OluwaBusayo (Busayo) Ojo
Med Surg #2
Nursing Care Plan #3
8/17/20
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
...
OluwaBusayo (Busayo) Ojo
Med Surg #2
Nursing Care Plan #3
8/17/20
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. Medical Diagnosis: Esophageal Cancer
Definition/etiology/pathophysiology
Esophageal cancer can be of two cell types: adenocarcinoma and squamous cell carcinoma. It
is found primarily in the distal esophagus and gastroesophageal junction.
Risk factors for esophageal cancer include chronic esophageal irritation or GERD. In the
U.S, cancer of the esophagus has been associated with ingestion of alcohol and the use of
tobacco. There is an apparent association between GERD and adenocarcinoma of the
esophagus. People with Barrett’s esophagus (which is caused by chronic irritation of the
mucous membranes due to reflux of gastric and duodenal contents) have a higher incidence
of esophageal cancer.
Tumor cells of adenocarcinoma and squamous cell carcinoma may spread beneath the
esophageal mucosa or directly into, through and beyond the muscle layers into the
lymphatics. In the latter stages, obstruction of the esophagus is noted, with possible
perforation into the mediastinum and erosion into the great vessels.
2. Common signs and symptoms:
Advanced ulcerated lesion of the esophagus
Dysphagia
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Sensation of a mass in the throat
Painful swallowing
Substernal pain or fullness
Regurgitation of undigested food with halitosis and hiccups
Progressive loss of weight and strength occurs from inadequate nutrition
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