Transcript Salivary Gland Disorders

NURSING CARE
SALIVARY GLAND DISORDERS
By
Ni Ketut Alit A
Faculty Of Nursing Airlangga University
REFERENCES
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Black, J.M. & Matassarin E, (1997). Medical Surgical
Nursing: Clinical Management for continuity of
care. J.B. Lippincott.co.
Barbara C.L & Wilma J.P. (2006). Essentials of Medical
Surgical Nursing. Philadelphia: Lippincott Williams &
Wilkins.
Smeltzer, S.C., & Bare, B. (2003). Brunner and
Suddarth's Textbook of Medical-Surgical Nursing
(10th ed.). Philadelphia: Lippincott Williams & Wilkins.
Ignativicius & Bayne. (2001). Medical and Surgical
Nursing. Philadelphia: W.B. Saunders Company.
Luckman & Sorensen. (2000). Medical Surgical
Nursing. Philadelphia: W.B. Saunders Company.
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OVERVIEW
•Salivary glands are exocrine glands
(have duct system to flow their secretions)
TYPES OF SALIVARY GLANDS
The Major Salivary Glands
•Parotid glands.
•Submandibular glands.
•Sublingual glands.
The Minor Salivary Glands
•Labial & buccal glands.
•Glossopalatine glands.
•Palatine glands.
•Lingual glands.
PAROTID GLAND
The largest salivary glands.
Located inferior and anterior to the ears, between the skin and the masseter
muscle.
The parotid duct (stanson’s duct ) emerges from the anterior border of
the gland and passes forward over the lateral surface of the masseter, enters
the vestibule of the mouth upon a small papilla opposite the upper second
molar tooth.
It’s a pure serous gland, composed mostly of serous acini.
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Structures passing through parotid gland:
Facial nerve.
Retromandibular vein.
External carotid artery.
SUBMANDIBULAR GLAND
Found in the floor of the mouth; it is medial and partly inferior to the body of
the mandible.
It is divided into superficial and deep parts by the mylohyhoid muscle.
The submandibular duct ( wharton’s duct ) emerges form the anterior
end of the deep part of the gland and runs forward beneath the mucous
membrane of the mouth, It opens at the lingual frenulum on the floor of
the mouth.
It has a mixed secretion both serous and mucous, consists of a mixture of
serous and mucous acini.
SUBLINGUAL GLAND
Located beneath the tongue and superior to the
submandibular gland.
It’s ducts open into the floor of the mouth in the oral cavity.
It’s a mixed gland, it has both serous and mucous acini, with
the latter predominating.
NERVE SUPPLY OF MAJOR SALIVARY GLANDS
Parotid Gland
Parasympthetic secretomotor supply arises from the
glossopharyngeal nerve.
NERVE SUPPLY OF MAJOR SALIVARY GLANDS
Submandibular Gland
Parasympathetic secremotor supply is from the facial nerve.
The postganglionic fibers pass directly to the gland.
Sublingual Gland
Parasympathetic secretomotor supply is from the facial nerve.
Postgaglionic fibers pass directly to the gland.
FUNCTION OF SALIVA
Digestion : Moistens dry foods to aid swallowing.
Disinfectants : Salivary lysozyme, IgA and other
antibacterial substances protect against caries and oral
cavity infections.
Hormonal : Saliva secretes Gustin hormone which is
thought to play a role in the development of taste buds.
Salivary Glands
Non-neoplastic diseases
(Infections and Inflammations )
Mumps
Mumps is an acute sialadenitis which
caused by an RNA virus
This RNA virus is the “paramxovirus”
Other virus which can cause salivary
infections are:
Cytomegalovirus
Coxsackieviruses
Echovirus
Mumps
CLINICAL FEATURES
Airborne droplets transmit mumps virus
It mainly effects the parotid gland.
Children between the ages of 5-18 years are infected the most.
Once exposed the patient will develop the disease within 2-3 weeks
There is rapid swelling of the parotids bilaterally
There is an acute pain while salivation.
Symptoms:
• Asymptomatic
•Swollen, painful salivary glands on one or both sides .
•Pain with chewing or swallowing
•Fever
•Weakness and fatigue
Complications:
Complications of mumps are potentially serious, but rare. These include:
•Pancreatitis
•Orchitis
•Meningitis
Mumps
Treatment:
• Mumps is a self-limited disease .
•Treated with bed rest .
•Use analgesics to relieve pain and reduce fever such as:
•Acetaminophen .
•Nonsteroidal anti-inflammatory drugs.
•Complications may require treatment in the hospital.
Prevention:
The most common preventative measure against mumps is immunization with
a mumps vaccine.
Sialolithiasis
•Sialolithiasis is the formation or presence of a calculus or
calculi in a salivary gland.
•It is most commonly seen in the submandibular gland
and duct (about 80% of cases), then the parotid gland
and duct .
•Sialolithiasis is rare in the sublingual gland.
•Most stones are solitary, but multiple stones may be present.
•The reason why a stone forms is unknown
Sialolithiasis
Symptoms:
• May be asymptomatic
•Dull pain from time to time over the affected gland
•Swollen .
•Pain with chewing or swallowing
Complications:
•Oral infection
Investigations:
•CT scan, ultrasound scan or MRI scan.
•Sialography (silogram).
•Sialendoscopy.
Sialolithiasis
Treatment:
• Gentle probing into the duct from inside the mouth with a thin blunt instrument
can sometimes free a stone which then falls into the mouth. This is done by a
doctor.
•Therapeutic sialendoscopy It uses a very thin endoscope (tube) with a camera and
light at the tip. The tube is pushed into the duct. If a stone is seen, then a tiny pair
of 'grabbers' that are attached to the tube is used to grab the stone and pull it out.
•A small operation. It can be used
if therapeutic sialendoscopy
is not an available
•Shock wave treatment uses
ultrasound waves to break
stones. The broken fragments
then pass out along the duct.
Sialadenitis
•The salivary glands contain a network of ducts. Saliva flows through them into
the mouth. If the flow is reduced or stopped for some reason, infection can
grow.
•This infection called sialadenitis .
•The most common infection is bacterial.
•Sialadenitis is most common in the parotid gland and the submandibular
gland.
Sialadenitis
Symptoms:
• Tender, painful in cheek or under chin.
•Pus may drain through the gland into the mouth.
•If the infection spreads, fever, chills and malaise may occur.
Complications:
•Oral infection.
•Upper respiratory tract infection.
•Upper GIT infection.
Investigations:
•Physical examinations.
•CT scan, ultrasound scan or MRI scan.
•Culture for identify the organism.
Sialadenitis
Treatment:
• The first step is to make sure about fluid balance.
•Patient needs to receive fluids intravenously
•Antibiotics to destroy the bacteria.
•Sugarless sour candies or gum is recommend ,they can stimulate the glands to
produce more saliva.
•If the infection is not improving, surgery may be needed to open and drain the
gland.
Prevention:
Always drink plenty of fluids. This is especially important after surgery, during illness
or in elderly people
ASSESSMENT
History : pain, swelling, edema
 Change Of appetite
 Diet
 Physical examination
 The nurse assesses for client anxiety and fear.
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NURSING PROBLEM
Discomport : pain
 Fluid volume deficit
 Nutrition deficit
 Anciety
 Regiment terapeutic inefectif
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