Management of Clients

with Oral Cavity Disorders

Gastrointestinal Nursing
Dental Plaques and Caries
Tooth decay = is an erosive
process that begins with the
action of bacteria on
fermentable carbohydrates
in the mouth, which
produces acids that dissolve
tooth enamel.
Tooth decay
Damage to the teeth may be related to the ff:
Presence of dental plaque, which is gluey, gelatinlike
substance that adheres to the teeth.
Length of time acids are in contact with the teeth.
Strength of acids and the ability of the saliva to
neutralize them.
Susceptibility of the teeth to decay.
Tooth decay
Contributing factors:
Not brushing teeth regularly
Improper diet
Older adults are at risk because of drug-induced or age-
related oral dryness.
Treatment:
Dentist can perform tooth filling, dental implants, or
tooth extraction.
Tooth decay
Prevention:
Practicing effective mouth care
Reducing the intake of starches and sugars
Applying fluoride to the teeth or drinking fluoridated
water
Refraining from smoking
Controlling diabetes
Using pi and fissure sealants
Regular dental visits
Candidiasis
Cause: Candida
albicans fungus,
predisposing
factors include
diabetes,
immunosuppressi
on and prolonged
intubation
Candidiasis
Signs and
symptoms: cheesy
white plaque that
looks like milk
curds; may bleed
when rubbed off.
Candidiasis
Management: antifungal medication (Nystatin
[Mycostatin], Amphotericin B, Clotrimazole,
Ketoconazole)
Stomatitis
inflammation of the oral
mucosa
Cause: chemotherapy,
radiation therapy and some
bacteria
Signs and symptoms: mild
redness (erythema),
painful ulceration, and
secondary infections
Stomatitis
Nursing management: mouth care including
brushing, flossing, and rinsing for any patients
receiving chemotherapy and radiation therapy;
avoid alcohol-based mouth rinses, and hot and
spicy food
Medications: anti-inflammatory, antibiotic, anesthetic
agents.
Oral Cancer
Cause: tobacco use,
alcohol intake, infection
with HPV
Predisposing factor: more
common in men; age 60
years old.
Oral Cancer
Manifestations: leukoplakia
“white patch”, or “smoker’s patch”
that becomes keratinized (hard
and leathery), dysphagia, pain
especially with seasoned foods.
Common sites of malignancy: lips,
lateral aspects of the tongue, and the
floor of the mouth
Diagnostic: biopsy
Management: surgery, radiation
and chemotherapy
 Management of Clients
with Oral Cavity Disorders

Gastrointestinal Nursing
Parotitis
Is an inflammation of the
parotid gland, is the most
common inflammatory
condition of the salivary glands.
Cause: Staphylococcus
aureus
Prolonged intubation
Dehydration and some
medication that can decrease
salivary production increase
risk for elderly and acutely ill
patients.
Parotitis
Signs and symptoms:
fever, otalgia,
dysphagia, red and
shiny overlying skin
Nursing Management:
good oral hygiene
nutrition and fluid
intake
Warm compress
Medications: antibiotic therapy, analgesic, and
discontinue tranquilizers and diuretics
Surgical: parotidectomy (gland is incised and drained)
used to treat chronic parotitis.
Mumps (Epidemic parotitis) = communicable
disease caused by viral infection and most
commonly affecting children, is an inflammation
of a salivary gland, the parotid.
Cause: paramyxovirus
Complication: orchitis in male
Management: isolation, use of sedatives and analgesics.
Sialadenitis
inflammation of the salivary glands (commonly
sublingual and submandibular)
Cause: dehydration, radiation therapy, stress,
malnutrition, salivary gland calculi (stones), improper
oral hygiene, and bacterial infections (S. aureas,
Streptococcus viridans, pneumococci. In hospitalized
patients, caused by methicillin-resistant Staphylococcus
aureus (MRSA).
Sialadenitis
Signs and symptoms: pain in the ear, swelling, and
purulent discharge.
Management: massage, hydration, warm compress,
antibiotics, and corticosteroids.
Surgical: surgical drainage of the gland or excision of the
gland.
Sialolithiasis
salivary calculi (stones), usually occurs in the
submandibular gland.
Cause: calcium phosphate deposits
Diagnostics: sialography (salivary gland
ultrasonography) = x-ray studies filmed after the
injection of a radiopaque substance into the duct;
reveals: calculi are irregular and diameter from 3 – 30
mm.
Sialolithiasis
Signs and symptoms: asymptomatic, unless infection
arises (sudden, local, and colicky pain), swollen glands.
Surgical: lithotripsy = a procedure that uses shock waves
to disintegrate stones.
 Lithotripsy requires no anesthesia, sedation and

analgesia.
 Side effects: local hemorrhage and swelling.
Sialolithiasis
Nursing management:
 Advise patient to chew sugarless gum
 Increase oral fluid intake
 Application of moist warm heat
 Management of Clients
with Esophageal Disorders

Gastrointestinal Nursing
Achalasia
is absent or ineffective peristalsis of the distal esophagus
accompanied by failure of the esophageal sphincter to
relax in response to swallowing.
Clinical Manifestations:
Dysphagia = the most common symptom
 Sensation of food sticking in the lower portion of the
esophagus
Regurgitation
Pyrosis = heartburn or chest pain
Pulmonary complications resulting from aspiration of
gastric contents
Achalasia
Assessment and Diagnostic Findings:
X-ray = shows esophageal dilation above the narrowing
at the gastroesophageal junction.
Barium swallow = reveals nonpropulsive waves and
esophageal dilation; barium mat retain in the esophagus
Endoscopy
Manometry = a process in which esophageal pressure is
measured by a radiologic or gastroenterologist, confirms
the diagnosis.
Achalasia
Nursing Management:
Eat slowly and to drink fluids with meals
Small frequent feedings
Soft, warm foods are better tolerated
Advise patient to eat slowly
Client should sleep with the head of the bed elevated
Wearing of constricting clothing is discouraged
Achalasia
Pharmacological Management:
Calcium channel blockers, eg. Verapamil (Calan)
Isosorbide Dinitrate (Isordil)
Surgical Management:
Injection of botulinum toxin (Botox) into quadrants of the esophagus
via endoscopy = inhibits the contraction of smooth muscle.
Pneumatic dilation = the LES muscle is disrupted from within using
balloons of progressively larger diameters and repeatedly dilated.
Performed endoscopically.
 Complication: perforation

Esophagomyotomy = the esophageal muscle fibers are separated

surgically to relieve the lower esophageal stricture.
Diffuse Esophageal Spasm (Nutcracker
Esophagus)
is a motor disorder of the esophagus characterized by
dysphagia or odynophagia and chest pain
Assessment and Diagnostic Findings:
Esophageal manometry = measures the motility of the
esophagus and the pressure within the esophagus
 Finding: simultaneous contractions of the esophagus

occur irregularly
Diffuse Esophageal Spasm (Nutcracker
Esophagus)
Nursing Management:
Small frequent feedings and soft diet
Pharmacological Management:
Sedative agents:
Calcium channels blockers (Nifedipine (Procardia),
Verapamil (Calan)
Surgical Management:
Pneumatic dilation
Esophagomyotomy or Heller myotomy
Hiatal Hernia
the opening in the diaphragm through which the
esophagus passes becomes enlarged, and part of the
upper stomach tends to move up into the lower
portion of the thorax.
Hiatal Hernia
Predisposing factors:
Older adults (increased age)
Women, pregnancy
Factors that increase intraabdominal pressure (use of
tight girdles, intense physical exertion, bending, lifting,
excessive straining)
Obesity, ascites, tumors
Hiatal Hernia
Types:
Type 1/ Sliding/ Axial = the
junction of the stomach and
esophagus is above the hiatus
of the diaphragm. The
stomach “slides” into the
thoracic cavity when the
patient is supine and usually
goes back to the abdominal
cavity when the patient is
standing upright. Most
common type of hiatal hernia.
Hiatal Hernia
Types:
Type 2/
Paraesophageal/
Rolling = the
esophagogastric
junction remains in the
normal position, but
the fundus and the
greater curvature of the
stomach roll up
through the diaphragm.
Hiatal Hernia
Clinical Manifestations:
50% of patients are asymptomatic
Heartburn
Regurgitation
Dysphagia
Sliding = associated with reflux
Paraesophageal = associated with a sense of fullness or
chest pain after eating; reflux does not occur because the
gastroesophageal sphincter is intact.
Hiatal hernia
Diagnostic: barium swallow, esophagoscopy
and x-ray
Complication: GERD, esophagitis,
strangulation of the hernia, bleeding,
obstruction and tracheal aspiration.
Hiatal hernia
Surgical management:
Herniotomy = excision of the hernial sac
Herniorraphy = closure of the hiatal defect
Antireflux procedures:
Gastropexy = attachment of the stomach
subdiaphramatically to prevent
reherniation.
 Hiatal hernia
Nissen
Fundoplication
= the fundus of
the stomach is
wrapped
around the
lower portion
of the
esophagus.
Hiatal hernia
Nursing management:
Soft bland diet, small frequent feedings, ask
patient to eat slowly
Low-fat diet, no carbonated drinks, milk,
tea, coffee, chocolate, alcohol
Not to recline for 1 hour after eating, elevate
head of the bed
Monitoring the patient for any
complications.
Gastroesophageal Reflux Disease (GERD)
backflow of gastric or duodenal contents into
the esophagus. The most common upper GI
problem seen in adults. Not a disease but a
syndrome.
Etioloy: no single cause but several factors or
combinations of factors
GERD
Incompetent LES = results in a decreased
pressure in the distal portion of the esophagus.
As a result, gastric contents are able to move
from an area of higher pressure (stomach) to an
area of lower pressure (esophagus).
Foods (caffeine and chocolate), and
anticholinergic drugs.
Hiatal hernia (common cause), obesity,
pregnant women, and cigarette smokers.
GERD
Manifestations:
Heartburn (most common manifestation),
dyspepsia, episodes of hypersalivation (brash
water), regurgitation, and respiratory
complications such as wheezing, coughing,
and dyspnea.
Diagnostic:
Barium swallow, endoscopy (EGD) with
biopsy and cytologic specimens, and
manometric studies
GERD
Complications:
Esophagitis =
inflammation of the
esophagus (frequent
complication).
Barrett’s esophagus =
esophageal metaplasia; a
precancerous lesion that
increases the patient’s
risk for esophageal
cancer.
GERD
There is replacement of
the normal squamous
epithelium with columnar
epithelium.
pH in the esophagus is
more than 4.5.
Potential complication for
asthma, chronic
bronchitis, and dental
erosion.
GERD
Nursing managements:
Lifestyle modification (smoking cessation)
Nutritional therapy
Avoid fatty foods, chocolate, peppermint,
spearmint, coffee, carbonated beverages,
and tea, avoid gas-forming foods.
Avoid irritating foods e.g., tomato-based

products, orange juice

GERD
Avoid milk products at bedtime, avoid late
evening meals and nocturnal snacking.
Small frequent meals, high-protein diet, fluids
should be taken between rather than with
meals to reduce gastric distension.
Weight reduction is recommended for
overweight.
Avoid reclining after meals.
GERD
Drug therapy:
“step-up approach” = means starting with
antacids and H2R blockers, and finally PPIs
Antacids: = act by neutralizing HCl acid.
Should be taken 1 to 3 hours after meals
and at bedtime.
Eg. Magnesium hydrochloride = causes

diarrhea
GERD
Aluminum hydrochloride = causes
constipation
Magnesium salts + Aluminun Hydroxide
(Gaviscon, Maalox, Mylanta, Gelusil)
Sodium bicarbonate (Alka-Seltzer)
GERD
Histamine2 Receptor (H2R) blockers =
(antisecretory agents) decrease the secretion of
HCl acid by the stomach.
Cimetidine (Tagamet), Ranitidine (Zantac),
Famotidine (Pepcid), Nizatidine (Axid)
Have longer onset of action than antacids
Side effects (Cimetidine): granulocytopenia,
gynecomastia, diarrhea, fatigue, dizziness,
rash, and mental confusion.
GERD
Proton-pump Inhibitors = (antisecretory
agents) decrease the secretion of HCl acid by
the stomach but more effective than H2R
blockers.
Act by inhibiting the proton pump
mechanism responsible for secretion of H+
ions.
Should be taken with meals.
GERD
Eg. Esomeprozole (Nexium), Lansoprazole
(Prevacid), Omeprazole (Prilosec),
Pantoprazole (Protonix), Rabeprazole
(Aciphex)
GERD
Cytoprotective drugs = it coats the mucosal
lining of the esophagus, stomach, and
duodenum.
Given at least 30 min before or after
antacids.
Eg. Misoprostol (Cytotec) should not be
used by pregnant women, Sucralfate
(Carafate) = the most common side effect is
constipation
GERD
Prokinetic = “motility-enhancing drug”,
promotes gastric emptying and reduce the risk
of gastric acid reflux.
Eg. Metoclopramide (Reglan), domperidone
(Motilium)
Side effects: restlessness, anxiety, insomnia,
and hallucinations
GERD
Cholinergic drugs = used to increase LES
pressure, improve esophageal and gastric
emptying.
Is used limitedly because they also stimulate
HCl acid secretion.
Eg. Bethanechol (Urecholine)
Side effects: urinary frequency, abdominal
cramping, diarrhea, and hypotension
GERD
Surgical Management:
Endoscopic intraluminal valvuloplasty =
gastric tissue is grafted to replace and repair
the LES
Endoscopic radiofrequency therapy = the
procedure uses an instrument called the
“Stretta device”, which is a balloon-tipped
four-needle catheter that delivers
radiofrequency energy to the smooth muscle
of the LES.
GERD
Radiofrequency energy induces collagen
contraction
Nissen Fundoplication = wrapping of fundus
around the distal esophagus and sutured to
itself.