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What is stomatitis? What are S&S?
- broad term that covers many inflam conditions such as ulcers, herpes, canker sores, candidiasis, etc
- open ares, bleeding, infection (bacterial or virus)
What is candidiasis? What is a tell-tale sign? what is the tx?
- a sometimes painful fungal (yeast) infection
- White plaque-like lesions
- dysphagia present
- use soft tooth brus, foam swabs (not lemon)
- tx: antifungals (swish and swallow) aka magic mouthwash, numbes lesions and decreases swelling 4x/d
- Avoid spicy or acidic food
What is oral cancer? cause? tx?
- a sore that doesn't heal
- usually squamous cell carcinoma (epithelial)
- caused by tobacco or alcohol
- tx: chemo/radiation
- glossectomy ( removal of the tongue [hemi/total])
- mandibulectomy (removal of the jaw including the manidible/teeth [hemi/total])
- (mets may move to lymph nodes)
What is radical neck Dissection? What pt recieves this? who is it contraindicated in? How is cancer diagnosed? what is necessary preop?
- removal of the sternocleidomastoid muscle, the internal jugular vein, and the spinal accessory nerve are removed in addition to removing all of the lymph nodes
- for pts with extensive neck cancer
- contra: in pts with cardiac disease, pulmonary disease, deep infiltration of the tumor, DM
- (lymph node mets reduce survival rates in half)
- dx: by CT with contrast, MRI, bx
- preop: TXM, NPO, void on call to OR
- assess pts ability to read/write/communicate (after)
What post op care is neccessary for radical neck dissection? How can you protect the airway? how should the bed be? How should you care for the site? how do you avoid atelectasis? What days should you be on the look out for fistulas to the esophagus?
- Vitals pox,
- airway protection: trach, suctioning,NPO x 24 h, NGT, humidified O2
- keep pt warm,
- Head elevated 30 degrees,
- IV fluids, Analgesia, UO, FC,
- site care: (infection, blood loss, dressings, JP drain, watch for hematoma formation)
- Avoid atelectasis: move pt out of bed the day after surgery with assistance, encourage deep breathing, Incentive spirometer and early ambulation
- days 3 and 4 esp mopnitor for fistulas
What post op care is needed for radical neck dissection? (cont) When can the patient go home? and what criteria must he meet prior to discharge? When are the sutures/clipos removed? How often does this pt need to be evaluated?
- once the suction and drains have been removed, the pt can go home usually on day 4 or 5
- criteria: sarisfactory healing or the surgical wound, no evidence of bleeding or infection, adequate airway and nutrition, hemodynamic stability, adequate family support, initiation of physical therapy
- sutures removed: 7-14 days (at least 10 days of radiation has been used)
- (discharge may be longer if there was other surgeries)
- follow up care: 7-10 days after, and should be seen every month for the first year, particularly if no primary lesion was initially found. continue every 2-4 months for up to 5 years, after this, seen yearly
What complications may occur due to radical neck dissection?
- wound infection
- skin flap death
- facial edema
- carotid artery rupture
What is peritonitis? Cause? S&S?
- acute viral or bacterial inflammation of the peritoneum, lining the abdominal cavity
- cause: perforation of organs such as appendix, stomach, bowel, uterus, etc
- S&S: rigid boardlike abdomen
- abd. pain
- n/v, decrease bowel sounds, rebound tenderness, high fever, tachycardia
What is Crohn's disease? who is predisposed? What are the s&s?
- inflammatory disease of the small intestine, colon, or both. Cobblestone appearence; characterized by exacerbations and remissions. Diarrhea, malabsorption, fibrotic lining of the bowel, scar tissue, obstruction and structure can occur
- fistulas can develop surgery is common,
- predisposed: gentic, ashkenazi jewish heritage (france, germany, eastern europe)
- S&S: thickened bowel wall, decrease bowel sounds, rigidity and tenderness, diarrhea, steatorrhea, abdominal pain, low grade fever
What is the crohn's disease assessment checklist?
- have you had any recebt weight loss?
- what do your stools look like?
- how often do you have a bowel movement?
- have you noticed any blood in your stools?
- have you had a fever?
- can you describe your abdominal pain?
- how often do you have pain? location? pain from 1-10?
- have you noticed any abdominal distention?
- how is the condition of the skin around your anus?
- have you noticed any dribbling around your anus?
- do your stools float in the toilet tank?
How is crohn's diagnosed? Treated?
- abdominal xray: narrowing, ulceration, strictures
- ct scan;
- tx: drug therapy (azathiorine, mercaptoprine, methotrexate) nutrtion,rest; fistulectomy, colectomy for perforation, obstruction
What is azathioprine?
- class: An immunosuppressant
- action: inhibits DNA and RNA synthesis in abnormal cells
- route: PO- onset in 6-8 weeks, peaks at 12 weeks
- SE: NVD, anemia
- AE: nephro and hepatotoxicity
- NI: assess for infection, I&O, bilirubin, LFT, administer with or after meal to prevent nausea
- teaching: difficulty urinating, S&S inf
What is mercaptopurine?
- class: antineoplastic
- action: inhibits DNA and RNA synthesis in abnormal cells
- SE: NVD, alopecia, anemia
- AE: hepatotoxicity
- NI: assess for infection, give with food to prevent nausea, bili and LFT
What is methotrexate?
- Class: immunosuppressant and antineoplastic
- Action: inhibits DNA synthesis in new tissue
- *metabolized through liver and kidney
- SE: dizziness, drowsiness, NV, itching, rash, stomatitis
- AE: arachnoiditis, hepatotox, and neuropathy
- NI: I&O, daily weight, nuchal rigidity, HA fevere, confusion, drowsiness, BUN, LFT, serum methotrexate levels
What is the nursing care for Crohn's disease?
- TPN, ensurem sustcal
- skin care for fistulas
- psychological therapy
- family support
- vitamin supplements
- teaching: aboput drugs, skin care, low residue diet, avoid spicy food
What is ulcerative colitis? Is there a family predisposition?
- inflammation of the rectum, sigmoid colon, or entire colon
- intestinal lining becomes edematous and reddened with small erosions, ulcers, and tissue necrosis
- stool contains blood and mucous
- colicky pain relieved by defecation
- runs in families
How is ulcerative colitis dx? what are the S&S?
- DX: colonoscopy, barium enema
- s&s: diarrhea and incontinence, abdominal pain/cramping, GI bleeding and anemia, anxiety and depression, decreased H&H and increased WBCs, F&E imbalance
What is the treatment for ulcerative colitis? what is the nursing care?
- drug therapy: sulfasalizine, H2 receptor antagonists (axid, pepcid, tagamet, zantac)
- surgical: colectomy with sigmoid resevoir), Ileostomy, Kock's pouch: continent ileostomy
- Nursing care: NPO for bowel rest, TPN for exacerbations, antidiarrheal drugs, glucocorticoids to decrease inflammation, teach pt to avoid foods that cause irritation
What are carbon dioxide releasing laxs? what are hyperosmotic laxs?
- CO2: potassium and sodium bicarb
- suppositories that encourage bowel movements by forming C)2, a gas. This gas pushes against intestinal wall, causing contractions that move along the stool mass
- hyperos lax: glycerin;sodium phosphates
- draw water into the bowel from surrounding body tissues. this provides a soft stool mass and increased bowel reaction.
What are mineral oil laxs? stimulant laxs?
- mineral oil: coats the bowel and the stool mass with a waterproof film. This keeps moisture in the stool. the stool remians soft and its passage is made easier
- Stimulant lax: bisacodyl, senna
- also known as contact laxs, act on the intestinal wall. They increase the muscle contractions that move along the stool mass; results usually obtained in 15 min-1 hour
What are stool softners?
- emollient laxs, docusate
- encourage bowel movements by helping liquids mix into the stool and prevent dry hard stool massess. This type of lax has been said not to cause bowel movement but instead allows pt to have bowel movement without straining
- weakness, increased sweating, and convulsion, may be especially likely to occur in the elderly pts, since they may be more sensitive than younger adults to the effects of rectal laxs