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.