Test #3 Chapter 56 Care of Patients with Oral Cavity Problems Flashcards Preview

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Flashcards in Test #3 Chapter 56 Care of Patients with Oral Cavity Problems Deck (36):
1

Stomatitis-

Inflammation or Erosion of protective lining of the mouth/oral cavity.

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What are the 2 classifications of Stomatitis?

Primary and secondary

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Primary Stomatitis (most common)-

Aphtlous, Herpes Simplex (HSV-1), Trauma, canker sores.

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**** Secondary Stomatitis-

Thrush, Related to bacteria, fungi, yeast. Usually is something that has to be treated with medication such as antibiotics. HIV patients or patients with decreased immune function are prone to get thrush

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*** Nursing Interventions for Secondary Stomatitis (Thrush)

Nutrition: Teach patients to avoid the following foods- Alcohol, Tobacco, Coffee, Fruits and Nuts, Spicy, Foods, Acidic Foods,

Medications: Anti-Fungals such as nystatin (Mycostatin)-swish and swallow, 4x daily for 7-10 days. They usually need to swallow so that it can get on the fungus in the throat as well.

Mouthcare: Soft-bristled toothbrush, Rinse every 2-3 hrs with Na Bicarbonate solution or Warm Saline solution, do not use mouthwash with alcohol.

6

Which of the following interventions is most appropriate for a client who has stomatitis?

a) Drinking hot tea at frequent intervals.

b) Gargling with antiseptic mouthwash

c) Using an electric toothbrush

d) Eating a soft, bland diet

d) Eating a soft, bland diet

7

A client who has a history of mitral valve prolapse tells the nurse that she is scheduled to get her teeth cleaned. Which of the following replies by the nurse is most appropriate?

a) “The physician will need to re-evaluate the status of your heart condition before your dental appointment.”

b) “Be sure to remind your dentist that you have a heart condition.”

c) “It is important for you to care for your teeth because your heart condition makes you more susceptible to developing oral infections.”

d) “We will prescribe a prophylactic antibiotic for you to take before getting your teeth cleaned.”

d) “We will prescribe a prophylactic antibiotic for you to take before getting your teeth cleaned.”

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Pre-Malignant Lesions

What are the 2 types of Oral Tumors (Pre-Malignant Lesions) That we went over?



1. Leukoplakia-
2. Erythroplakia-


Oral Tumors affects swallowing, chewing and speaking. We have a lot of airways issues in this group;.

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Leukoplakia-

the location will determine whether it is pre cancerous or not. They can be related to poor mouth care, poor fitting dentures that rub, bacteria can invade, but the main cause of these are due to chewing tobacco as well as cigs.

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Leukoplakia S&S:

thick white patches,

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Erythroplakia-

This type generally turns to cancer more than not.

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Erythroplakia S&S:

red velvety mucosal lesion

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*** Prevention of Pre-Malignant Lesions-

We need to educate patients on how to prevent these cancers because once they have it, it takes them down a whole new road of interventions.

1. Teach them to avoid too much Sun or Tanning Bed Exposure.

2. Tobacco- chewing and cigs.

3. Alcohol- in excess.

14

What are the two types of cancerous lesions of the mouth that we went over?

1. Squamous Cell Carcinoma of the mouth

2. Basal Cell Carcinoma of the mouth

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Squamous Cell Carcinoma of the mouth

1. 90% of oral cancers are squamous cell carcinoma

******2. Etiology: Increase age, tobacco, alcohol. This one metastasizes.

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Basal Cell Carcinoma of the mouth

1. Primary on lips or under the tongue, a raised scab

******2. Etiology: Excessive sunlight exposure, tobacco, usually does not metastasize

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Treatments of Squamous Cell Carcinoma and Basal Cell Carcinoma of the mouth-


Non-Surgical-

Radiation/Chemotherapy or Multimodal therapy.

Mouth Care: Rinse mouth with sodium bicarbonate solution or warm saline.

Do not use mouthwash with alcohol and no lemon-glycerine swabs

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Treatments of Squamous Cell Carcinoma and Basal Cell Carcinoma of the mouth-

** Surgical Management-

Types of surgeries:

These are pretty dramatic. Glossectomy-tongue removal or Hemiglossectomy- partial- they use skin from your wrist or from somewhere else to replace what they removed.

Mandibulectomy-jaw removal or mandibular resection.

Neck Dissection- where they remove lymph nodes ect.

**Airway is a big issue.



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Treatments of Squamous Cell Carcinoma and Basal Cell Carcinoma of the mouth-

** Surgical Management-

Pre-op:

Post-op:

Pre-op: accepting diagnosis- social and emotional aspects to deal with.

Post-op (ICU): Depends on the Size, location, invasion into bone and presence or absence of metastasis influence the extent of surgery. They will be intubated and Trached, with NG Tubes.

**Airway is a big issue.

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Treatments of Squamous Cell Carcinoma and Basal Cell Carcinoma of the mouth-

** Surgical Management-

What would you do to promote airway management?

Airway Management--
HOB elevated, especially if patient complains of swelling,

have suction ready. Make sure suction device is ready and hose it attached with a yanker at the bedside.

Patient may have trach after surgery, NPO, Respiratory, NG tube, dysarthria.

More than likely they will get TPN.

Promote early ambulation.

Turn Cough Deep Breathe and IS.

Increase fluids.

Help them communicate with a board.

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Treatments of Squamous Cell Carcinoma and Basal Cell Carcinoma of the mouth-

** Surgical Management-

What is the discharge teaching for the patient and family?

Leaving Hospital after surgery- Need to teach them 2 things.

1- mouthcare and

2 Monitor for metastasis of cancer.

Teach them where it would travel next such as the neck and lymph-nodes.

Cancerous lumps feel hard. Avoid Xerostomia because risk for cavities.

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The nurse is teaching a group of teenage boys who are on a college baseball team about the risks of chewing tobacco. Which of the following should the nurse instruct the teenagers to report to their parents and physicians? Select all that apply.


a) Dysphagia
b) Sensitive teeth
c) Unexplained mouth pain
d) Lump in the neck
e) Decreased saliva
f) White patch on the mucosa

a) Dysphagia

c) Unexplained mouth pain
d) Lump in the neck

f) White patch on the mucosa

23

A nurse is caring for a client who has just returned from surgery to treat a fractured mandible. Which of the following items should always be available at this client’s bedside? Select all that apply.

a) Nasogastric tube
b) Wire cutters
c) Oxygen cannula
d) Suction equipment
e) Code cart

b) Wire cutters
d) Suction equipment

24

The nurse is preparing a community presentation on oral cancer. Which of the following is a primary risk factor for oral cancer that the nurse should include in the presentation?

a) Use of alcohol
b) Frequent use of mouthwash
c) Lack of vitamin B12
d) Lack of regular teeth cleaning by a dentist

a) Use of alcohol

(or tobacco)

25

A client has entered a smoking cessation program to quit a two-pack-a-day cigarette habit. He tells the nurse that he has not smoked a cigarette for 3 weeks but is afraid he is going to slip up and smoke because of current job pressures. What would be the most appropriate reply for the nurse to make in response to the client’s comments?

a) “Don’t worry about it. Everybody has difficulty quitting smoking and you should expect to as well.”

b) “If you increase your self-control, I am sure you will be able to avoid smoking.”

c) “Try taking a couple of days of vacation to relieve the stress of your job.”

d) “It is good that you can talk about your concerns. Try calling a friend when you want to smoke.”

d) “It is good that you can talk about your concerns. Try calling a friend when you want to smoke.”

26

A client who was in a motor vehicle accident has a fractured mandible. Surgery has been performed to immobilize the injury by wiring the jaw. In the immediate post-operative phase the nurse should:

a) Prevent nausea and vomiting
b) Maintain a patent airway
c) Provide frequent oral hygiene
d) Establish a way for the client to communicate

b) Maintain a patent airway

27

A client who has had her jaws wired begins to vomit. What should be the nurse’s first action?

a) Insert a NG tube and connect it to suction

b) Use wire cutter to cut the wire

c) Suction the client’s airway as needed

d) Administer an antiemetic intravenously

c) Suction the client’s airway as needed


Suction first, then use wire cutters if needed.

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Acute Sialadenitis

Inflammation of a salivary gland caused by infectious agents, irradiation or immunologic disorders.

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What is the etiology of Acute Sialadenitis?

Etiology: could be related to infection, exposure to radiation, rheumatiod arthritis, lupus. can be Bacteria or Viral.

The bacteria or virus can enter through the opening in the mouth, that is how it migrates through.

Could also be related to a decrease in saliva if a person is severely dehydrated or has been NPO a long time (Xerostomia).

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***Salivary Gland Tumors-

It is slow growing, painless and rare. It involves the facial nerves depending on how large the tumor has grown, and it will be on that side of the face. They can have facial paralysis or weakness on that side and also have issues with their tongue.

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Who is at risk for Salivary Gland Tumors-

At risk those who have head radiation to head and neck areas

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****What do you need to assess when a patient has Salivary Gland Tumors-

Assessment of facial nerve, monitor for asymmetry-

Need to ask them to smile or frown. Raise your eyebrows, puff your cheeks out. This is how you assess the patients Trigeminal Nerve #5.

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What is the treatment for Salivary Gland Tumors-

Treatment: Same for benign and malignant tumors- Radiation and Surgical Excision

Parotidectomy (removal of parotid gland)- This depends upon which of the glands that it is.

Submandibular Gland Surgery

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*** What is the post-op care for Salivary Gland Tumors-

Post-op- They have gone to surgery and had a gland removed.

During the surgery, they have probably damaged their Trigeminal Nerve #5 (sensation, biting, chewing, those types of things).

So you will notice weakness, or complete loss of that cranial nerve on that side.

Cranial Nerve #7 Facial - controls muscle and facial expression. If a nerve was effected, they will be forever.

Facial weakness on operative side r/t facial nerve irritated during surgery

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**** What is cranial nerve number 5

Trigeminal Nerve #5 (sensation, biting, chewing, those types of things).

36

**** What is cranial nerve number 7

Cranial Nerve #7 Facial - controls muscle and facial expression.