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TL Laryngeal Cancer

Nursing of the adult with cancer of the larynx/laryngectomy

QuestionAnswer
Define cancer of the larynx. neoplasm of the larynx, most commonly squamous cell in origin
Name two lifestyle choices that are directly linked to the development of cancer of the larynx. pronlonged alcohol and tobacco use
What are some factors that contribute to cancer of the larynx(5)? vocal straining, chronic laryngitis, family predisposition, industrial exposure/carcinogens, nutritional deficits
How do risks for laryngeal cancer differ between men and women? Men are 8x more likely to be affected
Laryngeal cancer is usually diagnosed between what ages? 55 and 70
What is the earliest sign/symptom of cancer of the larynx? hoarseness or change in vocal quality
What is the usual treatment for cancer of the larynx? radiation therapy often with adjuvant chemotherapy or surgical removal of the larynx
What is the term for surgical removal of the larynx? Laryngectomy
What might the nurse find during the assessment of the client with cancer of the larynx? hoarseness for longer than 2 wks, color changes in mouth or tongue, dysphagia, dyspnea, cough, hemoptysis, weight loss, neck pain that may radiate to the ear, enlarged cervical lymph nodes, halitosis (later)
What appearance might the nurse find on inspection of the mouth of a client with cancer of the larynx? tongue and mouth may appear white, gray, dark brown, or black and may appear patchy
Name some diagnostic tests that may be used to detect cancer of the larynx. MRI, laryngoscopy, radiography, CT and biopsy
Name three applicable nursing diagnoses for the client undergoing a laryngectomy. anxienty; ineffective airway clearance; impaired verbal communication
What preoperative nursing interventions apply to the client who is going to have a laryngectomy? Explain the hows and whys of suctioning after surgery; give the client some hands on with tracheostomey tubes and suctioning equipment; work out acceptable alternate means of communication; discuss rehab program; refer to speech pathologist
Discuss communication with the postoperative laryngectomy client. simplify communication, use planned alternative communication, keep call light close to client, ask yes/no questions whenever possible
What nursing interventions promote respiratory function post laryngectomy. assess repiratory rate and characteristeic q1-2 hours; Semi-fowler position; keep laryngeal airway humidified; auscultate lung sounds q 2-4 hours; tracheostomy care q 2-4 hours and PRN
What three tasks are included in tracheostomy care? clean the inner cannula, suctioning, apply clean dressing
What nursing intervention addresses nutritional needs of the laryngectomy client? tube feeding as prescribed
What nursing interventions promote speedy healing and rehabilitation of the laryngectomy client? Early ambulation and referral for speech rahabiliation with artificial larynx to learn esophageal speech
Explain the reasoning for the need to humidify the laryngeal airway for a laryngectomy patient. The larygectomy patient has lost the nasobronchial pathway that would normally supply humidity to the air entering the lungs. Without humidification, dryer air in the lungs causes secretions to thicken.
What are the greatest postoperative risks for the laryngectomy patient in the first 24 hours? bleeding or occlusion of the laryngectomy tube
What is the size difference between a laryngectomy tube and a tracheostomy tube? the laryngectomy tube has a larger lumen and is shorter
Fear of choking is very real for the laryngectomy patient. Why is that? What can be done about it? the glottis is gone. Teach the glottal stop technique to remove secretions.
Describe the glottal stop technique. Take a deep breath, occlude the tube, cough, and simultaneously remove the finger from the tube.
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