include what nutrients

GERD

Disease where the lower esophageal sphincter is weakened so acid refluxes into the esophagus, could be caused by eating large meals, obesity, pregnancy, NGT or hiatal hernia, can cause barret's esophagus and strictures

Hiatal hernia

Education for this disorder include avoiding stomach irritating foods i.e. spicy/fatty, caffeine, acidic, eating 2 hours prior to lying flat, wearing non-restrictive clothing and maintaining a healthy weight

PPI

Hallmark pharmacologic management of hiatal hernia along with lifestyle changes

B D E

Health teaching for a patient with GERD is directed toward decreasing lower esophageal sphincter pressure and irritation. The nurse instructs the patient to do which of the following? Select all that apply. A)Drink three, 8 oz. glasses of regular milk daily to coat the esophagus B)Avoid beer, especially in the evening. C)Eat 1 hour before bedtime so there will be food in the stomach overnight to absorb excess acid. D)Elevate the head of the bed on 6- to 8-inch blocks. E)Elevate the upper body on pillows.

Wire cutters

Must have at the bedside after surgery for oral trauma

Right side, HOB >30 degrees

Nursing intervention to position a patient with a hiatal hernia or GERD

Paraesophageal hiatal hernia (type 2)

Piece of the stomach protrudes above the diaphragm, symptoms increase when laying flat, no reflux because the sphincter is intact but can twist or obstruct

Sliding hiatal hernia (Type 1)

Portion of the stomach protrudes up, more common hernia from wear and tear, obesity, trauma or hereditary weakness. Often asymptomatic, worse when flat, bending or coughing

Laparoscopic Nissen Fundoplication

Post op teaching for this procedure includes avoiding activities where air can be swallowed, avoiding heavy lifting and a soft diet with small bites

Barrets esophagus

Pre-cancerous cells in the esophagus

Oral cancer

Screening tests and labs for dgx of this disorder include CBC, Lytes, LFT, CXR, CT and MRI

ORIF

Surgery to fix oral trauma needed in severe cases

Esophagostomy

Surgical procedure that removes all or part of the esophagus and part of the stomach

Laproscopic Nissen Fundoplication

Surgical treatment for hiatal hernia or GERD when it gets larger over time. Wraps the stomach around the esophagus

Oral cancer

Surgical tx of this could include glossectomy, mandibulectomy, neck dissection to remove lymph nodes

Frequent water/saliva substitutes and oral humidification

Tx of xerostomia (dry mouth) that comes with oral cancer

Esophageal cancer

Type of cancer that is usually asymptomatic with no preventative screening, affects more males and risks include GERD, ETOH, smoking and obesity

Hiatal hernia

Upper abdominal xray, barium swallow and EGD are used to diagnose this disorder

Infection and compromised airway

2 high risk problems with oral trauma

A

A public health nurse is participating in a community health fair that is focused on health promotion and illness prevention. Which of the following older adults most likely faces the highest risk of developing oral cancer? A) A man who describes himself as always having been a "heavy smoker and a heavy drinker." B) A woman who is morbidly obese and has a longstanding diagnosis of systemic lupus erythematosus (SLE). C) A woman who describes herself as a "proud breast cancer survivor for over 10 years." D) A man who states that he enjoys good health, with the exception of "heartburn after nearly every meal."

Esophageal cancer

DGX includes Barium swallow, CT scan, PET scan, endoscopic U/S, upper GI and bronchoscopy, thorascopy and laparoscopy

Ambulatory pH monitoring

DGX test used to dg GERD by placing a catheter through the nose and keeping a food diary

Type 2

Which hiatal hernia almost always becomes incarcerated, noted by twisted and turns in the stomach