Question

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.

Answer 1

Esophageal cancer is cancer that occurs on the esophagus. It is caused by tobacco and alcohol use and different food habits and obesity. The patient has symptoms of difficulty swallowing, weight loss, chest pain, heartburn, and coughing. Barrett's esophagus is a precancerous condition, it increases the risk of esophageal cancer. Long term esophageal reflux disease (GERD) can cause Barrett's esophagus. it is important to checkup for precancerous cells if they diagnosed with Barrett's esophagus and GERD.
Patient with esophageal cancer initially they do not have any changes they have mild symptoms like pain swallowing when eating solid foods. When a tumor grows the pathway in the esophagus narrow there will be a pain even with liquid foods, heartburn, indigestion, pain in the chest, vomiting, chocking with foods, weight loss, hoarseness of voice, pain the throat.
chemotherapy and radiation therapy followed by surgery is recommeded. palliative and supportive care can be given to cahnge physical, emotional and social needs and reduce the symptoms. the patient needs medication, nutritional changes, and relaxation therapy. patient, in this case, needs total parenteral nutrition until the patient can able to swallow the foods.
Early postoperative period nursing care includes
-vital signs monitoring
-Respiratory and cardiac monitoring
-Observe patient neurological status for responsiveness, unilateral weakness, and pain, etc.
-Control pain with analgesia like morphine, NSAID and opioids, etc..
-Maintain proper positioning and make the patient comfortable.
-Provide suctioning and chest physiotherapy, nebulizers.
-Drainage should be monitored for any fresh bleeding. the amount should not be more than 100 to 200 ml/hr for the first day. drainage should decrease slowly.
-keep the chest tube clean and dry. Keep the tube free from loops, assess air leak.
- Observe the patient for fever, tachycardia, and hypoxemia.
-maintain IV fluids to prevent hypovolemia and avoid overloading.
-Total parenteral nutrition should be maintained for up to 3 days until the patient able to swallow the food.
-Monitor intake and output
-Provide wound care to avoid infection
-Heparin shots needed to avoid DVT until the patient mobilized.
-Provide counseling for the family and patients.
Nursing care when the patient begins to eat
-maintain upright positioning while eating.
-Ask the patient to chew slowly
-Provide 6 to 8 small frequent meals per day.
-Avoid hot, cold and spicy foods.
-Provide protein, high-energy foods
-Get dietician involved in patient care
-Eat before 3 hours bedtime to avoid reflux
-Provide a liquid diet and low carbohydrate meals.