Med Surg Ch 45 Oral and Esophageal Disorders

Sialadenitis definition

inflammation of the salivary glands

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction?

"Avoid coffee and alcoholic beverages." Page 1283

An adolescent client with multiple dental caries is discussing his diet with the nurse. The nurse explores the client's behaviors and identifies a risk factor for dental caries when the client states:

"I drink a can of carbonated soda at lunch every day." Page 1268

A client is diagnosed with a hiatal hernia. Which statement indicates effective client teaching about hiatal hernia and its treatment?

"I'll eat frequent, small, bland meals that are high in fiber." Page 1281

Oral Health Promotion

-Effective mouth care, including regular brushing and flossing -Reduce intake of starches and sugars and maintain good nutrition -Fluoride application or fluorinated water -Refrain from smoking and alcohol -Control diabetes -Regular dental care

During postoperative neck dissection assessment, the nurse notices excessive bleeding from the dressing site. She suspects possible carotid artery rupture and takes the immediate first step to:

Apply pressure to the bleeding site or major associated vessel. Page 1275

The client is postoperative following a graft reconstruction of the neck. It is most important for the nurse to

Assess the graft for color and temperature. Page 1272

Candidiasis (moniliasis/thrush)

Cheesy white plaque that looks like milk curds; when rubbed off, it leaves an erythematous and often bleeding base. Candida albicans fungus; predisposing factors include diabetes, antibiotic therapy, and immunosuppression

Which of the following is one of the first clinical manifestations of esophageal cancer?

Increasing difficulty in swallowing Page 1287

A client has a radical neck dissection to treat cancer of the neck. The nurse develops the care plan and includes all the following diagnoses. The nurse identifies the highest priority diagnosis as

Ineffective airway clearance related to obstruction by mucus Page 1275

Which of the following are functions of saliva? Select all that apply.

Lubrication Digestion Protection against harmful bacteria Page 1270

A client with a disorder of the oral cavity cannot tolerate tooth brushing or flossing. Which of the following strategies can the nurse employ to assist this client?

Provide the client with an irrigating solution of baking soda and warm water. Page 1272

Chancre

Reddened circumscribed lesion that ulcerates and becomes crusted Primary lesion of syphilis

Which term is used to describe stone formation in a salivary gland, usually the submandibular gland?

Sialolithiasis p. 1270.

An elderly patient is diagnosed with parotitis. The nurse is aware that this bacterial infection is most likely caused by:

Staphylococcus aureus. Page 1270

Select the assessment finding that the nurse should immediately report, post radical neck dissection.

Stridor Page 1275

Herpes simplex virus-1 (cold sore or fever blister)

Symptoms may be delayed up to 20 days after exposure; singular or clustered, irregular, painful vesicles throughout the oral cavity and lips that may An opportunistic infection; frequently seen in patients who are immunosuppressed May recur with menstruation, fever, or sun exposure

A nurse enters the room of a client who has returned to the unit after having a radical neck dissection. Which assessment finding requires immediate intervention?

The client lying in a lateral position, with the head of bed flat Page 1275

Parotitis Definition

inflammation of the parotid gland

Which of the following assessment findings would be most important for indicating dumping syndrome in a postgastrectomy client?

Weakness, diaphoresis, diarrhea 90 minutes after eating Page 1373

When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. Aphthous stomatitis is best described as:

a canker sore of the oral soft tissues. Page 1266

dysplasia

abnormal change in cells

periapical abscess

abscessed tooth

dysphagia

difficulty swallowing

gastroesophageal reflux disease (GERD)

disorder marked by backflow of gastric or duodenal contents into the esophagus that causes troublesome symptoms and/or mucosal injury to the esophagus

xerostomia

dry mouth

vagotomy syndrome

dumping syndrome; gastrointestinal symptoms, such as diarrhea and abdominal cramping, resulting from rapid gastric emptying

A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, the nurse should assign highest priority to:

maintaining a patent airway. Page 1287

hernia

protrusion of an organ or part of an organ through the wall of the cavity that normally contains it

Sialolithiasis definition

salivary calculi (stones), usually occur in the submandibular glands

Boerhaave syndrome

spontaneous esophageal rupture due to forceful vomiting or straining

Achalasia

absent or ineffective peristalsis (wavelike contraction) of the distal esophagus accompanied by failure of the esophageal sphincter to relax in response to swallowing

halitosis

foul odor from the oral cavity; in laymen's terms, "bad breath"

Pyrosis definition

heartburn, more specifically described as a burning sensation in the esophagus

gingivitis

inflammation of the gums; change in color from pink to red, with associated swelling, bleeding, and sensitivity/tenderness

stomatitis

inflammation of the oral mucosa

The nurse is conducting a health instruction program on oral cancer. The nurse determines that the participants understand the instructions when they state

"Many oral cancers produce no symptoms in the early stages." Page 1271

Which is an accurate statement regarding cancer of the esophagus?

Chronic irritation of the esophagus is a known risk factor. Page 1286

The nurse is obtaining a history on a patient who comes to the clinic. What symptom described by the patient is one of the first symptoms associated with esophageal disease?

Dysphagia Page 1279

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.

Elevate the upper body on pillows. Elevate the head of the bed on 6- to 8-inch blocks. Avoid beer, especially in the evening. Page 1283

An elderly client seeks medical attention for a vague complaint of difficulty swallowing. Which of the following assessment findings is most significant as related to this symptom?

Esophageal tumor Page 1287

Postoperatively, a client with a radical neck dissection should be placed in which position?

Fowler Page 1275

Postoperatively, a client with a radical neck dissection should be placed in which position?

Fowler p. 1275.

A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate?

Gastroesophageal reflux disease Page 1283

A client has a cheesy white plaque in the mouth. The plaque looks like milk curds and can be rubbed off. The best nursing intervention is to

Instruct the client to swish prescribed nystatin (Mycostatin) solution for 1 minute. Page 1266

Actinic cheilitis

Irritation of lips associated with scaling, crusting, fissure; white overgrowth of horny layer of epidermis (hyperkeratosis) Possible Causes and Sequelae: Exposure to sun; more common in fair-skinned people and in those whose occupations involve sun exposure, such as farmers Chronic inflammatory lesion that may lead to squamous cell cancer of the lip

Periodontitis

Little discomfort at onset; may have bleeding, infection, gum recession, and loosening of teeth; later in the disease, tooth loss may occur. Deep, chronic inflammation of the gingiva May result from untreated gingivitis Poor or inadequate dental hygiene and inadequate diet contribute to development

Stomatitis

Mild erythema and edema; severe forms include painful ulcerations, bleeding, and secondary infection. Inflammation of the mucous lining of the mouth Associated with chemotherapy; radiation therapy; severe drug allergy; myelosuppression (bone marrow depression)

Gingivitis

Painful, inflamed, swollen gums; usually, the gums bleed in response to light contact Reversible form of inflammation of the gingiva (i.e., mild form of periodontal disease) Associated with poor oral hygiene: food debris, bacterial plaque, and calculus (tartar) accumulate Gums may also swell in response to normal processes such as puberty and pregnancy, with certain medications (phenytoin [Dilantin], calcium channel blockers, cyclosporine [Neoral]), or with a deficiency in the immune system (i.e., AIDS) or nutritional status

A patient has been diagnosed with a hiatal hernia. The nurse explains the diagnosis to the patient and his family by telling them that a hernia is a (an):

Protrusion of the upper stomach into the lower portion of the thorax. Page 1280

Aphthous stomatitis (canker sore) (Classified as major or minor depending upon size)

Shallow ulcer with a white or yellow center and typically a well-defined red border; seen on the inner side of the lip and cheek or on the tongue; it begins with a burning or tingling sensation and slight swelling; painful; usually lasts 7-10 days (minor) and heals without a scar. Immune-mediated inflammatory disorder associated with HIV infection Associated with emotional or mental stress, fatigue, hormonal factors, minor trauma (e.g., biting), allergies, acidic foods and juices, and dietary deficiencies May recur

Nicotine stomatitis (smoker's patch)

Two stages—begins as a red stomatitis; over time, the tongue and mouth become covered with a creamy, thick, white mucous membrane, which may slough, leaving a beefy red base. Chronic irritation by tobacco

Oral hairy leukoplakia

White patches with rough hairlike projections; typically found on lateral border of the tongue Possibly viral Related to smoking and the use of tobacco Associated with HIV infection

Leukoplakia

White patches; may be hyperkeratotic; usually in buccal mucosa; typically painless Fewer than 2% are malignant, but may progress to cancer (premalignant) Common among tobacco users

pyrosis

a burning sensation in the stomach and esophagus that moves up to the mouth; commonly called heartburn

The most common symptom of esophageal disease is

dysphagia Page 1279

Odynophagia definition

pain on swallowing

lithotripsy

the use of shock waves to break up or disintegrate stones

A client has received a diagnosis of oral cancer. During client education, the client expresses dismay at not having recognized any early signs or symptoms of the disease. The nurse tells the client that in early stages of this disease:

there are usually no symptoms. p. 1271.