SESSION 1:

REVIEW OF DIGESTIVE SYSTEM

DIAGNOSTIC EVALUATION
RELATED PHARMACOLOGY
PAROTITIS
SIALADENITIS
SALIVARY CALCULUS
Learning Outcome:
At the end of the discussion, the students will be able
to:
1. Explain the anatomy and physiology of the gastrointestinal
system.
2. Identify the diagnostic tests in gastrointestinal problem.
3. Explain the normal values , significant result and nursing
management of each diagnostic exams.
4. Identify the related pharmacology
5. Explain the drug indication, side effects and nursing consideration
Learning Outcome:
At the end of the discussion, the students will be
able to:
6. Discuss the three salivary glands disorders ( PAROTITIS.
SIALADENITIS, SALIVARY CALCULUS).
7. Discuss pathophysiology of each disease condition.
8. Formulate Nursing Care Plan in each salivary gland
disorders.
 Diagnostic Evaluation
Complete Blood Count

1. Explain test procedure

2. Explain that slight discomfort may
be felt when skin is punctured
3. No fasting is necessary
4. Monitor puncture site for bleeding
or hematoma formation
Diagnostic Evaluation
Liver function test

1. Instruct patient to drink

plenty of fluids in the days
leading up to the exam
2. Avoid alcohol for at least
24 hours before test
 Diagnostic Evaluation
Laboratory Normal Values Nursing Management
studies

Amylase 23 -85 units/liter (U/L) Blood is drawn from arm, may advise to use loose-
0 - 160 units/liter (U/L) fitting or short sleeve shirt for easy access.
Lipase

Carcinoembryonic 0-2.5 nanogram per greater than 10 ng/mL suggests extensive disease,
antigen (CEA) milliliter of blood (ng/ml) greater than 20 ng/mL suggest the cancer may be
spreading.
Diagnostic Evaluation
Laboratory studies Normal Values Interpretation

Alpha-fetoprotein – for 0 ng/mL to 40 greater than 400 ng/mL—could be a

liver cancer ng/mL sign of liver tumors or cancers

Cancer Antigen 19-9 < 37U/mL May indicate cancer, but can also include
an infection of your pancreas, liver
disease, gallstones, and cystic fibrosis.
 Diagnostic Evaluation
Laboratory studies Purpose Nursing Management

Stool Exam ● can detect ● random specimens should be sent promptly

1. Fecal Occult occult to the laboratory for analysis;
Blood blood in ● the quantitative 24- to 72- hour collections
stools, must be kept refrigerated until transported to
(FOBT)
indicating the laboratory
GI bleeding
● Advise pt to avoid for 72 hours - red meats,
aspirin, vitamin C, nonsteroidal anti-
inflammatory drugs, turnips, and
horseradish - it may cause a false-positive
result
Diagnostic Evaluation
Laboratory studies Purpose
Breath test evaluates carbohydrate
absorption, in addition to aiding
1. Hydrogen in the diagnosis of bacterial
Breath Test overgrowth in the intestine and
short bowel syndrome
detects the presence of
2. Urea Breath Test Helicobacter pylori, the bacteria
that can live in the mucosal lining
of the
stomach and cause peptic ulcer
disease
Nursing Management
● Avoid antibiotics or loperamide
(Pepto Bismol) for 1 month
before the test;
● sucralfate (Carafate) and
omeprazole (Prilosec) for 1 week
before the test;
● cimetidine (Tagamet), famotidine
(Pepcid), and ranitidine (Zantac)
for 24 hours before the test
Radiographic Studies
Laboratory studies Purpose
Upper involves visualization by
Gastrointestinal fluoroscopy of the
esophagus and stomach
Series/Barium after the client swallows
Swallow barium sulfate. The GI series
enables the examiner to
detect or exclude anatomic
or functional disorders of
the upper GI organs or
sphincters. It also aids in
the diagnosis of ulcers,
varices, tumors,
regional enteritis, and
malabsorption syndromes
Nursing Management
Before:
Clear liquid diet, with nothing by mouth (NPO)
from midnight the night before the study.
Advise to avoid smoking, chewing gum, and using
mints because they can stimulate gastric motility.
Withhold oral medications on the morning of the
study and resumed that evening.
When a patient with insulin-dependent diabetes is
on NPO, his or her insulin requirements will need to
be adjusted accordingly.
After:
Fluids may be increased to facilitate evacuation of
stool and barium
Radiographic Studies
Laboratory studies Purpose Nursing Management

Lower involves instillation of Before:

Gastrointestinal barium into the large ● Assess the patient for allergy to iodine or contrast
Series/Barium Enema intestines, with agent.
Contraindications: fluoroscopy and filming ● Empty and cleanse the lower bowel.
● Active used to visualize ● o low-residue diet 1 to 2 days before the test
inflammatory structures and ● o clear liquid diet and a laxative the evening
disease of the determine the before
colon efficiency of emptying ● o NPO after midnight
● Signs of ● o cleansing enemas until returns are clear the
perforation or following morning
obstruction After:
● Active GI ● Increase fluid intake.
bleeding ● Evaluate bowel movements for evacuation of barium.
● Note for increased number of bowel movements
(barium may draw fluid into the bowel, thus
increasing the intraluminal contents and resulting in
Normal GI Series
Ultrasonographic Studies
Laboratory studies
Abdominal Ultrasonography
- produces an image of the
abdominal organs and structures
on the oscilloscope by using sound
waves.
Nursing Management
● Instruct the patient to fast for 8 to 12 hours
before the test to decrease the amount of gas in
the bowel.
● If gallbladder studies are being performed, the
patient should eat a fat- free meal the evening
before the test.
● If barium studies are to be performed, they
should be scheduled after ultrasonography;
otherwise, the barium could interfere with the
transmission of the sound waves
Imaging Studies
Laboratory studies Nursing Interventions

Computed Before:
● Assess the patient for allergies to contrast agents, iodine, or
Tomography shellfish
● Patients allergic to the contrast agent may be pre- medicated
- Provides cross- with IV prednisone 24 hours, 12 hours, and 1 hour before the
sectional images of scan.
abdominal organs ● Assess the patient’s current serum creatinine level
and structures. ● Determine the patient’s urine human chorionic gonadotropin.
Before & After:
● Administer IV sodium bicarbonate 1 hour before and 6 hours
after IV contrast.
● Administer oral acetylcysteine (Mucomyst) before or after the
study.
● o Both sodium bicarbonate and Mucomyst are free radical
scavengers that sequester the contrast byproducts
● that are destructive to renal cells.
Imaging Studies
Laboratory studies Nursing Interventions

Magnetic Resonance Before:

● NPO status 6 to 8 hours.
Imaging
● Remove all jewelry and other metals.
● Remove foil- backed skin patches (NicoDerm, nitroglycerine
-provides a supplement to
[Transderm-Nitro], scopolamine [Transderm- Scop],
ultrasonography and CT. It is
clonidine [Catapres-TTS])
useful in evaluating abdominal
Inform the patient and family:
soft tissues as well as blood
o that the study may take 60 to 90 minutes
vessels, abscesses, fistulas,
o he close-fitting scanners used in many MRI facilities may induce
neoplasms, and other sources of
feelings of claustrophobia
bleeding
o the machine will make a knocking sound during the procedure
o patients may choose to wear a headset and listen to music or to
wear a blindfold during the procedure
Note: Any ferromagnetic objects (metals that
contain iron) can be attracted to the magnet
and cause injury. Items that can be
problematic or dangerous include jewelry,
pacemakers, dental implants, paperclips, pens,
keys, IV poles, clips on patient
gowns, and oxygen tanks.
Contraindications:
Patients with permanent pacemakers, artificial
heart valves and defibrillators, implanted insulin
pumps, or implanted transcutaneous electrical
nerve stimulation devices, internal metal devices
(aneurysm clips), intraocular metallic fragments,
or cochlear implants.
Endoscopic Procedures
Laboratory studies
Upper Gastrointestinal
Fibroscopy /
Esophagogastroduodenoscopy
- allows direct visualization of the
esophageal, gastric, and duodenal
mucosa through a lighted endoscope
(gastroscope).
Nursing Management
Before:
● NPO for 8 hours.
● Given a local anesthetic gargle or spray.
● Administer Midazolam (Versed) - moderate sedation and
relieve anxiety.
● Administer Atropine to reduce secretions, and glucagon
to relax smooth muscle.
● Position the patient in left lateral position to facilitate
clearance of pulmonary secretions and provide smooth
entry of scope
● Use a finger or ear oximeters to monitor oxygen
saturation.
● Supplemental oxygen may be administered if needed.
● The patient wears a mouth guard to keep from biting the
scope
After:
• Assess the patient’s level of consciousness, vital
signs, oxygen saturation, pain level, and
monitoring
• for signs of perforation (pain, bleeding, unusual
difficulty swallowing, and rapidly elevated
temperature).
• After the patient’s gag reflex has returned, offer
lozenges, saline gargle, and oral analgesic agents to
• relieve minor throat discomfort.
• Remain patients who were sedated in bed until fully
alert.
• After moderate sedation, the patient must be
transported home with a family member or friend if
the procedure was performed on an outpatient
basis.
Endoscopic Procedures
Laboratory studies Nursing Management

Fiberoptic Before:
Colonoscopy ● Adequate colon cleansing provides optimal visualization and decreases the time
needed for the procedure. - laxative for 2 nights before the examination and a
Fleet’s or saline enema until the return is clear the morning of the test
- Direct visual
● Patient maintains a clear liquid diet starting at noon the day before the
inspection of
procedure
the large
● Informed consent is obtained before sedation.
intestine
● Administer an opioid analgesic or sedative agent (midazolam [versed]) to provide
(anus, rec- tum,
moderate sedation and relieve anxiety
sigmoid,
● Glucagon may be administered to relax the colonic musculature and to reduce
transcending
spasm during the test.
and ascending
● Position the patient on the left side with the legs drawn up toward the chest
colon).
- diagnostic aid
and screening
device.
Endoscopic Procedures
Laboratory studies Nursing Management

Fiberoptic During:
Colonoscopy ● Monitor the patient for changes in oxygen saturation, vital signs, color and
temperature of the skin, level of consciousness, abdominal distention, vagal
response, and pain intensity.
- Direct visual
After:
inspection of the
● Maintain the patient on bed rest until fully alert.
large intestine
● Monitor the patient for signs and symptoms of bowel perforation (rectal
(anus, rec- tum,
bleeding, abdominal pain or distention, fever, focal peritoneal signs).
sigmoid,
● Provide written instructions, because the patient may be unable to recall
transcending and
verbal information.
ascending colon).
● Instruct the patient to report any bleeding to the physician.
- diagnostic aid and
Contraindications: With suspected or documented colon perforation; Acute severe
screening device.
diverticulitis; or Fulminant colitis
Endoscopic Procedures
Laboratory studies Nursing Intervention

Anoscopy, Proctoscopy, and Before:

Sigmoidoscopy ● Place the patient on the left side with
the right leg bent and placed anteriorly.
- Endoscopic examination of the anus,
rectum, and sigmoid and descending
colon is used to evaluate chronic
diarrhea, fecal incontinence, ischemic
colitis, and lower GI hemorrhage and
to observe for ulceration, fissures,
abscesses, tumors, polyps, or other
pathologic processes. Biopsies and
polypectomies can be performed during
this procedure
Motility Studies
Laboratory studies Nursing Interventions

Motility Studies - use manometric catheters to ● Instruct patient to withhold

measure intraluminal pressure in the GI structures. medications for 24 hr before the
study.
1. Esophageal manometry ● Instruct the patient to fast and
- Evaluates peristaltic contractions and restrict fluids for 6 hr prior to the
sphincter integrity procedure to reduce the risk of
1. Rectal manometry aspiration related to nausea and
- Measures internal and external sphincter vomiting
pressures
Motility Studies
Laboratory studies Nursing Interventions

Gastric Analysis Upper GI:

- determines the nature of gastric secretions
● Patient is held NPO after midnight
the day before the exam in order to
empty the upper GI tract.
● Advise to avoid gum chewing and
smoking should be discouraged
the morning of the exam, as this
stimulates gastric action

Lower GI:
● Patient is held NPO after midnight
the day before the exam
Related Pharmacology

Gastrointestinal System
Classification Mechanism of Action Side Effects: Nursing Consideration
Drug Name

Antacids Neutralize the HCL by Alkalosis, Advise pt to take medication

Aluminum reacting with protons in Constipation, with food 20 mins to 1 hour or
hydroxide the lumen of the gut Diarrhea after meals or at bedtime.
(Amphojel), May be followed with milk or
Uses: Peptic Ulcer Disease water.
Aluminum and
magnesium
hydroxide
(Maalox)
 Classification MOA Side Effects Nursing Consideration

Antibiotics Prevent or treat infections Superinfection - in long 1. Before administration,

caused by pathogenic term use assess for allergies
Aminoglycosides microorganisms
(Gentamicin),
Amoxicillin

Anticholinergics Inhibits smooth muscle Abdominal distention

contraction in the GI tract Constipation
Atropine sulfate Urinary retention
(Benzedrine)
 Classification Mechanism of Side Effects Nursing Consideration
Action

Anti-diarrheals Activates opioid Drowsiness, Nausea, Paralytic 1. Advise pt to take with or

receptors in ileus without food
Diphenoxylate HCL enteric nervous 2. Do not use in children
(Lomotil) system, slows less than 4 years of age
Loperamide HCL motility with (increased chance of
(Imodium negligible CNS causing paralytic ileus)
effects

Uses: Acute
diarrhea

Anti - emetics Blocks Drowsiness, Hypotension, Dry Watch out for headache,
chemoreceptor mouth, Blurred vision dizziness and
Ondansetron, trigger zone and constipation
Dolasetron, enteric nervous
Alosetron system 5-HT3
Classification Mechanism of Side Effects: Nursing Consideration
Action

Antifungals Treat fungal infections Diarhea, GI distress, 1. Should be taken on an

caused by fungi Nausea and Vomiting empty stomach
Nystatine 2. Retain suspension in the
suspension mouth for as long as
possible before
swallowing
3. Do not take food/drink
at least 1 hr after a dose

Antispasmodics Relax smooth muscle of Drowsiness, May be taken with or

the GI tract without Hypotension, Dry without food
Dicyclomine anticholinergic effects mouth, Blurred vision
 Classification Mechanism of Action Side Effects Nursing Consideration

Histamine Blocks receptors that Blood 1. Advise pt to take with or

Receptor control the secretion of dyscariasis without food or at bedtime
Antagonists/ Anti- HCL by the parietal cells Skin rash
Secretory Agents Gynecomastia
Cimetidine Uses: PUD, GERD,
Ranitidine, Zollinger-Ellison
Famotidine Syndrome

Laxatives Stimulate peristalsis Drowsiness, 1. Not taken on a continuous basis or

through mucosal Hypotension, for extended periods w/o
investigating the cause of
Bisacodyl irritation Dry mouth,
constipation
Senna Retain and increase Blurred vision 2. Prolonged excessive use may lead
Psyllium water in the feces to fluid and electrolyte imbalance
 Classification Mechanism of Action Side Effects Nursing Consideration

Mucosal Protect the ulcer from Abdominal pain, 1. Advise patient to take
Protective Agents the destructive action Diarrhea, Uterine medication with food.
of the digestive enzyme cramping 2. Contraindicated for
Misoprostol, pepsin by changing Miscarriage - patients who are
Sucralfate stomach acid into misoprostol pregnant
vicous materials that
binds to protein in
ulcerated tissue

Proton pump Prevent the final Diarrhea, Headache, 1. Should be taken before
Inhibitors transport of hydrogen Abdominal pain, meals, ideally 30 mins to
into the gastric lumen Malabsorption, 1 hour before breakfast
Omerprazole by binding an enzyme Hypergastrinemia 2. Daily long-term use
Lansoprazole on gastric parietal cells (more than 3 years) may
lead to malabsorption or
deficiency of Vt b12
Salivary Gland Disorder
1.PAROTITIS
2.SIALADENITIS
3.SALIVARY CALCULUS
PAROTITIS
• Parotitis (inflammation of the parotid gland) is the
most common inflammatory condition of the
salivary glands.
• Mumps (epidemic parotitis), a communicable
disease caused by viral infection and most
commonly affecting children, is an inflammation of
a salivary gland, usually the parotid.
High Risk:

Children; Elderly
Acutely ill or debilitated people with decreased
salivary flow from general dehydration or
medications

Causative Agent: Staphylococcus aureus (except in

mumps)
Causes
- Bacterial Infection (Staphylococcus aureus and
Streptococcus species)
- Viral Infection (Mumps Virus)
- Reduced saliva production due to dehydration
- Sialolithiasis (Salivary Stones)
- Physical blockage of the ducts due to tumors or
trauma
- Sjögren's Syndrome (autoimmune disorder)
Pathophysiology
Pathophysiology
Pathophysiology
 PAROTITIS
Clinical Manifestation
Fever
Swollen, tender glands
Ear pain
Red and shiny overlying skin
Difficulty in swallowing
Medical Management: Surgical Management
Adequate nutrition, fluid intake, and Parotidectomy
good oral hygiene
Discontinue medications
(tranquilizers, diuretics) that can
diminish salivation.
Antibiotic therapy and Analgesics
 Nursing Care Plan
1. Acute pain
Assessment Goal Intervention

Subjective data: - Pain scale ratings - Assisting the patient in finding a comfortable position. RATIONALE: helps
- Patient reports pain decrease to [target minimize pressure on the parotid gland, reducing pain and discomfort.
and tenderness in pain scale rating]. - Monitor and Document Pain Levels Regularly. RATIONALE: Regular pain
the parotid gland - The patient reports a assessments guide the effectiveness of interventions and help in
area. reduction in pain adjusting the pain management plan as needed.
- Pain intensity rated within 24 to 48 hours. - Encourage rest and limiting physical activity. RATIONALE: help conserve
as [pain scale rating]. energy, reduce metabolic demands, and alleviate strain on the affected
area, contributing to pain relief.
Objective data: - Apply Warm Compresses to the Affected Area. RATIONALE: Warm
- Swelling, redness, compresses enhance blood circulation, reduce swelling, and alleviate
and tenderness over pain in the parotid gland area, providing comfort to the patient.
the parotid gland. - Administer Analgesics as Prescribed. RATIONALE: Analgesics, such as
-Patient guards the acetaminophen or NSAIDs, are administered to relieve pain and
affected area and discomfort associated with parotitis, improving the patient's overall
demonstrates comfort and well-being.
discomfort during
movement.
 Nursing Care Plan
2. Hyperthermia
Assessment
Subjective data:
- Reports feeling feverish and
experiencing chills
-Report difficulty swallowing
- Pain and tenderness below
the ear
Objective data:
-Elevated Body temperature
-Warm and flushed skin
- Tachycardia and increased
respiratory rate
- swelling, redness and
tenderness over the parotid
gland
Goal Intervention
The patient’s - Encourage increased fluid, especially if the patient has difficulty
temperature returns swallowing
to within the normal RATIONALE: Increased fluid intake is essential to prevent
range within 12-48 dehydration
hours -Apply cool compresses to the forehead and neck or perform TSB
RATIONALE: maintaining a cool environment helps dissipate
heat, providing comfort and aiding in temperature reduction
-Encourage to rest and limit physical activity
RATIONALE: Rest is crucial for conserving energy and allowing
the body to focus on healing. Physical activity may increase
metabolic demands and contribute to an elevated temperature
- Administer acetaminophen as prescribed. RATIONALE: can help
lower the elevated body temperature
- Administer IV fluids as prescribed. RATIONALE: to prevent
dehydration
 Nursing Care Plan
3. Impaired Oral Mucous Membrane
Assessment Goal Intervention

Subjective data: - The patient will - Encourage the patient to drink small sips of water regularly.
- Patient reports pain maintain intact oral RATIONALE: Hydration is essential for maintaining oral mucous
and tenderness in mucous membranes membrane integrity.
the parotid gland without signs of
- Encourage gentle brushing and rinsing with a non-alcoholic, saline solution.
area. infection or worsening
- Complaints of inflammation. RATIONALE: Maintaining good oral hygiene is crucial to prevent
difficulty in - The patient will secondary infections and promote healing
swallowing. demonstrate proper - Encourage use of moisturizing agents, such as water-based gels or oral
- History of oral hygiene lubricants. RATIONALE: can help alleviate dryness and prevent further
decreased oral practices. irritation of the oral mucous membrane
intake. - Assess the oral mucous membrane for signs of infection, such as increased
Objective data: redness, swelling, or purulent discharge regularly. RATIONALE: Report any
- Swelling, redness, changes promptly for further evaluation and intervention.
and tenderness over - Administer analgesics as prescribed. RATIONALE: to manage pain and
the parotid gland. discomfort, facilitating improved oral care.
- Dry or cracked oral - Collaborate with other healthcare professionals, such as the dentist or oral
mucous membrane. care specialist. RATIONALE: to ensure comprehensive care and address
specific oral health needs.
Nursing Care Plan
4. Imbalanced Nutrition: Less than body
requirements
Assessment Goal Intervention

Subjective data: - The patient will report - Assess weight monitoring regularly. RATIONALE:helps assess the
- Patient reports increased appetite and effectiveness of the nutrition plan and identifies the need for
difficulty chewing and better tolerance of oral adjustments to prevent further weight loss.
swallowing due to intake. - Encourage the patient to sip water or other non-caffeinated, non-alcoholic
pain in the parotid - The patient will beverages. RATIONALE: Adequate hydration supports overall well-
gland area. demonstrate improved being and may facilitate swallowing
-Complaints of ability to chew and - Modifying food texture, such as making foods softer or pureed.
decreased appetite swallow without significant RATIONALE: reduces the effort required for chewing and swallowing,
and reduced food difficulty. improving the patient's ability to eat.
intake. - Providing nutrient-dense snacks between meals. RATIONALE: ensures a
more consistent intake of essential nutrients, promoting overall
Objective data: nutritional status.
- Swelling, redness, - Consuming smaller, more frequent meals may be easier for the patient.
and tenderness over RATIONALE: reducing the physical stress on the parotid gland and
the parotid gland. facilitating better nutritional intake.
- Weight loss or - Consultation with a dietitian. RATIONALE: helps in developing a
Nursing Care Plan
5. Infection
Assessment Goal Intervention

Subjective data: - Patient will demonstrate - Regular monitoring of vital signs, including temperature, heart rate and
- Reports pain, a reduction in signs and respiratory rate. RATIONALE: helps identify changes that may
tenderness and symptoms of infection indicate worsening infection or complications
difficulty of associated with parotitis - Encourage gentle brushing and rinsing with a non-alcoholic, saline
swallowing within 48-72 hours. solution. RATIONALE: Good oral hygiene helps prevent secondary
-Complaint of infections and promotes overall oral health.
malaise and feeling - Applying warm compresses to the affected parotid gland. RATIONALE:
unwell can promote blood circulation, reduce swelling and alleviate
discomfort
Objective data: - Encourage increased oral fluid intake. RATIONALE: Adequate
- swelling, redness hydration helps maintain hydration status.
and tenderness over - Administer Antibiotics as prescribed.RATIONALE: Antibiotics, such as
the parotid gland those effective against Staphylococcus aureus and Streptococcus
- elevated body species, are prescribed to target the bacterial infection causing
temperature parotitis.
-Purulent discharge - Administer pain reliever as prescribed. RATIONALE: Controlling pain
from the parotid duct helps improve the patient's overall comfort and encourages
- difficulty opening adherence to other aspects of the care plan.
the mouth and limited
SIALADENITIS
- This is an inflammation of the salivary glands,
commonly affects parotid and submandibular
glands.
Risk Factors:
1. Dehydration
2. Radiation therapy
3. Stress; Malnutrition
4. Salivary gland calculi (stones)
5. Improper oral hygiene
CAUSES

INFECTIOUS NON-INFECTIOUS

1. Viral Infection 1. Sjogren Syndrome

- Mumps
2. Sarcoidosis

2. Bacterial Infection 3. Radiation Therapy

- Ascending Infection
- Staph. Aureus 4. Allergens
- Staph. Pyogenes
- Strep. viridans, or pneumococci
- Methicillin-resistant S. aureus
(MRSA) - from hospitals and
institution
 SIALADENITIS
General Clinical Medical Management: Surgical Management
Manifestation

Pain Antibiotics Management: Surgical

Swelling Corticosteroids drainage of the gland or
Gland Massage, excision of the gland and its
Purulent discharge Hydration, and Warm duct for chronic and
compresses uncontrolled pain
Severe cases: Fever, Encouraging saliva flow
chills and general Improve oral hygiene
weakness
BACTERIAL SIALADENITIS

ACUTE CHRONIC

Most Common Abdominal Surgery Recurrent & persistent

Causes ductal obstruction

Location Mostly in parotid gland Mostly in

submandibular gland

Signs & Swollen & painful glands Pain in meal time

Symptoms Skin is warm & erythematous
Purulent Discharge
Fever and Trismus (late stage)

Histopathologic Accumulation of Neutrophils Patchy infiltration by

Features Lymphocytes & Plasma

Treatment Antibiotic Therapy Removal of sialolith or

Rehydration any obstruction
Surgical Drainage Conservative Therapy
Gland Removal
ALLERGIC SIALADENITIS

Most Common Causes Drugs or Allergens

Location Parotic, Submandibular, Sublingual

Glands

Signs & Symptoms Acute Salivary Gland enlargement

Itching over the gland
May have rash

Treatment Self limited disease

Supportive Therapy
Avoid Allergen
Hydration
Nursing Care Plan
Pain related to swollen glands
Assessment Goal Intervention

Subjective data:
-

Objective data:
Nursing Care Plan
Pain related to swollen glands
Assessment Goal Intervention

Subjective data: - Patient - Assisting the patient in finding a comfortable position.

- Patient reports pain describes RATIONALE: helps minimize pressure on the parotid gland,
and tenderness in the satisfactory pain reducing pain and discomfort.
affected area. control at a level - Monitor and Document Pain Levels Regularly.
- Pain intensity rated [target pain scale RATIONALE: Regular pain assessments guide the effectiveness
as [pain scale rating]. rating]. of interventions and help in adjusting the pain management plan
- The patient as needed.
Objective data: reports a - Encourage rest and limiting physical activity.
- Swollen & painful reduction in pain RATIONALE: help conserve energy, reduce metabolic demands,
glands. within 24 to 48 and alleviate strain on the affected area, contributing to pain
- Skin is warm & hours. relief.
erythematous - Patient displays - Apply Warm Compresses to the Affected Area.
- -Patient guards the improvement in RATIONALE: Warm compresses enhance blood circulation,
affected area and mood, coping. reduce swelling, and alleviate pain in the parotid gland area,
demonstrates providing comfort to the patient.
discomfort during - Administer Analgesics as Prescribed.
movement. RATIONALE: Analgesics, such as acetaminophen or NSAIDs, are
administered to relieve pain and discomfort associated with
parotitis, improving the patient's overall comfort and well-being.
 Nursing Care Plan
Hyperthermia
Assessment Goal Intervention

Subjective data:
- Reports feeling feverish and
experiencing chills
- Pain and tenderness below
the ear
Objective data:
-Elevated Body temperature
-Skin is warm &
erythematous
- Tachycardia and increased
respiratory rate
- swelling, redness and
tenderness over the parotid
gland
The patient’s - Encourage increased fluid, especially if the patient has difficulty
temperature swallowing
returns to RATIONALE: Increased fluid intake is essential to prevent
within the dehydration
normal range -Apply cool compresses to the forehead and neck or perform TSB
within 12-48 RATIONALE: maintaining a cool environment helps dissipate
hours heat, providing comfort and aiding in temperature reduction
-Encourage to rest and limit physical activity
RATIONALE: Rest is crucial for conserving energy and allowing
the body to focus on healing. Physical activity may increase
metabolic demands and contribute to an elevated temperature
- Administer acetaminophen as prescribed.
RATIONALE: can help lower the elevated body temperature
- Administer IV fluids as prescribed.
RATIONALE: to prevent dehydration
Nursing Care Plan
Impaired Swallowing related to painful glands
Assessment Goal Intervention

Subjective data The patient will Review the patient’s ability to swallow
- Report be able to exhibit RATIONALE: To verify access of feeding route
difficulty ability to safety Before mealtime, provide adequate rest periods.
swallowing swallow as RATIONALE: Fatigue can further add to swallowing impairment
evidenced by Place suction equipment at the bedside, and suction as needed.
absence of RATIONALE: With impaired swallowing reflexes, secretions can rapidly
aspiration and accumulate in the posterior pharynx and upper trachea, increasing the risk of
Objective data ability to ingest aspiration.
- Swollen & foods/fluids. Position the patient upright at a 90-degree angle with the head flexed forward at a 45-
painful degree angle.
glands RATIONALE: This position allows the trachea to close and esophagus to open,
- Incomplete which makes swallowing easier and reduces the risk of aspiration.
lip closure Ensure the patient is awake, alert, and able to follow sequenced directions before
- Lack of attempting to feed.
chewing RATIONALE: As the patient becomes less alert the swallowing response
decreases, which increases the risk of aspiration.
Provide oral care based on individuals need prior to meal.
RATIONALE: Patients with excess saliva will benefit from use of drying
agent like lemon or glycerin swabs before meal and a moisturizing agent
Nursing Care Plan
Poor appetite related to disease
Assessment Goal Intervention

Subjective data: - The patient will report - Assess weight monitoring regularly.
- Patient reports considerable appetite for RATIONALE:helps assess the effectiveness of the nutrition plan and
difficulty chewing and food. identifies the need for adjustments to prevent further weight loss.
swallowing due to pain - The patient will - Encourage the patient to sip water or other non-caffeinated, non-alcoholic
in the affected area. demonstrate improved beverages.
-Complaints of ability to chew and swallow RATIONALE: Adequate hydration supports overall well-being and may
decreased appetite without significant difficulty. facilitate swallowing
and reduced food - Modifying food texture, such as making foods softer or pureed.
intake. RATIONALE: reduces the effort required for chewing and swallowing,
improving the patient's ability to eat.
Objective data: - Providing nutrient-dense snacks between meals.
- Swollen & painful RATIONALE: ensures a more consistent intake of essential nutrients,
glands. promoting overall nutritional status.
- Weight loss or - Consuming smaller, more frequent meals may be easier for the patient.
inadequate weight RATIONALE: reducing the physical stress on the parotid gland and
gain facilitating better nutritional intake.
- Evidence of poor - Consultation with a dietitian.
nutritional intake. RATIONALE: helps in developing a customized nutrition plan based on
the patient's preferences, dietary restrictions, and nutritional needs.
 SALIVARY CALCULUS
(SIALOLITHIASIS)
• Sialolithiasis, or salivary calculi (stones),
usually occur in the submandibular gland.
• They are formed mainly from calcium
phosphate.
• Pain subsides before swelling
• Recurrent painful swelling at mealtime
• Persistent obstruction damages the gland
making it harder and tender
SALIVARY CALCULUS
(SIALOLITHIASIS)
Causes:
1. Dehydration and Decreased food intake
2. Infection
3. Salivary dysfunction
4. Ductal anomalies
5. Foreign Bodies
6. Ductal epithelium metaplasia
SALIVARY CALCULUS (SIALOLITHIASIS)

Clinical Medical Management: Surgical

Manifestation Management
Swollen, tender gland Diagnostic Test: Salivary gland Removal of the gland
Palpable stone ultrasonography or sialography – to for repeated
With obstruction: demonstrate obstruction of the duct by recurrence
sudden, local, and stenosis
often col-icky pain,
which is abruptly Antibiotics and anti-inflammatory
relieved by a gush of Stone extraction
saliva Lithotripsy - a procedure that uses shock
Pain worsen during waves to disintegrate the stone. Lithotripsy
eating requires no anesthesia, sedation, or analgesia.
Side effects can include local hemorrhage and
swelling.
Nursing Care Plan
Acute Pain
Assessment Goal Intervention

Subjective data: - Patient - Assisting the patient in finding a comfortable position.

- Patient reports pain describes RATIONALE: helps minimize pressure on the parotid gland,
and tenderness in the satisfactory reducing pain and discomfort.
affected area. pain control at a - Monitor and Document Pain Levels Regularly.
- Pain intensity rated level [target RATIONALE: Regular pain assessments guide the effectiveness
as [pain scale rating]. pain scale of interventions and help in adjusting the pain management plan
rating]. as needed.
Objective data: - The patient - Encourage rest and limiting physical activity.
- Swollen & painful reports a RATIONALE: help conserve energy, reduce metabolic demands,
glands. reduction in and alleviate strain on the affected area, contributing to pain
- Skin is warm & pain within 24 relief.
erythematous to 48 hours. - Apply Warm Compresses to the Affected Area.
- -Patient guards the - Patient RATIONALE: Warm compresses enhance blood circulation,
affected area and displays reduce swelling, and alleviate pain in the parotid gland area,
demonstrates improvement in providing comfort to the patient.
discomfort during mood, coping. - Administer Analgesics as Prescribed.
movement. RATIONALE: Analgesics, such as acetaminophen or NSAIDs, are
administered to relieve pain and discomfort associated with
parotitis, improving the patient's overall comfort and well-being.
Nursing Care Plan
Hyperthermia
Assessment
Subjective data:
- Reports feeling feverish and
experiencing chills
- Pain and tenderness below
the ear
Objective data:
-Elevated Body temperature
-Skin is warm & erythematous
- Tachycardia and increased
respiratory rate
- swelling, redness and
tenderness over the parotid
gland
Goal Intervention
The patient’s - Encourage increased fluid, especially if the patient has difficulty
temperature returns swallowing
to within the normal RATIONALE: Increased fluid intake is essential to prevent
range within 12-48 dehydration
hours -Apply cool compresses to the forehead and neck or perform TSB
RATIONALE: maintaining a cool environment helps dissipate
heat, providing comfort and aiding in temperature reduction
-Encourage to rest and limit physical activity
RATIONALE: Rest is crucial for conserving energy and allowing
the body to focus on healing. Physical activity may increase
metabolic demands and contribute to an elevated temperature
- Administer acetaminophen as prescribed.
RATIONALE: can help lower the elevated body temperature
- Administer IV fluids as prescribed.
RATIONALE: to prevent dehydration
 Nursing Care Plan
Impaired Oral Mucous Membrane
Assessment Goal Intervention

Subjective data: - The patient - Encourage the patient to drink small sips of water regularly. Give sugarless gum and
- Patient reports will maintain candy to stimulate saliva production
pain and tenderness intact oral RATIONALE: Hydration is essential for maintaining oral mucous membrane
in the parotid gland mucous integrity.
area. membranes
- Encourage gentle brushing and rinsing with a non-alcoholic, saline solution.
- Complaints of without signs
difficulty in of infection or RATIONALE: Maintaining good oral hygiene is crucial to prevent secondary
swallowing. worsening infections and promote healing
- History of inflammation. - Encourage use of moisturizing agents, such as water-based gels or oral lubricants.
decreased oral - The patient RATIONALE: can help alleviate dryness and prevent further irritation of the oral
intake. will mucous membrane
demonstrate - Assess the oral mucous membrane for signs of infection, such as increased redness,
Objective data: proper oral
- Swelling, redness, swelling, or purulent discharge regularly.
hygiene
and tenderness over practices. RATIONALE: Report any changes promptly for further evaluation and
the parotid gland. intervention.
- Dry or cracked oral - Administer analgesics as prescribed.
mucous membrane. RATIONALE: to manage pain and discomfort, facilitating improved oral care.
- Collaborate with other healthcare professionals, such as the dentist or oral care
specialist.
Complications of
Salivary Gland Disorders
• Abscess of salivary gland
• Spread of infection
• Facial nerve injury (Sialorrhea)
• Dry mouth (Xerostomia
Prevention of
Salivary Gland Disorders
• Get immunized against mumps and influenza
• There are no specific guidelines to protect against
other types of disorders. However, it is helpful to:
✓ Avoid smoking
✓ Eat a healthy diet
✓ Drink plenty of water to avoid dehydration
✓ Practice good oral hygiene, with regular tooth
✓ brushing and flossing