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Lewis’s Medical Surgical Nursing > Chapter 46 Upper Gastrointestinal Problems Part 1 > Flashcards

Chapter 46 Upper Gastrointestinal Problems Part 1 Flashcards

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1
Q

What are the common upper gastrointestinal (GI) problems reviewed in this chapter?

A
  • Nausea and vomiting
  • Oral and gastric cancers
  • Gastrosophageal reflux
  • Ulcerative disease
  • Inflammatory and infectious bowel disorders
  • GI bleeding
  • Structural problems

These conditions impact patient care during upper GI surgery.

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2
Q

What may patients with impaired GI function experience?

A
  • Malnutrition from decreased intake
  • Altered fluid balance
  • Altered electrolyte balance
  • Altered acid-base balance

These issues arise from difficulties in eating, drinking, or talking.

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3
Q

How can pain affect patients with upper GI issues?

A
  • Disrupt sleep
  • Cause fatigue

Pain may also impair communication abilities.

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4
Q

What is the risk associated with problems swallowing in patients?

A

Increased risk for aspiration

Aspiration can lead to serious complications, including pneumonia.

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5
Q

What are the most common manifestations of GI disease?

A

Nausea and vomiting

These symptoms can indicate a variety of underlying GI issues.

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6
Q

What is nausea?

A

A feeling of discomfort in the epigastrium with a conscious desire to vomit.

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7
Q

What is vomiting?

A

The forceful ejection of partially digested food and secretions from the upper GI tract.

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8
Q

Name some conditions unrelated to GI disease that can cause nausea and vomiting.

A
  • Pregnancy
  • Infection
  • Central nervous system problems (e.g., meningitis, tumor)
  • Cardiovascular disease (e.g., myocardial infarction, heart failure)
  • Psychological states (e.g., stress, fear)
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9
Q

True or False: Women are less likely to experience nausea and vomiting associated with anesthesia and motion sickness.

A

False

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10
Q

What coordinates the multiple components involved in vomiting?

A

A vomiting center in the medulla.

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11
Q

What types of receptors relay information to the vomiting center?

A

Receptors for afferent fibers found in the GI tract, kidneys, heart, and uterus.

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12
Q

List the structures involved in the act of vomiting.

A
  • Closure of the glottis
  • Deep inspiration with contraction of the diaphragm
  • Closure of the pylorus
  • Relaxation of the stomach and lower esophageal sphincter
  • Contraction of abdominal muscles
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13
Q

What is the chemoreceptor trigger zone (CTZ)?

A

A zone in the brainstem that responds to chemical stimuli from drugs, toxins, and labyrinthine stimulation.

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14
Q

What is the result of sympathetic activation during vomiting?

A
  • Tachycardia
  • Tachypnea
  • Diaphoresis
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15
Q

What occurs during parasympathetic stimulation related to vomiting?

A
  • Relaxation of the lower esophageal sphincter
  • Increased gastric motility
  • Increased saliva
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16
Q

What is anorexia?

A

Lack of appetite.

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17
Q

What complications can arise from prolonged nausea and vomiting?

A
  • Dehydration
  • Electrolyte imbalances
  • Circulatory failure
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18
Q

What metabolic condition can result from loss of gastric hydrochloric acid?

A

Metabolic alkalosis.

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19
Q

Fill in the blank: The main goals of care in managing nausea and vomiting are to determine and treat the underlying cause, recognize and correct any complications, and provide _______.

A

[symptomatic relief]

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20
Q

What is the risk associated with the parenteral route of Promethazine?

A

Severe tissue injury.

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21
Q

What are 5-HT3 receptor antagonists effective for?

A
  • Chemotherapy-induced vomiting (CINV)
  • Postoperative nausea and vomiting (PONV)
  • Nausea and vomiting related to migraine headache and anxiety
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22
Q

What is a potential risk of chronic use or high doses of Metoclopramide (Reglan)?

A

Tardive dyskinesia.

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23
Q

What characterizes tardive dyskinesia?

A

Involuntary and repetitive movements of the body (e.g., extremity movements, lip smacking).

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24
Q

What is the mechanism of action of scopolamine transdermal?

A

Block cholinergic pathways to vomiting center

Commonly used to prevent nausea and vomiting.

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25
What are the side effects of scopolamine transdermal?
Dry mouth, somnolence ## Footnote These side effects can limit its use in some patients.
26
Which drug is an antihistamine used for nausea and vomiting?
dimenhydrinate (Dramamine) ## Footnote Other antihistamines include diphenhydramine, hydroxyzine, and meclizine.
27
What is the primary mechanism of action of cannabinoids like dronabinol?
Inhibit vomiting control mechanism in the medulla oblongata ## Footnote Cannabinoids are often used in patients undergoing chemotherapy.
28
List some side effects of cannabinoids.
* Dry mouth * Amnesia * Ataxia * Confusion * Coordination problems * Dizziness * Somnolence ## Footnote These side effects can affect patient quality of life.
29
What is the mechanism of action for dexamethasone in preventing nausea?
Not well understood how it prevents nausea and vomiting ## Footnote Dexamethasone is a corticosteroid often used in cancer treatment.
30
What are the side effects of dexamethasone?
Hyperglycemia, insomnia, euphoria ## Footnote These side effects may necessitate monitoring of blood sugar levels.
31
What type of receptor does amisulpride block?
Dopaminergic receptors in the CTZ ## Footnote CTZ refers to the chemoreceptor trigger zone in the brain.
32
List some side effects of amisulpride.
* Chills * Hypokalemia * Hypotension * Abdominal distention ## Footnote Monitoring for these side effects is important in clinical practice.
33
What do 5-HT3 (Serotonin) antagonists block?
Action of serotonin ## Footnote These are commonly used in chemotherapy-induced nausea.
34
List the side effects of 5-HT3 antagonists.
* Constipation * Diarrhea * Headache * Fatigue * Malaise * Liver function tests abnormalities ## Footnote Regular monitoring of liver function is advised.
35
What is the action of phenothiazines in treating nausea?
Act in the CNS level of the CTZ and block dopamine receptors ## Footnote Phenothiazines are often used for severe nausea.
36
List some side effects of phenothiazines.
* Dry mouth * Hypotension * Sedation * Rashes * Constipation ## Footnote These side effects are important to consider when prescribing.
37
What is the mechanism of action of metoclopramide?
Inhibit action of dopamine ## Footnote Metoclopramide is used to enhance gastric motility.
38
What do Substance P/Neurokinin-1 receptor antagonists block?
Interaction of substance P at NK-1 receptor ## Footnote These antagonists are effective in preventing chemotherapy-induced vomiting.
39
List some side effects of Substance P/Neurokinin-1 receptor antagonists.
* Anxiety * Hallucinations * Extrapyramidal side effects * Headache * Hiccups * Fatigue * Constipation * Diarrhea * Anorexia ## Footnote Awareness of these side effects is essential for safe use.
40
What is an oral cannabinoid that may be used to manage CINV?
Dronabinol ## Footnote Dronabinol is considered when other therapies are ineffective due to its potential for abuse and sedation.
41
What is the first step in nursing management for patients with nausea and vomiting?
Thorough assessment ## Footnote Assessment helps to identify patients at high risk and the precipitating factors.
42
What should be assessed to identify the precipitating cause of nausea and vomiting?
Specific food, timing, prior history, and others' reactions ## Footnote This includes determining when the food was eaten and if anyone else who ate it is sick.
43
What does emesis containing partially digested food several hours after a meal indicate?
Gastric outlet obstruction or delayed gastric emptying ## Footnote This suggests that food is not moving through the digestive system as it should.
44
What does the presence of fecal odor and bile in emesis suggest?
Intestinal obstruction below the level of the pylorus ## Footnote This indicates a significant blockage in the intestines.
45
What does bile in the emesis suggest?
Obstruction below the ampulla of Vater ## Footnote This is an important anatomical landmark in the digestive system.
46
What does bright red blood in emesis indicate?
Active bleeding ## Footnote This could be due to various conditions such as a Mallory-Weiss tear or esophageal varices.
47
What does vomitus with a 'coffee-grounds' appearance indicate?
Gastric bleeding ## Footnote The interaction of blood with hydrochloric acid changes its color.
48
Differentiate between vomiting, regurgitation, and projectile vomiting.
Vomiting: forceful expulsion; Regurgitation: effortless; Projectile vomiting: forceful without nausea ## Footnote Understanding these differences is crucial for proper assessment.
49
What often causes projectile vomiting?
Brain and spinal cord tumors ## Footnote This type of vomiting is typically associated with neurological issues.
50
What can the timing of nausea and vomiting indicate?
The cause of nausea and vomiting
51
When is early morning vomiting common?
During pregnancy
52
What can elicit vomiting during or right after eating?
Emotional stressors
53
What syndrome is characterized by recurring episodes of nausea, vomiting, and fatigue?
Cyclic vomiting syndrome
54
What are some clinical problems associated with nausea and vomiting?
* Fluid imbalance * Electrolyte imbalance * Nutritionally compromised * Impaired GI function
55
What are the overall goals for a patient with nausea and vomiting?
* Minimal or no nausea and vomiting * Normal electrolyte levels and hydration status * Return to normal fluid and nutrient intake
56
What is the common initial treatment for patients with persistent vomiting?
NPO status and IV fluids
57
What might be required for a patient with persistent vomiting and possible bowel obstruction?
A nasogastric (NG) tube connected to suction
58
What should be monitored with prolonged vomiting?
* Intake and output * Vital signs * Signs of dehydration
59
What position should a patient who cannot manage self-care be placed in to prevent aspiration?
Semi-Fowler's or side-lying position
60
What type of therapy is necessary for a patient with severe vomiting?
IV fluid therapy with electrolyte and glucose replacement
61
What is the initial fluid of choice for oral rehydration after vomiting?
Water
62
What is a recommended method for rehydration in a patient recovering from vomiting?
Sip small amounts of fluids (5 to 15 mL) every 15 to 20 minutes
63
What types of foods are ideal for a recovering patient?
* High in carbohydrates * Low in fat * Bland foods like baked potato, rice, cooked chicken, and cereal
64
What should patients avoid when recovering from nausea and vomiting?
* Coffee * Spicy foods * Highly acidic foods * Foods with strong odors
65
What should the patient be advised regarding food intake?
Eat slowly and in small amounts
66
What environmental conditions should be maintained for a patient experiencing nausea?
* Quiet * Free of noxious odors * Well-ventilated
67
What techniques can help in managing nausea?
* Relaxation techniques * Frequent rest periods * Diversion
68
What are some priority nursing interventions for a patient with vomiting?
Assess for signs of dehydration and provide appropriate care
69
Fill in the blank: The patient with vomiting should be encouraged to manage _______.
[nausea]
70
What can the timing of nausea and vomiting indicate?
The cause of nausea and vomiting
71
When is early morning vomiting common?
During pregnancy
72
What can elicit vomiting during or right after eating?
Emotional stressors
73
What syndrome is characterized by recurring episodes of nausea, vomiting, and fatigue?
Cyclic vomiting syndrome
74
What are some clinical problems associated with nausea and vomiting?
* Fluid imbalance * Electrolyte imbalance * Nutritionally compromised * Impaired GI function
75
What are the overall goals for a patient with nausea and vomiting?
* Minimal or no nausea and vomiting * Normal electrolyte levels and hydration status * Return to normal fluid and nutrient intake
76
What is the common initial treatment for patients with persistent vomiting?
NPO status and IV fluids
77
What might be required for a patient with persistent vomiting and possible bowel obstruction?
A nasogastric (NG) tube connected to suction
78
What should be monitored with prolonged vomiting?
* Intake and output * Vital signs * Signs of dehydration
79
What position should a patient who cannot manage self-care be placed in to prevent aspiration?
Semi-Fowler's or side-lying position
80
What type of therapy is necessary for a patient with severe vomiting?
IV fluid therapy with electrolyte and glucose replacement
81
What is the initial fluid of choice for oral rehydration after vomiting?
Water
82
What is a recommended method for rehydration in a patient recovering from vomiting?
Sip small amounts of fluids (5 to 15 mL) every 15 to 20 minutes
83
What types of foods are ideal for a recovering patient?
* High in carbohydrates * Low in fat * Bland foods like baked potato, rice, cooked chicken, and cereal
84
What should patients avoid when recovering from nausea and vomiting?
* Coffee * Spicy foods * Highly acidic foods * Foods with strong odors
85
What should the patient be advised regarding food intake?
Eat slowly and in small amounts
86
What environmental conditions should be maintained for a patient experiencing nausea?
* Quiet * Free of noxious odors * Well-ventilated
87
What techniques can help in managing nausea?
* Relaxation techniques * Frequent rest periods * Diversion
88
What are some priority nursing interventions for a patient with vomiting?
Assess for signs of dehydration and provide appropriate care
89
Fill in the blank: The patient with vomiting should be encouraged to manage _______.
[nausea]
90
What are some important health history factors to consider when assessing nausea and vomiting?
* GI problems * Chronic indigestion * Food allergies * Pregnancy * Infection * CNS problems * Recent travel * Eating disorders * Metabolic problems * Cancer * CVD * Renal disease ## Footnote These factors can influence the patient's condition and response to treatment.
91
Which medications are relevant in the assessment of nausea and vomiting?
* Antiemetics * Digitalis * Opioids * Ferrous sulfate * Aspirin * Aminophylline * Alcohol * Antibiotics * Chemotherapy * General anesthesia ## Footnote Certain medications can contribute to or alleviate symptoms.
92
What functional health patterns should be assessed in a patient experiencing nausea and vomiting?
* Nutritional-metabolic * Activity-exercise * Cognitive-perceptual * Coping-stress tolerance ## Footnote These patterns help identify the impact of symptoms on daily life.
93
What are some subjective data to collect regarding nutritional-metabolic patterns?
* Amount of vomitus * Frequency of vomiting * Character and color of vomitus * Presence of dry heaves * Anorexia * Weight loss ## Footnote Detailed information can indicate the severity of the condition.
94
Which objective data may indicate dehydration in a patient with nausea and vomiting?
* Lethargy * Sunken eyeballs * Pallor * Dry mucous membranes * Poor skin turgor * Decreased urinary output * Concentrated urine ## Footnote These signs can help assess the patient's hydration status.
95
What specific characteristics of vomitus should be noted during assessment?
* Amount * Frequency * Character (e.g., projectile) * Content (undigested food, blood, bile, feces) * Color (red, coffee-grounds, green-yellow) ## Footnote The characteristics can provide insight into the underlying cause of vomiting.
96
True or False: Abdominal tenderness or pain is a cognitive-perceptual symptom related to nausea and vomiting.
True ## Footnote This symptom can help identify the cause of nausea.
97
What possible diagnostic findings are associated with nausea and vomiting?
* Altered serum electrolytes (especially hypokalemia) * Metabolic alkalosis * Abnormal upper GI findings on endoscopy or abdominal x-rays ## Footnote These findings can guide further management and treatment.
98
What should be done when symptoms occur in a patient with nausea and vomiting?
Stop all foods and drugs until the acute phase is over ## Footnote This is crucial to prevent further complications.
99
What action should be taken if a medication is suspected to be causing nausea?
Notify the HCP at once ## Footnote The healthcare provider may adjust the medication accordingly.
100
What is the risk of stopping medication without consulting the HCP?
It may have adverse effects on their health ## Footnote Patients should always consult their healthcare provider before making changes to their medication regimen.
101
What types of drugs should a patient take for nausea?
Only antiemetic drugs prescribed by the HCP ## Footnote Over-the-counter drugs may worsen the problem.
102
Which alternative therapies may reduce PONV?
Acupressure, acupuncture, ginger, and peppermint oil ## Footnote These methods can provide relief for some patients.
103
What are the expected outcomes for a patient with nausea and vomiting?
* Be comfortable, with minimal or no nausea and vomiting * Have normal electrolyte levels * Able to maintain adequate intake of fluids and nutrients ## Footnote These outcomes ensure the patient’s recovery and well-being.
104
What considerations should be made for older adults experiencing nausea and vomiting?
Careful assessment and monitoring due to higher risk for fluid and electrolyte imbalances ## Footnote Older adults may have underlying health issues that complicate treatment.
105
Why are older adults at greater risk for complications from fluid and electrolyte replacement?
They may have heart or renal problems ## Footnote Excess replacement can lead to adverse consequences.
106
What is the risk for older adults with a decreased level of consciousness?
High risk for aspirating ## Footnote Monitoring is crucial to prevent aspiration-related complications.
107
What are the CNS side effects of antiemetic drugs in older adults?
Confusion and increased fall risk ## Footnote Doses should be reduced for safety.
108
What should be closely evaluated when administering antiemetic drugs to older adults?
Efficacy of the drugs ## Footnote This ensures that the treatment is both safe and effective.
109
What are some causes of oral inflammation and infections?
* Specific mouth diseases * Systemic problems like leukemia or vitamin deficiency ## Footnote Understanding the root cause is essential for effective treatment.
110
Who is at higher risk for oral infections?
Patients who are immunosuppressed ## Footnote This includes those undergoing chemotherapy or using corticosteroid inhalants.
111
What is aphthous stomatitis?
Recurrent and chronic form of infection characterized by painful ulcers of mouth and lips ## Footnote Related to systemic disease, trauma, stress, or unknown causes
112
What are the manifestations of gingivitis?
Inflamed gingivae and interdental papillae, bleeding during tooth brushing, development of pus, abscess formation ## Footnote Neglected oral hygiene, malocclusion, missing or irregular teeth, faulty dentistry
113
What treatments are used for aphthous stomatitis?
* Corticosteroids (topical or systemic) * Tetracycline oral suspension ## Footnote Prevention through health teaching and dental care
114
What is the primary cause of herpes simplex lesions?
Herpes simplex virus (type 1 or 2) ## Footnote Risk factors include upper respiratory tract infections, excessive exposure to sunlight, food allergies, emotional tension, onset of menstruation
115
List the treatments for herpes simplex.
* Spirits of camphor * Corticosteroid cream * Mild antiseptic mouthwash * Viscous lidocaine * Antiviral agents (e.g., acyclovir, valacyclovir)
116
What is oral candidiasis?
Infection caused by Candida albicans characterized by pearly, bluish white 'milk-curd' membranous lesions ## Footnote Also known as moniliasis or thrush
117
What are the symptoms of parotitis?
Pain in area of gland and ear, absence of salivation, purulent exudate from gland, redness, ulcers
118
What treatments are used for parotitis?
* Miconazole buccal tablets (Oravig) * Nystatin or amphotericin B as oral suspension or buccal tablets * Antibiotics, mouthwashes, warm compresses * Good oral hygiene
119
What are the causes of stomatitis?
* Trauma * Pathogens * Irritants (tobacco, alcohol) * Renal, liver, hematologic diseases * Side effect of chemotherapy and radiation
120
What is Vincent's infection?
Acute necrotizing ulcerative gingivitis caused by fusiform bacteria and Vincent spirochetes ## Footnote Risk factors include stress, excessive fatigue, and poor oral hygiene
121
What are the symptoms of Vincent's infection?
* Painful, bleeding gingivae * Eroding necrotic lesions of interdental papillae * Ulcers that bleed * T Saliva with metallic taste, fetid mouth odor * Anorexia, fever, malaise
122
What is the recommended diet for someone with Vincent's infection?
Soft, nutritious diet ## Footnote Nutrition deficiencies in B and C vitamins can be a risk factor
123
Fill in the blank: The treatment for stomatitis includes _______.
[remove or treat cause, oral hygiene with soothing solutions, topical medications, soft, bland diet]
124
What is a potential risk of oral infections?
Oral infections may predispose the patient to infections in other body organs ## Footnote For example, the oral cavity can be a reservoir for respiratory heart disease.
125
What are the main focuses in managing oral problems?
Identifying the cause, eliminating infection, providing comfort measures, and maintaining intake.
126
What is the effect of regular and good oral and dental hygiene?
Reduces oral infections and inflammation.
127
What are the two types of oral cancer?
Oral cavity cancer and oropharyngeal cancer.
128
What term is used for cancers of the oral cavity, pharynx, and larynx?
Head and neck squamous cell carcinoma (HNSCC).
129
Where do most oral cancer lesions occur?
On the lower lip, lateral border and undersurface of the tongue, labial commissure, and buccal mucosa.
130
How many Americans are diagnosed with oral cancer each year?
51,540 Americans.
131
What is the estimated number of deaths from oral cancer each year?
10,030 people.
132
At what age is oral cancer more common?
After age 35.
133
What is the average age at diagnosis for oral cancer?
65 years.
134
How much more common is oral cancer in men compared to women?
2 times more common.
135
What is the 5-year survival rate for localized oral cancer?
84%.
136
What is the 5-year survival rate for all stages of oral cavity and pharynx cancer?
65%.
137
Which demographic has the highest incidence and mortality rates for oral cancer?
Black men.
138
Which demographic has the highest incidence of esophageal cancer?
Non-Hispanic white men.
139
Which group has the highest rates of stomach cancer?
Asian Americans and Pacific Islanders, Blacks, and Hispanics.
140
What is a significant risk factor for oral cancer?
History of tobacco or frequent alcohol use.
141
What percentage of patients with lip cancer have outdoor occupations?
More than 30%.
142
What virus contributes to 25% of oral cancer cases?
Human papillomavirus (HPV).
143
What are common nonspecific symptoms of oral cancer?
Chronic sore throat, sore mouth, and voice changes.
144
What is leukoplakia commonly referred to as?
Smoker's patch.
145
What percentage of leukoplakia lesions transform into cancer?
15%.
146
What is erythroplasia also known as?
Erythroplakia.
147
What percentage of erythroplasia cases progress to squamous cell cancer?
More than 50%.
148
What is a typical presentation of lip cancer?
An indurated, painless ulcer on the lip.
149
What is a common first sign of tongue cancer?
An ulcer or area of thickening.
150
What are later symptoms of oral cancer?
Increased saliva, slurred speech, dysphagia, toothache, and earache.
151
What diagnostic test involves scraping a suspicious lesion?
Oral exfoliative cytologic study.
152
What is the toluidine blue test used for?
A screening test for oral cancer.
153
What is a risk factor for oral cancer related to the lip?
Constant overexposure to sun, ruddy and fair complexion ## Footnote Additional risk factors include recurrent herpetic lesions, pipe stem irritation, syphilis, and immunosuppression.
154
What are the common manifestations of oral cancer?
Indurated, painless ulcer, leukoplakia, erythroplakia, ulcers, sore spot, rough area, pain, dysphagia, a lump or thickening in the cheek, sore throat, difficulty chewing and speaking ## Footnote Later signs include slurred speech, toothache, and earache.
155
What are the risk factors associated with oral cavity cancer?
* Poor oral hygiene * Tobacco usage (pipe and cigar smoking, snuff, chewing tobacco) * Chronic alcohol use * Chronic irritation (jagged tooth, ill-fitting prosthesis, chemical or mechanical irritants) * HPV
156
What are the risk factors for tongue cancer?
Tobacco and alcohol use, chronic irritation, syphilis
157
What are the treatment options for oral cancer?
* Surgery * Radiation
158
Fill in the blank: The surgery for removing part of the tongue is called _______.
hemiglossectomy or glossectomy
159
What surgical procedures are mentioned for oral cancer treatment?
* Mandibulectomy * Radical neck dissection * Resection of buccal mucosa * Hemiglossectomy or glossectomy
160
True or False: Limited tongue movement is an early sign of oral cancer.
False
161
What is the purpose of a toluidine blue test in cancer diagnosis?
To stain an area where cancer cells may be present ## Footnote A negative result does not rule out cancer.
162
What imaging techniques are used for staging cancer after diagnosis?
CT scan, MRI, and positron emission tomography (PET) ## Footnote These techniques help assess the extent of cancer spread.
163
What are the main types of management for oral cancer?
Surgery, radiation, chemotherapy, or a combination of these ## Footnote Curative treatments are typically surgery and radiation.
164
What is the most effective treatment for early-stage oral cancer?
Surgery ## Footnote The type of surgery depends on the tumor's location and extent.
165
List some surgical procedures used in the treatment of oral cancer.
* Partial mandibulectomy * Hemiglossectomy * Glossectomy * Resections of buccal mucosa and floor of the mouth * Radical neck dissection ## Footnote These procedures vary based on the tumor's size and location.
166
What does radical neck dissection involve?
Wide excision of the primary lesion and removal of regional lymph nodes ## Footnote It may include removal of associated structures like the sternocleidomastoid muscle and internal jugular vein.
167
Why is radiation therapy usually not performed before surgery?
Radiated tissue becomes fibrotic and heals slower, making removal difficult ## Footnote Most patients begin radiation about 6 weeks after surgery.
168
What are the components of the diagnostic assessment for oral cancer?
* History and physical assessment * Biopsy * Oral exfoliative cytology * Toluidine blue test * CT, MRI, PET scans ## Footnote These assessments help in diagnosing and staging the cancer.
169
What is the role of chemotherapy in managing oral cancer?
* Shrink lesions before surgery * Decrease metastasis * Sensitize cancer cells to radiation * Treat distant metastases ## Footnote Common drugs include fluorouracil, cisplatin, and carboplatin.
170
When is palliative treatment indicated for oral cancer patients?
When the prognosis is poor, the cancer is inoperable, or the patient opts against surgery ## Footnote Palliation focuses on symptom management and comfort.
171
What nutritional support may be required for patients before and after surgery?
* Percutaneous endoscopic gastrostomy (PEG) * Enteral nutrition (EN) * Parenteral nutrition (PN) ## Footnote These supports are crucial for patients unable to ingest nutrients orally.
172
What are some clinical problems associated with oral cancer?
* Nutritionally compromised * Pain * Difficulty coping ## Footnote Effective management addresses these issues to improve patient quality of life.
173
What are the overall goals for a patient with oral cancer?
* Maintain a patent airway * Communicate effectively * Ensure adequate nutritional intake * Relieve pain and discomfort ## Footnote These goals guide nursing management and patient care.
174
Identify some key aspects of nursing management for oral cancer patients.
* Early detection * Risk factor education * Smoking cessation support ## Footnote Nurses play a vital role in patient education and intervention.
175
What are the health impacts of good oral hygiene?
* Improves quality of life * Lowers risk for teeth loss * Reduces pain and disability * Aids in early detection of oral and craniofacial cancers * Decreases cost of care needed from dental professionals * Decreases risk for periodontal disease, gingivitis, and dental caries ## Footnote Good oral hygiene is crucial for overall health and can lead to significant improvements in both physical and economic aspects of dental care.
176
Why is early detection of oral cancer important?
It aids in timely intervention and treatment of potential malignancies. ## Footnote Patients should be taught to report symptoms such as unexplained pain, unusual bleeding, dysphagia, sore throat, voice changes, or swelling.
177
What should be done for a person with an ulcerative lesion that does not heal within 2 to 3 weeks?
Refer to a healthcare provider (HCP). ## Footnote Non-healing lesions can be indicative of serious conditions, including cancer.
178
What are expected outcomes for a patient with oral cancer post-surgery?
* Have no respiratory complications * Be able to communicate ## Footnote These outcomes are essential for a patient's recovery and quality of life.
179
What does GERD stand for?
Gastroesophageal reflux disease ## Footnote GERD is a syndrome characterized by the reflux of stomach acid into the esophagus.
180
What causes GERD?
* Incompetent lower esophageal sphincter (LES) * Increased intraabdominal pressure * Certain foods and drugs * Obesity * Cigarette and cigar smoking * Hiatal hernia ## Footnote The causes of GERD can vary and often involve a combination of factors.
181
What is the most common upper GI problem in Americans?
GERD ## Footnote Approximately 15 million Americans experience GERD symptoms daily.
182
What is the primary factor causing GERD?
Incompetent lower esophageal sphincter (LES) ## Footnote An incompetent LES fails to prevent gastric contents from moving into the esophagus.
183
Fill in the blank: GERD is a symptom of _______ damage caused by reflux of stomach acid into the lower esophagus.
mucosal ## Footnote The mucosal damage is a key aspect of the syndrome.
184
What contributes to medication-induced esophagitis?
* Nonsteroidal antiinflammatory drugs (NSAIDs) * Potassium ## Footnote Certain medications can irritate the esophageal mucosa, exacerbating GERD symptoms.
185
What should preoperative care for a patient undergoing a radical neck dissection include?
* Physical preparation for major surgery * Special emphasis on oral hygiene * Information on postoperative communication and feeding ## Footnote Comprehensive care is necessary to address both physical and psychosocial needs.
186
What is a significant health history factor related to oral cancer?
Recurrent oral herpetic lesions, HPV infection or vaccination, syphilis, exposure to sunlight ## Footnote These factors are important for assessing risk and history in patients.
187
What type of medications are associated with oral cancer risk?
Immunosuppressants ## Footnote These medications may increase susceptibility to infections and malignancies.
188
What surgical history may be relevant in a patient with oral cancer?
Removal of prior tumors or lesions ## Footnote Previous surgeries can indicate a history of malignancy or precancerous conditions.
189
What are common health perception-health management factors in oral cancer patients?
Alcohol and tobacco use, pipe smoking, poor oral hygiene ## Footnote These behaviors significantly increase the risk of developing oral cancer.
190
What nutritional-metabolic issues might be present in a patient with oral cancer?
Reduced oral intake, weight loss, difficulty chewing food, increased saliva, intolerance to some foods or temperatures of food ## Footnote These symptoms can affect the patient's overall health and nutritional status.
191
What cognitive-perceptual symptoms may indicate oral cancer?
Mouth or tongue soreness or pain, toothache, earache, neck stiffness, dysphagia, difficulty speaking ## Footnote These symptoms can significantly impact the patient's quality of life.
192
What are some objective data findings in a physical assessment for oral cancer?
Areas of thickening or roughness, ulcers, leukoplakia, or erythroplakia on the tongue or oral mucosa, limited tongue movement ## Footnote These findings are critical for diagnosis and further evaluation.
193
What additional objective data might be observed in a patient with oral cancer?
Increased saliva, drooling, slurred speech, foul breath odor ## Footnote These signs can indicate advanced disease or complications.
194
What skin findings may be associated with oral cancer?
Indurated, painless ulcer on lip, painless neck mass ## Footnote These findings can suggest local or regional spread of cancer.
195
What are possible diagnostic findings for oral cancer?
Positive exfoliative smear cytology, positive biopsy ## Footnote These tests are essential for confirming the diagnosis of oral cancer.
196
What is a significant health history factor related to oral cancer?
Recurrent oral herpetic lesions, HPV infection or vaccination, syphilis, exposure to sunlight ## Footnote These factors are important for assessing risk and history in patients.
197
What type of medications are associated with oral cancer risk?
Immunosuppressants ## Footnote These medications may increase susceptibility to infections and malignancies.
198
What surgical history may be relevant in a patient with oral cancer?
Removal of prior tumors or lesions ## Footnote Previous surgeries can indicate a history of malignancy or precancerous conditions.
199
What are common health perception-health management factors in oral cancer patients?
Alcohol and tobacco use, pipe smoking, poor oral hygiene ## Footnote These behaviors significantly increase the risk of developing oral cancer.
200
What nutritional-metabolic issues might be present in a patient with oral cancer?
Reduced oral intake, weight loss, difficulty chewing food, increased saliva, intolerance to some foods or temperatures of food ## Footnote These symptoms can affect the patient's overall health and nutritional status.
201
What cognitive-perceptual symptoms may indicate oral cancer?
Mouth or tongue soreness or pain, toothache, earache, neck stiffness, dysphagia, difficulty speaking ## Footnote These symptoms can significantly impact the patient's quality of life.
202
What are some objective data findings in a physical assessment for oral cancer?
Areas of thickening or roughness, ulcers, leukoplakia, or erythroplakia on the tongue or oral mucosa, limited tongue movement ## Footnote These findings are critical for diagnosis and further evaluation.
203
What additional objective data might be observed in a patient with oral cancer?
Increased saliva, drooling, slurred speech, foul breath odor ## Footnote These signs can indicate advanced disease or complications.
204
What skin findings may be associated with oral cancer?
Indurated, painless ulcer on lip, painless neck mass ## Footnote These findings can suggest local or regional spread of cancer.
205
What are possible diagnostic findings for oral cancer?
Positive exfoliative smear cytology, positive biopsy ## Footnote These tests are essential for confirming the diagnosis of oral cancer.
206
What is considered GERD in terms of symptom frequency?
Persistent mild symptoms more than twice a week or moderate to severe symptoms once a week ## Footnote GERD stands for gastroesophageal reflux disease.
207
What is the most common symptom of GERD?
Heartburn (pyrosis) ## Footnote Heartburn is characterized by a burning sensation beneath the lower sternum.
208
Describe heartburn in terms of its sensation and triggers.
Burning, tight sensation beneath the lower sternum, spreading to the throat or jaw; may occur after ingesting food or drugs that decrease LES pressure ## Footnote LES stands for lower esophageal sphincter.
209
When should an HCP evaluate heartburn?
If it occurs more than twice a week, is severe, associated with dysphagia, or occurs at night and wakes a person from sleep ## Footnote Dysphagia refers to difficulty swallowing.
210
What can GERD-related chest pain mimic?
Angina ## Footnote Angina is chest pain due to reduced blood flow to the heart.
211
How does GERD-related chest pain differ from angina in terms of relief?
Antacids relieve GERD-related chest pain ## Footnote Angina typically does not improve with antacids.
212
What is dyspepsia?
Pain or discomfort centered in the upper abdomen ## Footnote Dyspepsia is often associated with GERD.
213
Define regurgitation in the context of GERD.
Hot, bitter, or sour liquid coming into the throat or mouth ## Footnote Regurgitation can be a common experience for GERD patients.
214
List some respiratory symptoms associated with GERD.
* Wheezing * Coughing * Dyspnea ## Footnote Dyspnea refers to difficulty breathing.
215
What are some otolaryngologic symptoms of GERD?
* Hoarseness * Sore throat * Globus sensation * Hypersalivation * Choking ## Footnote Globus sensation is the feeling of a lump in the throat.
216
What is a common complication of GERD?
Esophagitis (inflammation of the esophagus) ## Footnote Chronic inflammation can lead to further complications.
217
What is Barrett esophagus?
Reversible change from flat epithelial cells to columnar epithelial cells in the distal esophagus ## Footnote Barrett esophagus is a precancerous condition associated with GERD.
218
What percentage of people with chronic GERD may develop Barrett esophagus?
5% to 30% ## Footnote Other risk factors for BE include age, gender, ethnicity, and obesity.
219
What increases the risk of esophageal cancer in patients with Barrett esophagus?
It is a precancerous lesion ## Footnote Surveillance endoscopy or radiofrequency ablation may be necessary for these patients.
220
List some respiratory complications that can arise from GERD.
* Cough * Bronchospasm * Laryngospasm * Cricopharyngeal spasm ## Footnote These complications result from gastric secretions irritating the upper airway.
221
What diagnostic tests are often used for GERD?
* Endoscopy * Manometric studies * Ambulatory esophageal pH monitoring * Radionuclide tests ## Footnote These tests help assess the severity of GERD and rule out complications.
222
What is the primary approach to managing GERD?
Lifestyle modifications, drug therapy, and nutrition therapy ## Footnote Patient education is crucial for effective management.
223
What factors decrease lower esophageal sphincter pressure?
* Alcohol * Chocolate (theobromine) * Drugs * Anticholinergics * B-Adrenergic blockers * Calcium channel blockers * Diazepam (Valium) * Morphine sulfate * Nitrates * Progesterone * Theophylline * Fatty foods * Nicotine * Peppermint, spearmint * Tea, coffee (caffeine) ## Footnote These factors can contribute to gastroesophageal reflux disease (GERD) due to their impact on sphincter function.
224
What medications can increase lower esophageal sphincter pressure?
* Bethanechol (Urecholine) * Metoclopramide (Reglan) ## Footnote These medications may help in managing conditions related to low sphincter pressure.
225
True or False: Alcohol decreases lower esophageal sphincter pressure.
True ## Footnote Alcohol is known to relax the lower esophageal sphincter, increasing the risk of reflux.
226
Fill in the blank: _______ is a drug that acts as an anticholinergic and decreases lower esophageal sphincter pressure.
[Anticholinergics] ## Footnote Anticholinergics can lead to reduced muscle tone in the sphincter.
227
List three foods that decrease lower esophageal sphincter pressure.
* Fatty foods * Chocolate * Peppermint ## Footnote These foods are known to exacerbate symptoms of reflux.
228
What is the primary focus of drug therapy for GERD?
Decreasing the volume and acidity of reflux, improving LES function, increasing esophageal clearance, and protecting the esophageal mucosa ## Footnote LES stands for Lower Esophageal Sphincter.
229
What are the most common and effective treatments for symptomatic GERD?
Proton pump inhibitors (PPIs) and histamine (H2) receptor blockers ## Footnote PPIs and H2 receptor blockers are designed to manage symptoms and promote healing.
230
What lifestyle modification should be taught to patients with GERD?
Elevate the head of the bed 30 degrees and avoid being supine for 2 to 3 hours after a meal ## Footnote This can be achieved using pillows or blocks under the bed.
231
What should patients who smoke be encouraged to do?
Stop smoking ## Footnote Patients may be referred to community resources for assistance.
232
What is the effect of PPIs on esophagitis compared to H2 receptor blockers?
PPIs are more effective in healing esophagitis than H2 receptor blockers ## Footnote PPIs should be taken once daily before the first meal.
233
What is the potential risk associated with long-term PPI use?
Increased risk for hip, wrist, and spine fractures ## Footnote Patients should take the lowest dose for the shortest duration needed.
234
What is the onset of action for H2 receptor blockers?
1 hour ## Footnote Therapeutic effects can last up to 12 hours depending on the specific drug.
235
Fill in the blank: The neutralizing effects of antacids taken on an empty stomach last only _______.
20 to 30 minutes ## Footnote Antacids are most effective when taken 1 to 3 hours after meals.
236
What are common ingredients found in antacids?
Magnesium hydroxide or aluminum hydroxide ## Footnote Antacids can be single preparations or various combinations.
237
True or False: Antacids are effective for patients with moderate to severe GERD symptoms.
False ## Footnote Antacids are not effective in relieving symptoms or healing lesions in such cases.
238
What adjunctive treatments are mentioned for GERD?
Antacids and prokinetic drugs ## Footnote Antacids provide quick, short-lived relief of heartburn.
239
What are the key components of the diagnostic assessment for GERD and Hiatal Hernia?
• History and physical assessment • Upper Gi endoscopy with biopsy and cytologic analysis • Esophagram (barium swallow) • Motility (manometry) studies • pH monitoring (laboratory or 24 hr ambulatory) • Radionuclide studies ## Footnote These assessments help in diagnosing the condition accurately.
240
What is the recommended conservative management for GERD?
• Elevate head of bed 30 degrees • Avoid reflux-inducing foods (fatty foods, chocolate, peppermint) • Avoid alcohol • Reduce or avoid acidic ph beverages (colas, red wine, orange juice) ## Footnote These lifestyle changes can significantly alleviate symptoms.
241
What type of drug therapy is used for GERD management?
• PPls • H2 receptor blockers • Antacids • Prokinetics ## Footnote These medications help reduce stomach acid and improve gastrointestinal motility.
242
What are the surgical therapy options for GERD?
• Nissen fundoplication • Toupet fundoplication ## Footnote Surgical options are considered when conservative and drug therapies fail.
243
What are the endoscopic therapy options for GERD?
• Intraluminal valvuloplasty • Radiofrequency ablation ## Footnote These procedures aim to improve the function of the lower esophageal sphincter.
244
What are Proton Pump Inhibitors (PPIs) used for?
To inhibit HCl acid secretion by blocking the proton pump (H+-K+-ATPase) ## Footnote Examples include dexlansoprazole, esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole.
245
Name a common side effect of Proton Pump Inhibitors.
Headache ## Footnote Other side effects include abdominal pain, nausea, diarrhea, vomiting, and flatulence.
246
What is the mechanism of action for Histamine (H2) Receptor Blockers?
Block the action of histamine on H2 receptors to decrease HCl acid secretion ## Footnote Examples include cimetidine, famotidine, and nizatidine.
247
Fill in the blank: Antacids are used to _______.
Neutralize HCl acid
248
What are the side effects of aluminum hydroxide?
Constipation, phosphorus depletion with chronic use ## Footnote Aluminum hydroxide is commonly found in antacid formulations.
249
What are the side effects of calcium carbonate?
Constipation or diarrhea, hypercalcemia, milk-alkali syndrome, renal calculi ## Footnote Calcium carbonate is another common antacid.
250
What is the mechanism of action for the drug sucralfate (Carafate)?
Forms a protective layer in the stomach and protects against acid, bile salts, and enzymes ## Footnote It acts as a cytoprotective agent.
251
What is the purpose of prokinetic agents like metoclopramide?
Increase gastric motility and emptying ## Footnote Metoclopramide also helps with reflux.
252
True or False: Prostaglandin (Synthetic) misoprostol is used to decrease gastric emptying.
False ## Footnote Misoprostol actually increases gastric emptying.
253
What are common side effects of prokinetic agents?
CNS side effects ranging from anxiety to hallucinations ## Footnote Extrapyramidal side effects like tremor and dyskinesias can also occur.
254
Fill in the blank: Sodium preparations can lead to _______ if used with large amounts of calcium.
Milk-alkali syndrome
255
What is the effect of cholinergic drugs like bethanechol?
Increase gastric motility and emptying ## Footnote Cholinergic agents may also help with reflux.
256
What is a primary action of cytoprotective agents?
Increase production of gastric mucus and bicarbonate secretion
257
How often may antacids be given to patients?
Hourly ## Footnote Antacids may be administered either orally or through the NG tube.
258
What should be tested when an NG tube is in place?
pH level of stomach contents ## Footnote Periodic aspiration of the stomach contents is necessary.
259
What action may be taken if the pH level is less than 5?
Intermittent suction may be used or increase frequency/dosage of antacid ## Footnote This is to manage acid levels effectively.
260
What factors determine the type and dosage of antacid given?
Side effects and potential drug interactions ## Footnote Individual patient factors are crucial in determining appropriate antacids.
261
Why should antacids high in sodium be used cautiously?
In older adults and patients with CVD, liver, and renal disease ## Footnote Sodium can exacerbate health issues in these populations.
262
Why should patients with renal failure avoid magnesium preparations?
Risk for magnesium toxicity ## Footnote Magnesium can accumulate in patients with compromised renal function.
263
What is the benefit of combining aluminum and magnesium in antacids?
Decreases side effects of both ## Footnote This combination can provide effective relief with fewer adverse effects.
264
How do antacids interact with benzodiazepines and pseudoephedrine?
Enhance their effects ## Footnote This can lead to increased sedation or other enhanced effects.
265
What effect do antacids have on the absorption rates of certain drugs?
Decrease absorption rates ## Footnote Drugs affected include thyroid hormones, phenytoin, and tetracycline.
266
What should be adjusted when administering medications with antacids?
Timing of medication administration ## Footnote This is necessary to minimize interaction effects.
267
What is the primary function of prokinetics in upper gastrointestinal problems?
Prokinetics increase LES pressure and improve gastric emptying ## Footnote This may result in a small improvement in regurgitation and vomiting.
268
Name some common prokinetic agents.
* Cisapride * Metoclopramide (Reglan) * Bethanechol * Baclofen ## Footnote Many prokinetics have significant side effects.
269
What dietary changes may help patients with GERD?
Patients may need to avoid foods that decrease LES pressure, such as: * Chocolate * Peppermint * Fatty foods * Coffee * Tea ## Footnote Foods like tomato-based products, orange juice, cola, and red wine may irritate the esophagus.
270
What are some recommendations for meal timing in GERD patients?
Avoid late evening meals, nighttime snacking, and milk, especially at bedtime ## Footnote These habits increase gastric acid secretion.
271
What is the goal of antireflux surgery?
The goal is to reduce reflux by enhancing LES integrity.
272
What are the common types of laparoscopic antireflux surgeries?
* Nissen fundoplication * Toupet fundoplication
273
What are some complications associated with laparoscopic fundoplication?
* Gastric or esophageal injury * Splenic injury * Pneumothorax * Perforation * Bleeding * Infection * Pneumonia
274
What symptoms may occur after laparoscopic fundoplication surgery?
Mild dysphagia due to edema, which should resolve ## Footnote Persistent symptoms such as heartburn and regurgitation should be reported.
275
What is the LINX Reflux Management System?
A ring of small, flexible magnets that strengthen the weak LES ## Footnote It is implanted laparoscopically and prevents reflux by keeping the LES closed under resting conditions.
276
What are some problems associated with the LINX system?
* Nausea * Swallowing problems * Pain when swallowing food ## Footnote Patients with a LINX system cannot have an MRI due to potential harm.
277
What is a hiatal hernia?
Herniation of part of the stomach into the esophagus through an opening in the diaphragm.
278
What are the two types of hiatal hernias?
* Sliding hiatal hernia * Paraesophageal (rolling) hiatal hernia
279
What characterizes a sliding hiatal hernia?
The junction of the stomach and esophagus is above the diaphragm, and the hernia usually returns to the abdominal cavity when upright.
280
What characterizes a paraesophageal or rolling hiatal hernia?
The fundus and greater curvature of the stomach roll up through the diaphragm, forming a pocket alongside the esophagus.
281
What factors may contribute to the development of a hiatal hernia?
* Aging * Obesity * Pregnancy * Ascites * Tumors * Intense physical exertion * Heavy lifting
282
What are some potential complications of a hiatal hernia?
* GERD * Esophagitis * Bleeding from erosion * Stenosis * Ulcerations * Strangulation of the hernia * Regurgitation with tracheal aspiration
283
What diagnostic study can show gastric mucosa protruding through the esophageal hiatus?
An esophagram (barium swallow).
284
What are alternatives to surgery for treating upper gastrointestinal problems?
* Endoscopic mucosal resection (EMR) * Radiofrequency ablation
285
What is the purpose of visualization of the lower esophagus?
To provide information on the degree of mucosal inflammation or other abnormalities ## Footnote Other tests done are similar to those for GERD.
286
What is the conservative therapy for hiatal hernia?
Similar to that for GERD, including reducing intraabdominal pressure by eliminating constricting garments and avoiding lifting ## Footnote This is part of the nursing and interprofessional management.
287
List the surgical treatments for hiatal hernia.
* Reducing the herniated stomach into the abdomen * Herniotomy (excision of the hernia sac) * Herniorrhaphy (closure of the hiatal defect) * Fundoplication * Gastropexy (attachment of the stomach below the diaphragm) ## Footnote The goals are to reduce the hernia, provide an acceptable LES pressure, and prevent movement of the gastroesophageal junction.
288
What techniques are often used for surgery to repair hiatal hernia?
Laparoscopic techniques, specifically Nissen or Toupet techniques ## Footnote The approach used (thoracic or abdominal) depends on the patient.
289
What factors increase the incidence of hiatal hernia and GERD?
* Weakening of the diaphragm * Obesity * Kyphosis * Other factors that increase intraabdominal pressure ## Footnote Older patients may take drugs that decrease LES pressure.
290
What are the first signs of serious issues in older patients with hiatal hernia?
Esophageal bleeding from esophagitis or respiratory complications (e.g., aspiration pneumonia) ## Footnote These may occur due to aspiration of gastric contents.
291
What is the overall 5-year survival rate for esophageal cancer?
20% ## Footnote In 2020, there were 18,400 new cases and 16,170 deaths from esophageal cancer in the United States.
292
Most esophageal cancers are classified as what type?
Adenocarcinomas ## Footnote The others are squamous cell tumors.
293
What are key risk factors for esophageal cancer?
* Barrett's esophagus (BE) * Smoking * Excess alcohol use * Obesity ## Footnote Current smoking or a history of smoking has a twice greater risk for esophageal cancer.
294
Where do most esophageal tumors occur?
In the middle and lower portions of the esophagus ## Footnote The tumor usually appears as an ulcerated lesion and may penetrate the muscular layer.
295
What is the most common symptom of esophageal cancer?
Progressive dysphagia ## Footnote Dysphagia may initially occur only with meat, then with soft foods, and eventually with liquids.
296
True or False: The cause of esophageal cancer is well understood.
False ## Footnote The exact cause of esophageal cancer is unknown.
297
What condition is associated with squamous cell cancer of the esophagus?
Achalasia ## Footnote Achalasia is marked by delayed emptying of the lower esophagus.
298
What areas does pain typically occur in esophageal cancer?
Pain typically occurs in the substernal, epigastric, or back areas ## Footnote Pain usually increases with swallowing and may radiate to the neck, jaw, ears, and shoulders.
299
What symptoms may occur if the tumor is in the upper third of the esophagus?
Symptoms may include sore throat, choking, and hoarseness ## Footnote Most patients also experience weight loss.
300
What occurs when esophageal stenosis is severe?
Regurgitation of blood-flecked esophageal contents is common ## Footnote Bleeding can occur if the cancer erodes through the esophagus and into the aorta.
301
What are potential complications of esophageal cancer?
Complications may include esophageal perforation and fistula formation into the lung or trachea ## Footnote The tumor may also cause esophageal obstruction, especially in late stages.
302
What is needed to diagnose esophageal cancer?
Endoscopic biopsy is needed to diagnose esophageal cancer.
303
What is the importance of endoscopic ultrasonography (EUS) in esophageal cancer?
EUS is important in staging esophageal cancer.
304
What might an esophagram (barium swallow) show?
An esophagram may show narrowing of the esophagus at the tumor site.
305
What factors determine the treatment for esophageal cancer?
Treatment depends on the tumor's location and whether invasion or metastasis is present.
306
What is the prognosis for esophageal cancer?
Esophageal cancer usually has a poor prognosis because it is often diagnosed at an advanced stage.
307
What is a multimodal approach in treating esophageal cancer?
A multimodal approach includes surgery, endoscopic ablation, chemotherapy, and radiation therapy.
308
What are the types of surgical procedures for esophageal cancer?
Types include: * Esophagectomy * Esophagogastrostomy * Esophagoenterostomy ## Footnote Surgical approaches may be open or laparoscopic.
309
What is minimally invasive esophagectomy?
Minimally invasive esophagectomy is laparoscopic vagal nerve-sparing surgery.
310
What does endoscopic therapy include?
Endoscopic therapy includes: * Photodynamic therapy * EMR * Radiofrequency ablation
311
What is photodynamic therapy?
Photodynamic therapy involves an IV injection of porfimer sodium and directing light towards the cancerous area.
312
What is EMR in the context of esophageal cancer?
EMR involves removing cancer tissue using an endoscope.
313
What is the purpose of dilation and stent placement?
Dilation increases the lumen of the esophagus and relieves obstruction; stents allow food and liquid to pass through.
314
What are self-expandable metal stents used for?
Self-expandable metal stents prevent stent migration and tumor ingrowth.
315
What is the role of radiation therapy in esophageal cancer treatment?
Radiation therapy may be given for palliation of symptoms and can be combined with chemotherapy.
316
What chemotherapy regimens are used for esophageal cancer?
Regimens may include: * Carboplatin and paclitaxel * Cisplatin and irinotecan * Oxaliplatin, paclitaxel, or cisplatin with fluorouracil or capecitabine * DCF (docetaxel, cisplatin, fluorouracil)
317
What is targeted therapy in relation to HER-2 protein?
Some esophageal cancers have too much HER-2 protein, which helps cancer cells grow.
318
What areas does pain typically occur in esophageal cancer?
Pain typically occurs in the substernal, epigastric, or back areas ## Footnote Pain usually increases with swallowing and may radiate to the neck, jaw, ears, and shoulders.
319
What symptoms may occur if the tumor is in the upper third of the esophagus?
Symptoms may include sore throat, choking, and hoarseness ## Footnote Most patients also experience weight loss.
320
What occurs when esophageal stenosis is severe?
Regurgitation of blood-flecked esophageal contents is common ## Footnote Bleeding can occur if the cancer erodes through the esophagus and into the aorta.
321
What are potential complications of esophageal cancer?
Complications may include esophageal perforation and fistula formation into the lung or trachea ## Footnote The tumor may also cause esophageal obstruction, especially in late stages.
322
What is needed to diagnose esophageal cancer?
Endoscopic biopsy is needed to diagnose esophageal cancer.
323
What is the importance of endoscopic ultrasonography (EUS) in esophageal cancer?
EUS is important in staging esophageal cancer.
324
What might an esophagram (barium swallow) show?
An esophagram may show narrowing of the esophagus at the tumor site.
325
What factors determine the treatment for esophageal cancer?
Treatment depends on the tumor's location and whether invasion or metastasis is present.
326
What is the prognosis for esophageal cancer?
Esophageal cancer usually has a poor prognosis because it is often diagnosed at an advanced stage.
327
What is a multimodal approach in treating esophageal cancer?
A multimodal approach includes surgery, endoscopic ablation, chemotherapy, and radiation therapy.
328
What are the types of surgical procedures for esophageal cancer?
Types include: * Esophagectomy * Esophagogastrostomy * Esophagoenterostomy ## Footnote Surgical approaches may be open or laparoscopic.
329
What is minimally invasive esophagectomy?
Minimally invasive esophagectomy is laparoscopic vagal nerve-sparing surgery.
330
What does endoscopic therapy include?
Endoscopic therapy includes: * Photodynamic therapy * EMR * Radiofrequency ablation
331
What is photodynamic therapy?
Photodynamic therapy involves an IV injection of porfimer sodium and directing light towards the cancerous area.
332
What is EMR in the context of esophageal cancer?
EMR involves removing cancer tissue using an endoscope.
333
What is the purpose of dilation and stent placement?
Dilation increases the lumen of the esophagus and relieves obstruction; stents allow food and liquid to pass through.
334
What are self-expandable metal stents used for?
Self-expandable metal stents prevent stent migration and tumor ingrowth.
335
What is the role of radiation therapy in esophageal cancer treatment?
Radiation therapy may be given for palliation of symptoms and can be combined with chemotherapy.
336
What chemotherapy regimens are used for esophageal cancer?
Regimens may include: * Carboplatin and paclitaxel * Cisplatin and irinotecan * Oxaliplatin, paclitaxel, or cisplatin with fluorouracil or capecitabine * DCF (docetaxel, cisplatin, fluorouracil)
337
What is targeted therapy in relation to HER-2 protein?
Some esophageal cancers have too much HER-2 protein, which helps cancer cells grow.
338
What is Herceptin?
A drug that targets the HER-2 protein and kills cancer cells.
339
What is the function of Ramucirumab (Cyramza)?
An angiogenesis inhibitor that binds to the receptor for vascular endothelial growth factor (VEGF) and prevents its signaling.
340
What type of cancers does Ramucirumab treat?
Advanced cancers that start at the gastroesophageal junction.
341
What is the purpose of nutrition therapy after esophageal surgery?
To provide IV fluids and assess swallowing before starting oral fluids.
342
What should be given when starting oral fluids post-esophageal surgery?
Water (30 to 60 mL) hourly, progressing to small, frequent, bland meals.
343
What position should the patient be in after starting fluids?
Upright position for 2 hours to prevent regurgitation.
344
What are the symptoms of leakage into the mediastinum during enteral nutrition?
Pain, fever, and dyspnea.
345
What history should be assessed in a patient with esophageal cancer?
History of GERD, hiatal hernia, achalasia, Barrett's esophagus, and tobacco and alcohol use.
346
What are common clinical problems for patients with esophageal cancer?
* Pain * Nutritionally compromised * Impaired GI function * Difficulty coping
347
What are the overall goals for patients with esophageal cancer?
* Relief of symptoms, including pain and dysphagia * Optimal nutrition intake * Quality of life appropriate to stage of disease and prognosis
348
What should health promotion counseling for GERD patients include?
Importance of regular follow-up evaluation and smoking cessation.
349
What dietary habits should be encouraged for patients with esophageal issues?
Good oral hygiene and intake of fresh fruits and vegetables.
350
What emotional reactions might patients experience upon diagnosis of esophageal cancer?
Shock, disbelief, and depression.
351
What type of diet is recommended for patients with esophageal cancer?
A high-calorie, high-protein diet.
352
What is essential for maintaining oral care preoperatively?
Cleanse the mouth thoroughly, including the tongue, gingivae, and teeth.
353
What are common postoperative complications for esophageal cancer patients?
* Dysrhythmias * Anastomotic leaks * Fistula formation * Interstitial pulmonary edema * Acute respiratory distress
354
How long is the NG tube usually in place post-esophageal surgery?
5 to 7 days.
355
What should be monitored regarding NG tube drainage?
Assess the drainage and notify the healthcare provider of excess drainage (over 400 to 600 mL in 8 hours).
356
What measures should be implemented to prevent respiratory complications?
Have the patient turn, cough, deep breathe, and use an incentive spirometer every 2 hours.
357
What position should the patient be placed in to prevent reflux and aspiration?
Semi-Fowler's or Fowler's position.
358
What might be necessary for long-term care after surgery for esophageal cancer?
Chemotherapy and radiation treatment, and possibly a permanent feeding gastrostomy.
359
What is the expected outcome for a patient with esophageal cancer regarding airway?
Maintain a patent airway ## Footnote This is crucial for patient safety and comfort.
360
What relief should a patient with esophageal cancer experience?
Have relief of pain ## Footnote Pain management is an important part of cancer care.
361
What should a patient with esophageal cancer be able to do related to swallowing?
Be able to swallow comfortably and consume adequate intake ## Footnote This is vital for maintaining nutritional health.
362
What quality of life aspect is expected for a patient with esophageal cancer?
Have a quality of life appropriate to stage of disease and prognosis ## Footnote This reflects the holistic approach to cancer care.
363
What is eosinophilic esophagitis characterized by?
Swelling of the esophagus from an infiltration of eosinophils ## Footnote EoE is often associated with allergic diseases.
364
What are the most common food triggers for eosinophilic esophagitis?
* Milk * Egg * Wheat * Rye * Beef ## Footnote Identifying and avoiding these triggers is essential for management.
365
What are common symptoms of eosinophilic esophagitis?
* Severe heartburn * Difficulty swallowing * Food impaction * Nausea * Vomiting * Weight loss ## Footnote These symptoms can significantly impact quality of life.
366
How is eosinophilic esophagitis diagnosed?
Based on symptoms and biopsy findings of eosinophils infiltrating esophageal tissue obtained from endoscopy ## Footnote Endoscopy allows for direct visualization and sampling.
367
What treatments are commonly used for eosinophilic esophagitis?
* Avoiding allergic triggers * PPIs * Corticosteroids ## Footnote Corticosteroids can be used orally or topically.
368
What is a common side effect of corticosteroid treatment for eosinophilic esophagitis?
Esophageal candidiasis ## Footnote This fungal infection is a notable risk with corticosteroid use.
369
What are esophageal diverticula?
Saclilke outpouchings of 1 or more layers of the esophagus ## Footnote They can lead to various symptoms and complications.
370
What are the three main areas where esophageal diverticula occur?
* Above the upper esophageal sphincter (Zenker diverticulum) * Near the esophageal midpoint (traction diverticulum) * Above the LES (epiphrenic diverticulum) ## Footnote Zenker diverticulum is the most common type.
371
What are typical symptoms of esophageal diverticula?
* Dysphagia * Regurgitation * Chronic cough * Aspiration * Weight loss ## Footnote These symptoms often result from food becoming trapped.
372
What complications can arise from esophageal diverticula?
* Malnutrition * Aspiration * Perforation ## Footnote Complications may require surgical intervention.
373
What is the most common cause of esophageal strictures?
Chronic GERD ## Footnote Other causes include trauma and radiation.
374
What symptoms can esophageal strictures cause?
* Dysphagia * Regurgitation * Weight loss ## Footnote These symptoms can severely affect nutrition and quality of life.
375
How can esophageal strictures be treated?
* Mechanical bougies * Balloons * Surgical excision ## Footnote Dilation may be performed with or without endoscopy.
376
What is achalasia?
A rare, chronic disorder where peristalsis of the lower two thirds of the esophagus is absent ## Footnote The exact cause of achalasia is unknown.
377
What happens to the esophagus in achalasia?
Esophageal obstruction occurs at or near the diaphragm, causing dilation above the affected segment ## Footnote This leads to accumulation of food and fluid.
378
What is the most common symptom of achalasia?
Dysphagia ## Footnote This occurs with both liquids and solids.
379
What sensation may patients report during or right after a meal?
Globus sensation and/or substernal chest pain ## Footnote This pain is similar to angina pain.
380
What is a common symptom experienced by about a third of patients at night?
Nighttime regurgitation ## Footnote This may contribute to discomfort during sleep.
381
What condition can cause halitosis and the inability to eructate?
Esophageal disorders ## Footnote Halitosis refers to foul-smelling breath.
382
What symptoms may be reported when patients are lying down?
Symptoms of GERD and regurgitation of sour-tasting food and liquids ## Footnote GERD stands for gastroesophageal reflux disease.
383
What is a common physical change in patients with esophageal disorders?
Weight loss ## Footnote This can result from difficulty swallowing.
384
What diagnostic tests are used to diagnose esophageal disorders?
* Esophagram (barium swallow) * Manometric evaluation (high-resolution manometry) * Endoscopic evaluation ## Footnote These tests help assess esophageal function and structure.
385
What are the primary goals of treatment for esophageal disorders?
* Relieve dysphagia * Manage regurgitation * Improve esophageal emptying * Prevent megaesophagus ## Footnote Megaesophagus refers to the enlargement of the lower esophagus.
386
What does endoscopic pneumatic dilation involve?
Dilating the LES muscle using balloons of progressively larger diameter ## Footnote The diameters used are 3.0, 3.5, and 4.0 cm.
387
What is a Heller myotomy?
A surgical procedure where the muscles of the LES are cut ## Footnote This allows food to pass more easily.
388
What common complication may require anti-reflux surgery during a Heller myotomy?
GERD with esophagitis and stricture ## Footnote This is due to the risk of reflux issues post-surgery.
389
How long does it typically take for a patient to return to usual activities after surgery?
1 to 2 weeks ## Footnote Recovery time may vary based on individual circumstances.
390
What is the efficacy of medical therapy compared to invasive procedures?
Medical therapy is less effective ## Footnote Invasive procedures often provide better outcomes.
391
What is the role of botulinum toxin injection in treating esophageal disorders?
It provides short-term relief of symptoms and improves esophageal emptying ## Footnote It promotes relaxation of the smooth muscle.
392
What types of medications can relax the LES?
* Nitrates (e.g., isosorbide dinitrate) * Calcium channel blockers (e.g., nifedipine) ## Footnote These medications are taken sublingually before meals.
393
What are some limitations of using nitrates and calcium channel blockers?
* Side effects * Drug tolerance * Short duration of action ## Footnote These factors can limit their effectiveness.
394
What symptomatic treatment can help patients with esophageal disorders?
* Eating a semi-soft diet * Eating slowly * Drinking fluid with meals * Sleeping with the head elevated ## Footnote These strategies can alleviate discomfort.
395
What are esophageal varices?
Dilated, tortuous veins occurring in the lower part of the esophagus ## Footnote They are a result of portal hypertension.
396
What condition commonly leads to the development of esophageal varices?
Portal hypertension ## Footnote This is often associated with liver disease.
397
What is Peptic Ulcer Disease (PUD)?
A condition characterized by erosion of the GI mucosa from the digestive action of HCl acid and pepsin. ## Footnote PUD affects about 4.6 million people in the United States each year.
398
What parts of the GI tract are susceptible to ulcer development?
Lower esophagus, stomach, duodenum, and margin of a gastrojejunal anastomosis after surgical procedures. ## Footnote Any part of the GI tract in contact with gastric secretions can develop ulcers.
399
How are peptic ulcers classified?
As acute or chronic and by location (gastric or duodenal). ## Footnote Acute ulcers cause superficial erosion and resolve quickly, while chronic ulcers are long-lasting and can erode through the muscular wall.
400
What distinguishes acute ulcers from chronic ulcers?
Acute ulcers cause superficial erosion and minimal inflammation, while chronic ulcers are present for many months or intermittently throughout life. ## Footnote Chronic ulcers are more common than acute ulcers.
401
What is the role of HCl acid in ulcer development?
Peptic ulcers develop only in an acid environment, but excess HCl acid is not necessary for ulcer development. ## Footnote Pepsinogen converts to pepsin in the presence of HCl acid at a pH of 2 to 3.
402
What happens to pepsin activity when pH increases to 3.5 or more?
Pepsin has little or no proteolytic activity. ## Footnote This can occur when food or antacids neutralize stomach acid levels.
403
What is the pathophysiology of ulcer development?
Back diffusion of HCl acid into the gastric mucosa causes cellular destruction and inflammation, leading to histamine release, vasodilation, and increased capillary permeability. ## Footnote This process further increases acid and pepsin secretion.
404
What is the major risk factor for Peptic Ulcer Disease?
Infection with Helicobacter pylori. ## Footnote 80% of gastric and 90% of duodenal ulcers are related to H. pylori.
405
What percentage of the population is affected by H. pylori in the United States?
20% of persons younger than 30 years and 50% of those older than 60 years. ## Footnote Infection likely occurs during childhood through family transmission.
406
Which ethnic groups have the highest and lowest rates of H. pylori infection?
Highest in Hispanics and lowest in East Asians. ## Footnote Most individuals infected with H. pylori do not develop ulcers.
407
What strains of H. pylori are more likely to cause PUD?
CagA-positive strains. ## Footnote Infection with these strains increases the likelihood of developing peptic ulcer disease.
408
What allows bacteria to survive in the stomach?
Colonizing the gastric epithelial cells within the mucosal layer ## Footnote This process helps bacteria withstand the harsh acidic environment of the stomach.
409
What enzyme do bacteria produce that affects the stomach?
Urease ## Footnote Urease metabolizes urea, producing ammonium chloride and other damaging chemicals.
410
What immune response does urease activate?
Antibody production and the release of inflammatory cytokines ## Footnote This immune response can lead to increased gastric secretion and tissue damage.
411
What is the primary cause of non-H. pylori peptic ulcers?
NSAID use ## Footnote NSAIDs are non-steroidal anti-inflammatory drugs that can damage the gastric mucosa.
412
How do NSAIDs contribute to peptic ulcer disease (PUD)?
Inhibit prostaglandin synthesis, increase gastric acid secretion, and reduce mucosal barrier integrity ## Footnote Prostaglandins play a crucial role in maintaining the gastric mucosal barrier.
413
What is the effect of NSAID use in the presence of H. pylori?
Increases the risk for PUD ## Footnote H. pylori infections can exacerbate the damaging effects of NSAIDs.
414
Which patients have a higher risk for PUD when taking NSAIDs?
Patients taking corticosteroids or anticoagulants ## Footnote Corticosteroids affect mucosal cell renewal and decrease protective effects.
415
What lifestyle factor can cause acute mucosal lesions?
High alcohol intake ## Footnote Alcohol consumption can damage the gastric mucosa.
416
What substances stimulate gastric acid secretion?
* Alcohol * Smoking * Coffee ## Footnote These stimulants can exacerbate ulcer conditions.
417
What factors can delay the healing of ulcers?
* Smoking * Psychological distress * Stress * Depression ## Footnote These factors can negatively impact the healing process of existing ulcers.
418
Where can gastric ulcers occur?
Any part of the stomach, most often in the antrum ## Footnote Gastric ulcers are less common than duodenal ulcers.
419
In which demographic are gastric ulcers more prevalent?
Women and those over 50 years of age ## Footnote This demographic shows a higher incidence of gastric ulcers.
420
What is the shape of gastric ulcers?
Superficial, smooth margins. Round, oval, or cone shaped.
421
Where are gastric ulcers predominantly located?
Predominantly antrum, also in body and fundus of stomach.
422
What is the gastric secretion level in gastric ulcers?
Normal to decreased.
423
What is the peak age for gastric ulcers?
50-60 years.
424
Is there a cancer risk associated with gastric ulcers?
Yes, there is a cancer risk.
425
What percentage of gastric ulcers is associated with H. pylori infection?
80%.
426
What is the location of duodenal ulcers?
First 1-2 cm of duodenum.
427
What is the peak age for duodenal ulcers?
35-45 years.
428
Is there a cancer risk associated with duodenal ulcers?
No, there is no cancer risk.
429
What percentage of duodenal ulcers is associated with H. pylori infection?
90%.
430
What are some diseases associated with duodenal ulcers?
* COPD * Pancreatic disease * Hyperparathyroidism * Zollinger-Ellison syndrome (ZES) * Chronic renal failure
431
What are the clinical manifestations of gastric ulcers?
Burning or gaseous pressure in epigastrium.
432
What is the timing of pain for gastric ulcers?
Pain 1-2 hr after meals.
433
How does discomfort with penetrating ulcers change with food?
Aggravation of discomfort with food.
434
What are the clinical manifestations of duodenal ulcers?
Burning, cramping, pressure-like pain across midepigastrium and upper abdomen.
435
What is the timing of pain for duodenal ulcers?
Pain 2-5 hr after meals and midmorning, midafternoon, middle of night.
436
What provides pain relief for duodenal ulcers?
Pain relief with antacids and food.
437
What is the recurrence rate for gastric ulcers?
High.
438
What is the recurrence rate for duodenal ulcers?
High.
439
What is the mortality rate comparison between gastric ulcers and duodenal ulcers in older adults?
The mortality rate from gastric ulcers is greater than that from duodenal ulcers.
440
What are the main risk factors for gastric ulcers?
* H. pylori * NSAIDs * Bile reflux
441
What percentage of peptic ulcers are duodenal ulcers?
Duodenal ulcers account for about 80% of all peptic ulcers.
442
At what age is the incidence of duodenal ulcers especially high?
The incidence is especially high between 35 and 45 years of age.
443
What is the most common factor related to the development of duodenal ulcers?
H. pylori is the most common factor.
444
What conditions increase the risk of developing duodenal ulcers?
* Chronic obstructive pulmonary disease (COPD) * Cirrhosis * Pancreatitis * Hyperparathyroidism * Chronic kidney disease * Zollinger-Ellison syndrome (ZES)
445
What characterizes Zollinger-Ellison syndrome (ZES)?
ZES is characterized by severe peptic ulceration and HCl acid hypersecretion.
446
How do the symptoms of gastric ulcers typically present?
Discomfort is generally high in the epigastrium, occurring about 1 to 2 hours after meals, described as 'burning' or 'gaseous'.
447
When do symptoms occur in duodenal ulcers?
Symptoms occur generally 2 to 5 hours after a meal.
448
What type of pain is associated with duodenal ulcers?
Pain is described as 'burning' or 'cramplike', often in the midepigastric region.
449
What are the common symptoms of duodenal ulcers?
* Bloating * Nausea * Vomiting * Early feelings of fullness
450
What is the most accurate procedure to determine the presence and location of an ulcer?
Endoscopy is the most accurate procedure.
451
What is the gold standard for diagnosing H. pylori infection?
A biopsy of the antral mucosa with testing for urease.
452
What types of tests are available to confirm H. pylori infection?
* Noninvasive tests: serology, stool, breath testing * Invasive tests: biopsy
453
What can high fasting serum gastrin levels indicate?
The presence of a possible gastrinoma (ZES).
454
What laboratory tests may be done in relation to ulcers?
* CBC * Liver enzyme studies * Serum amylase * Stool examination
455
What is the aim of conservative care for ulcers?
To decrease gastric acidity and enhance mucosal defense mechanisms.
456
How long does it typically take for pain to disappear after ulcer treatment?
Pain disappears after 3 to 6 days.
457
How long may complete ulcer healing take?
Complete healing may take 3 to 9 weeks.
458
What should be done with aspirin and nonselective NSAIDs during ulcer treatment?
They should be stopped for 4 to 6 weeks.
459
What may be prescribed when aspirin must be continued during ulcer treatment?
Co-administration with a PPI, H2 receptor blocker, or misoprostol.
460
Fill in the blank: Silent peptic ulcers are more likely to occur in older adults and those taking _______.
NSAIDs
461
What effect does enteric-coated aspirin have on GI bleeding risk?
Decreases localized irritation but does not reduce overall risk for GI bleeding.
462
How does smoking affect mucosal healing in patients with ulcers?
Irritating effect on the mucosa and delays mucosal healing.
463
What lifestyle changes are recommended for ulcer healing?
* Stop or severely reduce smoking * Adequate physical and emotional rest * Avoid or restrict alcohol use
464
What is the focus of drug therapy for ulcers?
Reducing gastric acid secretion and eliminating H. pylori infection.
465
What therapy is needed for patients with H. pylori infection?
Antibiotics and a PPI.
466
What is the recommended duration for antibiotic therapy in H. pylori eradication?
14 days.
467
What should be done if a patient has a penicillin allergy during H. pylori treatment?
Use metronidazole instead of amoxicillin.
468
What is Talicia and what does it contain?
A rifabutin-based treatment for resistant H. pylori infection containing omeprazole, amoxicillin, and rifabutin.
469
How do PPIs compare to H2 receptor blockers in ulcer treatment?
PPIs are more effective in reducing gastric acid secretion and promoting ulcer healing.
470
What is the role of sucralfate in ulcer treatment?
Provides mucosal protection for the esophagus, stomach, and duodenum.
471
What is a key consideration when administering sucralfate?
Give it at least 60 minutes before or after an antacid.
472
Which drugs can sucralfate bind to, reducing their bioavailability?
* Cimetidine * Digoxin * Warfarin * Phenytoin * Tetracycline
473
What is the action of antacids in ulcer therapy?
Increase gastric pH by neutralizing HCl acid.
474
What is misoprostol used for?
To prevent gastric ulcers caused by NSAIDs and LDA.
475
What are the side effects of misoprostol?
* Diarrhea * Abdominal pain
476
Why must misoprostol be used with caution in women of childbearing age?
It is teratogenic.
477
What role do tricyclic antidepressants play in ulcer treatment?
They may contribute to overall pain relief.

Lewis’s Medical Surgical Nursing (10 decks)

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