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375 Exam 1
Head and Neck Cancer
| Term | Definition |
|---|---|
| risk factors for head and neck cancer | age over 50, men more common, tobacco or alcohol use, sun exposure, asbestos, industrial carcinogens, radiation, poor oral hygeine |
| manifestations head and neck cancer | ringing in the ears, constant coughing |
| oral cavity cancer | white or red patches in the mouth, swelling of the jaw that causes dentures to fit poorly or become uncomfortable; unusual bleeding or pain in the mouth |
| laryngeal cancer | hoarseness that lasts more than 2 weeks, pain when swallowing |
| late manifestations of head and neck cancer | unintentional weight loss, difficulty swallowing and moving the tongue, partially or fully obstructed airway |
| leukoplakia | white patches that do not scrape off |
| erythroplakia | abnormal red area or patches |
| diagnostic studies for lesions | pharyngoscopy or laryngoscopy, inspect lesions and tissue mobility, may take biopsy |
| speech therapy | work to regain vocal strength |
| electrolarynx | hand held battery powered device to create sound waves; mechanical sounding |
| transesophageal puncture (TEP) | opening between the trachea and esophagus then a one way prosthetic valve is placed in the tract; to speak the client plugs stoma with the finger; speech is made by the air vibrating against the esophagus |
| esophageal speech | depends on the amount of air introduced in the esophagus and then expelled, takes a lot of effort; difficult to converse |
| head and neck cancer treatment | TNM stage (size of the tumor, number and location of involved lymph nodes, extent of metastasis), ability to talk, swallow, age and general health |
| vocal cord stripping | removes outer layers of tissue on vocal cord, will not affect speech |
| laser surgery | an endoscope with a high intensity laser vaporizes tumor |
| cordectomy | removal of some or all of the vocal cords; speech is impacted dependent upon how much is removed |
| total laryngectomy | entire larynx is removed; client will have a tracheostomy and stoma in place; monitor for aspiration, cannot do bag mask breathing need to provide ventilation through stoma; airway is separated from the airway to the mouth |
| radical neck dissection | removal of all the tissue on the side of the neck from the mandible to the clavicle; concerned for carotid arteries and jugular veins |
| modified radical neck dissection | most common, all lymph nodes are removed; nerves, blood vessels and muscles may be spread |
| selective neck dissection | depends on how far the cancer has spread, fewer lymph nodes are removed; muscle, nerves and blood vessels may remain intact |
| external beam therapy | a machine is used to deliver radiation to the exact location; three dimensional and image guided |
| brachytherapy | places a radioactive source near or into the tumor; uses thin, hollow, plastic needles with radioactive seeds; aware of radiation precautions |
| chemotherapy and targeted therapy | reserved for stage 3 or 4 head and neck cancers |
| targeted therapy | cetuximab; targets epidermal growth factor receptor and stops the cells from growing, need to monitor during and after for side effects |
| nutritional therapy | swallow screen |
| eating precaution | head of bed elevated, suction available, ensure correct diet is provided, assess for dysphagia, observe signs of choking |
| physical therapy | work to gain strength in upper extremities, increase neck range of motion, maintain strength; can develop frozen shoulder |
| goals for patient | establish a patent airway, acceptable body image, no complications, pain management, ability to communicate effectively |
| post op care | monitor trach site; suction as needed, monitor drainage (will be bloody), use humidification, encourage cough and deep breathing, keep HOB elevated |
| wound care | do not change without provider order, may have a skin flap in place, drains may be present (monitor color and amount) |
| when can feeds be resumed | ability to swallow, passing gas, bowel movement and sounds |
| radiation nursing | dry mouth; encourage fluids and gum; nonalcoholic mouth rinses |
| stoma care | wash around area daily, remove dried secretions, can be covered with loose material, swimming is contraindicated, respiratory etiquette (cover when cough, cover when foreign substance can be inhaled) |
| tracheostomy | surgical procedure where an opening is made into the trachea, stoma may be temporary or permanent |
| indications for a tracheostomy | establish a patent airway, bypass an obstruction (tumor), facilitate removal of secretions, long term mechanical ventilation, facilitate weaning |
| fenestrated tube | has an opening on the dorsal side of the tube; upper portion of outer cannula; allows for spontaneous respirations, allows passage of air and ability to talk |
| non fenestrated tube | has no opening |
| cuffed tube | most common, is needed if client requires mechanical ventilation; cuff is inflated via balloon port on the tracheostomy tube; when the cuff is inflated the client is unable to talk |
| uncuffed tube | used more frequently with long term clients, mechanical ventilation is not required; easier for client to eat and talk; longer term patients |
| surgical tracheostomies | completed in OR under general anesthesia, horizontal incision is made in anterior part of trachea; tube inserted, incision sutured and sterile dressing applied |
| percutaneous tracheostomies | uses local anesthesia, sedation and video assisted guidance, less bleeding and fewer complications, can be done bedside |
| pre procedure tracheostomy equipment | ambu bag, suction, code cart; ensure IV patent, client supine |
| post procedure tracheostomy | ensure cuff is inflated, confirm placement (auscultate lungs, CO2 detection, chest Xray), trach is secured with ties |
| client monitoring | clean around stoma with normal saline (never hydrogen peroxide), use foam dressing (do not cut gauze), suction with sterile technique |
| suction need | remove mucus and secretions from trachea and lower airway, a low pulse ox, tachypnea or respiratory distress, unable to effectively clear secretions |
| suctioning | sterile procedure; do not suction longer than 15 seconds, allow client to recover (30 secs) and place oxygen back on; only going out, never when advancing the catheter |
| suction kit | sterile gloves, sterile saline, suction catheter |
| tracheostomy care | clean technique, semi fowler position; unlock and remove inner cannula, replace and be sure to only touch outer portion, clean around stoma and under trach plate; use pre cute gauze |
| changing trach ties | after the first 24 hours, 2 person technique; secure and not too loose; should be able to slide one finger between tie and back of the neck |
| dislodgment | immediately call for help, if distress occurs cover stoma with sterile dressing and provide ventilation with bag mask valve over nose and mouth (2 people) |
| what to complete before a swallow eval | deflate cuff, ensure correct diet, head of bed >3- or out of bed to chair for meals, encourage small bites |
| speech protocol for tracheostomy | Passy Muir used to facilitate; cuff needs to be deflated, may only tolerate for short period of time, stay with client, remove immediately if respiratory distress |
| decannulation (removal) | completed by physician, stoma should be covered with sterile occlusive dressing, apply nasal cannula first; epithelial tissue develop 24 - 48 hours and will close 4 - 5 days |
| outer cannula | keeps airway patent, component of tracheostomy tube that remains in place until the entire tube is replaced or removed |
| inner cannula | inserted into the outer cannula and can be disposable or non disposable, helps prevent buildup of mucus inside the tube |
| obturator | a curved guide that is inserted into the tube to help with placement, this is removed after insertion so air can flow |
| confirmed tracheostomy placement | chest x ray |
Created by:
ahommel
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