Test Answers on Laryngeal Cancer – Flashcards

-Tobacco use -Chronic laryngitis -Alcohol intake -Exposure to Industrial Chemicals -Marijuana use -Hardwood Dust -Voice abuse -Poor oral hygiene

-men get it 3x more often than women -people >65 y.o.

1. Tumor in the Larynx -Laryngoscopy/Biopsy -CT scan/MRI/PET scan to see if spread 2. Tumor impedes action of vocal cords during speech 3. Treat w/ chemotherapy, radiation, & surgery

-Pain -Lump in the mouth, throat, or neck -Difficulty Swallowing -Shortness of Breath -Color changes in mouth or tongue to red, white, gray, dark brown,or black -Oral lesions or sore that does not heal in 2 weeks -Persistent or unexplained oral bleeding -Numbness of mouth, lips, or face -change in fit of dentures -Burning sensation when drinking citrus juices/hot liquids -persistent, unilateral ear pain -hoarseness or change in voice quality -Persistent/recurrent sore throat -Anorexia or weight loss

-Lump left in neck -Difficulty swallowing -Dyspnea -Lymph node enlargement -Weight Loss -Pain radiating to ear w/ metastases -Glottic area: Hoarse & low pitch voice -Subglottic & Supraglottic area: pt complaines of pain & burning in throat when drinking hot liquids or citrus juices -Foul breath -Unilateral nasal obstruction or discharge

-CBC -Bleeding time -Urine analysis -Complete Metabolic panel -Total protein -Albumin -Renal -Liver Function Test

-Surgery -Radiation -Chemotherapy

Monitor Respiratory System: RR, breath sounds, pulse oximetry, arterial blood gas values, & results of pulmonary function tests -Fowler's or Semi-Fowlers position for best air exchange -Radiation Therapy -Chemotherapy

-Treats small cancers in specific locations -Cure rate of at least 80% -S/E: hoarseness, dysphagia, skin problems, dry mouth (xerostomia) for few weeks after therapy -Teach: gargling saline or sucking ice decrease discomfort; mouthwashes & throat sprays w/ anesthetic temporary relief, avoid exposing skin to sun, heat, cold & abrasive treatments (shaving); wear protective clothing & wash area gently W/ mild soap

Tumor size & location (TNM classification) determines type of surgery needed -Laryngectomy (partial or total) -Cord Stripping: remove tumor from cord, save the cord -Cordectomy: removal of a vocal cord -"Radial neck" dissection:removal of lymph nodes, sternocleidomastoid muscle, jugular vein, 11th cranial nerve (shoulder drop), & surrounding soft tissue

1 cord involved High cure rate Leaves hoarse voice AIRWAY INTACT

Early supraglottis tumors PRESERVES VOICE Temporary tracheostomy ASPIRATION POTENTIAL COMPLICATION NG tube feeding until healing & no danger of aspiration Some difficulty swallowing for 1st 2 weeks Speech Therapy Risk that cancer will recur

Tumor extends beyond vocal cord, but <1 cm & limited to subglottic area Tracheostomy & NG tube 10-14 days post-op Increased risk for aspiration after surgery Voice-rough, raspy, hoarse AIRWAY & ABILITY TO SWALLOW REMAIN INTACT

Cancer extends beyond vocal cords For recurrent or persistent CA following RT PERMANENT TRACHEAL STOMA. NO VOICE NORMAL SWALLOWING- no risk for aspiration b/c airway & esophagus completely separated Metastasis to cervical Lymph Node COMPLICATIONS: infection, wound breakdown, fistulas, stomal stenosis, dysphagia secondary to pharyngeal & esophageal structure

1st priority are airway maintenance & ventilation -raise head of bed -monitor airway patency & vital signs -frequent suctioning (gently-fragile tissue) Observe surgical site for bleeding (lots of veins/arteries) Place call light w/in easy reach b/c pt can't talk Monitor pain level & administer analgesics Monitor: hemodynamic status. BP Wound Care: cleanse & dress wounds. Monitor skin/wound for breakdown & document Monitory skin flap for adequate circulation hourly for 1st 72 hours post-op Initiate nutritional intake: NG tube feedings BLOOD-TINGED SECRETIONS NORMAL 1-2 DAYS

Pt's voice & quality of speech are altered after surgery. Discuss principles of speech therapy w/ the pt & family early in course of treatment. -Esophageal Speech -Tracheoesophageal Puncture (TEP) -Artificial Larynx (Electro Larynx)

Sound produced by "burping" and shaping words in the mouth. Difficult to master! Speech is monotone 1. Tongue press to inject air into esophagus 2. Air enters esophagus 3. Air releases from esophagus to produce sound-use abdominal muscles to burp 4. Sound shaped into speech 5. Location of tissue vibration for sound

AKA: Tracheoesophageal fistula. Used if esophageal speech ineffective 1. Small hole is made rear of stoma leading to esophagus (between trachea & esophagus) 2. A prosthesis is fitted & inserted into opening 3. To speak, pt has to close stoma w/ finger & force air through prosthesis into the esophagus & out the mouth 4. Lip & tongue movement, not prothesis itself produces speech

Surgical incision into trachea for purpose of establishing an airway (tracheostomy). Temporary or permanent. Emergency or scheduled.

-Use saline & cotton-tipped swabs to cleanse stoma -Use humidifier &/or saline atomizer -Wear buttoned cotton shirt or stoma covering (keeps dust & other particles out of lungs) -Wear shower shield over stoma during showers -Report signs of infection: fever, purulent drainage, redness, foul odor, swelling -Diet high in Protein & Calories -Avoid water sports -No lifting (epiglottis doesn't close) -All other activities allowed

-Airway Obstruction -Aspiration

Following laryngectomy there are copious amounts of secretions. If not removed a mucous plug forms which occludes the airway.

Monitor Respiratory Status: -SaO2, breath sounds, RR, depth Maintain humidity. Humidify Oxygen. (helps remove crusts) Suction but remember to oxygenate before Encourage deep breathing & coughing to help remove secretions

Causes pneumonia. Pt's with 1 vocal cord or epiglottis removed are @ risk. -Total laryngectomy not @ risk because esophagus is farther away.

-Sit upright -Tuck chin down when swallowing -Thickened liquids. Cut food in small pieces. Chew well. Mechanical soft/pureed diet -Give foods that form into bolus before swallowing (meat,bread) -Suspect Aspiration? Call doctor. NPO

Assess: -Respiratory Status -Condition of the Wound -Psychosocial Status -Temperature -Pt's understanding of illness & adherence to treatment -Nutritional Status

-Observe rate & depth of respiration -Auscultate lungs -Check patency of airyway -Examine tracheostomy drainage for amount, color & character -Examine nail beds & mucous membranes for cyanosis -Pulse oximetry

-Remove dressings (note condition of dressing) -Cleanse wound -Compare w/ previous notations of wound condition (presence/amount/nature of exudate, presence/absence of cellulitis, presence/absence of odor)

-Ask pt about passing the time, visitors, & trips outside house -Observe if pt communicates directly or if family member speaks for the pt -Observe pt & family member interactions -Determine what method of communication pt has selected & observe pt's skill w/ it -Observe if pt is dressed in pj's or street clothes

-Manifestations to report to healthcare provider -Medication plan (correct timing & dose) -Ambulation or positioning schedule -Dressing changes/skin care -Diet modifications (24 hr diet recall) -Skill in tracheostomy or dressing care

-Change in muscle mass -Lackluster nails/sparse hair -Recent weight loss greater than 10% of usual weight -Impaired oral intake -Difficulty swallowing -Generalized edema