module 8/9 chronic rehab

leukoplakia

- thickened, white firmly attached patches on the oral mucosa - not easily scraped off - slightly raised and sharply rounded - most are benign - lips can be cancerous - tobacco use increases risk

a patient diagnosed with inflammatory bowel disease experiences an obstruction in the small bowel. when assessing the patient, which of the following will the student nurse anticipate? a. scaphoid abdomen b. hypovolemia c. passage of melena d. increased flatus

b

peptic ulcer disease (PUD) etiology

- GI mucosal defenses become impaired and no longer protect the epithelium from the effects of acid/pepsin - many are cause by h. pylori infections

symptoms of stomatitis

- airway obstruction - aspiration pneumonia - malnutrition - above three all due to dysphagia - coughing/choking when swallowing - sensation of food sticking in the pharynx

barrett epithelium

- columnar - during the healing process, the body substitutes this for normal squamous - also called the barrett esophagus - the new tissue is more resistant to acid and supports esophageal healing, however it is premalignant and increases the risk for cancer

duodenal ulcers

- most common -

basal cell carcinoma

- occurs mostly on the lips - related to sun exposure - lesion is asymptomatic and resembles a raised scab - with time, it evolves into a raised ulcer with pearly borders - does not metastasize, but aggressively involves skin of the face

gastroesophageal reflux disease (GERD)

- often cause by helicobacter pylori - highest risk factor; obesity with increased intra-abdominal pressure (IAP) - increased risk for; asthma, laryngitis, dental decay, aspiration pneumonia, cardiac disease, and hemorrhage

chronic gastritis

- patchy, diffuse/spread out inflammation of the stomach lining. stomach walls thin and atropy. - decreased parietal cell (acid secreting) function - the source of intrinsic factor is lost, which is needed for vitamin b12 - leads to pernicious anemia - few symptoms are present unless ulceration occurs - n/v, upper abdominal discomfort, anorexia, and periodic epigastric pain after meals - increased gastric cancer risk - treatment is vit b12 - bell peppers/onions are commonly irritating foods - early sign; thickened, reddened mucous membrane with rugae/folds - type b gastritis; caused by helicobacter pylori infection, most common type - risk factors; crohn's disease, graft vs host disease, and uremia - pyloroplasty; surgical procedures with the pyloric sphincter. can make alkalis reflux into the stomach

erythroplakia

- precancerous, red velvety lesions on the floor of the mouth, tongue palate, and mandibular musosa - difficult to distinguish from inflammatory or immune reactions

secondary stomatitis

- results from infection by opportunistic viruses/fungi/bacteria in immunocompromised patients - can also be a result of chemotherapy, radiation, or steroid drug therapy

occupational risk factors for oral cancer

- textile workers - plumbers - coal/metal workers - have prolonged exposure to polycyclic aromatic hydrocarbons (PAHs)

primary stomatitis

- the most common form - includes noninfectious aphthous stomatitis, herpes simplex stomatitis, and traumatic ulcers

acute gastritis

- various degrees of necrosis & inflammation occur - if stomach is involved, hemorrhage may occur - if the stomach is not involved, complete recovery usually occurs in a few days - rapid onset of dyspepsia, epigastric pain, hematemesis, or melena - risk factors; radiation therapy, ingestion of acids/alkalie like lye and drain cleaners, use of steroids, aldosterone antagonists, and SSRIs - treatments; H2 receptor antagonists like famotidine & nizatidine. blocks gastric secretions. sucralfate is a mucosal barrier fortifier. proton pump inhibitors (PPIs) like omeprazole & pantoprazole suppress gastric acid. antacids are buffering agents. aluminum hydroxide with magnesium hydroxide, and then that plus simethicone. calcium carbonate causes rebound acid secretion

kaposi sarcoma

- vascular tumor appearing as a raised, purple, reddish, or brownish nodule or plaques - usually painless - can be found on hard palate, gums, tongue, or tonsils - most often associated with AIDS

interventions for GERD

1. NG tube to decrease esophageal sphincter function, keep the cardiac sphincter open, and allow acidic content from the stomach to enter the esophagus 2. sitting upright for one or more hours after eating can promote proper digestion and decrease the risk for reflux 3. for prompt relief; sit upright, drink fluids, take antacids 4. recommend 4-6 small meals daily rather than three large ones, because large meals increase the stomach's volume and pressure, as well as gastric emptying 5. teach the patient to eat slowly and chew thoroughly to facilitate digestion and prevent eructation/belching 6. avoid eating three or more hours before bed 7. sleep propped up to promote gas exchange 8. drugs that decrease lower esophageal sphincter (LES) pressure (which is bad); oral contraceptives, anticholinergics, NSAIDs, sedatives, nitrates, and calcium channel blockers 9. foods to avoid that lower LES pressure; caffeine, coffee (decaf too), tea, soda, chocolate, citrus fruits, nitrates, tomatoes/tomato products, alcohol, peppermint, spearmint, smoking/tobacco 10. 3 meds for GERD (which are the same for PUD); antacids, histamine blockers, and proton pump inhibitors (PPIs). they either inhibit gastric acid secretion, increase gastric emptying, or protect the gastric mucosa. PPIs like IV esomeprazole/pantoprazole may be short-term or for stress ulcers, & recurrence is common when stopped; stopping determines if the reflux is fixed. research has linked long-term PPI use to pneumonia, c. diff, bone fractures, chronic kidney injury, & vitamin/mineral deficiencies 11. antireflux surgery; usually reserved for patients not responding to medical treatment, high-volume reflux, and severe esophagitis 12. laparoscopic nissen fundoplication (LNF); minimally invasive, is the standard GERD surgical approach 13. LINX reflux management system; device that shows LES with a ring composed of rare earth magnets to allow swallowing of food. used for patients with typical symptoms, abnormal pH study, partially respond to PPI therapy, & do not have a hiatal hernia or sever esophagitis. tell each HCP about this procedure, as not all are safe with an MRI!! 14. stretta procedure; nonsurgical applies radiofrequency (RF) energy through an endoscope using needles placed near the esophageal junction. decreases vagus nerve activitym reducing discomfort. do not use with obese or severe symptom patients. clear liquids 24hrs after procedure. soft diet after first day. avoid NSAIDs/aspirin for 10 days. no NGT for at least a month!

interventions for oral cancer

1. adults visit the dentist twice a year for hygiene and inspecting/palpating mouth for lesions 2. stop tobacco and alcohol use 3. avoid sun exposure to lips 4, avoid exposure to human papillomavirus (HPV) 5. for lesions that do not heal in two weeks, or a lump/thickening in the cheek, warrants further assessment 6. incisional/needle biopsy; assess for premalignant changes in very small lesions. this can permit complete tumor removal 7. CT/MRI may be performed to determine metastasis 8. antibiotics for infection 9. steroids for edema with oral lesions 10. the PRIORITY of care is airway maintenance to promote gas exchange 11. cool mist supplied by face tent; may help with edema & O2 transport 12. aspiration precautions; assess LOC, gag reflex, and ability to swallow. semi or high fowler's position and keep suction equipment nearby. thickened liquids may be indicated 13. scalpel, laser, or cryoprobe removal of part/all of hard palate 14. glossectomy; removal of the tongue 15. laryngectomy; removal of the larynx and tumor 16. mandible resection; removal of part/all of mandible 17. maxillectomy; removal of part/all of hard palate 18. microsurgery; reconstruction of mouth, throat, or mandible with body tissue from intestine, arm, and abdomen 19. mohs micrographic surgery; removal of cancer on the lip by taking thin slices until no cancer is left 20. neck dissection; removal of lymph nodes in the neck, with or without muscle, nerve tissue, and veins. can be partial, radical, or modified radical 21. provide teaching and perform oral care before any procedure take place

common drugs for infection due to stomatitis

1. clotrimazole troches 2. nystatin swish & spit suspension 3. swish & spit chlorhexidine

patient teachings for stomatitis

1. use toothpaste without sodium lauryl sulfate (SLS) 2. avoid commercial mouthwashes & lemon-glycerin swabs because they can irritate the mucosa 3. always ask patients about a history of tobacco use 4. avoid citrus fruits/juice, salty/spicy foods, tomato products, alcohol, carbonated drinks, and caffeine

swish & spit drugs for pain management due to stomatitis

1. viscous lidocaine; topical anesthetic effect, patient may not feel burns from hot liquids! risk for aspiration also increases 2. diphenhydramine liquid 3. aluminum hydroxide/magnesium hydroxide/simethicone suspension

what is the diagnostic test for gastritis?

EGD via endoscope with biopsy

the student nurse is caring for an elderly female patient who has osteoporosis. when educating the patient, the student should include information about which major complication? a. bone fracture b. loss of estrogen c. scoliosis d. negative CA balance

a

which patient statement regarding diet and nutrition after a total gastrectomy requires further nursing teaching? a. "i should stay sitting up for an hour after i eat" b. "i will avoid liquids with my meals" c. "i need to eat small frequent meals" d. "i need to stay away from concentrated sweets"

a

a client who has rheumatoid arthritis is prescribed etanercept. what health teaching by the nurse about this drug is appropriate? a. giving subcutaneous injections b. having a chest x-ray once a year c. taking the medication with food d. using heat on the injection site

a

a nurse is caring for four patients. which patient does the nurse identify as being at the highest risk for development of oral cancer? a. 28 y/o with HPV infection b. 30 y/o with recurrent aphthous stomatitis (RAS) c. 55 y/o who quit chewing tobacco five years ago d. 76 y/o who's sometimes negligent in dental care

a

a patient had an open partial colectomy and colostomy placement 6 hours ago. which assessment would concern the nurse? a. purple, moist stoma b. stoma edema c. liquid stool collecting in the drainage bag d. serosanguineous fluid from the drain(s)

a

an adult is admitted to the hospital. x-rays reveal a fractured tibia and a cast is applied. of the following, which nursing action would be most important to check after the cast is applied? a. assessing for capillary refill b. arranging for physical therapy c. teaching the patient case care d. helping the patient ambulate on crutches

a

the graduate nurse and her preceptor are establishing priorities for their morning assessments. which client should they assess first? a. the newly admitted client with acute abdominal pain b. the client who needs a routine abdominal dressing change c. the client receiving continuous tube feedings, who needs the residual checked d. the sleeping client who received pain medication one hour ago

a

the nurse is teaching a patient about nutrition and diverticulosis. which food will the nurse teach the patient to avoid? a. cucumbers b. beans c. carrots d. radishes

a

a patient has a new synthetic leg cast for a right fractured tibia. what health teaching will the nurse include before discharge to home? SATA a. "elevate your right leg as often as possible to reduce swelling" b. "report increased pain or burning sensations under your cast" c. "use ice on the affected leg for the first 24-36 hours" d. "do not bear weight on the affected leg until instructed to do so" e. "do not cover the cast when you're in bed; keep it open to air to dry"

a, b, c, d

the nurse is caring for an older patient who experiences an exacerbation of ulcerative colitis with severe diarrhea and rectal bleeding that's lasted a week. which complication(s) will the nurse assess for? a. increased BUN b. hypokalemia c. leukocytosis d. anemia e. hyponatremia

a, b, c, d, e

the nurse is talking with a group of older patients about colorectal cancer risk factors. which are considered to be common? SATA a. high fat diet b. crohn's disease c. smoking d. alcoholism e. family history of cancer f. obesity

a, b, c, d, e, f

which assessment data are factors that increase the risk for osteoporosis for an older euro-american female? SATA a. drinks 3-4 glasses of wine per day b. sits at a desk all day at her job c. smokes a pack of cigarettes per day d. takes a mile-long walk five days per week e. takes 1,000 mg of acetaminophen daily for arthritis f. weighs 110 lbs

a, b, c, f

a patient had a left noncemented posterolateral total hip arthroplasty (THA) 2 days ago. which statements will the nurse include in health teaching for the patient? a. "practice leg exercises each day as instructed" b. "take deep breaths and use incentive spirometer every 2 hours" c. "be sure to cross your legs to be more comfortable in a chair" d. "report sudden increased hip pain or rotation immediately to the nurse" e. "stand on your right leg and pivot into the chair when getting out of bed"

a, b, d, e

which teaching will the nurse provide to a community group about early detection of colorectal cancer? SATA a. home testing kits are available with a prescription b. sigmoidoscopy should be performed every ten years c. people over 40 y/o should be tested for colon cancer d. bowel prep is necessary prior to performance of a colonoscopy e. virtual colonoscopes (CT colonoscopy) can be performed every five years

a, d, e

which assessment findings will the nurse expect for the patient with early stage rheumatoid arthritis (RA)? SATA a. joint inflammation b. subcutaneous nodules c. severe weight loss d. fatigue e. thrombocytosis f. anorexia

a, d, f

when providing discharge teaching about mouth care, which substance will the nurse teach the client with oral cancer to avoid? SATA a. mouthwash b. lip lubricant c. warm saline rinses d. ultrasoft toothbrush e. disposable foam brushes f. bicarbonate mouth rinse

a, e

a client with rheumatoid arthritis has an acutely swollen, red, and painful joint. what nonpharmacologic treatment does the nurse apply? a. heating pad b. ice packs c. splints d. wax dip

b

a community health nurse is screening clients for esophageal cancer. which client has the highest risk? a. 22 y/o who drinks a glass of beer weekly b. 44 y/o who smokes one pack of cigarettes each day c. 50 y/o who takes OTC omeprazole d. 63 y/o who uses protein supplements regularly

b

a nurse is caring for a client with recurrent aphthous stomatitis (RAS), who asks about food choices while healing. which food will the nurse suggest? a. half of an orange b. chocolate pudding c. chips with hummus d. glass of tomato juice

b

a nurse works in the rheumatology clinic and sees clients with rheumatoid arthritis. which client should the nurse see first? a. client who reports jaw pain when eating b. client with a red, hot, swollen right wrist c. client who has a puffy looking area behind the knee d. client with a joint deformity in both hands

b

a patient diagnosed with ulcerative colitis is admitted to the medical unit. when assessing the patient, which of these findings would be of the most concern? a. oral temperature of 99.0 F/37.2 C b. rebound tenderness c. bloody diarrhea d. borborygmi

b

a patient received a right hip ORIF after a fall. in the immediate postoperative period, the nurse should... a. maintain the leg in an adducted position b. maintain the leg in an abducted position c. maintain the leg in a neutral position d. maintain the leg with the hip flexed greater than 90 degrees

b

the RN is providing a list of recommended foods to the family of a patient who recently had a total colectomy and colostomy. which food item should the RN recommend in the client's postop diet? a. carbonated beverages b. chicken noodle soup c. boiled cabbage d. bean burritos

b

the nurse is caring for a male client postoperatively following creation of a colostomy. which nursing problem should the nurse include in the plan of care? a. sexual dysfunction b. disturbed body image c. fear related to poor prognosis d. imbalanced nutrition, more than body requirements

b

when assessing a patient diagnosed with osteoarthritis (OA), the nurse looks for which characteristics of this condition? a. waddling gait b. joint crepitus c. bilateral joint swelling d. decreased grip strength

b

a patient had an exploratory laparotomy to treat the cause of peritonitis and has a large incision that's closed with staples and two abdominal drains. which finding(s) would the nurse report immediately to the surgeon? a. serosanguineous drainage b. increased abdominal distention c. fever and chills d. pain level of 2/10 e. passing flatus

b, c

the primary HCP prescribes daily celecoxib for a patient experiencing persistent joint pain in both knees. which health teaching will the nurse provide for the patient regarding this drug for long-term pain control? SATA a. "take the prescribed drug before breakfast each day" b. "report any sign of bleeding, including bloody or dark tarry stools" c. "do not take other NSAIDs while on celecoxib" d. "report any major changes in the amount of urine you excrete each day" e. "follow up with lab tests to assess liver function"

b, c, d

a patient had an open reduction internal fixation (ORIF) of the right wrist. what health teaching is appropriate for the nurse to provide for this patient before returning home? SATA a. "keep your right arm below the level of the heart as often as possible" b. "use an ice pack for the first 24 hours to decrease tissue swelling" c. "report coolness or discoloration of your right hand to your doctor" d. "don't place any device under the cast to itch your skin" e. "move the fingers of the right hand frequently to promote blood flow"

b, c, e

the nurse is caring for a patient diagnosed with peptic ulcer disease (PUD). for which potential complication will the nurse monitor? SATA a. pneumonia b. peritonitis c. anemia d. stroke e. hypotension f. cirrhosis

b, c, e

which client statement about GERD triggers requires further nursing teaching? SATA a. "i will decrease my alcohol intake" b. "smoking one or two cigarettes a day won't hurt" c. "my plan is to eat six small meals daily" d. "tomato-based foods should be avoided" e. "i love soda, but i'm going to stop drinking it" f. "our family eats tacos and burritos several times weekly"

b, f

a client has been diagnosed with rheumatoid arthritis. the client has experienced increased fatigue and worsening physical status and is finding it difficult to maintain the role of student president in his school. the student is expected to attend social events and make class decisions. stress seems to exacerbate the condition. what action by the nurse is best? a. suggest the client give up the role of president b. see if the client will call a student body meeting c. assess the client's psychosocial support more thoroughly d. ignore the problem and let the patient work it out

c

a nurse provides discharge teaching for a male client who had a minimally invasive hernia repair this morning. which patient statement requires further nursing teaching? a. "i should avoid coughing if at all possible" b. "i can shower in a day or two after i remove my surgical bandage" c. "i can't go back to work for at least six weeks" d. "i should use an ice pack to relieve my pain"

c

a patient has a severe exacerbation of ulcerative colitis. long-term medications will probably include... a. antacids b. antibiotics c. corticosteroids d. histamine2 (H2) receptor blockers

c

a patient has had an exacerbation of ulcerative colitis with cramping and diarrhea persisting longer than one week. the nurse should assess the patient for which complication? a. heart failure b. deep vein thrombosis c. hypokalemia d. hypocalcemia

c

assistive personnel are assigned to care for a patient who had a cemented total knee arthroplasty (TKA) yesterday. which observation by the AP indicates a need for follow-up by the nurse? a. "the client's discolored knee is very swollen and discolored" b. "the client states the surgical knee is very painful when moving" c. "the client's lower leg on the surgical side is painful and red" d. "the client needs assistance when walking to the bathroom"

c

the nurse assesses a patient recently diagnosed with metastatic vertebral bone cancer. which intervention is the priority when caring for this patient? a. consultation with rehab therapy b. referral to hospice care c. drug therapy to manage persistent pain d. oxygen therapy to prevent dyspnea

c

the nurse is caring for a patient immediately after a bunionectomy. what is the nurse's primary action? a. relieve/reduce the patient's pain b. maintain the patient's airway c. assess neurovascular status in the surgical foot d. apply a hot compress to the surgical area

c

the nurse is educating a patient about acute versus chronic osteomyelitis. which statement when made by the patient is accurate? a. neither type of osteomyelitis involves pain b. only acute osteomyelitis occurs due to infection c. chronic osteomyelitis often occurs due to an infection in a foot ulcer d. acute osteomyelitis will resolve on its own without antibiotics

c

the nurse is providing dietary instructions to a patient who is immobile and experiencing frequent episodes of constipation. the patient complains that the constipation is uncomfortable. the nurse should tell the patient that which food item would be most helpful to include in the diet? a. pasta b. white bread c. whole grain bread d. cabbage

c

the nursing student studying rheumatoid arthritis learns which fact about the disease? a. permanent damage is inevitable b. morning stiffness is rare c. it consists of an autoimmune process d. it affects single joints only

c

what is the nurse's priority when doing an admission for a patient who returned directly from the operating suite after a carpal tunnel repair? a. monitor vital signs, including pulse oximetry b. check the surgical dressing to ensure that it's intact c. assess neurovascular status of the affected limb d. monitor intake & output

c

you're caring for a patient with a sigmoid colostomy. the stool from this colostomy is... a. semi liquid b. semi solid c. formed d. watery

c

you're caring for beth who underwent a billroth II procedure (surgical removal of the pylorus and duodenum) for treatment of a peptic ulcer. which findings suggest that the patient is developing dumping syndrome, a complication associated with this procedure? a. flushed, dry skin b. headache and bradycardia c. dizziness and sweating d. dyspnea and chest pain

c

you're caring for carin who just had ileostomy surgery. during the first 24 hours postop, how much drainage can you expect from the ileostomy? a. 100mL b. 500mL c. 1500mL d. 5000mL

c

UNF student nurse hannah is teaching a group of middle-aged men about peptic ulcers. when discussing risk factors for peptic ulcers, the nurse should mention... a. a sedentary lifestyle & smoking b. a history of hemorrhoids & smoking c. alcohol abuse & a history of acute renal failure d. alcohol abuse & smoking

d

a patient returns to the postanesthesia care unit (PACU) after a total knee arthroplasty. what is the nurse's priority when caring for this patient? a. perform passive range of motion exercises b. keep the affected limb immobilized c. ensure that the patient uses the patient controlled analgesia d. check the neurovascular status of the affected leg and foot

d

a patient who had an elective below the knee amputation (BKA) reports pain in the foot that was amputated last week. what is the nurse's most appropriate response to the patient's pain? a. "the pain will go away after the swelling decreases" b. "that's phantom limb pain, and every amputee has that" c. "your foot has been amputated, so it's in your head" d. "on a scale of 0-10, how would you rate your pain?"

d

jerod is experiencing an acute episode of ulcerative colitis. which is priority for this patient? a. monitor for increased serum glucose level from steroid therapy b. restrict the dietary intake of foods high in protein c. note any changes in the color and consistency of stools d. replace lost fluid and sodium

d

sitty, a 66y/o patient underwent a colostomy for ruptured diverticulum. she did well during the surgery and returned to your med-surg floor in stable condition. you assess her colostomy 2 days after surgery. which finding do you report to the doctor? a. beefy red stoma b. edematous stoma c. reddish-pink stoma d. brownish-black stoma

d

the nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? a. administering pain medication b. obtaining a blood sample for laboratory studies c. preparing to insert a nasogastric tube d. start an IV & administer IV fluids

d

the nurse is working with a client who has rheumatoid arthritis. the nurse has identified the priority problem of poor body image for the client. what finding by the nurse indicates the goal for this client is being met? a. uses assistive devices to protect joints b. takes medication as directed c. has a positive outlook on facebook d. attends meetings of a book club

d

the nurse is working with a student nurse, providing care for a patient who experienced an above the knee (AKA) amputation this morning due to injuries from a motor vehicle accident. which is not a common complication with amputation? a. phantom limb pain b. infection c. flexion contractures d. pulselessness at the femoral artery

d

the nurse is caring for a client with esophageal cancer who is scheduled for surgery. when the client asks "is this treatment going to cure me?" which nursing response is appropriate? SATA a. "the surgery has been useful for many patients so it should work for you" b. "you can beat this disease if you just put your mind to it and don't give up" c. "yes, and you have the best surgeon around who specializes in cancer treatment" d. "your surgeon can give you more information about the effectiveness of this treatment" e. "it sounds like you're concerned about surgical outcomes. let's talk about your feelings"

d, e

after one month of short term corticosteroid therapy, a patient with an acute exacerbation of rheumatoid arthritis returns to the clinic for a follow up visit. which laboratory finding should the nurse review for potential adverse effects? a. fasting serum glucose b. serum liver function test c. erythrocyte sedimentation rate d. serum electrolyte levels

either a or d is correct.

stomatitis is a broad term for inflammation within the...

oral cavity