Term
| What is important to note about oral care? |
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Definition
An integral component of overall health
Primary focus of mouth care is to lessen the amount of bacterial film that accumulates on teeth, around gums, and in saliva
The nurse must perform this care conscientiously if the patient is unable |
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Term
| What are the risk factors for oral cancer? |
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Definition
| Risk factors include alcohol and tobacco use |
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Term
| How is oral/throat cancer treated? |
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Definition
Management involves radiation therapy, chemotherapy, and surgery:
Frequently metastasizes to the lymphatic system, necessitating neck dissection surgery |
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Term
| What do assessments post neck dissection focus on? |
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Definition
| focus on altered respiratory status (airway integrity and management of secretions), wound infection, and hemorrhage |
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Term
| What do interventions prioritize post neck dissection? |
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Definition
| prioritize protecting the airway, preventing infection, relieving pain, providing wound care, supporting nutrition, and facilitating coping and communication |
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Term
A patient with cancer of the tongue has had a radical neck dissection. What nursing assessment would be the highest priority for this patient?
Assessment of acute pain and anxiety
Assessment of tissue integrity and color of the operative site
Assessment of respiratory status and airway clearance
Assessment of self-esteem and body image |
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Definition
C. Assessment of respiratory status and airway clearance
Rationale: All of the listed assessments are relevant considerations in the care of a patient who has had neck dissection surgery. However, the patient’s airway is always the priority assessment. |
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Term
| What are the esophageal disorders? |
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Definition
Achalasia
Hiatal hernia
Diverticulum
Perforation
Foreign bodies
Barrett’s esophagus |
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Term
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Definition
| May occur because of an incompetent lower esophageal sphincter, pyloric stenosis, or a motility disorder |
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Term
| What are the manifestations of GERD? |
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Definition
| pyrosis (burning sensation in the esophagus), dyspepsia, regurgitation, dysphagia |
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Term
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Definition
| lifestyle modifications (diet, positioning), proton-pump inhibitors, and prokinetic agents (drugs that accelerate gastric emptying |
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Term
| What teaching is involved with GERD? |
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Definition
| 5-6 small meals, avoid smoking, alcohol, dairy, spearmint/peppermint, or anything acidic, elevate HOB |
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Term
Identify which of the following factors contribute to decreased lower esophageal sphincter (LES) and the occurrence of GERD: (Select all that apply)
Cigarette smoking
Decaffeinated coffee
Ice cream with chocolate sauce
Candy cane
Diltiazem
Cheeseburger and French fries
Low fat milk
Tomato salsa
Alcohol
Exercise
Weight loss |
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Definition
Cigarette smoking
Ice cream with chocolate sauce
Diltiazem
Cheeseburger and French fries
Tomato salsa
Alcohol |
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Term
| What does REFLUX stand for? (GERD) |
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Definition
R - Regurg
E - Esophageal Spasm
F - Small meals
L - Lifestyle mod
U - Use of Prilosec, Regland, Antacds, H2 histamine antagonists
X - X out colas and milk to decrease acid production |
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Term
| What is the common ending for H2 antagonists? |
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Definition
DINE!
Cimetidine
Famotidine
Nizatidine
Ranitidine
Take when you DINE. Reflux at sleep? Take at bedtime |
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Term
Is the following statement true or false?
A patient who has GERD is likely to benefit from taking over-the-counter antacids after each meal. |
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Definition
False
Rationale: The etiology of GERD does not involve abnormalities in the pH of gastric contents. As such, patients are unlikely to experience relief of symptoms by taking antacids. |
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Term
| What are the risk factors for cancer of the esophagus? |
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Definition
| male gender, alcohol and tobacco use |
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Term
| What are the treatments of cancer of the esophagus? |
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Definition
| surgery (esophagectomy), radiation, chemotherapy |
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Term
| What is the nursing management post esophagectomy? |
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Definition
| nutrition promotion, prevention of aspiration pneumonia, wound care, and maintenance of the patient’s nasogastric tube |
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Term
| Why do we do GI intubation? |
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Definition
Decompress (remove) stomach fluid or air
Lavage the stomach and remove toxins
Administer medications and nutrition
Treat an obstruction
Bypass sections of the tract |
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Term
| What are the types of GI intubations? |
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Definition
Nasogastric and orogastric tubes
Postpyloric tubes |
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Term
| What does NG TUBE stand for? |
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Definition
N - Never give meds without checking position
G - Give warm
T - Turn to right side
U - Use gravity
B - Be sure to aspirate
E - End with water and chart |
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Term
| What color are normal gastric contents? |
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Definition
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Term
| How should the top of the NG tube be positioned? |
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Definition
| - Blue part of NG tube must be elevated and fastened |
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Term
| What is the nursing management of an NG tube? |
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Definition
Preinsertion assessment
Patient preparation
Tube insertion
Placement confirmation
Securing the tube
Recording fluid intake, feedings, and irrigation
Administering medications
Unclogging the tube
Oral and nasal hygiene
Monitoring and preventing complications:
Fluid volume deficit (FVD)
Pulmonary complications
Irritation of the mucous membranes
Tube removal |
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Term
Which of the following methods is the most accurate indication of correct GI tube placement?
Instillation of air with simultaneous abdominal auscultation
Abdominal X-ray
Aspiration of gastric contents
Gentle traction on the tube |
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Definition
B. Abdominal X-ray
Rationale: Various methods are used to confirm tube placement. However, the most accurate method involves X-ray of the radiopaque tip of the tube. |
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Term
| When are tube feedings given? |
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Definition
| Given to meet nutritional requirements when oral intake is inadequate or not possible and the GI tract is functioning normally |
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Term
| Where do tube feedings go? |
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Definition
| Delivered to the stomach (NG intubation or gastrostomy) or to the distal duodenum or proximal jejunum: |
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Term
| What are the priorities of care for tube feeding? |
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Definition
Reducing the risk of aspiration
Residual assessment
Preventing dumping syndrome (highly related to the formula that is chosen) |
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Term
| What is dumping syndrome? |
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Definition
High - too much too soon. As the truck gets close to the edge, you get nervous, you are so nervous you defecate (oh poop)
Low - low carb, low salt, low sugar, low volume, low water dry meal, low position lie down after meals. |
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Term
Is the following statement true or false?
The symptoms of dumping syndrome are precipitated by hypertonic intestinal contents. |
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Definition
True
Rationale: Foods high in carbohydrates and electrolytes must normally be diluted in the jejunum before absorption can take place. In patients experiencing dumping syndrome, the passage of food from the stomach remnant into the jejunum is too rapid. The hypertonic intestinal contents draw extracellular fluid from the circulating blood volume into the jejunum and contribute to the symptoms. |
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Term
Is the following statement true or false?
Constipation is among the most common complications of tube feedings and appropriate nursing interventions to prevent this problem are necessary. |
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Definition
False
Rationale: Diarrhea is a common complication of tube feeding and is due to the hyperosmolality of the feedings and/or the decreased serum osmolality of the patient’s serum. Constipation is a comparatively uncommon complication. |
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Term
Identify which of the following should be avoided by clients with dumping syndrome. (Select all that apply)
Soup
Cinnamon roll with icing
Sweetened orange juice
Pancakes and syrup
White bread with diet jelly
Cooked carrots with butter sauce
Toasted cheese sandwich
Cup of coffee with meals
Glass of water with meals |
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Definition
Soup
Cinnamon roll with icing
Sweetened orange juice
Pancakes and syrup
Cup of coffee with meals
Glass of water with meals |
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Term
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Definition
A surgical procedure in which an opening is created into the stomach for the purpose of administering foods and fluids via a feeding tube
PEG tube |
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Term
| What must TPN run through? |
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Definition
| filtered tubing -> CENTRAL LINE |
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Term
| Can TPN run with anything else? |
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Definition
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Term
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Definition
Nontunneled (or percutaneous) central catheter
Peripherally inserted central catheter
Tunneled catheter
Implanted port |
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Term
| How often do you change TPN tubing? |
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Definition
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Term
| What is the only other substance that can run with TPN? |
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Definition
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Term
| How often do you change lipid tubing? |
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Definition
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