Chapter39 (1)-1

Chapter 39: Management of Patients with Oral and Esophageal Disorders

Role of the Mouth in General Health

• Digestion begins in the mouth.

• Changes in the oral cavity can influence:

  • The type and amount of food ingested.

  • The degree of mixing of food with salivary enzymes.

• Mouth diseases interfere with communication.

• Esophageal problems:

  • Affect food and fluid intake.

  • Jeopardize general health.

Periodontal Disease

• Periodontal disease: Leading cause of tooth loss in adults.

  • Gingivitis: Inflammation of the gums.

  • Periodontitis: Involves soft tissue and bone supporting the teeth.

• At-risk individuals include older adults, smokers, low income, and less educated.

• Linked to systemic diseases such as cardiovascular (CV), diabetes mellitus (DM), and rheumatoid arthritis.

Dental Plaque and Caries

• Dental plaque leads to dental decay (caries).

• Treatment for caries includes:

  • Fillings, dental implants, or extraction.

• Prevention methods include:

  • Use of fluoride varnish/gel and fluoride toothpaste.

  • Routine dental care and application of dental sealants.

  • Community water fluoridation.

  • Healthy dietary choices: less sugar and starch, healthy snacks, and brushing after meals.

  • Managing systemic diseases.

Periapical Abscess

• Abscessed tooth: Presence of pus in the apical dental periosteum and surrounding tissue.

• Clinical manifestations: Pain, cellulitis, facial edema, fever, malaise.

• Medical and nursing management:

  • Needle aspiration and drill opening for drainage.

  • Extraction, assess for bleeding, and provide saline rinses.

  • Antibiotic and analgesic as needed.

Disorders of the Jaw

• Temporomandibular disorders (TMD) include:

  • Myofascial pain, internal derangement of the joint, and degenerative joint disease.

• Other conditions:

  • Jaw fractures and mandibular structural abnormalities.

Disorders of the Salivary Glands

• Parotitis: Inflammation of the parotid gland.

• Sialadenitis: Inflammation of the salivary glands.

• Sialolithiasis: Formation of salivary stones.

• Possible neoplasms.

Oral Cancer

• Risk factors include:

  • Tobacco use, alcohol consumption, HPV infection, and history of head and neck cancer.

• Higher incidence in men than women.

• Common locations: Lips, lateral tongue, floor of the mouth.

Manifestations of Oral Cancer

• Early stage:

  • Few or no symptoms; painless sore/mass that does not heal.

  • Indurated ulcer with raised edges; may bleed easily.

• Later manifestations:

  • Complaints of tenderness.

  • Difficulty chewing, swallowing, or speaking.

  • Coughing blood-tinged sputum, enlarged cervical lymph nodes.

Assessment and Medical Management of Oral Cancer

• Assessment:

  • Health history related to oral problems, oral hygiene, tobacco and alcohol use, and nutrition.

  • Inspection and palpation of mouth and neck.

• Medical management:

  • Surgical resection, radiation therapy, chemotherapy.

Nursing Management of Patients with Oral Disorders #1

• Promoting mouth care:

  • Preventive oral care and dental appointments before surgery/radiation.

  • Encourage gentle brushing/flossing or mouthwashes if brushing is intolerable.

  • Educate patients on oral hygiene and encourage fluid intake to reduce dry mouth.

  • Consider synthetic saliva or saliva production stimulants.

Nursing Management of Patients with Oral Disorders #2

• Ensure adequate food and fluid intake:

  • Assess nutritional requirements and dietary preferences while accounting for social/cultural factors.

  • Dietary consultation if needed.

• Support a positive self-image:

  • Encourage verbalization and active listening.

  • Referral to support groups or professionals for continued support.

Nursing Management of Patients with Oral Disorders #3

• Minimize pain:

  • Avoid hot, spicy, or hard foods.

  • Use oral care methods and pain medications.

• Prevent infection:

  • Monitor for symptoms and appropriate wound care.

• Patient education: Inform patients about their condition and care strategies.

Question #1: What is xerostomia?

• Choices: Protrusion of an organ in the mouth, difficulty swallowing, heartburn, dry mouth.

Answer to Question #1

• D. Dry mouth: Common sequela of oral cancer. Also seen in patients taking multiple medications or having specific health conditions.

Radical Neck Dissection Surgery

• Involves removal of all cervical lymph nodes and other critical structures.

• Modified radical neck dissection is more common.

Nursing Management of the Patient Undergoing a Neck Dissection

• Preoperative assessment: Knowledge and preparation for surgery.

• Postoperative assessment: Risks such as altered respiratory status, wound infection, and bleeding.

• Goals: Knowledge of surgical procedures, maintenance of respiratory status, effective coping strategies, and absence of complications.

Nursing Interventions for Neck Dissection #1

• Maintain airway clearance; encourage cough/deep breathing.

• Pain assessment and management.

Nursing Interventions for Neck Dissection #2

• Monitor wound care, drainage, and assess graft and incision.

Nursing Interventions for Neck Dissection #3

• Ensure adequate nutrition; consider dietary modifications based on patient’s needs and preferences.

Nursing Interventions for Neck Dissection #4

• Provide extensive education about surgery, postoperative self-care, and signs to report.

Question #4: True/False about feeding positions after neck dissection

• Correct Answer: False. Postoperative patients should be in the Fowler position.

Delivering Nutrition Enterally

• Ensure nutritional requirements are met when oral intake is inadequate.

• Advantages include safety, cost-effectiveness, and maintaining GI integrity.

Administering Tube Feedings

• Important steps include tube insertion, placement confirmation, monitoring, and managing complications.

Maintaining Feeding Equipment

• Administer feedings correctly; prevent contamination by time management of feedings.

Purposes of Gastrointestinal Intubation

• Indicated for a variety of issues including decompression and administering medications.

Types of Tubes

• Includes lavage tubes (Levin, gastric sump) and enteric tubes.

Nursing Management of the Patient Receiving Enteral Nutrition

• Maintain hydration and nutrition; monitor conditions and educate the patient.

Assessment of Patients with Gastrostomy/Jejunostomy

• Evaluate self-care abilities, skin condition, and nutrition status.

Collaborative Problems after Gastrostomy/Jejunostomy

• Risks include infection, bleeding, leakage, and tube obstruction.

Planning Goals for Gastrostomy/Jejunostomy Patients

• Goals include optimal nutrition, infection prevention, and maintaining skin integrity.

Disorders of the Esophagus

• Includes motility disorders, hiatal hernias, GERD, and cancer.

Symptoms of Esophageal Disease

• Dysphagia (difficulty swallowing) is the most common symptom.

Management of GERD

• Includes dietary changes and medication management.

Cancer of the Esophagus

• Types: Adenocarcinoma and squamous cell carcinoma.

• Risk factors include tobacco and alcohol use, characterized by dysphagia.

Assessment of Non-cancerous Disorders of the Esophagus

• Evaluate health history and pain levels.

Planning Goals for Non-cancerous Esophagus Disorders

• Goals include adequate nutrition, pain relief, and knowledge enhancement.

Nursing Interventions for Non-cancerous Esophagus Disorders

• Ensure nutritional intake, decrease aspiration risks, and relieve pain.