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