Prepu Chapt 45 Mgt Oral and Esophageal Disorders

altered oral mucous membranes.

A patient has been NPO for two days anticipating surgery which has been repeatedly delayed. In addition to risks of nutritional and fluid deficits, the nurse determines that this patient is at the greatest risk for: altered oral mucous membranes. physical injury ineffective social interaction confusion

Hairy leukoplakia

A patient who is HIV positive comes to the clinic and is experiencing white patches with rough hairlike projections. The nurse observes the lesions on the lateral border of the tongue. What abnormality of the mouth does the nurse determine these lesions are? Aphthous stomatitis Nicotine stomatitis Erythroplakia Hairy leukoplakia

The client should not recline with a full stomach. The client should be instructed to avoid caffeine, beer, milk, and foods containing peppermint or spearmint, and to eat a low-fat diet. The client should be instructed to elevate the head of the bed on 6- to 8-inch blocks.

Discharge planning for gastroesophageal reflux disease (GERD) patients which measure to manage the disease?

Difficulty swallowing

Which is the primary symptom of achalasia? Chest pain Pulmonary symptoms Heartburn Difficulty swallowing

Increasing difficulty in swallowing

Which of the following is one of the first clinical manifestations of esophageal cancer? Increasing difficulty in swallowing Sensation of a mass in throat Foul breath Hiccups

Candidiasis (Thrush)

is a fungal infection that results in a cheesy white plaque in the mouth that looks like milk curds. It commonly occurs in antibiotic therapy. Antifungal medications such as nystatin (Mycostatin), amphotericin B, clotrimazole, or ketoconazole may be prescribed.

Metoclorpramide (Reglan)

is a prokinetic agent that accelerates gastric emptying.

esophageal sphincter pressure, thereby increasing reflux. Clients do not need to eliminate spicy foods unless such foods bother them.

Chocolate, tea, cola, and caffeine lower?

Neck swelling

A client who has had neck surgery is at risk for?

Approximately 80 to 120 mL

A nurse caring for a client who has had radical neck surgery notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. What is an expected, normal amount of drainage? Between 40 and 80 mL Approximately 80 to 120 mL Between 120 and 160 mL Greater than 160 mL

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

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? Serosanguineous drainage on the dressing Foley catheter bag containing 500 ml of amber urine A piggyback infusion of levofloxacin The client lying in a lateral position, with the head of bed flat

Impaired tissue integrity related to surgical intervention Imbalanced nutrition: less than body requirements, related to treatment Risk for infection related to surgical intervention Ineffective airway clearance related to obstruction by mucus

All the nursing diagnoses are appropriate for a client who has a radical neck dissection.

Staphylococcus aureus

An older adult patient who has been living at home alone is diagnosed with parotitis. What causative bacteria does the nurse suspect is the cause of the parotitis? Methicillin-resistant Streptococcus aureus (MRSA) Pneumococcus Streptococcus viridian Staphylococcus aureus

The patient first becomes aware of intermittent and increasing difficulty in swallowing. As the tumor grows and the obstruction becomes nearly complete, even liquids cannot pass into the stomach. Other clinical manifestations may include sensation of a mass in the throat, foul breath, and hiccups.

Clinical manifestations of esophageal cancer?

Apply pressure to the bleeding site or major associated vessel

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: Summon assistance. Apply pressure to the bleeding site or major associated vessel. Elevate the head of the patient's bed. Notify the surgeon to repair the vessel.

diverticulosis

Foods with seeds are restricted in?

Lithotripsy

For a client with salivary calculi, which procedure uses shock waves to disintegrate the stone? Radiation Lithotripsy Chemotherapy Biopsy

may include pyrosis (burning sensation in the esophagus), dyspepsia (indigestion), regurgitation, dysphagia or odynophagia (pain on swallowing), hypersalivation, and esophagitis.

Gastroesophageal reflux disease symptoms

an solution of 1 tsp of baking soda to 8 oz of warm water, half strength hydrogen peroxide, or normal saline solution is recommended.

If a client cannot tolerate brushing or flossing?

the ingestion of alcohol and the use of tobacco.

In the United States, cancer of the esophagus has been associated with

more often in men as in women. It is seen more frequently in African Americans than in Caucasian Americans. It usually occurs in the fifth decade of life.

In the United States, carcinoma of the esophagus occurs more than three times

Stridor

Select the assessment finding that the nurse should immediately report, post radical neck dissection. Temperature of 99°F Pain Stridor Localized wound tenderness

retain vitamins and decrease fat intake.

Steamed foods are encouraged to?

Assess the graft for color and temperature.

The client is postoperative following a graft reconstruction of the neck. It is most important for the nurse to Reinforce the neck dressing when blood is present on the dressing. Assess the graft for color and temperature. Administer prescribed intravenous vancomycin at the correct time. Cleanse around the drain using aseptic technique.

Fowler position

The client should be placed in this choice position postoperatively, to facilitate breathing and promote comfort. This position also promotes expansion of the lungs because the diaphragm is pulled downward and the abdominal viscera are pulled away from the lungs.

Staphylococcus aureus (except in mumps).

The infecting organisms travel from the mouth through the salivary duct. The organism is usually?

dysphagia

The most common symptom of esophageal disease is nausea vomiting dysphagia odynophagia

is a painless sore that does not heal. The client may complain of tenderness and difficulty chewing, swallowing, or speaking as the disease progresses.

The most frequent symptom of oral cancer Biopsy is used to diagnose oral cancer. A typical lesion in oral cancer is a painless, hardened ulcer with raised edges.

Avoiding chocolate and coffee.

The nurse instructs the client with gastroesophageal reflux disease (GERD) regarding dietary measures. Which action by the client demonstrates that the client has understood the recommended dietary changes? Eliminating spicy foods Avoiding chocolate and coffee. Eliminating cucumbers and other foods with seeds. Avoiding steamed foods.

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

The nurse is conducting a health instruction program on oral cancer. The nurse determines that the participants understand the instructions when they state "Most oral cancers are painful at the outset." "Blood testing is used to diagnose oral cancer." "A typical lesion is soft and craterlike." "Many oral cancers produce no symptoms in the early stages."

difficulty in swallowing both liquids and solids.

The primary symptom of achalasia is ? The client may also report chest pain and heartburn that may or may not be associated with eating. Secondary pulmonary complications may result from aspiration of gastric contents.

chancre

The term for a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis is a(n) lichen planus. actinic cheilitis. chancre. leukoplakia.

Vomiting

What is a nonspecific symptom that may have a variety of causes?

Nausea

What is the most common symptom of gastrointestinal problems in general?

Lithotripsy

What uses shock waves to disintegrate stones. It may be used instead of surgical extraction for parotid stones and smaller submandibular stones.

A canker sore of the oral soft tissues

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. How is aphthous stomatitis best described by the nurse? A canker sore of the oral soft tissues An acute stomach infection Acid indigestion An early sign of peptic ulcer disease

A canker sore of the oral soft tissues

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. How is aphthous stomatitis best described by the nurse? A canker sore of the oral soft tissues An acute stomach infection Acid indigestion An early sign of peptic ulcer disease

Chronic irritation of the esophagus is a known risk factor.

Which is an accurate statement regarding cancer of the esophagus? It is three times more common in women than men in the United States . It is seen more frequently in Caucasian Americans than in African Americans. It usually occurs in the fourth decade of life. Chronic irritation of the esophagus is a known risk factor.

Lichen planus

are white papules at the intersection of a network of interlacing lesions.

Leukoplakias

are white patches usually found in the buccal mucosa.

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

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? Regularly wipe the outside of the client's mouth to prevent germs from entering. Provide the client with an irrigating solution of baking soda and warm water. Recommend that the client drink a small glass of alcohol at the end of the day to kill germs. Urge the client to regularly rinse the mouth with tap water.

Uncontrolled rhythmic movements of the face or limbs

A client has a new order for metoclorpramide (Reglan). The nurse knows that this medication should not be used long term and only in cases where all other options have been exhausted. This is because this medication has the potential for extrapyramidal side effects. Extrapyramidal side effects include which of the following? Dry mouth not relieved by sugar-free hard candy Uncontrolled rhythmic movements of the face or limbs Excessive drowsiness Anxiety or irritability

Ineffective airway clearance related to obstruction by mucus

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 Impaired tissue integrity related to surgical intervention Imbalanced nutrition: less than body requirements, related to treatment Risk for infection related to surgical intervention Ineffective airway clearance related to obstruction by mucus

The client is free from esophagitis and achalasia.

A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? The client has normal gastric structures. The client is free from esophagitis and achalasia. The client reports diminished duodenal inflammation. The client doesn't exhibit rectal tenesmus.

To prevent respiratory complications, the head of the bed should be at least at a 30-degree angle. This position gives the lungs room to expand and decreases swelling by promoting venous and lymphatic drainage. This position also minimizes the risk of aspiration

A neck surgery puts a patient is at risk for neck swellings, what nursing interventions will help?

Assessing the graft for color and temperature addresses circulation. Airway, breathing, circulation (ABCs) take priority. Administer prescribed intravenous vancomycin at the correct time. Cleanse around the drain using aseptic technique. Reinforce the neck dressing when blood is present on the dressing.

The nurse may do all these activities related to the neck wound and dressing.

chancre

is a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis.

Actinic Cheilitis

is an irritation of the lips associated with a scaling, crusting fissure.

Serosanguineous drainage on the dressing, a Foley bag containing amber urine, and levofloxacin infusing.

Interventions to expect after a pt has had a radical neck dissection:

Metoclopramide (Reglan)

It is contraindicated with hemorrhage or perforation.

Parotitis (Mumps)

People who are older, acutely ill, or debilitated with decreased salivary flow from general dehydration or medications are at high risk for?

Fowler

Postoperatively, a client with a radical neck dissection should be placed in which position? Supine Fowler Prone Side-lying

dysphagia

This symptom may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain upon swallowing..

Nystatin (Mycostatin)

A client has been taking a 10-day course of antibiotics for pneumonia. The client has been having white patches that look like milk curds in the mouth. What treatment will the nurse educate the client about? Nystatin Cephalexin Fluocinolone acetonide oral base gel Acyclovir

Maintaining a patent airway

A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, what should the nurse assign highest priority to? Maintaining a patent airway Helping the client cope with body image changes Ensuring adequate nutrition Preventing injury

Gastroesophageal reflux disease

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? Peptic ulcer disease Esophageal cancer Gastroesophageal reflux disease Diverticulitis

take priority .Under physiological needs, airway, breathing, circulation (ABCs) take highest priority

According to Maslow's hierarchy of needs, physiological needs.

is the presence of coarse, high-pitched sounds on inspiration. The nurse would auscultate frequently over the trachea. This finding must be immediately reported because it indicates airway obstruction.

Stridor

Avoid eating or drinking 2 hours before bedtime

The nurse teaches the client with gastroesophageal reflux disease (GERD) which measure to manage the disease? Minimize intake of caffeine, beer, milk, and foods containing peppermint or spearmint Avoid eating or drinking 2 hours before bedtime Elevate the foot of the bed on 6- to 8-inch blocks Eat a low-carbohydrate diet

"Avoid coffee and alcoholic beverages."

To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? "Limit fluid intake with meals." "Take antacids with meals." "Lie down after meals to promote digestion." "Avoid coffee and alcoholic beverages."

the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.

To prevent reflux of stomach acid into the esophagus?

Metoclopramide (Reglan)

can have extrapyramidal side effects that are increased in certain neuromuscular disorders, such as Parkinson's disease, it should be used only if no other option exists, and the client should be monitored closely.

The first action is to apply pressure on the bleeding site. Then summon assistance (do not leave the patient alone), elevate the head of the bed, and ask someone else to notify the surgeon.

possible carotid artery rupture takes the immediate first step to:

Odynophagia definition

refers specifically to acute pain upon swallowing.