Ch. 35: Management of Patients with Oral and Esophageal Disorders

Mumps, a viral infection affecting children, is usually an inflammation of which gland(s)?

Parotid

Contact dermatitis

Reddened area or rash associated with itching

Chancre

Reddened circumscribed lesion that ulcerates and becomes encrusted

Canker sore

Shallow ulcer with a red border and white or yellow center

Discuss about 9 major nursing diagnoses related to the surgical process of neck dissection.

..."The Patient Undergoing a Neck Dissection"

Discuss nursing interventions for the postoperative care of a patient who has had a neck dissection.

..."The Patient Undergoing a Neck Dissection"

What would you tell the patient to explain why nasogastric suctioning is needed?

...Nasogastric suctioning is needed to remove stomach contents, thereby reducing the danger of aspiration

On physical examination, Edith evidenced changes associated with cancer of the mouth, such as:

- a sore, roughened area that has not healed in 3 weeks -minor swelling in an area adjacent to the lesion -numbness in the affected area of the mouth

Neoplasms of the salivary glands:

-are normally malignant and are treated by surgical excision -commonly recur, and recurrences are more malignant than the original tumor -are usually always treated with radiation

After a radical neck dissection, a patient is placed in Fowler's position to:

-decrease venous pressure on the skin flaps -facilitate swallowing -increase lymphatic drainage

Actinic cheilitis is a lip lesion that results from sun exposure and can lead to squamous cell carcinoma. It is evidenced by:

-erythema -fissuring -white hyperkeratosis

The incidence of most dental caries is directly related to an increase in the dietary intake of :

. sugar

Compare and contrast the clinical manifestations and medical/nursing interventions for sialadenitis and sialolithiasis.

...""Disorders of the Salivary Glands"

Distinguish between the 3 types of neck disscetion: a classic radical neck, an modified radical neck, and a selective neck.

...""Neck Dissection"

Discuss the nursing interventions for a patient with cancer of the esophagus.

..."Cancer of the Esophagus"

Discuss the various nursing interventions for a patient with cancer of the oral cavity.

..."Cancer of the Oral Cavity and Pharynx"

Explain the infectious processes, clinical manifestations, and medical/nursing interventions associated with a periapical abscess.

..."Dentoalveolar Abscess or Periapical Abscess"

Compare and contrast the etiology, clinical manifestations, and medical/nursing interventions for achalasia and diffuse esophageal spasm.

..."Disorders of the Esophagus"

Discuss at least 8 healthy oral hygiene habits that have been found to promote good dental health.

..."Mouth Care"

William, a 17-year-old student, suffered a mandibular fracture while playing football. He is scheduled for jaw repositioning surgery. Preoperatively, the nurse explains the surgical procedure for treatment of a mandibular fracture. Describe the procedure that would be used.

...Rigid plate fixation (insertion of metal plates and screws into the bone to approximate and stabilize the bone) is the current treatment of choice

Edith, a 64-year-old mother of two, has been a chain smoker for 20 years. During the past month she noticed a dryness in her mouth and a roughened area that is irritating. She mentioned her symptoms to her dentist, who referred her to a medical internist. On the basis of the patient's health history, the nurse suspects oral cancer. Describe, what the nurse would expect the lesion to look like.

...The typical lesion is a painless, indurated (hardened) ulcer with raised edges

What essential item must be sent home with William when he is discharged?

...a wire cutter

List three postoperative complications expected when someone has surgery to the neck area

...altered respiratory status, wound infection, and hemorrhage

Three collaborative, postoperative nursing problems may be:

...hemorrhage, nerve injury, and chyle fistula

A radical neck dissection is often performed to help prevent ________, the primary reason for death from neck malignancies.

...local-regional metastasis

Reconstructive techniques involve grafts that normally use the ________ muscle.

...pectoralis major

Two common morbidities associated with a radical neck dissection are: ________ and ________.

...shoulder drop and poor cosmesis (visible neck

A frequent complication of oral surgery when the salivary glands have to be radiated is:

...xerostomia

A nurse knows that adequate nutrition is related to good dental health. As part of health assessment, a nurse also knows that about what percentage of adults 45 to 64 years of age have severe periodontal disease?

15%

Preventive orthodontics for malocclusion can start as early as age:

5 years

If detected early, prior to lymph node involvement, the 5-year survival rate for oral cancer is about what percent?

60%

For emergency use, which of the following should be available at the head of the bed?

A wire cutter or scissors

Leukoplakia

Hyperkeratotic white patches usually in buccal mucosa

Gingivitis

Painful, inflamed, swollen gums

A patient complains about a inflamed salivary gland below his right ear. The nurse documents probable inflammation of which gland(s)?

Parotid

Parotitis, frequently seen in the elderly or debilitated patient, is usuallly caused by:

Staphylococcus aureus

Lichen planus

Ulcerated and painful, white papules

Actinic cheilitis

White overgrowth of horny layer of epidermis

Hairy leukoplakia

White patches with rough, hairlike projections usually found on the tongue

To confirm a diagnosis of carcinoma of the mouth, a physician would order:

a biopsy

temporomandibular disorders

a group of conditions that cause pain or dysfunction of the temporomandibular joint (TMJ) and surrounding structures

dysplasia

abnormal change in cells

periapical abscess

abscessed tooth

achalasia

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

The nurse suspects that a patient who presents with the symptom of food "sticking" in the lower portion of the esophagus may have the motility disorder known as:

achalasia

Intervention for a person who has swallowed strong acid includes all of the following EXCEPT:

administering an irritant that will stimulate vomiting

A hiatal hernia involves:

an extension of the esophagus through an opening in the diaphragm

The typical lesion in oral cancer can be described as:

an indurated ulcer

Postoperatively, the nurse's primary goal is to maintain:

an open airway

A common lesion of the mouth that is also referred to as a "canker sore" is:

aphthous stomatitis

A nurse who is caring for a patient who has had radical neck surgery notices an abnormal amount of serosanguineous secretions in the wound suction unit during the first postoperative day. An expected normal amount of drainage is:

approximately 80 to 120 mL

A common postoperative complication of esophageal surgery for cancer is:

aspiration pneumonia

gastroesophageal reflux

back-flow of gastric or duodenal contents into the esophagus

Cancer of the esophagus occurs primarily in:

black men older than 50 years of age

A nurse inspects the Stensen duct of the parotid gland to determine inflammation and possible obstruction. The nurse would examine the oral cavity in the area of the:

buccal mucosa next to the upper molars

A major potential complication from graft necrosis or artery damage is hemorrhage from the:

carotid artery

A recommended initial postoperative diet for William would be:

clear liquid

dysphagia

difficulty swallowing

xerostomia

dry mouth

vagotomy syndrome

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

Usually, the first symptom associated with esophageal disease is:

dysphagia

William must be instructed not to chew food until the _______ postoperative week.

fifth

Postoperative nursing care for drainage of a dentoalveolar or periapical abscess includes all of the following EXCEPT:

fluid restriction for the first 48 hours because the gums are swollen and painful *Includes: soft diet after 24 hours, external heat by pad or compress to hasten the resolution of the inflammatory swelling

A common disease of oral tissue characterized by painful, inflamed, and swollen gums is:

gingivitis

pyrosis

heartburn

Postoperatively, the nurse observes excessive drooling. She assesses for damage to the:

hypoglossal nerve

stomatitis

inflammation of the oral mucosa

parotitis

inflammation of the parotid gland

sialadenitis

inflammation of the salivary glands

The most common site for cancer of the oral cavity is the:

mouth

Postoperatively, the nurse should immediately position William:

on his side with his head slightly elevated to prevent aspiration

During the health history, the nurse noted that Edith did not mention a late-occurring symptom of mouth cancer, which is:

pain

odynophagia

pain or swallowing

esophagogastroduodenoscopy (EGD)

passage of a fiberoptic tube through the mouth and throat into the digestive tract for visualization of the esophagus, stomach, and small intestine; biopsies can be performed

hernia

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

The most common symptom that patients with gastroesophageal reflux disease (GERD) mention is:

pyrosis

Postoperatively, a finding that should be immediately reported because it may indicate airway obstruction is:

stridor

lithotripsy

use of shock waves to break up or disintegrate stones