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Laryngeal-Cancer

Laryngeal Cancer by Lucy

QuestionAnswer
S & Sx of Laryngeal Cancer Persistent hoarseness, chronic sore throat, painful swallowing, pain the ear, voice changes, coughing up bloody sputum, and lump in the neck.
Leukoplakia A callus like area in the mouth.
Laryngeal Cancer Is any cancer in the hypopharynx.
Laryngeal Polyps A polyp is a ball of tissue, attached to the vocal cord by a stalk. Laryngeal polyps are made up of the cells that line the vocal cords.
Diagnosing Laryngeal Cancer Direct or indirect laryngoscopy, sometimes they may use bronchoscope, MRI, CT scan, and PET scan is used for metastasis.
Biopsy for tumor staging (TNM) T: Measure tumor N: Lymph nodes in Laryngoscopic anatomy M: Metastasis
Etiology of Laryngeal cancer Epidemiology; squamous cell. Pathophysiology;intrinsic tumors. Extrinsic tumors.
Treatment for Laryngeal cancer Ablation, Radiation, Chemotherapy, and laser surgery.
Treatment for Laryngeal Cancer in the Supra-glottis Surgery with or without post-op RT (radiation therapy), and definitive RT.
Treatment for Laryngeal Cancer in the Glottis Surgery with or without post-op RT, and definitive RT.
Treatment for Laryngeal Cancer in the Sub-Glottis Laryngectomy + isolated thyroidectomy + tracheosophageal node dissection + post-op RT, and RT only.
Laryngectomy (two parts) 1. Removal of the diseased or injured larynx. 2. Creation of a new opening, called a stoma, through which breathing will take place.
First Part of a Laryngectomy The surgeon makers an incision in the neck and divides the muscles that are attached to the larynx. The larynx and surrounding tissue are removed. In a partial laryngectomy, surgeon removes the tumor and only a portion of the larynx.
Second Part of a Laryngectomy Next, a stoma is created through the skin in the neck, and the trachea(windpipe) is connected to the opening to breathe. A tracheostomy tube may be inserted.
Third Part of a Laryngectomy Drains (Hemovac or JP) are inserted to allow for adequate drainage. The muscles and skin are brought together and closed with stitches or clips. Drains will be removed in about five days, stitches in about one week.
Laryngectomy Surgery Partial: Hemilaryngectomy-removal of false cord, arytenoid, & inside of thyroid cartilage. Total-remove epiglottis, thyroid cartilage, 3 or 4 tracheal rings, close pharynx, make tracheostomy.
The Outcomes for a Patient with a permanent Tracheostomy They will have a peg tube to eat, and they may lose the use of their vocal cords.
Nursing Management with a Total Laryngectomy Pre-op: Emotional needs and artificial speech/method of communication. Post-op: Respiratory status, pain, and complications.
Nursing Interventions Post-op of a Laryngectomy Prevent aspiration pneumonia, using sterile technique during dressing changes, nurse and patient will wear masks during dressing changes, Watch for fistula formation and bleeding in case an artery is cut. Change dressing PRN.
Radical neck Dissection The aim of the procedure is to remove lymph nodes & other structures from the neck in which cancer cells may have migrated. Metastasis of SCC into the lymph nodes of the neck reduce survival and is the most important factor in the spread of the disease.
T R A C H E T- Tapes, to keep trache secure R- Resuscitate, Know CPR A- Airway clear, use correct suction technique. C- Care of the site, Stoma and neck. H- Humidity, essential to keep tube clear. E- Emergency box,supplies needed for emergency.
Nursing Diagnoses Ineffective airway clearance, risk for infection, impaired verbal communication, impaired swallowing, and ineffective therapeutic regimen management.
Complications of Surgery Airway obstruction, Hemorrhage, Carotid artery rupture(watch for pulsating trache tube), and Fistula formation(can occur from the larynx to the trachea).
Laryngospasm Spasm of the laryngeal muscles. May occur after anesthesia, after intubation, and after extubation. Treatment; oxygen and bronchodilators.
Tracheostomy A surgical opening into the trachea. Used to maintain airway over an extended period of time.
Nursing Intervention For a Patient with a Tracheostomy Must establish method of communication. Maintain safety. Assess breathing. Maintain cuff pressure appropriately (whistling or wheezing around trache tube means the cuff is deflated). Keep stoma clean and dry until it heals.
Nursing Management for Tracheostomy Providing tracheostomy care, swallowing dysfunction, speech with a tracheostomy tube, and decannulation.
Decannulation When a patient can adequately exchange air and expectorate. Stoma closed with tape & covered with dressing. Instruct patient to splint stoma with fingers when coughing, swallowing, or speaking. Tissue form in 24-48hrs. Opening will close in 3-4wks.
Cuff Maintenance You only want the cuff deflated to eat or for speech therapy. The cuff must be inflated all other times to prevent aspiration.
Suctioning You only go in as far as the length of the trache tube. Always suction on the way out not going in, you will take their breath away. Make sure you have an emergency box nearby.
Teaching: Self Care Proper care of tube: inner cannula, suctioning, and humidification. Stoma care, resuscitation measures, accidental decannulation (reinsertion of entire tube).
Client Teaching Guide Covering and cleaning stoma, no swimming/no smoking, loss of smell- use smoke detectors, and ID bracelet.
Created by: tiniekittie12
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