GI 35

immediate postop period of neck dissection, nurse should assess for ___ by listening frequently over trachea with stethoscope. THIS FINDING MUST BE REPORTED IMMEDIATELY B/C INDICATES OBSTRUCTION OF AIRWAY

stridor

___ and ___ are standard tx for oral cancers However, with advanced disease, ___ is used

surgical resection and radiation therapy chemotherapy

tumors larger than ___ often recur in oral cancers

4cm

what is used for tx herpes simplex( cold sore/fever blister)

Acyclovir(zovirax) ointment or systemic Rxs as prescribed

___- surgical removal of half of the tongue ___- surgical removal of the tongue

Hemiglossectomy total glossectomy

major goal for ____ include participation in tx plan, maintenance or resp. status, comfort, absence of infection, liability of graft, maintenance of adequate intake of food and fluids, effective coping strategies and communication, maintenance of shoulder and neck motion, and absence of complications.

neck dissection

___- dryness of the mouth, a frequent sequela of oral cancer

xerostomia

surgical procedures for cancer of the tongue are ___ and ____

hemiglossectomy and total glossectomy

A typical lesion in _____ is a painless indurated ulcer(hardened) w/raised edges.

oral cancer

early stages- no symptoms, later stages - most frequent symptom is a painless sore or mass that does NOT heal, may bleed easy or present w/red/white patch

oral cancers

What is Tx for herpetic gingivostomatitis?

-Apply topical anesthetic as prescibedmay may need opiods if pain is severe -Saline or 2%-3% hydrogen peroxide irrigation -antiviral such as acyclovir may be prescribed

What are causes and Tx for stomatitis?

-chemo, radiation, severe Rx allergy, myelosuppression(bone marrow depression) -prophylactic mouth care- brushing, flossing, rinsing for any pt. receiving chemo/radiation -teach proper oral hygiene- soft bristle toothbrush, nonabrasive toothpaste; for painful ulcers oral swabs w/sponge-like applicators; avoid alcohol based rinses & hot/spicy foods -Apply topical anti-inflamatory, ABX, & anesthetic agents as prescribed -swish & spit salt(NS) & soda

dx for oral cancer include

oral examination as well as assessment of cervical lymph nodes to detect possible metastasis bx- performed w/suspicious lesions( ones that have not healed in 2wks)

If a radial graft is to be performed, an ___ on the donor arm must be performed to ensure that the ulnar artery is patent and can provide blood flow to the hand after removal of the radial artery.

Allen test

A patient is scheduled for a radical neck dissection and removal of a malignant tumor of the jaw. A radial graft is to be performed, so an Allen test must be done on the donor arm. What is the Allen test performed for? A) To ensure that the ulnar artery is patent and can supply blood to the hand B) To ensure that the radial artery is patent and can supply blood to the hand C) To ensure that the brachial artery is patent and can supply blood to the hand D) To ensure that the popleteal artery is patent and can supply blood to the hand

Ans: A Feedback: If a radial graft is to be performed, an Allen test on the donor arm must be performed to ensure that the ulnar artery is patent and can provide blood flow to the hand after removal of the radial artery. The brachial artery is not involved in this procedure. The popleteal artery is in the leg, not the arm.

A patient with GERD has a diagnosis of Barrett's esophagus has been admitted to your unit. You are writing a care plan for this patient. What information is essential to include? A) He will need to undergo an upper endoscopy every 6 months to detect malignant changes. B) Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage. C) Small amounts of blood are likely to be present in his stools and should not cause concern. D) Antacids may be discontinued when symptoms of heartburn subside.

Ans: A Feedback: In the client with Barrett's esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer. In order to facilitate early detection of malignant cells, an upper endoscopy is recommended every 6 months. H2 receptor antagonists are commonly prescribed for clients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or that are tarry are not expected and should be reported immediately. When antacids are prescribed for clients with GERD, they should be taken as ordered whether or not the client is symptomatic.

The nurse is developing a teaching plan for a patient with GERD who has a diagnosis of Barrett's esophagus. Which of the following information is essential to include? A) He will need to undergo an upper endoscopy every 6 to 12 months to detect malignant changes. B) Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage. C) Small amounts of blood are likely to be present in his stools and should not cause concern. D) Antacids may be discontinued when symptoms of heartburn subside.

Ans: A Feedback: In the patient with Barrett's esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer. In order to facilitate early detection of malignant cells, an upper endoscopy is recommended every 6 to 12 months. H2 receptor antagonists are commonly prescribed for patients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or which are tarry are not expected and should be reported immediately. When antacids are prescribed for patients with GERD, they should be taken as ordered whether or not the patient is symptomatic.

After surgery for esophageal cancer, the patient is instructed to remain upright for at least 2 hours to allow the food to move through the gastrointestinal tract. What drug is used to promote gastric motility in these patients? A) Reglan B) Prilosec C) Previcid D) Ranitidine

Ans: A Feedback: Metoclopramide (Reglan) is useful in promoting gastric motility. Options B, C, and D are incorrect.

Which of the following patients is at the greatest risk for developing cancer of the tongue? A) A 65-year-old man with alcoholism who smokes B) A 45-year-old woman who smokes and has diabetes C) A 32-year-old man who uses smokeless tobacco and has hypertension D) A 57-year-old man with alcoholism and a history of dental caries

Ans: A Feedback: Oral cancers are often associated with the use of alcohol and tobacco, which if used together have a synergistic carcinogenic effect. Research shows that about 75% cases of oral cancers occur in people over the age of 60. Men are more affected than women, but this is starting to change.

You are caring for four oncology patients. What patient is at the greatest risk for developing cancer of the tongue? A) A 65-year-old man with alcoholism who smokes B) A 45-year-old woman who smokes and has diabetes C) A 32-year-old man who uses smokeless tobacco and has hypertension D) A 57-year-old man with alcoholism and a history of dental caries

Ans: A Feedback: Oral cancers are often associated with the use of alcohol and tobacco, which when used together have a synergistic carcinogenic effect. Research shows that about 75% of cases of oral cancers occur in people over the age of 60. Men are more affected than women, but this is starting to change.

A patient diagnosed with achalasia is admitted to your unit. You know that a common complaint of this disorder is what? A) Sensation of food sticking in the lower portion of the esophagus B) Burning sensation in the esophagus C) Frequent burping after eating D) Recurring hiccups

Ans: A Feedback: The primary complaint of achalasia is sensation of food sticking in the lower portion of the esophagus. A burning sensation in the esophagus is associated with hiatal hernias. Frequent burping after eating and recurring hiccups are not common complaints of achalasia.

The nurse caring for a patient who is being discharged home after a radical neck dissection has worked with the Home Health nurse to develop a plan of care for this patient. What is a priority psychosocial outcome for a patient who has had a radical neck dissection? A) Indicates acceptance of altered appearance and demonstrates positive self-image B) Freely expresses needs and concerns related to postoperative pain management C) Compensates effectively for alteration in ability to communicate related to dysarthria D) Demonstrates effective stress management techniques to promote muscle relaxation

Ans: A Feedback: Since radical neck dissection involves removal of the sternocleidomastoid muscle, spinal accessory muscles, and cervical lymph nodes on one side of the neck, the client's appearance is visibly altered. The face generally appears asymmetric with a visible neck depression; shoulder drop also occurs frequently. These changes have the potential to negatively affect self-concept and body image. Facilitating adaptation to these changes is a crucial component of nursing intervention. Clients who have had head and neck surgery generally report less pain as compared with other postoperative clients; however, the nurse must assess each individual client's level of pain and response to analgesics. Clients may experience transient hoarseness following a radical neck dissection; however, their ability to communicate is not permanently altered. Stress management is beneficial but would not be considered the priority in this clinical situation.

Which of the following is a priority psychosocial outcome for a patient who has had a radical neck dissection? A) He indicates acceptance of altered appearance and demonstrates positive self-image. B) He freely expresses needs and concerns related to postoperative pain management. C) He compensates effectively for alteration in ability to communicate related to dysarthria. D) He demonstrates effective stress management techniques to promote muscle relaxation.

Ans: A Feedback: Since radical neck dissection involves removal of the sternocleidomastoid muscle, spinal accessory muscles, and cervical lymph nodes on one side of the neck, the patient's appearance is visibly altered. The face generally appears asymmetric with a visible neck depression; shoulder drop also occurs frequently. These changes have the potential to negatively affect self-concept and body image. Facilitating adaptation to these changes is a crucial component of nursing intervention. Patients who have had head and neck surgery generally report less pain as compared with other postoperative patients; however, the nurse must assess each individual patient's level of pain and response to analgesics. Patients may experience transient hoarseness following a radical neck dissection; however, their ability to communicate is not permanently altered. Stress management is beneficial but would not be considered the priority in this clinical situation.

The nurse notes that a client who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the most important consideration for the nurse when suctioning this client? A) Avoid applying suction on or near the graft site. B) Position client on her nonoperative side with the head of the bed down. C) Assess viability of the graft before beginning suctioning. D) Evaluate the client's ability to swallow saliva and clear fluids.

Ans: A Feedback: The nurse should avoid positioning the suction catheter on or near the graft suture lines. Application of suction in these areas could damage the graft. Following a modified radical neck dissection with graft, the client is usually positioned with the head of the bed elevated to promote drainage and reduce edema. Assessing viability of the graft is important but is not part of the suctioning procedure and may delay initiating suctioning. Maintenance of a patent airway is a nursing priority. Similarly, the client's ability to swallow is an important assessment for the nurse to make; however, it is not directly linked to the client's need for suctioning.

A patient who has undergone skin, tissue, and muscle grafting following a modified radical neck dissection requires suctioning. What is the most important consideration for the nurse when suctioning this patient? A) Avoid applying suction on or near the graft site B) Position the patient on his non-operative side with the head of the bed down C) Assess viability of the graft before beginning suctioning D) Evaluate the patient's ability to swallow saliva and clear fluids

Ans: A Feedback: The nurse should avoid positioning the suction catheter on or near the graft suture lines. Application of suction in these areas could damage the graft. Following a modified radical neck dissection with graft, the patient is usually positioned with the head of the bed elevated to promote drainage and reduce edema. Assessing viability of the graft is important but is not part of the suctioning procedure and may delay the initiation of suctioning. Maintenance of a patent airway is a nursing priority. Similarly, the patient's ability to swallow is an important assessment for the nurse to make; however, it is not directly linked to the patient's need for suctioning.

The patient is complaining of dysphagia, substernal pain, and regurgitation of undigested food. Based upon these symptoms, the nurse anticipates that the physician will schedule the patient for: A) An esophagogastroduodenoscopy (EGD) B) A colonoscopy C) A CAT scan of the head and neck D) A barium swallow

Ans: A Feedback: The patient is exhibiting symptoms of cancer of the esophagus. Diagnosis is confirmed in 95% of cases by an EGD with biopsy and brushings

The nurse is caring for a patient who has a perforated esophagus as a result of a bullet wound to the neck. Which of the following interventions is the nurse most likely to implement in order to meet this patient's needs for nutrition and hydration? A) Administering fluids and nutrients parenterally until the wound is closed. B) Providing enteral nutrition via a nasogastric tube for a minimum of 30 days. C) Administering feedings via a percutaneous endoscopic gastrostomy tube. D) Maintaining the patient in Fowler's position when offering fluids to minimize reflux

Ans: A Feedback: The patient with a perforated esophagus is likely to have a nasogastric tube inserted; however, its purpose is not related to feeding. It is inserted to enable suction to decrease the amount of gastric juice that could potentially reflux into the esophagus and mediastinum. Typically, parenteral nutrition is required. Parenteral feeding is preferred to gastrostomy feedings. Reflux can occur following PEG tube feedings. The patient is generally NPO; therefore, clear liquids would not be offered. The patient's position should be adjusted for comfort; however, high-Fowler's position is not mandated.

The nurse is caring for a patient who is diagnosed with achalasia. The nurse determines that a common complaint of this disorder is: A) Sensation of food sticking in the lower portion of the esophagus B) Burning sensation in the esophagus C) Frequent burping after eating D) Recurring hiccups

Ans: A Feedback: The primary complaint of achalasia is sensation of food sticking in the lower portion of the esophagus. A burning sensation in the esophagus is associated with hiatal hernias.

The nurse caring for a patient who has had surgery for oral cancer realizes that the most important long-term need for this patient is what? A) Verbal communication B) Nutrition C) Social support D) Fluid balance

Ans: A Feedback: Verbal communication may be impaired by radical surgery for oral cancer. It is therefore vital to assess the patient's ability to communicate in writing before surgery. Pen and paper are provided postoperatively to patients who can use them to communicate. A communication board with commonly used words or pictures is obtained preoperatively and given after surgery to patients who cannot write so that they may point to needed items. A speech therapist is also consulted postoperatively. Nutrition, social support, and fluid balance are all important, but they are not as important to the patient long-term as communication.

You are caring for a patient in the latter stages of esophageal cancer. What signs and symptoms might this patient experience at this time? (Mark all that apply.) A) Perforation into the mediastinum B) Everything tastes hot C) Erosion into the great vessels D) Everything tastes cold E) Obstruction of the esophagus

Ans: A, C, E Feedback: In the latter stages, obstruction of the esophagus is noted, with possible perforation into the mediastinum and erosion into the great vessels. Whether food tastes either hot or cold, it is not a sign or symptom of esophageal cancer in the latter stages.

You are caring for a patient who underwent surgery for esophageal cancer 24 hours ago. You know that what is a common postoperative complication of surgery for esophageal cancer? A) Inability to clear secretions B) Aspiration pneumonia C) Decreased nutritional status D) Inability to breathe

Ans: B Feedback: A common postoperative complication is aspiration pneumonia. Therefore, the patient is placed on a vigorous pulmonary plan of care that includes incentive spirometry, sitting up in a chair, and if necessary, nebulizer treatments. Therefore options A, C, and D are incorrect.

The patient has had a neck resection with a radial forearm free flap. The nurse assesses the graft and notes the color to be blue with mottling. What might this indicate? A) A viable graft B) Venous congestion C) Arterial occlusion D) A room that is too cool

Ans: B Feedback: A graft that is blue with mottling may indicate venous congestion. A graft that is white may indicate arterial occlusion.

You are caring for a patient who has had a neck resection with a radial forearm free flap. When you assess the graft you note the color to be blue with mottling. What might this indicate? A) A viable graft B) Venous congestion C) Arterial occlusion D) A room that is too cool

Ans: B Feedback: A graft that is blue with mottling may indicate venous congestion. A graft that is white may indicate arterial occlusion. Therefore options A, C, and D are incorrect.

A 78-year-old male patient with an esophageal diverticulum has been admitted to your unit. What assessment finding is characteristic of this disorder? A) Burning pain on swallowing B) Regurgitation of undigested food C) Symptoms mimicking a heart attack D) Chronic parotid abscesses

Ans: B Feedback: An esophageal diverticulum is an outpouching of mucosa and submucosa that protrudes through the esophageal musculature. Food becomes trapped in the pouch and is frequently regurgitated when the client assumes a recumbent position. The client may experience difficulty swallowing; however, burning pain is not a typical finding. Symptoms mimicking a heart attack are characteristic of GERD. Chronic parotid abscesses are not associated with a diagnosis of esophageal diverticulum.

The nurse is caring for a 78-year-old patient who has an esophageal diverticulum. Which of the following assessment findings is characteristic of this disorder? A) Burning pain on swallowing B) Regurgitation of undigested food C) Symptoms mimicking a heart attack D) Chronic parotid abscesses

Ans: B Feedback: An esophageal diverticulum is an outpouching of mucosa and submucosa that protrudes through the esophageal musculature. Food becomes trapped in the pouch and is frequently regurgitated when the patient assumes a recumbent position. The patient may experience difficulty swallowing; however, burning pain is not a typical finding. Symptoms mimicking a heart attack are characteristic of GERD. Chronic parotid abscesses are not associated with a diagnosis of esophageal diverticulum.

A patient returns to your unit after a neck dissection. The surgeon placed a Jackson Pratt drain in the wound. When assessing the wound drainage over the first 24 postoperative hours you would notify the physician immediately for what? A) Blood clots in the drainage B) 300 cc. of milky or cloudy drainage C) Spots of drainage on the dressings surrounding the drain D) 120 cc. of serosanguinous drainage

Ans: B Feedback: Between 80 and 120 mL of serosanguineous secretions may drain over the first 24 hours. Excessive drainage may be indicative of a chyle fistula or hemorrhage.

The nurse is participating in a local health fair where he is assessing patients' mouths for signs of oral cancer. What is most characteristic of oral cancer in its early stages? A) Dull pain radiating to the ears and teeth B) Presence of a painless sore with raised edges C) Areas of tenderness that make chewing difficult D) Diffuse inflammation of the buccal mucosa

Ans: B Feedback: Malignant lesions of the oral cavity are most often painless lumps or sores with raised borders. Because they do not bother the client, delay in seeking treatment occurs frequently, and negatively affects prognosis. Dull pain radiating to the ears and teeth is characteristic of malocclusion. Inflammation of the buccal mucosa causes discomfort and often occurs as a side effect of chemotherapy. Tenderness resulting in pain on chewing may be associated with gingivitis, abscess, irritation from dentures, and other causes. Pain related to oral cancer is a late symptom.

The nurse is assessing a patient's mouth for signs of oral cancer. Which of the following is most characteristic of oral cancer in its early stages? A) Dull pain radiating to the ears and teeth B) Presence of a painless sore with raised edges C) Areas of tenderness that make chewing difficult D) Diffuse inflammation of the buccal mucosa

Ans: B Feedback: Malignant lesions of the oral cavity are most often painless lumps or sores with raised borders. Because they do not bother the patient, delay in seeking treatment occurs frequently and negatively affects prognosis. Dull pain radiating to the ears and teeth is characteristic of malocclusion. Inflammation of the buccal mucosa causes discomfort and often occurs as a side effect of chemotherapy. Tenderness resulting in pain on chewing may be associated with gingivitis, abscess, irritation from dentures, and other causes. Pain related to oral cancer is a late symptom

When caring for a patient with the nursing diagnosis of impaired swallowing related to neuromuscular impairment, the nurse should: A) Position the patient in a supine position. B) Elevate the head of the bed 90 degrees during meals. C) Encourage the patient to remove dentures. D) Encourage thin liquids for dietary intake.

Ans: B Feedback: The head of the bed must be elevated while the patient is eating. The patient should be placed in a recumbent position, not a supine position, when lying down to reduce the risk of aspiration. Encourage the patient to wear properly fitted dentures to enhance his chewing ability. Thickened liquids, not thin liquids, decrease aspiration risk

A nurse is caring for a patient who has just had a rigid fixation of a mandibular fracture. When planning the discharge teaching for this patient, what would the nurse be sure to include? A) Increase calcium intake for bone healing B) Not to chew food for 1 to 4 weeks after surgery C) Dietary counseling to minimize caloric and protein intake D) Minimize fluid intake through a straw

Ans: B Feedback: The patient who has had rigid fixation should be instructed not to chew food in the first 1 to 4 weeks after surgery. A liquid diet is recommended, and dietary counseling should be obtained to ensure optimal caloric and protein intake. These patients would not be instructed to increase their calcium intake, minimize caloric and protein intake, or minimize fluid intake through a straw.

A patient who had a radical neck dissection has a Jackson-Pratt drain in place. The nurse observes the output from the drain over a 24-hour period. Which of the following findings should be reported to the physician immediately? A) 80 cc of serosanguinous drainage B) 400 cc of milky or cloudy drainage C) Spots of drainage on the dressings surrounding the drain D) Several small clots noted in the drainage

Ans: B Feedback: The presence of more that 120 cc of drainage may indicate the development of a chyle fistula as a result of damage to the thoracic duct during surgery. The drainage from a chyle fistula is generally milk-like. Laboratory analysis indicates the presence of fat. The typical amount of drainage per day during the immediate postoperative period is 80 to 120 cc. The nurse should immediately report drainage of any amount which appears cloudy. Small spots of drainage on the dressing are an expected finding; however, the nurse should circle these with a pen and monitor them closely to determine if they are increasing in circumference. This would indicate that drainage is escaping around the drain rather than through it. Small clots are also an expected finding; any frank bleeding should be reported at once.

A patient diagnosed with esophageal reflux disorder has been admitted to your floor. When planning teaching for this patient, what should you advise the patient to do? A) Keep the head of the bed lowered. B) Drink a cup of hot tea before bedtime. C) Avoid carbonated drinks. D) Drink a carbonated drink after meals.

Ans: C Feedback: For a patient diagnosed with esophageal reflux disorder, the nurse should instruct the patient to keep the head of the bed elevated. Carbonated drinks, caffeine, and tobacco should be avoided. A high-fiber low-fat diet should be eaten daily.

A patient who had a hemiglossectomy earlier today is assessed postoperatively, revealing a patent airway, stable vital signs, and no bleeding or drainage from the operative site. The nurse notes the patient is alert. What is the patient's priority need at this time? A) Emotional support from visitors and staff B) An effective means of communicating with the nurse. C) Referral to a speech therapist D) Dietary teaching focused on consistency of food and frequency of feedings

Ans: B Feedback: Verbal communication may be impaired by radical surgery for oral cancer. It is therefore vital to assess the patient's ability to communicate in writing before surgery. Pen and paper are provided postoperatively to patients who can use them to communicate. A communication board with commonly used words or pictures is obtained preoperatively and given after surgery to patients who cannot write so that they may point to needed items. A speech therapist is also consulted postoperatively. Without a means of communication, the client is likely to experience anxiety and frustration. Referral to a speech therapist will be required as part of the client's rehabilitation; however, it is not a priority at this time. Emotional support and dietary teaching are critical aspects of the plan of care; however, the client's ability to communicate would be essential for both. Communication with the nurse is crucial for the delivery of safe and effective care.

The nurse is caring for a patient who had a hemiglossectomy earlier that day. Postoperative assessment reveals a patent airway, stable vital signs, and no bleeding or drainage from the operative site. The patient is alert. What is the patient's priority need at this time? A) Emotional support from visitors and staff B) An effective means of communicating with the nurse C) Referral to a speech therapist D) Dietary teaching focused on consistency of food and frequency of feedings

Ans: B Patient Needs: C, D Feedback: The patient's ability to speak will be compromised by this surgical procedure. In order to assess the patient and evaluate his response to nursing intervention, the nurse must be able to communicate with the patient. Without a means of communication, the patient is likely to experience anxiety and frustration. Referral to a speech therapist will be required as part of the patient's rehabilitation; however, it is not a priority at this time. Emotional support and dietary teaching are critical aspects of the plan of care; however, the patient's ability to communicate would be essential for both. Communication with the nurse is crucial for the delivery of safe and effective care.

A patient going home after treatment for oral cancer is going home with dentures. What would be important for the nurse to teach the patient? A) Instructions on removing dentures to eat B) Instructions on what to eat with dentures C) Instructions on the use and care of dentures D) Instructions on oral care

Ans: C Feedback: For patients with oral cancer, instructions are provided in the use and care of any dentures. You don't remove dentures to eat, and you don't eat a special diet with dentures.

A nurse is obtaining a health history on a new patient with oral cancer. The patient had surgery earlier today. What is the priority postoperative assessment for the nurse caring for this patient? A) Assess ability to clear oral secretions B) Assess ability to pucker lips C) Assess for a patent airway D) Assess for ability to communicate

Ans: C Feedback: Postoperatively, the nurse assesses for a patent airway. The patient may be unable to manage oral secretions, making suctioning necessary. All answers are correct to a degree. However, the priority is the patent airway.

A patient with cancer of the tongue has had a radical neck dissection. What nursing assessment would be a priority for this client? A) Presence of acute pain and anxiety B) Tissue integrity and color of the operative site C) Respiratory status and airway clearance D) Self-esteem and body image

Ans: C Feedback: Postoperatively, the patient is assessed for complications such as altered respiratory status, wound infection, and hemorrhage. All of the assessments above are part of the plan of care for a client who had had a radical neck dissection but are not the nurse's chief priority.

An adult patient with a fractured mandible has returned to the unit postoperatively. The patient's jaws are wired and will remain wired for the next 6 weeks. What should be kept at the patient's bedside for this patient? A) Thermometer B) Sterile gauze packing C) Wire cutters D) Ice water

Ans: C Feedback: A patient who has his or her jaws wired shut is unable to open the mouth. Wire cutters must be kept at the bedside so that if the patient vomits, the nurse can cut the wires to prevent aspiration.

A patient has undergone surgery for oral cancer and has just been extubated. When the anesthesia wears off, what nursing action would promote comfort and facilitate breathing for this patient? A) Placing the patient in the lateral position B) Placing the patient in the prone position C) Placing the patient in Fowler's position D) Placing the patient in semi-Fowler's position

Ans: C Feedback: After the endotracheal tube or airway has been removed and the effects of the anesthesia have worn off, the patient may be placed in Fowler's position to facilitate breathing and promote comfort. You would not place a patient who had just come out from under anesthesia in the lateral or the prone position.

The nurse is caring for a patient who had a radical neck dissection for treatment of a malignant tumor. Which of the following nursing assessments would be a priority for this patient? A) Presence of acute pain and anxiety B) Tissue integrity and color of the operative site C) Respiratory status and airway clearance D) Self-esteem and body image

Ans: C Feedback: All of the assessments above are part of the plan of care for a patient who has had a radical neck dissection but are not the nurse's chief priority. Assessment of respirations, a vital function, is the most important. It is crucial for the nurse to establish that the patient's breathing is within normal limits and that he is not experiencing initial symptoms of aspiration pneumonia due to inability to manage oral secretions.

Which of the following is the most significant risk factor for esophageal cancer? A) Delayed gastric emptying time B) Ingestion of 2 or more carbonated drinks daily C) Chronic gastroesophageal reflux disease (GERD) D) Persistent hiccups

Ans: C Feedback: Chronic irritation of the esophagus is a major risk factor for esophageal cancer. GERD may progress to Barrett's esophagus, which may later progress to adenocarcinoma. Delayed gastric emptying time is a risk factor for gastric cancer. Persistent hiccups are associated with advanced gastric cancer and are caused by pressure placed on the phrenic nerve by a tumor. Ingestion of carbonated beverages is not associated with esophageal cancer; however, they do precipitate reflux.

You are talking with a group of nursing students about esophageal cancer. What would you tell the students is the most significant risk factor for esophageal cancer? A) Delayed gastric emptying time B) Ingestion of 2 or more carbonated drinks daily C) Chronic gastroesophageal reflux disease D) Persistent hiccups

Ans: C Feedback: Chronic irritation of the esophagus is a major risk factor for esophageal cancer. GERD may progress to Barrett's esophagus, which may later progress to adenocarcinoma. Delayed gastric emptying time is a risk factor for gastric cancer. Persistent hiccups are associated with advanced gastric cancer and are caused by pressure placed on the phrenic nerve by a tumor. Ingestion of carbonated beverages is not associated with esophageal cancer; however, they do precipitate reflux.

A patient visiting the clinic tells the nurse that he has a diverticulum and is having surgery in 2 weeks. He asks why his breath is so foul. The nurse informs the patient that this is most likely due to: A) Diet choices B) Poor oral hygiene C) Decomposition of food retained in the diverticulum D) Breakdown of the oral mucosa

Ans: C Feedback: Decomposition of food retained in the diverticulum commonly causes halitosis and a sour taste in the mouth

A nurse is caring for a patient diagnosed with esophageal reflux disorder. The patient should be advised to: A) Keep the head of the bed lowered. B) Drink a cup of hot tea before bedtime. C) Avoid carbonated drinks. D) Drink a carbonated drink after meals.

Ans: C Feedback: For a patient diagnosed with esophageal reflux disorder, the nurse should instruct the patient to keep the head of the bed elevated. Carbonated drinks, caffeine, and tobacco should be avoided. A high-fiber low-fat diet should be eaten daily.

A client who has had a radical neck dissection is being prepared for discharge. The discharge plan includes referral to an outpatient rehabilitation center for physical therapy. What would the goals of physical therapy for this client include? A) Promoting circulation to the graft site on the affected side B) Relieving nerve paralysis in the cervical plexus C) Promoting maximum shoulder function D) Alleviating achalasia decreasing esophageal peristalsis

Ans: C Feedback: Shoulder drop occurs as a result of radical neck dissection. Shoulder function can be improved by rehabilitation exercises. Rehabilitation would not be initiated until the client's neck incision and graft, if present, were sufficiently healed. Nerve paralysis in the cervical plexus affects swallowing and would be managed by a speech therapist rather than a physical therapist. Achalasia, ineffective peristalsis, can result from a number of physiologic and psychosocial factors and is not a frequently occurring sequella of radical neck dissection.

The nurse is preparing a patient who has had a radical neck dissection for discharge. The discharge plan includes referral to an outpatient rehabilitation center for physical therapy. The nurse recognizes that the goals of physical therapy for this patient include: A) Promoting circulation to the graft site on the affected side B) Relieving nerve paralysis in the cervical plexus C) Promoting maximum shoulder function D) Alleviating achalasia, decreasing esophageal peristalsis

Ans: C Feedback: Shoulder drop occurs as a result of radical neck dissection. Shoulder function can be improved by rehabilitation exercises. Rehabilitation would not be initiated until the patient's neck incision and graft, if present, were sufficiently healed. Nerve paralysis in the cervical plexus affects swallowing and would be managed by a speech therapist rather than a physical therapist. Achalasia, ineffective peristalsis, can result from a number of physiologic and psychosocial factors and is not a frequently occurring sequelae of radical neck dissection.

A 6-year-old child is brought to the emergency room after swallowing a piece from a wooden puzzle. Which of the following medications is the nurse likely to administer intramuscularly in order to relax the esophagus to facilitate removal of the foreign body? A) Haloperidol B) Prostigmin C) Epinephrine D) Glucagon

Ans: D Feedback: Glucagon is administered prior to removal of a foreign body because it relaxes the smooth muscle of the esophagus thereby facilitating insertion of the endoscope . Haloperidol is an antipsychotic drug and is not indicated. Prostigmin is prescribed for patients with myasthenia gravis. It increases muscular contraction, an effect opposite that which is desired to facilitate removal of the foreign body. Epinephrine is indicated in asthma attack and bronchospasm; however, these are not the reasons the child is undergoing treatment.

When you come on shift you find that one of your patients had a Heller myotomy earlier in the day. You know that a Heller myotomy is treatment for what? A) Esophogeal cancer B) GERD C) Barrett's esophagus D) Diffuse spasm

Ans: D Feedback: If none of the conservative approaches to diffuse esophageal spasm is successful in managing symptoms, surgery may be considered. An esophageal Heller myotomy (a surgical procedure in which the cardiac sphincter is cut, allowing food and liquids to pass into the stomach) by a minimally invasive approach is considered first and has shown positive results.

A patient comes to the walk in clinic complaining of pain and discomfort in the neck and shoulder muscles continuing up into the jaw. What should the nurse suspect? A) Temperomandibular joint disease B) Malocclusion C) Periapical abcess D) Myofascial pain

Ans: D Feedback: Myofascial pain—a discomfort in the muscles controlling jaw function and in neck and shoulder muscles.

A nurse is caring for a patient who is postoperative from a neck dissection. What would be the most appropriate nursing action to enhance the patient's appetite? A) Serve the patient only food that he or she likes. B) Encourage visitors at mealtime. C) Feed the patient only when he or she is hungry. D) Give oral care before eating.

Ans: D Feedback: Oral care before eating may enhance the patient's appetite, and oral care after eating is important to prevent infection and dental caries. Asking the patient what food he or she likes is appropriate to encourage a patient to eat, just not the most appropriate nursing action. Encouraging visitors at mealtime makes it more social and a patient may eat more, or may not. Feeding the patient only when hungry is not enhancing his or her appetite.

You are presenting an educational event at the local high school. You have been asked to talk about oral cancer. What would you tell the students is critical in preventing oral cancers? A) Avoiding smokeless tobacco B) Maintaining good oral hygeine C) Eating a nutritious diet D) Avoiding high-risk behaviors

Ans: D Feedback: Patient education directed toward avoiding high-risk behaviors is critical to prevent oral cancers. Maintaining good oral hygiene and eating a nutritious diet will not prevent oral cancers. Avoiding smokeless tobacco is an incomplete answer.

A patient has been diagnosed with a malignancy of the head and neck. The prognosis is poor. The patient asks the nurse why the physician said that they had a poor prognosis. What would be the nurse's best response? A) Surgery on these tumors is not very successful. B) Surgery on these tumors is very successful. C) The cancer is regional but we can try radiation therapy. D) The cancer has metastasized and these tumors respond poorly to chemotherapy.

Ans: D primarily attributable to local-regional metastasis to the cervical lymph nodes in the neck. This often occurs by way of the lymphatics before the primary lesion has been treated. This local-regional metastasis is not amenable to surgical resection and responds poorly to chemotherapy and radiation therapy.

The staff educator is reviewing the causes of gastroesophageal reflux disease (GERD) with new staff nurses. What area of the GI tract should the educator identify as the cause of reduced pressure associated with GERD?

Ans: Lower esophageal sphincter Feedback: Normally, there is enough pressure around the lower esophageal sphincter (LES) to close it. Reflux occurs when LES pressure is deficient or when pressure in the stomach exceeds LES pressure.

reconstruction for neck dissection include ___ - skin and subcutaneous tissue, such as delto pectoral flap may be used. - ___ subcutaneous tissue, muscle, and skin**more frequently used graft ** the pectoralis major muscle is usually used. -____ a microvascular free flap may be used, this involves transfer of muscle, skin, or bone with an artery or vein through the area of reconstruction using microinstrumentation.

Cutaneous flap myocutaneous flap large grafts

What is tx for Aphthous stomatitis (canker sore)?

Instruct patient in comfort measures such as saline rinses, and soft bland diet, ABX or corticosteroids may be prescribed

Any area of the oropharynx can be a site of malignant growth nut ___, ____ & _____ are most commonly affected.

Lips, lateral aspect of tongue & floor of mouth

___ is a longitudinal tear in the esophagus and stomach junction. coughing, vomiting, Sz. can cause prolapse of stomach into esophagus - most have hiatal hernia w/this -can have H/H & EGD - can give zofran & PPIs(proton pump inhibitors0 - can have bright red bloody emesis, bloody /tary stool -usually alcoholic

Mallory Weiss Tear

Post op of radial graft for oral cancer, the nurse assess ___-

a patent airway

the graft is assessed postop, although color is assessed, white may indicate ____ and blue mottling may indicate____

arterial occlusion venous congestion

oral lesions can be painful. strategies to reduce pain and discomfort are?

avoiding foods that are spicy, hot, or hard soft or liquid diet may be preferred soft toothbrush may prevent secondary trauma analgesic such as lidocaine topical medications such as carafate reduce pt fear of pain by providing info about pain control methods

S/S of herpetic gingivostomatitis

burning sensations w/appearance of small vesicles 24-48hr later; vesicles may rupture, forming a sore, shallow ulcers covered w/ a gray membrane

____ is removal of sternocleidomastoid and smaller muscle, all tissue from the ramus of the jaw to the clavicle is removed, jugular vein also removed

classical radical neck dissection

Nsg Mgmt. for oral cancer: the patient may require __ or ___ feedings before and after surgery to maintain adequate nutrition.

enteral and parenteral

after endotrachial tube or airway has been removed pt is placed in ___ to facilitate breathing and promote comfort, this increases lymphatic and venous drainage, facilitates swallowing, decreases venous pressure on skin flaps, and prevents regurgitation/ aspiration of stomach contents

fowlers

areas used for ___ include scapulae, radioarea of the forearm, or the fibula. ( the fibula provides large bone area, may be used if mandibular reconstruction is involved)

free flap

with oral cancers, if suctioning of the mouth or tracheostomy tube is required, the necessary equipment is obtained and the pt and caregivers are taught how to use it. the pt and caregivers are taught how to assess ___, ___, and ____

hemorrhage, obstruction, and infection

neck dissection are done for ___ and___, - death from malignancies of head and neck are primarily attributed to ____ to the cervical lymph nodes in the neck. - -radical neck dissection involves removal of ____,____, ____, &____ on one side of the neck.

malignancies of the head and neck local regional metastasis cervical lymph nodes from mandible to clavicle, sternocleidomastoid muscle, and internal jugular vein, and and spinal accessory muscle.

___ preserves one or more of 9 lymphatic structures - is used more often

modified radical neck dissection

Nursing diagnosis for ___ include ineffective airway clearance r/t obstruction by mucus, hemorrhage, or edema

neck dissection

post op ___ assess for complications such as resp. status, wound infection, hemorrhage,

neck dissection

potential post op comp for ___ may develop hemorrhage, chyle fistula, nerve injury

neck dissection

cancer of the oral cavity has metastasized through the extensive lymphatic channel in the neck region, requiring a ___ and ___ of the oral cavity.

neck dissection and reconstructive surgery

What is tx for candidiasis/

nystatin(Mycostatin), amphotericin B, clotrimazole or kentoconazole may be prescribed, instruct patient to swish vigorously for 1 min & then swallow

Carafate is used for stomach ulcers, it coats it. Incompatible with ____. what is the main side effect? how do you give it?

protonix constipation give on empty stomach

people more prone to xerostomia are?

pt receiving psychopharmacologic agents, pt with HIV mouth-breathers

One common reconstructive technique involves use of a ____ (a thin layer of skin from the forearm along with the radial artery)

radial forearm free flap.

___ may be more appropriate for larger lesions involving more than one third of the lip b/c of superior cosmetic results.

radiation therapy

for ___ and ___ the wound is closed and portable suction drainage tubes are placed.

radical neck and selective neck dissection

___ is similar to classical radical neck dissection but preserves the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve

selective neck dissection

radical neck dissection associated complications include ___ & ____

shoulder drop and poor cosmesis(visible neck depression)

___- or mucositis, which involves inflammation and breakdown of the oral mucosa, is often a side effect of chemo and radiation therapy

stomatitis

As oral cancer progress may complain of:

tenderness, difficulty- chewing, swallowing, speaking coughing blood tinged sputum, or enlarged cervical lymph nodes