Management of Patients With Oral and Esophageal Disorders 

1. George Smith, a 55-year-old patient is admitted to the intensive care unit after a thoracotomy approach was used for an esophagectomy to remove an early stage adenocarcinoma of the distal esophagus and gastroesophageal junction. The patient has a history of GERD and Barrett’s esophagus. The patient sought medical treatment for dysphagia with solid foods, feeling that there was a lump in his throat and substernal pain with swallowing and subsequent regurgitation of undigested food and the development of hiccups. The patient has no other medical problems. (Learning Objectives 6 and 7) 

1. Describe the esophageal cancer that the patient has and how it relates to his history of GERD and Barrett’s esophagus.
2. Explain the rationale for the early symptoms and late symptoms of esophageal cancer.
3. What course of cancer treatment should the nurse anticipate that the patient in this case study would have?
4. What nursing care should be provided for the patient in the intensive care unit in the early postoperative period?
5. Explain the care the nurse should provide when the patient begins to eat.

2. Mr. Owens is a 62-year-old man who underwent a neck dissection yesterday due to cancer of the mouth. You are the nurse assigned to care for Mr. Owens during his first postoperative day. Initial assessment finds Mr. Owens sitting up in bed; he is drowsy, but oriented ×3 when aroused. He has significant edema in his neck and mouth area, but does not appear to be in respiratory distress. His respiratory rate is 16 to 18, and his oxygen saturation is 96% on 40% oxygen via face tent. He has two peripheral IV lines both infusing Lactated Ringer’s solution at 75 mL/hr. Two Jackson Pratt drainage tubes are partially filled with serosanguinous drainage. (Learning Objective 5)

1. What is the rationale for the patient being placed in Fowler’s position after surgery?
2. The nurse notes that there has been 240 mL output in the drainage tubes during the first 24 hours after the surgical procedure. What should the nurse do?
3. Postoperatively, the nurse identifies that the patient is at risk for imbalanced nutrition, less than body requirements related to anorexia and dysphagia. The nurse instructs Mr. Owens to eat soft food and suggests that he tilt his head to the unaffected side to facilitate swallowing. What is the rationale for these instructions?
4. In reviewing Mr. Owens’ medical record, what findings in his health history are associated with development of oral cancer?