1. Gastrointestinal System: Part II – Oral Cavity Problems
Chapter 53
Mrs. April Page MSN ARNP FNPC
Gulf Coast State College
NUR1213c Intermediate Adult Care

2. Lesson Objectives
Describe the nursing management of patients with abnormalities of the oral cavity, jaw, and salivary glands.
Describe the relationship of dental hygiene and dental problems to nutrition and to disease.

3. Lesson Objectives
Describe the nursing management of patients with various conditions of the esophagus, including cancer of the oral cavity and the esophagus.
Illustrate the nursing process in providing care of patients undergoing neck dissection and various conditions of the esophagus.

4. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of Gastroesophageal Reflux Disease (GERD), Hiatal Hernia and esophageal problems.
Identify risk factors and prevention methods associated with GERD, Hiatal Hernia, and Esophageal problems.

5. Lesson Objectives
Evaluate expected outcomes for an individual with GERD, Hiatal Hernia, oral and Esophageal Tumors.

6. INTRODUCTION Oral cavity and esophagus are part of the upper GI tract
Structures are vulnerable
Injury, infection, trauma, and cancer
Many cancers are preventable by eliminating risk factors
<<Instructor: Review each bulleted item while referring to the following notes.>>
According to Healthy People 2020, many cancers are preventable by eliminating risk factors such as tobacco products, physical inactivity, obesity, and exposure to ultraviolet light.
Diseases of the oral cavity and esophagus are particularly vulnerable to lifestyle choices.

7. ORAL AND ESOPHAGEAL DISEASES
Stomatitis
Epidemiology
Inflammatory condition affecting the oral mucosa, dentition, and periosteum
Occurs in 40% of patients receiving chemotherapy
Pathophysiology and clinical manifestations
Also known as oral mucositis
Painful inflammation/ulceration of the lining of the mouth
<<Instructor: Review each bulleted item while referring to the following notes.>>

8. ORAL AND ESOPHAGEAL DISEASES (cont’d)
Stomatitis (cont’d)
Primary stomatitis
Secondary stomatitis
Management
Frequent assessment of the oral cavity before, during, and after chemotherapy and radiation therapy
Complications
May demonstrate dysphagia or odynophagia
Xerostomia
<<Instructor: Review each bulleted item while referring to the following notes.>>

9. ORAL CANCER Epidemiology 3% of all cancers are oral cancers
30,000 new cases and 4,800 deaths per year
Men are affected 2-4 x’s more than women
Squamous cell carcinomas tend to grow rapidly and metastasize
Basal cell carcinomas tend to grow slowly and become invasive over time
<<Instructor: Review each bulleted item while referring to the following notes.>>

10. ORAL CANCER (cont’d) Pathophysiology Clinical manifestations
Premalignant lesions
Leukoplakia
Erythroplakia
Clinical manifestations
Early symptoms affect the floor of the mouth or tongue
Asymptomatic in the early stages
<<Instructor: Review each bulleted item while referring to the following notes.>>

11. ORAL CANCER (cont’d) Management Complications Surgical management
Radiation therapy
Medications
Complications
Infiltration to muscles and underlying tissue, resulting in difficulty eating or talking
Surgical management
Treatment of small noninvasive lesions under local or general anesthesia
<<Instructor: Review each bulleted item while referring to the following notes.>>

12. ORAL TRAUMA Epidemiology Pathophysiology
Injury to specific bones of the face, including nasal, mandibular, and maxillary fractures
Soft tissue injuries in and around the mouth
Pathophysiology
Related to location and severity of injury
Direct damage to the oral cavity that can lead to partial or complete airway occlusion
Le Fort I, II, III
<<Instructor: Review each bulleted item while referring to the following notes.>>

13. ORAL TRAUMA (cont’d) Clinical manifestations Management
Increased respiratory rate, stridor, shortness of breath, decreased oxygen saturation, hypercarbia, elevated heart rate, and changes in level of consciousness
Oral bleeding, swelling, edema, loss of teeth, and pain
Management
Directed at establishing and maintaining the airway and controlling bleeding
Increased risk for infection, therefore, broad-spectrum antibiotics are ordered
<<Instructor: Review each bulleted item while referring to the following notes.>>

14. Gastrointestinal System: Part III – Esophageal Problems
Chapter 54
Mrs. April Page MSN ARNP FNPC
Gulf Coast State College
NUR1213c Intermediate Adult Care

15. ORAL AND ESOPHAGEAL DISEASES
Gastroesophageal reflux disease
Caused by acid reflux from stomach into esophagus
Epidemiology
Highly prevalent disorder in Western countries
10% to 20% affected
H pylori has been found to decrease gastric acid secretion
<<Instructor: Review each bulleted item while referring to the following notes.>>

16. ORAL AND ESOPHAGEAL DISEASES (cont’d)
Gastroesophageal reflux disease (cont’d)
Pathophysiology and clinical manifestations
Results when there is retrograde flow of GI contents into esophagus
Resulting in inflammation
Management
pH monitoring and recording
Esophageal manometry or motility testing
Medications
<<Instructor: Review each bulleted item while referring to the following notes.>>

17. ORAL AND ESOPHAGEAL DISEASES (cont’d)
Gastroesophageal reflux disease (cont’d)
Endoscopic treatments
Stretta procedure involves the use of radiofrequency energy through an endoscope by using needles positioned near the GEJ
Surgical management
Small number of patients with GERD require surgery
<<Instructor: Review each bulleted item while referring to the following notes.>>

18. ORAL AND ESOPHAGEAL DISEASES (cont’d)
Hiatal hernia
Epidemiology
Increases with age as supportive structures weaken over time
60% of those affected are 50 or older
Pathophysiology and clinical manifestations
Portion of the stomach protrudes upward through the LES and into the esophagus
Type 1 and type 2
<<Instructor: Review each bulleted item while referring to the following notes.>>

19. ORAL AND ESOPHAGEAL DISEASES (cont’d)
Hiatal hernia (cont’d)
Management
Upper abdominal x-ray
Endoscopy
Barium swallow with fluoroscopy
Esophagogastroduodenoscopy or EGD
Medications for symptoms of heartburn and acid reflux
Surgery
<<Instructor: Review each bulleted item while referring to the following notes.>>

20. ORAL AND ESOPHAGEAL DISEASES (cont’d)
Hiatal hernia
Epidemiology
Increases with age as supportive structures weaken over time
60% of those affected are 50 or older
Pathophysiology and clinical manifestations
Portion of the stomach protrudes upward through the LES and into the esophagus
Type 1 and type 2
<<Instructor: Review each bulleted item while referring to the following notes.>>

21. ORAL AND ESOPHAGEAL DISEASES (cont’d)
Hiatal hernia (cont’d)
Management
Upper abdominal x-ray
Endoscopy
Barium swallow with fluoroscopy
Esophagogastroduodenoscopy or EGD
Medications for symptoms of heartburn and acid reflux
Surgery
<<Instructor: Review each bulleted item while referring to the following notes.>>

22. ESOPHAGEAL CANCER 2 types of esophageal cancers
Squamous cell carcinomas and adenocarcinomas
Less than 1% include small cell neuroendocrine cancers, lymphomas, and sarcomas
Epidemiology
Estimated death rate from esophageal cancer for 2013 was 15,210
12,220 males and 2,990 females
<<Instructor: Review each bulleted item while referring to the following notes.>>

23. ESOPHAGEAL CANCER (cont’d)
Pathophysiology
Upper 2/3 of esophagus are squamous cell carcinomas
Lower 1/3 of esophagus are esophageal adenocarcinoma
Clinical manifestations
Progressive dysphagia is the most common symptom
Management and diagnostic tests
Barium swallow, CT, PET, endoscopic ultrasonography, thoracoscopy and laparoscopy
<<Instructor: Review each bulleted item while referring to the following notes.>>

24. ESOPHAGEAL CANCER (cont’d)
Complimentary and alternative medicine
Yoga, meditation, spirituality, and religion are used to relieve pain
Complications
Risks related to treatment in addition to risks associated with advanced disease
Surgical management
Palliative surgical interventions to restore patients’ ability to swallow and to maintain optimal nutrition
<<Instructor: Review each bulleted item while referring to the following notes.>>

25. ESOPHAGEAL TRAUMA Pathophysiology Epidemiology
Most common causes from diagnostic and therapeutic interventions
Diagnostic endoscopy complication rate is 0.1%
Therapeutic endoscopic procedures have a complication rate of 10% to 15%
Pathophysiology
Related to the cause of trauma
<<Instructor: Review each bulleted item while referring to the following notes.>>

26. ESOPHAGEAL TRAUMA (cont’d)
Management
Control of bleeding, wound management and drainage, prevention of infection, and providing nutrition
Diagnostic tests
Chest x-ray, chest CT, contrast esophagography
Surgical management
Control bleeding, remove damaged tissue, repair wounds, resect part of the esophagus
Replace the esophagus with a bowel segment
<<Instructor: Review each bulleted item while referring to the following notes.>>