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