Final Exam: NUR2392/ NUR 2392 (New 2023/ 2024) Multidimensional Care II/ MDC 2 Exam Review| Complete Guide with Questions and Verified Answers| 100% Correct- Rasmussen
Final Exam: NUR2392/ NUR 2392 (New
2023/ 2024) Multidimensional Care II/ MDC
2 Exam Review| Complete Guide with
Questions and Verified Answers| 100%
Correct- Rasmussen
QUESTION
Chemotherapy
Answer:
Kill cancer cells that divide rapidly
QUESTION
What should the activity level of a patient receiving chemo be?
Answer:
Based on current health status-build on skills and strength training
QUESTION
Radiation
Answer:
§ largely are limited to the areas exposed to radiation
§ Changes to the skin, radiation dermatitis are the most common side effects; ranges from
redness and rash to skin desquamation
Altered taste, fatigue, & bone marrow suppression (also loss of appetite
QUESTION
Radiation: what kind of diet would someone need who is not eating very much?
Answer:
Small frequent meals high in fiber, protein, calories
QUESTION
Stomatitis
Answer:
Help the patient select soft, bland, nonacidic foods
QUESTION
Oral cancer: Prevention strategies
Answer:
Prevention strategies include minimizing sun and tanning-bed exposure, tobacco cessation, and ↓
ETOH intake
QUESTION
Hiatal hernia
Answer:
–Sliding (most common) and rolling (reflux generally not present but at risk for volvulus,
obstruction, & strangulation high).
–Straining and vigorous activity can cause hernias. Movement and diet. Obesity, aging,
smoking.
–Reflux worsen after a meal or when the pt is supine. In rolling, the patient will feel
full/breathless after eating, like they’re suffocating. Chest pain.
QUESTION
GERD – patient teaching
Answer:
Teach patient to limit or eliminate foods that decrease LES pressure & irritate inflamed tissue
(ie: peppermint, chocolate, ETOH, fatty foods, caffeine, & carbonated beverages)
Restrict spicy & acidic foods (ie: OJ, tomatoes)
QUESTION
PUD: What would you tell your patient to avoid taking for pain?
Answer:
Make sure to tell your patients not to take NSAIDS for pain relief- use Tylenol instead
QUESTION
EGD
Answer:
major diagnostic test for PUD
QUESTION
Duodenal ulcers – S/S
Answer:
Duodenal ulcer pain is usually located to the right of or below the epigastrium. The pain
associated with a duodenal ulcer occurs 90 minutes to 3 hours after eating and often awakens the
patient at night. Pain may also be exacerbated (made worse) by certain foods (e.g., tomatoes, hot
spices, fried foods, onions, alcohol, caffeine drinks) and certain drugs (e.g., NSAIDs,
corticosteroids). Perform a comprehensive pain assessment.
QUESTION
Gastritis: Pathophysiology
Answer:
o Prostaglandins provide a protective mucosal barrier that prevents the stomach from digesting
itself (acid autodigestion); break in protective barrier = mucosal injury occurs
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How to maintain a Healthy Oral Cavity
caused by
– cancer
– HIV
– viruses
– bacteria
– chemo
– long term antibiotic use
– yeast
Long-term antibiotic therapy destroys other normal flora and allows the Candida to overgrow. The result can be candidiasis, also called moniliasis, a fungal infection that is very painful.
Candidiasis is also common in those undergoing immunosuppressive therapy, such as chemotherapy, radiation, and steroids.
recurrent aphthous ulcers (RAUs)
Stomatitis: Assessment History
Stomatitis: Planning and Implementation: Generate Solutions & Take Action
Wear gloves, use a penlight to ensure adequate lighting, and use a tongue blade to aid examining the oral cavity. Assess the mouth for lesions, coating, and cracking. Document characteristics of the lesions, including their location, size, shape, odor, color, and drainage.
If lesions are seen along the pharynx and the patient reports dysphagia (difficulty on swallowing) or throat pain, the lesions might extend down the esophagus
Because you are accountable for the delegated task, remind the UAP to
Use a soft-bristled toothbrush or disposable foam swabs to stimulate gums and clean the oral cavity.
Use toothpaste that is free of sodium lauryl sulfate (SLS), if possible, because this ingredient has been associated with stomatitis.
Follow up by inspecting the patient’s oral cavity after the UAP completes the task.
Teach the patient to rinse the mouth every 2 to 3 hours with a sodium bicarbonate solution or warm saline solution (may be mixed with hydrogen peroxide).
He or she should avoid most commercial mouthwashes because they have high alcohol content, causing a burning sensation in irritated or ulcerated areas
Care of the Patient With Problems of the Oral Cavity
•Remove dentures if the patient has severe stomatitis or oral pain.
•Encourage the patient to perform oral hygiene or provide it after each meal and as often as needed.
• Increase mouth care to every 2 hours or more frequently if stomatitis is not controlled.
• Use a soft toothbrush or gauze for oral care.
• Encourage frequent rinsing of the mouth with warm saline, sodium bicarbonate (baking soda) solution, or a combination of these solutions.
•Teach the patient to avoid commercial mouthwashes, particularly those with high alcohol content, and lemon-glycerin swabs.
•Help the patient select soft, bland, and nonacidic foods.
•Apply topical analgesics or anesthetics as prescribed by the health care provider and monitor their effectiveness.
antimicrobials, immune modulators, and symptomatic topical agents
A regimen of IV acyclovir (Zovirax, Xerese ) is prescribed for immunocompromised patients who contract herpes simplex stomatitis.
For fungal infections such as yeast, nystatin (Mycostatin, Nadostine , PMS-Nystatin ) oral suspension swish/swallow is most commonly prescribed.
Ice-pop troches (lozenges) of the antifungal preparation allow the drug to slowly dissolve, and the cold provides an analgesic effect.
Oral Tumors: Premalignant Lesions
thickened, white, leathery-looking spots on the inside of the mouth that can develop into oral cancer
Leukoplakia is the most common oral lesion among adults
Most of these lesions are benign. However, a small percentage of them become cancerous. Although leukoplakia can be found anywhere on the oral mucosa, lesions on the lips or tongue are more likely to progress to cancer.
Leukoplakia results from mechanical factors that cause long-term oral mucous membrane irritation, such as poorly fitting dentures, chronic cheek nibbling, or broken or poorly repaired teeth.
Leukoplakia not associated with HIV infection is more often seen in people older than 40 years.
Lateral border, white, corrugated lesions, associated with HIV, Epstein Barr virus.
A clinical term used to describe an oral mucosal lesion that appears as a smooth red patch or granular red and velvety patch.
any red patch of tissue in the oral cavity that cannot be associated with inflammation
There are more malignant changes in erythroplakia than in leukoplakia; therefore erythroplakia is often considered “precancerous” in presentation. As such, these lesions should be regarded with suspicion and analyzed by biopsy.
Erythroplakia is most commonly found on the floor of the mouth, tongue, palate, and mandibular mucosa. I
Prevention strategies for oral cancer include
minimizing sun and tanning-bed exposure, tobacco cessation, and decreasing alcohol intake
More than 90% of oral cancers are
An increased rate of squamous cell cancer is found in people with occupations such as
Basal cell carcinoma of the mouth occurs primarily on the
If the patient has extensive tumor involvement and copious, tenacious (thick and “stringy”) secretions, maintaining an open airway is your priority for care to promote
Implement interventions to manage the patient’s airway by increasing air exchange, removing secretions, and preventing aspiration as needed.
Assess for dyspnea resulting from the tumor obstruction or from excessive secretions.
Assess the quality, rate, and depth of respirations. Auscultate the lungs for adventitious sounds, such as wheezes caused by aspiration.
Listen for stridor caused by partial airway obstruction. Promote deep breathing to help produce an effective cough to mobilize the patient’s secretions.
Modifications might be needed because of oral discomfort, bleeding, or edema.
Oral care with a soft-bristled toothbrush is preferred.
If the platelet count falls below 40,000/mm3 , switch the patient to an ultrasoft “chemobrush.” The use of “Toothettes” or a disposable foam brush is discouraged because these products may not adequately control bacteremia-promoting plaque and may further dry the oral mucosa.
Lubricant can be applied to moisten the lips and oral mucosa as needed.
•Salivary gland inflammation that is usually bacterial in origin and presents with pain, swelling, erythema, fever, and trismus; parotid gland most common site
•Untreated infections of the salivary glands can evolve into abscesses, which can rupture and spread infection into the tissues of the neck and the mediastinum
•Often occurs with ionizing radiation to head or neck
•Treatment includes hydration, moist heat, massage, NSAIDs, antibiotics
• Placement of a temporary tracheostomy, oxygen therapy, and suctioning
• Temporary loss of speech because of the tracheostomy
• Frequent monitoring of postoperative vital signs
• NPO status until intraoral suture lines are healed
• Need to have IV lines in place for drug delivery and hydration
• Postoperative drug therapy and activity (out of bed on the day or surgery or first postoperative day)
• Possibility of surgical drains
Three factors influence the extent of surgery performed for oral cancers:
Complications from radiation to the head or neck can be acute or delayed.
Acute effects include treatment-related mucositis, stomatitis, and alterations in taste. Long-term effects such as xerostomia (excessive mouth dryness) and dental decay require ongoing oral care, the use of saliva substitutes, and follow-up dental visits
Care of the Patient With Oral Cancer at Home
• Follow the treatment plan for cancer therapies.
• Remember that taste sensation may be decreased; add nonspicy seasonings to food to better enjoy it.
• Use a thickening agent for liquids if dysphagia is present. • Eat soft foods if stomatitis occurs.
• Inspect the mouth every day for changes, such as redness or lesions.
• Continue meticulous oral hygiene at home using a chemobrush and frequent rinsing; clean brush after every use.
• Use saliva substitute as prescribed. • Avoid sun or tanning-bed exposure if radiation is part of therapy.
• Clean with a gentle, nondeodorant soap, such as Ivory.
Collection of pus underneath the skin
The surgical opening is usually small enough to be closed by sutures. These smaller lesions may also be responsive to carbon dioxide laser therapy or cryotherapy (extreme cold application), as well as photodynamic therapy.
These procedures can be performed as an ambulatory care procedure in a surgical center but may require general anesthesia.
acute or persistent sialadenitis.
With acute sialadenitis, be sure to
The salivary glands are sensitive to ionizing radiation, such as from radiation therapy or radioactive iodine treatment of thyroid cancers.
Exposure of the glands to radiation produces a type of sialadenitis known as xerostomia (very dry mouth caused by a severe reduction in the flow of saliva) within 24 hour
Xerostomia may be temporary or permanent, depending on the dose of radiation and the percentage of total salivary gland tissue irradiated. Little can be done to relieve the patient’s dry mouth during the course of radiation therapy. Frequent sips of water and frequent mouth care, especially before meals, are the most effective interventions
rare, generally benign, and occur in parotid gland
Facial nerve repair with grafting can be done at the time of surgery
gastroesophageal reflux disease (GERD)
backflow of contents of the stomach into the esophagus, often resulting from abnormal function of the lower esophageal sphincter, causing burning pain in the esophagus
•Most common upper GI disorder in the U.S.
•Occurs as a result of backward flow of stomach contents into esophagus
•Hiatal hernias increase risk for GERD
•During healing, Barrett’s epithelium and esophageal stricture are concerns
GERD: Etiology and Genetic Risk
GERD: Assessment: Recognize Cues
GERD health promotion and maintenance
Factors Contributing to Decreased Lower Esophageal Sphincter Pressure
• Caffeinated beverages, such as coffee, tea, and cola • Chocolate
• Citrus fruits
• Nitrates
• Peppermint, spearmint
• Alcohol
• Tomatoes and tomato products
• Smoking and use of other tobacco products
• Calcium channel blockers
• Anticholinergic drugs
• High levels of estrogen and progesterone
• Nasogastric tube placement
Symptoms associated with “indigestion” may include abdominal discomfort, feeling uncomfortably full, nausea, and burping.
Because indigestion might not be viewed as a serious concern, patients may delay seeking treatment. The symptoms typically worsen when the patient bends over, strains, or lies down. If the indigestion is severe, the pain may radiate to the neck or jaw or may be referred to the back, mimicking cardiac pain.
Gastroesophageal Reflux Disease Symptoms
visual examination of the GI tract, from esophagus to duodenum
A pH monitoring examination is the most accurate method of diagnosing GERD. This involves either
Health Promotion and Lifestyle Changes to Control Reflux
• Eat four to six small meals a day.
• Limit or eliminate fatty foods, coffee, tea, cola, and chocolate.
• Reduce or eliminate from your diet any food or spice that increases gastric acid and causes pain.
• Limit or eliminate alcohol and tobacco and reduce exposure to secondhand smoke.
• Do not snack in the evening and do not eat for 2 to 3 hours before you go to bed.
• Eat slowly and chew your food thoroughly to reduce belching.
• Remain upright for 1 to 2 hours after meals, if possible. • Elevate the head of your bed 6 to 12 inches using wooden blocks or elevate your head using a foam wedge. Never sleep flat in bed.• If you are overweight, lose weight.
• Do not wear constrictive clothing.
• Avoid heavy lifting, straining, and working in a bent-over position.
• Chew “chewable” antacids thoroughly and follow with a glass of water.
H2 receptor blockers, proton pump inhibitors, antacids
Sliding Hiatal Hernias vs Rolling
Hiatal Hernias: Assessment: Recognize Cues
Hiatal Hernias: Interventions: Take Action
Laparoscopic Nissen fundoplication (LNF)
Surgical procedure to correct a hiatal hernia and considered the preferred operative procedure
Rolling hernias are usually clearly visible, and sliding hernias can often be observed when the patient moves through a series of positions that increase intra-abdominal pressure.
To visualize sliding hernias, an esophagogastroduodenoscopy (EGD) may be performed to view both the esophagus and gastric lining
• Persistent and progressive dysphagia (most common feature)
• Feeling of food sticking in the throat
• Odynophagia (painful swallowing)
• Severe, persistent chest or abdominal pain or discomfort
• Regurgitation
• Chronic cough with increasing secretions
• Hoarseness
• Anorexia
• Nausea and vomiting
• Weight loss (often more than 20 pounds)
• Changes in bowel habits (diarrhea, constipation, bleeding)
Esophageal Tumors: Interventions: Take Action
The most specific common problem for patients with esophageal cancer is
Potential for compromised nutrition due to impaired swallowing and possible metastasis
abnormal side pockets in the intestinal wall
Surgical management is aimed at removing the diverticula. After surgery, the patient is NPO status for several days to promote healing. During that period, he or she receives IV fluids for hydration and tube feedings; after that, he or she is given oral fluid and food. Provide pain relief measures and monitor for complications such as bleeding or perforation.
• Be aware that airway management is the priority of care for patients having surgery for oral cancer.
• Place patients having oral cancer surgery in a high-Fowler’s position to facilitate breathing and prevent aspiration.
• Assess for swallowing ability to prevent aspiration by checking the gag reflex before offering liquids or food to the patient who has had oral cancer surgery.
Instruct patients to avoid harsh commercial mouthwashes if they have oral lesions.
• Provide gentle oral care for patients with oral lesions by using chemobrushes and warm saline or sodium bicarbonate solution.
• Be aware that patients with stomatitis receive antimicrobials, anti-inflammatory agents, immune modulators, and topical agents for relief of symptoms.
• Differentiate leukoplakia and erythroplakia: leukoplakia presents as thin, white patches; and erythroplakia presents as red, velvety lesions.