nursing 115 chapters 56 57 58 59
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oral hygiene for patients with stomatitis
use soft bristled tooth brush or disposable form swabs to stimulate gums and clean the oral cavity
when rinsing the mouth what should and should not be used
- should use solution
- NOT commercial mouth wash
how often should oral mouth care be done for patients with stomatitis
every 2 hours and twice during the night
key features of oral caner
- bleeding from the mouth
- poor appetite
- difficulty chewing
- difficulty swallowing
- poor nutritional status and weight loss
- thick or absent saliva
- painless oral lesion that is red, raised or eroded
- thickening or lump in cheek
what is the definite method of diagnosing oral cancer
- physician obtains needle biopsy specimen of the abnormal tissue to assess for malignant or premalignant changes
the postoperative care after radical neck disection
what position should patient be placed in and why?
- fowlers or semi fowlers
- elevate the head of the bed to assist in decreasing edema by gravity
what is the most accurate method to diagnose GERD?
24 hour Ambulatory esophageal pH monitoring
nonsurgical management for GERD
- elevate the Head of the bed 6 inches for sleep
- Sleep on the right side-lying position
- stop smoking and alcohol
- wear nonbinding clothing
- refrain from lifting heavy objects, straining or working in a bent over position
what is the main treatment for GERD
Proton Pump Inhibitors
what do Protons Pump Inhibitors do?
provide long acting inhibition of gastric acid secretion
what do antacids do?
elevate the pH level of the gastric contents
what do Histamine receptor antagonist do?
decrease acid production
what do Prokinetic drugs do?
increase gastric emptying and improve lower esophageal sphincter pressure and esophageal peristalsis
cause of gastritis
- H Pylori
- Escherichia coli
- other causes: long term NSAID use, corticosteroids, ETOH, radiation, stress
what is the gold standard for diagnosing gastritis?
EGD via endoscope with biopsy
what is the major diagnostic test for diagnosing PUD?
describe Gastric Ulcer Pain
gastric ulcer occurs in the upper epigastrium with localization to the left of the midline and is aggravated by food
Describe Duodenal Ulcer Pain
Duodenal ulcer pain is usually located to the right of the epigastrium
Occurs 90 mins to 3 hours after eating and often awakens patient at night
what is the gold standard for surgical management of GERD?
Laparoscopic Nissen Fundoplication (LNF)
what is the role of the nurse regarding GERD?
patient and family education
discuss the pathology of GERD
- the most common upper GI disorder
- Reflux/backflow of the GI contents into the esophagus
- produces symptoms by exposing the esophageal mucosa to the irritating effects of gastric contents which results in inflammation
- the cause is the esophageal sphincter relaxes allowing the contents to come up
clinical manifestations of GERD
- regurgitation-backward flow
- eructation- belching
- dysphagia- difficulty swallowing
- odynophagia- painful swallowing
what are the 3 major drug therapies for GERD
- Antacids-increase gastric pH by deactivating pepsin, short action length
- Histamine receptor antagonist (histamine blockers)-decrease acid
- Proton Pump Inhibitors-long acting, inhibition of gastric acid secretion
what are the key features of s hiatal hernia?
- chest pain
- fullness after eating
- breathlessness after eating
- feeling of suffocation
- chest pain that mimics angina
- worsening of manifestations in recumbent position
what is the most specific diagnostic test for identifying hiatal hernia
a barium swallow with fluoroscopy
sometimes a sliding hiatal hernia cannot be seen so an EGD is done
nonsurgical treatments for hiatal hernia
- drug therapy
- nutritional therapy
- lifestyle changes
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