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esophageal cancer done (Rx (nursing intervention (assess dysphagia when…

- - - - 10% post op mortality
      - 20 % 5 year survival
      - 2 approach
        
        middle & distal 1/3 lesion
        
        transthroacic
        
        transhiatal stomach anastomsis
        
        Cervical lesion
        
        bilateral neck dissection
        
        laryngectomy & thyroidectomy
        
        esophagectomy with jejunal graft
      - post op complication
        
        pneumonia
        
        dumping syndrome
        
        vagotomy cause quick gastric emptying into SI
        
        nutritional deficiencies
        
        reflux esophagitis
        
        anastomosis leakage
        
        hemorrhage
      - post op care
        
        IV fluid
        
        TPN
        
        NPO for 5-7days
        
        NG tube caring
        
        :red_cross: move/ manipulate/ irrigate/ reinsert NG tube which will damage the anastomosis
        
        all oral drug is through NG tube
        
        check for patency, dislodge, drain characteristic
  - - - diet change
      - weight loss
    - - dysphagia
      - pain
      - cough, hoarseness
  - - - jejunostomy tube
        
        clamp for 2-3 days till feeding prescribed
      - saliva drooling,
        
        meticulous mouth caring, suctioning
      - assess swallowing and leakage of anastomosis by VFSS
      - assess bowel sound
      - gradual progression from liquid to soft diet
      - remian upright for 2 hrs post meal to promote digestion
      - avoid dumping syndrome
      - consult dietitian
    - - diffculty in chewing
      - choking
      - pain during swallowing
      - ecessive throat clearing
      - sensation of food get stucks in pharyn or esophagus
      - SOB after eating
      - regurgitation
      - drooling / coughing
      - check tongue for flaccidity, spasticity
      - slurred or gurgled speech
      - weight loss
      - difficulty swallowing of liquid indicate poor muscular control
      - refer to speech therapist for swallowing reflex evaluation
      - 3 spoon of water then half a glass
        
        note for coughing, choking, wet voice
    - - monitor hemodynamic stability
        
        BP/P, RR, SpO2
      - dysrrhythmias
      - hemorrhage
      - infection
      - aspiration
      - anastomosis leakage
        
        ultrasound
      - chesst tube 1/2/3 bottle system
      - ab drains
      - cervical/neck drain : J-P drain, penrose
      - maintain pulmonary function
        
        CXR
        
        Mechanical ventilation during immediate post op
        
        pulse oximetry
        
        deep breathing & coughing exercise pre and post op
        
        incentive spirometer
        
        chest physiotherapy
        
        note for mediastinits
    - - Characteristic & amount of drainage
        
        avoid miling as it ↑ intrapleural pressure
      - Fluid swing
        
        oscillation indicate patency of system
      - pain & discomfort of chest tube
        
        secure it
      - bubble/ air leak
        
        pneumothorax not resolved
      - note for infection
        
        alert for exit site infecetion/empyema
      - don't clamp tube unless changing bottle
      - drain should below chest level
    - - Meds
        
        Initially
        
        epidural PCA
        
        then
        
        IMI analgesia prn after PCA discontinued
        
        Oral analgesia
        
        opioid/ NSAIDS
      - Non meds
        
        positioning
        
        heat aplication
        
        massage
        
        distraction
    - - observe for hemorrhage
      - note for s/s of infection
      - aseptic dressing changing
      - check for exit site of subcutaneous emphysema
        
        sudden new onset of such indicate leakage of anastomosis
      - saliva may leak form neck wound
    - - low molecular weight Heparin
        
        Fraxiparine, enoxaparine s.c route daily
      - isometric leg exercise
      - early ambulation
      - encourage PCA use of pain control
      - compression stocking
        
        remove hose 2-3 times for 30mins per day to assess skin intergrity/neurovacular status
      - intermittent pneumatic compression device on leg
    - - special consideration on diet
        
        avoid overeating
        
        small bite, avoid chunkf of meat
        
        avoid stringy raw vegies
        
        chew food well
        
        avoid meal 3 hours pre sleep
        
        Dumping syndrome
        
        frequent small meals
        
        don't drink along meals but between meals
      - report s/s of complication
        
        nausea
        
        elevated temp
        
        cough
        
        diffculty swallowing
      - ADL
        
        advance activities as tolerated
    - - encourage expression of feeling & emotion
      - diversional therapy for anxiety
      - refer to msw
      - support group
- - - - Men > women
    - - lead to squamous carcinoma
    - - cause chronic esophageal mucosal inflammation & stricture
- - - - late sign, regional/ systemic involvement
      - progressive weight loss & malnutrition**
    - - increase in mass sign
        
        resp difficulty
        
        nocturnal aspiration
        
        regugitation of food
        
        foul breath
        
        excessive saliva
        
        hiccups
      - Metastasis: hepatomegaly
- - - - estimation of tumor length
        
        polyp
        
        infiltrative / ulcerative lesion
    - - delineate extent of tumor
      - identify if adjacent invasion & metastases
    - - Adenopathy
      - widened mediastinum
      - tracheo-esophageal fistul
      - metastasis
    - - detect distant metastases
  - - - indicatied @ motility disorder
        
        esophageal spasm
        
        GERD
        
        Dysphagia
        
        achalasia
- - - - sepsis