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ADULT HEALTH 1
CHAPTER 48-49 Assessment of the Gastrointestinal System
| Question | Answer |
|---|---|
| WHAT IS THE FUNCTION OF THE GI TRACT? | Secretion-ENZYMES-BEGINS IN ORAL CAVITY • Digestion-mechanical -breakdown food • Absorption- small intestine(chyme)-h20 and electrolytes in large.I • Motility- • Elimination- |
| THE ANATOMY OF THE GI INCLUDES: | THE ORAL CAVITY-ESOPHAGUS, SMAL AND LARGE INTESTINE SPHINCTER-PREVENT BACKFLOW OF CONTENT LIVER, GALLBLADDER, SALIVARY GLAND, PANCREAS=BREAKDOWN FOOD |
| DOES AGING CHANGE THOSE FUNCTIONS? | YES- I.E ORALL CAVITY(DENTATION)LOSE TEETH , PROBLEM WITH DENTURE=DIFFICULTY BREAKING DOWN FOOD IN MOUTH |
| DOES AGING CHANGE THOSE FUNCTIONS? | YES I.E ESOPHAGEAL-LOTS OF REGURGITATION ATROPHY OF GASTRIC MUCOSA, DECREASE CHLORIDE ACID FOOD BREAKDOWN AFFECT LNUTRITION |
| DOES AGING CHANGE THOSE FUNCTIONS? | YES I,E POOR SECRETION OF DIGESTIVE ENZYME, AND ABSORPTION OF VIT B12 AND IRON |
| DOES AGING CHANGE THOSE FUNCTIONS? | YES I.E-DECREASE PERISTALSIS, IMPULSE = CONSTIPATION DUE NOT HAVING URGE TO DEFECATE |
| DOES AGING CHANGE THOSE FUNCTIONS? | YES I.E-DECREASE EXCRETION, DECREASE HEPATIC CELL THAT RELEASE ENZYME FOR FAT BREAKDOWN -COULD LEAD TO TOXICITY |
| High-patient centered care start with? | A GOOD PT. HX ANY NSAID, LAXATIVE, STIMULANT,ANTICOAGULLANT? SURGERY HX? ANY RECENT TRAVEL? COULD HAVE INTRODUCE BACTERIA INTO GOUT ... ANY SMOKING,? VOIDING, BM? |
| WHAT IS INCLUDE IN NUTRITION HX? | WHAT DIET ? HOW OFTEN EATING? ANY ALLERGIES? ANYTHING CULTURAL? ANY CHANGE IN APPETITE RECENTLY? HOW OFTEN EATING? SPECIAL FAT DIET-HELP INDICATE NEW PROBLEM IN THEIR LIFE |
| FAMILY HX INCLUDE? | DIRECT HISTORY OF FAMILY MEMBER WITH CANCER-I.E POLYPS OR COLON ARE GENETIC ANY OTHER? |
| WHAT IS THE FIRST INDICATION THAT A GI PROBLEM IS OCCURING? | SORE IN MOUTH CHANGE IN APPETITE-ABSORPTION WEIGHT GAIN/LOSS MALNUTRITION-POOR FOOD BREAKDOWN POOR ELIMINATIONS |
| PAIN ASSESSMENT? | WHEN DID IT START, LOCATION, WHAT MAKES IT BETTER OR WORSE, HOW LONG? WHAT IS THE INTENSITY? SHARP, DULL, PINS AND NEEDLE? |
| DURING AN ASSESSMENT, THE NURSE MUST START WITH | AN INSPECTION OF THE ABDOMEN-DISTENTION, BULGING, SYMMETRY, EVEN SKIN TONE? JAUNDICE THEN AUSCULTATION-HYPE/HYPOREACTIVE? ANY FLATUS, BRUIT? THEN LIGHT PALPATION-START AWAY FROM PAINFUL AREA |
| WHAT ARE THE PSYCHOSOCIAL FACTORS ASSOCIATE WITH GI SYSTEM? | STRESS-DEPRESSION:IF WORRIED ABOUT SURGERY OR HAVE A BAG OF ILEOSTOMY , SORE IN MOUTH WILL MAKE IT HARD TO EAT IN PUBLIC-CHANGE IN BM |
| WHAT LABS MIGHT BE NEEDED FOR DIAGNOSTIC EXAM? | URINE:AMYLASE-PANCREATITIS STOOL:FECAL OCCULT BLOOD FECAL IMMUNOCHEMICAL TEST-COLORECTAL CANCER PARASITES OR INFECTIOUS AGENTS C.DIFF FECAL FATS-MALABSORPTION |
| WHAT IS CBC? | ANEMIA-GI BLEED OR INFECTION HGB-HCT |
| WHAT IS BMP? | ELECTROLYTES ABSORPTION- OR DISTURBANCE WITH DIARRHEA, VOMITING LOOK AT CA LEVEL AS IT IS ABSORB IN INTESTINE |
| ALT/AST? | THEY ARE THE LIVER ENZYMES |
| PT-prothrombin time, | LIVER IS RESPONSIBLE FOR MANY COAGULATION |
| IMAGING COULD BE? | XRAY:PLAIN FILM-CHECK FOR MASSES, AIR OR STRUCTURAL CHANGES ACUTE ABDOMEN SERIES-IMAGE TAKEN FROM DIFFERENT ANGLES-HERNIAS, BOWEL PERFORATION UPPER GI-ENDOSCOPY-BARIUM LOWER GI-SCREEN FOR CANCER CT OR MRI |
| EGD(ESOPHAGOGASTRODUODENOSCOPY) | assess ESOPHAGUS-STOMACH AND DUODENUM PATIENT IS NPO 6-8 HOURS PRIOR MODERATE SEDATION AVOID NSAIDS OR ANTICOAGULANT PRIOR upper gi bleed can be treated while endoscopy is in place |
| ERCP(ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY) | SPRAY TO NUMB GAG RELFEX NPO 6-8 HRS PRIOR MODERATE SEDATION ASSESS ALLERGIES TO CONTRAST NURSE MONITOR LOC AND O2 SAT-VITALS |
| SMALL BOWEL CAPSULE STUDY | PROVIDE IMAGE OF SMALL BOWEL- H20 ONLY FOR 810 HOURS BEFORE NPO 2 HOURS AFTER SWALLOWING CAPSULE NORMAL DIET AFTER 4 HOURS |
| A NURSE KNOWS THAT A COLONOSCOPY PREPARATION INCLUDE? | CLEAR LIQUID DIET NPO 4-6 HOURS PRIOR BOWEL CLEASING PREP -APPROPRIATELY |
| A NURSE KNOWS THAT A COLONOSCOPY PROEDURE INCLUDE? | MUST HAVE A 20G IV ACCESS-SEDATION(PROPOFOL+PAIN MEDS) MONITOR VITALS , LOC, PATENT AIRWAY AND HEMODYNAMICS STATUS GO BACK TO MED ROUTINE |
| A NURSE KNOWS THAT A COLONOSCOPY FOLLOW UP CARE? | MONITOR FOR PAIN AND VITALS PATIENT ON LEFT SIDE KEEP NPO UNTIL ALERT AND PATIENT PASSES FLATUS |
| OTHER DX TESTS-NON INVASIVE ARE? WASH HAND PROPERLY FOR 24HRS | FASTING PRIOR: ULTRASONOGRAPHY-:ASSESS SOFT TISSUE-LIVER-SPLEEN-BILE ENDOSCOPIC ULTRASONOGRAPHY-:TUMOR OF LYMPH NODE, STOMACH AND RECTUMS MUCOSA LINING, PANCREAS LIVER-SPLEEN SCAN-USE CONTRAST THROUGH IV TO SEE TUMOR,OR ABSCESSES-SIZE, LOCATION |
| CHAPTER 49 | |
| Care of Patients with Oral Cavity and Esophageal Problems | |
| WHAT ACTIONS SHOULD A NURSE IMPLEMENT WITH PATIENT SUFFERING WITH ORAL CAVITY OR ESOPHAGEAL PROBLEMS? | THE NURSE SHOULD FOCUS ON NUTRITION, TISSUE INTEGRETY, GAS EXCHANGE, PAIN AND SELF-ESTEEM |
| WHAT IS STOMATITIS AND WHAT ARE THE PRIMARY AND SECONDARY TYPE? | STOMATITIS:PAINFUL SORES IN MOUTH PRIMARY CAN LEAD TO SECONDARY TYPE PRIMARY TYPE: APHTHOUS HERPES SIMPLEX TRAUMATIC ULCERS SECONDARY TYPE-IMMUNO COMPROMISED ARE PRONE TO THIS: CANDIDIASIS |
| WHAT ARE THE RISK FACTOR AND ETIOLOGY OF STOMATITIS? | THEYR ARE: INFECTION ALLERGIES TO FOOD(IRRITATION OF LINING OF MOUTH) VITAMIN DEFICIENCY/WEAKEN IMMUNE SYSTEM SYSTEMIC DISEASE-OR MEDICATION USED FOR TREATMENTS IRRITANTS(SMOKING/ALCOHOL) STRESS |
| THE MOST CRUCIAL NURSING CARE IS | PATIENT EDUCATION FOR PREVENTION NOT SMOKING/ALCOHOL MANAGING STRESS A THOROUGH PATIENT HX PHYSICAL ASSESSMENT(NOTE LOCATION, DRAINAGE, COLOR)HOW DOES IT AFFECT PATIENT EATING /SWALLOWING ABILITY? |
| NURSING INTERVENTION? | EDUCATE APPROPRIATE ORAL CARE(DELEGATE) CLEAN Q2H SPECIAL CONSIDERATION TO INTUBATED PATIENT AVOID ALCOHOL MOUTHWASH; USE HCO3, HYDROGEN PEROXIDE OR WARM RINSES |
| A PATIENT WITH STOMATITIS SHOULD LIMIT USE OF MEDICATION THAT HAS STOMATITIS AS AN ADR SUCH AS: | ANTIBIOTIC-CHANGE NORMAL FLORA IN MOUTH=SUSCEPTIBLE TO CANDIDIASIS |
| THE PATIENT KNOW TO USE TOPICAL OR ANTIMICROBIAL RINSES AGENT SUCH AS? | BACTERIAL-TETRACYCLINE VIRAL-ACYCLOVIR FUNGAL-NYSTATIN ORAL GEL OTC |
| NAME 1 OF THE 3 COMMONS ORAL LESIONS: | LEUKOPLAKIA-WHITE PATCHES BENIGN-CAN PROGRESS TO MALIGNANT DUE MECHANICAL TRAUMA POOR FITTING DENTURE, TOBACCO USES, POOR ORAL CARE ONE OF HIV S/S- RELATED TO (epstein barr) |
| NAME 1 OF THE 3 COMMONS ORAL LESIONS: | ERYTHROPLAKIA (RED VELVETY PATCHES) PROGRESS TO MALIGNANT LESION AND NEEDS BIOPSY TO DISTINGUISHED FROM INFLAMMATORY LESIONS |
| NAME 1 OF THE 3 COMMONS ORAL LESIONS: | ORAL CANCER VISIT DENTIST TWICE YEARLY |
| A PATIENT COMES TO THE ER WITH RED RAISED AND ERODED LESIONS ON THE LIPSTHAT LASTED MORE THAT 2WEEKS. WHICH TYPE OF ORAL CANCER IS THIS? | SQUAMOUS CELL CARCINOMA (CAN AFFECT LIPS, TONGUE, BUCCAL MUCOSA, AND OROPHARYNX) |
| WHAT ARE THE RISK FACTORS OF SQUAMOUS CELL CARCINOMA? | MOST COMMON, 90% OF ORAL CANCER TOBACCO USE ADVANCING AGE GUM OR PERIODONTAL DISEASE SUN EXPOSURE POOR NUTRITION SPECIFIC HPV VIRAL STRAND |
| I KNOW THAT RAISED SCAB, PRIMARILY ON THE LIPS IS: | BASAL CELL CARCINOMA ASYMPTOMATIC SCAB PROGRESS IN RAISED ULCER |
| THE RISK FACTORS: | EXPOSURE TO SUN LIGHT |
| A PATIENT WITH AIDS COME FOR AN ANNUAL CHECK UP WITH RAISED PURPLE NODULE ON THE HARD PALATE, GUMS, TONGUE AND TONSILS. THE NURSE KNOW THAT TIT IS CALLED? | KAPOSI'S SARCOMA LESS COMMON |
| THE NURSE MUST GATHER: | PMHX-TOBACCO USE, ORAL CARE , SUN EXPOSSURE, EATING HABIT, DIFFICULTY EATING OR SWALLOWING? EFFECT ON LIFESTYLES-SOCIAL |
| BIOPSY CT SCAN- OR MRI TUMOR THICKNESSS OR METASTASES | |
| THE NURSE SHOULD DO WHAT WHEN TREATING ORAL CANCER? | MANAGE AIRWAY CHECK ABILITY TO SWALLOW PREVENT ASPIRATION ORAL HYGIENE-Q2H RADIATION-SHORT VISIT WITH FAMILY MEMBER-PREGNANT WOMEN SHOULD NOT BE IN CONTACT WITH RADIATION EDUCATE PATIENT |
| WHAT EXTENT DOES THE SURGERY DEPENDS ON? | SIZE AND LOCATION-PROGRESSION INVASION OF TUMOR METASTASIS *(COULD EXTEND REMOVAL TO TONGUE, PART OF JAR, OR NECK WHEN LYMPH NODES ARE INCLUDED)* |
| PREOPERATIVE CARE | PATIENT AND FAMILY SHOULD BE FULLY INFORMED PROFESSIONAL TEETH CLEAN DECREASE RISK OF INFECTION DIET STATUS |
| POST-OPERATIVE CARE | MAINTAIN PATENT AIRWAY TAKE CARE OF INCISON PAIN DIET LIFESTYLE CHANGE AFTER SURGERY INFORM PATIENTOF ANY ABNORMALITY THAT WILL NEED TO BE NOTIFIED. |
| DISORDER OF the SALIVARY GLANDS | |
| WHAT IS ACUTE SIALDENITIS? | AN INFLAMMATION OF SALIVARY GLANDS CAUSE BY INFECTION, IRRADIATION, HUMOLOGIC DISORDER RISK FOR PUS OR ABSCESS |
| THE NURSE KNOWS TO ASSESS FOR? | DRY MOUTH, DEHYDRATION ( POOR SKIN TURGOR ) STOP TETRACYCLINE(CAN DECREASE SALIVA) CRANIAL VII-PROBLEM WITH SALIVRA CAN INHIBIT ITS FUNCTION |
| THE NURSE MUST MAKE SURE THAT THE PATIENT IS: | WELL HYDRATED WARM COMPRESS OR MASSAGE OF GLAND SALIVA SUBSTITUTE FOOD THAT STIMULATED FLOW OF SALIVA SYNAGOGUE |
| WHAT IS POST-IRRADIATION SIALADENITIS? | XEROSTOMIA-EXCESSIVE DRY MOUTH DUE TO RADIATION EXPOSURE *INCREASED DRYNESS OF MOUTH; LONG TERM SALIVA SUBSTITUE* |
| WHAT IS SALIVARY TUMOR? | CAN AFFECT CRANIAL NERVE 7 RAISE EYEBROW-POCK CHEEKS LOOK AT LIPS AND LOOK FOR SYMMETRY REMOVAL WILL REQUIRE LONG TERM SALIVA SUBSTITUTE, |
| WHAT IS GASTROESOPHAGEAL REFLUX (GERD)? | IT IS THE BACKFLOW OF FLUID INTO THE ESOPHAGUS, DUE TO RELAXATION OF THE LOWER ESOPHAGEAL SPHINCTER(LES) |
| THE CONTRIBUTING FACTORS ARE : | OBESITY NIGHTTIME HIATAL HERNIA H.PYLORI(DECREASE GASTRIC EMPTYING) INCREASE PRESSURE AGAIN LES. FULL STOMACH=EXCESSIVE PRESSURE ON LES |
| PATHOPHYSIOLOGY OF GERD: | PH OF STOMACH IS 1.5-2 PH OF ESOPHAGUS 6-7 CONSTANT BACKFLOW IRRITATES THE LINING, MAKES IT DIFFICULT FOR REMOVAL OF REFLUX=EROSIONS=ESOPHAGUS NOT HEALING FROM ACIDIC CONTENTS |
| HOW DOES THE BODY COMPENSATE FOR THIS? | 1. INCREASE BLOOD FLOW TO ESOPHAGUS=EROSIONS-ULCERATION 2. USE BARRETT'S EPITHELIUM , INSTEAD OR SQUAMOUS CELL. THIS CAUSES PRE-MALIGNANT TISSUE=INCREASE RISK FOR ESOPHAGEAL CANCER IN FUTURE 3.SCARING , CAUSES ESOPHAGEAL SCTRICTURE=DYSPHAGIA |
| IF THE REFLUX IS NOT APPROPRIATELY CONTROLLED, WE CAN EXPECT: | BLEEDING, ASPIRATION=PNEUMONIA AND DENTAL DECAYS. |
| THE RISK FACTORS OF GERD: | OVERREACTING, SMOKING, ALCOHOL, CAFFEINE, HIGHLY ACIDIC FOODS, PREGNANCY, AND ASCITES |
| THE NURSE CARING FOR A PATIENT WITH GERD, SHOULD? | GET HX:WHEN DID IT START? ANY INDIGESTION. PAIN, DISCOMFORT? BLECHIN/FLATULENCE LUNG SOUND-DUE TO ASPIRATION DYSPHAGIA/ODYNOPHAGIA COUGH(FLUID IN BACK OF THROAT) ANY CHEST PAIN? UPPER ENDOSCOPY(EGD,) BIOPSY(TO SEE IF ITS H.PYLORI) PH MONITORING |
| WHY IS THE THE CAPSULE ATTACHED TO WALL OF ESOPHAGUS? | PH MONITORING FOR 24 -HOURS, TO MONITOR THE PH OF THE INGESTED FOOD ASSESS IF THERE IS ANY INAPPROPRIATE PH CHANGE, WHICH INDICATE GERD |
| IS NUTRITION THERAPY IMPORTANT? | YES, A DIETICIAN CONSULT IS CRUCIAL AS IT WILL DISCOURAGE FOOD THAT MAY INCREASE PT S/S I.E CAFFEINE, ALCOHOL OR FATTY FOOD. |
| WHAT IS INCLUDE IN THE DRUG THERAPY? | ANTACIDS HISTAMINE BLOCKERS PROTON PUMP INHIBITORS (PPI)(LONG-TERN-INCREASE OSTEOPOROSIS, NEPHROTOXICITY, C.DIFF, COMMUNITY ACQUIRED PNEUMONIA) CAN BE PO, OR IV (PPI) SUCRALFATE |
| WHAT ARE SOME LIFESTYLE CHANGES? | CHANGING SLEEPING POSITION AVOID LIFTING HEAVY ITEM(PREVENT PRESSURE ON LES) DO NOT LAYDOWNS RIGHT AFTER EATING AVOID CONSTRICTING CLOTHING |
| WHAT ARE THE SURGICAL PROCEDURE? | LAPAROSCOPIC NISSEN FUNDOPLICATION LINX |
| WHAT IS HIATAL HERNIA? | A STOMACH PROTRUDE THROUGH THE ESOPHAGEAL HIATUS . Hiatal hernia, part of the stomach pushes into the chest cavity. It enters via an opening where the food tube (esophagus) passes on its way to the stomach. |
| WHAT ARE THE COMMON TYPES OF HIATAL HERNIA? | SLIDING HIATAL HERNIA(TYPE 1) AND PARAESOPHAGEAL(ROLLING) HIATAL HERNAL |
| WHAT ASSESSMENT SHOULD I BE CONCERN ABOUT? | PMH ANY PAIN, DISCONFORT, REFLUX, EATING HABITS TYPE 1(REGURGITATION, BELCHING OR CHEST PAIN) TYPE2(ROLLING) SOBFEELING OF BEING TOO FULL AFTER EATING ASS LUNG SOUND |
| WHAT DIAGNOSTIC TESTS? | BARIUM SWALLOW STUDY WITH FLUOROSCOPY-HW CONTENT MOVE THROUGH GI SYSTEM EGD-CHECKING FOR ANY ABNORMALITIES THAT'S OCCURRING |
| WHAT SHOULD I IMPLEMENT, NON-SURGICALLY? | DRUG THERAPY I.E:PPI LIFESTYLE CHANGES |
| WHAT PROCEDURES ARE USED FOR HIATAL HERNIA? | PRE-OP- LAP NISSEN TRANS-THORACIC PARAESOPHAGEAL REPAIR |
| WHAT ARE PRE-OP EDUCATION? | ENCOURAGE PATIENT AT WEIGHT LOSS DIETARY RESTRICTIONS EDUCATE ON LIFESTYLE, ACTIVITES, DIETARY CHANGES AFTER SURGERY |
| WHAT ARE POST-OP CONSIDERATION? | COMPLICATION? TEMPORARY DYSPHAGIA AT RISK FOR ASPIRATION DIFFICULTY PASSING GAS ACTIVITY AND DIET WILL PROGRESS SLOWLY INCENTIVE SPIROMETRY CARE FOR INCISION NG TUBE |
| ESOPHAGEAL TUMORS ARE: | MOSTLY MALIGNANT THAN BENIGN. SUCH AS: SQUAMOUS CELL CARCINOMA = UPPER PORTION OF ESOPHAGUS ADENOCARCINOMA=DISTAL THIRD OF ESOPHAGUS(COMMON) METASTASIS=EXCESSIVE LYMPH TISSUE IN ESOPHAGUS. |
| WHAT ARE THE RISK FACTORS? | UNTREATED GERD(BARRET ESO) OBESITY SMOKING DIET(FERMENTED FOOD) AND LOW IN FRESH FOOD AND VEGETABLE |
| SYMPTOMS OF ESOPHAGEAL TUMORS: | DYSPHAGIA(STRICTURE FORM AS ESOPHAGUS TRIED TO HEAL) FOUL BREATH FREQUENT HICCUPS , REGURGITATION AND VOMITING |
| WHAT ARE DX TESTING? | BARIUM SWALLOW STUDY WITH FLUORSCOPY ESOPHAGEAL ULTRASOUND PET-METASTASIS-TISSUE EXPOSED TO LYMPH TISSUE EGD-BIOPSY |
| THE NURSE MUST ASSESS.... FOR ESOPHAGEAL TUMOR? | PMH DIET LIFESTYLE PAIN PHYSICAL DYSPHAGIA, ODYNOPHAGIA HALITOSIS AND COUGH |
| THE NON-SURGICAL MEASURES FOR ET ARE: | MONITOR FOR S/S OF MALNUTRITION AND ASPIRATION DUE TO INABILITY TO EAT DIETICIAN CONSULT CHEMOTHERAPY +RADIATION(FOR NON-SURGICAL CANDIDATE) ESOPHAGEAL DILATION-METAL STENT-RELIEVE DYSPHAGIA-ULCER, BACTEREMIA ,FISTULA CAN OCCUR ENDOSCOPIES THERAPIES |
| THE SURGICAL MEASURES FOR ET ARE: | Esophagectomy • Esophagogastrostomy -REMOVAL OF TUMOR(PART OF ESOPHAGUS-SUSTITUE WITH OTHER PART OF BODY) • Minimally invasive esophagectomy • Colon interposition |
| WHAT ARE PRE-OP CONSIDERATION FOR ESOPHAGEAL TUMOR? | PROMOTE SMOKING CESSATION NUTRITION SUPPORT=TO ALLOW THEM TO EAT TUBE FEEDING-PN-START BEFORE TO IMPROVE HEALING AFTER SURGERY PSYCHOLOGICAL SUPPORT |
| WHAT ARE POST-OP CONSIDERATION FOR ESOPHAGEAL TUMOR? | RESPIRATORY CARE-INCENTIVE SPIROMETER -DEEP COUGH AND BREATHE *PREVENT PNEUMONIA AND ATELECTASIS* IF LYMPH NODES REMOVAL=PT AT RISK FOR FLUID OVERLOAD=ARRHYTHMIAS CARDIOVASCULAR MONITORING INFECTION PREVENTION NG TUBE |
| WHAT IS THE BIGGEST COMPLICATION WITH A MORE INVASIVE PROCEDURE, WHERE A PART COLON WAS USED TO CREATE A NEW ESOPHAGUS? | AT INCRESED RISK FOR LEAKAGE AT SITE MONITOR FOR FEVER, INFLAMMATION, TACHYCARDIA, TACHYPNEA FOR ANY SUDDEN CHANGE PATIENT WILL HAVE NG TUBE AFTER-MONITOR FOR BLOCKAGE ELEVATE HEAD AT 30 DEGREE |
| WHAT ARE THE 3 TYPES OF ESOPHAGEAL TRAUMA? | BLUNT, CHEMICAL AND STRESS TRAUMA |
| WHAT ASSESSMENT ARE DONE FOR E.TRAUMA? | MAINTAIN PATENT AIRWAY MONITOR DYSPHAGIA AND BLEEDING |
| WHAT ARE SOME INTERVENTIONS NEEDED? | NPO ESOPHAGEAL REST STEROID TO DECREASE INFLAMMATION , PAIN MANAGEMENT AND SURGICAL REPAIR |
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