Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) - Management of Patients with Oral and Esophageal Disorders

Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) - Management of Patients with Oral and Esophageal Disorders Related

Review Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) - Management of Patients with Oral and Esophageal Disorders related questions and content

A medical nurse who is caring for a patient being discharged home after a radical neck dissection has collaborated with the home health nurse to develop a plan of care for this patient. What is a priority psychosocial outcome for a patient who has had a radical neck dissection?

  • A. Indicates acceptance of altered appearance and demonstrates positive self-image
  • B. Freely expresses needs and concerns related to postoperative pain management
  • C. Compensates effectively for alteration in ability to communicate related to dysarthria
  • D. Demonstrates effective stress management techniques to promote muscle relaxation
Correct Answer: A

Rationale: Since radical neck dissection involves removal of the sternocleidomastoid muscle, spinal accessory muscles, and cervical lymph nodes on one side of the neck, the patients appearance is visibly altered. The face generally appears asymmetric, with a visible neck depression; shoulder drop also occurs frequently. These changes have the potential to negatively affect self-concept and body image. Facilitating adaptation to these changes is a crucial component of nursing intervention. Patients who have had head and neck surgery generally report less pain as compared with other postoperative patients; however, the nurse must assess each individual patients level of pain and response to analgesics. Patients may experience transient hoarseness following a radical neck dissection; however, their ability to communicate is not permanently altered. Stress management is beneficial but would not be considered the priority in this clinical situation.

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A patient returns to the unit after a neck dissection. The surgeon placed a Jackson Pratt drain in the wound. When assessing the wound drainage over the first 24 postoperative hours the nurse would notify the physician immediately for what?

  • A. Presence of small blood clots in the drainage
  • B. 60 mL of milky or cloudy drainage
  • C. Spots of drainage on the dressings surrounding the drain
  • D. 120 mL of serosanguinous drainage
Correct Answer: B

Rationale: Between 80 and 120 mL of serosanguineous secretions may drain over the first 24 hours. Milky drainage is indicative of a chyle fistula, which requires prompt treatment.

A patient who had a hemiglossectomy earlier in the day is assessed postoperatively, revealing a patent airway, stable vital signs, and no bleeding or drainage from the operative site. The nurse notes the patient is alert. What is the patients priority need at this time?

  • A. Emotional support from visitors and staff
  • B. An effective means of communicating with the nurse
  • C. Referral to a speech therapist
  • D. Dietary teaching focused on consistency of food and frequency of feedings
Correct Answer: B

Rationale: Verbal communication may be impaired by radical surgery for oral cancer. It is therefore vital to assess the patients ability to communicate in writing before surgery. Emotional support and dietary teaching are critical aspects of the plan of care; however, the patients ability to communicate would be essential for both. Referral to a speech therapist will be required as part of the patients rehabilitation; however, it is not a priority at this particular time. Communication with the nurse is crucial for the delivery of safe and effective care.

A nurse is providing health promotion education to a patient diagnosed with an esophageal reflux disorder. What practice should the nurse encourage the patient to implement?

  • A. Keep the head of the bed lowered.
  • B. Drink a cup of hot tea before bedtime.
  • C. Avoid carbonated drinks.
  • D. Eat a low-protein diet.
Correct Answer: C

Rationale: For a patient diagnosed with esophageal reflux disorder, the nurse should instruct the patient to keep the head of the bed elevated. Carbonated drinks, caffeine, and tobacco should be avoided. Protein limitation is not necessary.

A patient has been diagnosed with an esophageal diverticulum after undergoing diagnostic imaging. When taking the health history, the nurse should expect the patient to describe what sign or symptom?

  • A. Burning pain on swallowing
  • B. Regurgitation of undigested food
  • C. Symptoms mimicking a heart attack
  • D. Chronic parotid abscesses
Correct Answer: B

Rationale: An esophageal diverticulum is an outpouching of mucosa and submucosa that protrudes through the esophageal musculature. Food becomes trapped in the pouch and is frequently regurgitated when the patient assumes a recumbent position. The patient may experience difficulty swallowing; however, burning pain is not a typical finding. Symptoms mimicking a heart attack are characteristic of GERD. Chronic parotid abscesses are not associated with a diagnosis of esophageal diverticulum.

A nurse is assessing a patient who has just been admitted to the postsurgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize?

  • A. Assess ability to clear oral secretions.
  • B. Assess for signs of infection.
  • C. Assess for a patent airway.
  • D. Assess for ability to communicate.
Correct Answer: C

Rationale: Postoperatively, the nurse assesses for a patent airway. The patients ability to manage secretions has a direct bearing on airway patency. However, airway patency is the overarching goal. This immediate physiologic need is prioritized over communication, though this is an important consideration. Infection is not normally a threat in the immediate postoperative period.

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