Primary Nursing Diagnosis

Risk for aspiration related to regurgitation of food, fluid, or secretions that have accumulated in diverticula

OUTCOMES. Knowledge: Treatment procedures; Respiratory status: Ventilation; Neurological status; Nutritional status: Food and fluid intake; Oral health; Self-care: Eating

INTERVENTIONS. Airway suctioning; Surveillance; Respiratory monitoring; Feeding; Positioning

^ PLANNING AND IMPLEMENTATION Collaborative

MEDICAL. When achalasia is implicated, pharmacologic therapy may be the first procedure. Assess the effects of treatments because the drugs may worsen the diverticula by relaxing an already weakened esophageal musculature.

SURGICAL. An esophagomyotomy (incision into the esophageal musculature) and divertic-ulectomy (surgical removal of the diverticulum) may be warranted, particularly for patients with Zenker's diverticulum. A cricopharyngeal myotomy, a procedure in which the surgeon divides the cricopharyngeal muscle, involves cutting the muscle to make it incompetent so that when the individual swallows, the muscle relaxes and allows food to pass through. Postoperative care is determined by the incisional approach. With a cervical approach, a drain is commonly inserted in the neck to diminish edema at the incisional site. A chest incision (thoracic approach) requires care associated with a thoracotomy. Postoperative care is directed at monitoring the patency of the airway, maintaining pulmonary ventilation by chest drainage with chest tubes, monitoring neck drainage with either gravity drainage or low suction, and preventing aspiration.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Smooth muscle

Varies with drug

Nitrates or calcium-

Relax the cardiac sphincter, preventing

relaxants

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