MDC2 FINAL EXAM STUDY GUIDE 1. stomatitis S&S - Dysphagia nutrition changes, oral hygiene habits, oral trauma, and stress. Also collect a drug history, including over-the-counter (OTC) drugs and nutrition and herbal supplements. dry, painful mouth to open ulcerations, placing the patient at risk for infection. These ulcerations can alter NUTRITION status because of difficulty with eating or swallowing. When they are severe, stomatitis and edema have the potential to obstruct the airway. oral candidiasis, white plaquelike lesions appear on the tongue, palate, pharynx (throat), and buccal mucosa (inside the cheeks) (Fig. 53-1). When these patches are wiped away, the underlying surface is red and sore. Patients may report alterations in COMFORT, but others describe the lesions as dry or hot. 2. Stomatitis Causes - Primary the most common type, includes aphthous (noninfectious) stomatitis, herpes simplex stomatitis, and traumatic ulcers. Secondary stomatitis generally results from infection by opportunistic viruses, fungi, or bacteria in patients who are immunocompromised. It can also result from drugs such as chemotherapy. 3. Oral Cancer Post-op management - Assess the mouth and surrounding tissues for candidiasis, mucositis, and pain; assess for loss of appetite and taste. • Monitor the patient's weight. • Monitor nutrition and fluid intake. • Assess for difficulty in eating or speech. • Assess pain status and measures used to control pain. • Monitor the patient's response to medications. • Identify psychosocial problems, such as depression, anxiety, and fear. • Assess the patient's overall physiologic condition and how this may affect pharmacologic therapy. 4. GERD S&S - Dyspepsia (indigestion) • Regurgitation (may lead to aspiration or bronchitis) • Coughing, hoarseness, or wheezing at night • Water brash (hypersalivation) • Dysphagia • Odynophagia (painful swallowing) • Epigastric pain • Generalized abdominal pain • Belching • Flatulence • Nausea • Pyrosis (heartburn) • Globus (feeling of something in back of throat) • Pharyngitis • Dental caries (severe cases) 5. GERD diagnositcs - Endosocpic procedure- Patients may drink a solution and then have x-rays performed as part of a barium swallow, which shows hiatal hernias, strictures, and other structural or anatomic esophageal problems. Although this test, when conducted by itself, does not confirm GERD, it can be helpful when used in combination with other diagnostic procedures. esophagogastroduodenoscopy (Purpose)-visual examination of the esophagus, stomach, and duodenum. This procedure has largely replaced upper GI series testing. If GI bleeding is found during an EGD, the physician can use clips, thermocoagulation, injection therapy, or a topical hemostatic agent (Chen & Barkun, 2015). If the patient has an esophageal stricture, it can be dilated during an EGD. In addition, gastric lesions can be visualized using this procedure, and suspicion for celiac disease can be affirmed. 6. GERD Non-surgical management - it can be controlled by NUTRITION therapy, lifestyle changes, and drug therapy. The most important role of the nurse is patient and family education. Teach the patient that GERD is a chronic disorder that requires ongoing management. The disease should be treated more aggressively in older adults. limit or eliminate foods that decrease LES pressure and irritate inflamed tissue, causing heartburn, such as peppermint, chocolate, alcohol, fatty foods (especially fried), caffeine, and carbonated beverages. The patient should also restrict spicy and acidic foods (e.g., orange juice, tomatoes) until esophageal healing can occur. Patients who are smart phone users may find different types of applications ("apps") that can help them follow a healthier diet, such as MyFitnessPal 7. GERD Surgical management - aparoscopic Nissen fundoplication (LNF) is a minimally invasive surgery (MIS) and is the standard surgical approach for treatment of severe GERD 8. GERD Health promotion and maintenance Education - Teach patients to engage in healthy eating habits that include consuming small, frequent meals and limiting intake of fried, fatty, and spicy foods, and caffeine. Sitting upright for at least 1 hour after eating can promote proper digestion and reduce the risk for reflux. 9. Hiatal Hernia S&S - Sliding Hiatal Hernias • Heartburn • Regurgitation • Chest pain • Dysphagia • Belching Paraesophageal Hernias • Feeling of fullness after eating • Breathlessness after eating • Feeling of suffocation • Chest pain that mimics angina • Worsening of manifestations in a recumbent position 10. Hiatal hernia health promotion and maintenance (patient teaching - similar to those for GERD and include drug therapy, NUTRITION therapy, and lifestyle changes. The primary health care provider typically recommends antacids and a protonpump inhibitor such as lansoprazole (Prevacid), omeprazole (Prilosec), or esomeprazole (Nexium) in an attempt to control reflux and its symptoms. NUTRITION therapy is also important and follows the guidelines discussed earlier for GERD.