Be sure to support the incision during coughing to reduce pain and to prevent

Be sure to support the incision during coughing to

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Be sure to support the incision during coughing to reduce pain and to prevent excessive strain on the suture line, especially with obese patients. Lifestyle modifications - eliminate alcohol, elevate bed, stop smoking, avoid lifting, reduce weight, use anti-secretory agents and antacids Surgical Therapy: o Reduction of herniated stomach o Herniotomy- excision of hernia sac o Herniorrhaphy- closure of hiatal defect ESOPHAGEAL TUMORS Although esophageal tumors can be benign, they are most often malignant. Esophageal tumors grow rapidly because there is no serosal layer to limit their extension, and spread to the lymph nodes occurs early. Risk Factors : smoking, excessive alcohol intake, Barrett’s metaplasia, central obesity, history of achalasia- delayed emptying of the lower esophagus, is associated with squamous cell cancer Clinical Manifestations : o Pain develops late- sub sternal, epigastric, or back area, increases with swallowing o Weight Loss o Regurgitation of blood- flecked esophageal contents- narrowing esophagus is severe The diagnosis of esophageal cancer causes high patient anxiety, as it is accompanied by distressing symptoms and is often terminal. Medical and surgical treatment is based on the extent and location of the tumor. Respiratory care is the highest postoperative priority for patients having an esophagectomy.
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o Which is a removal of part or all of esophagus Before beginning oral feedings postoperatively, a cine-esophagram study is performed to detect the presence of anastomotic leaks or strictures or signs of aspiration. When discharged, teach patients about the signs of anastomosis leakage and the importance of reporting them to the health care provider immediately. Teach the patient and family members to report the presence of fever and a swollen, painful neck incision, which could indicate an anastomotic leak. The most specific common problem for patients with esophageal cancer is decreased nutritional intake related to impaired swallowing and possible metastasis. Many patients with cancer also have pain and are fearful due to the diagnosis of cancer. ESOPHAGEAL DIVERTICULA Diverticula are sacs that may develop anywhere along the length of the esophagus, resulting from the herniation of esophageal mucosa and submucosa into surrounding tissue. Occur in 3 main areas: o Zenker’s diverticula - (pharyngeal pouches) above the upper esophageal sphincter- it is the most common form and occurs most often in older adults above 60 o Traction diverticulum - near esophageal midpoint, may not have signs and symptoms o Patient frequently complains of tasting sour food and smelling a foul odor caused by the stagnant food o Epiphrenic diverticulum - above the LES Patients complain of dysphagia, regurgitation, nocturnal cough, and halitosis, and may be at risk for perforation because the mucosa is without the protection of the normal esophageal muscle layer.
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  • Fall '19
  • acute pain, Helicobacter pylori

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