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Lecture 3

NURS 371 Lecture Notes - Lecture 3: Laryngectomy, Laryngoscopy, Dysphonia

Course Code
NURS 371
Heather Mitchell

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I. Cancers
A. Laryngeal Cancer
A.i. Risk factors- family history prolonged use of tobacco and alcohol, history
of frequent episodes of laryngitis, chemical exposures
A.ii. Manifestations- hoarseness or change in voice, unilateral ear or throat
pain, weight loss, pain, Lump in throat, mouth, or neck, Dysphagia, foul
breath, airway obstruction (late symptoms)
A.iii. Diagnostics- H&P, CT, laryngoscope, biopsy
A.iv. Treatment
A.iv.1. Radiation therapy/brachytherapy
A.iv.2. Chemotherapy
A.iv.3. Surgical measures e.g., partial or total laryngectomy with
radical neck dissection
A.iv.4. Nutritional management
A.v. Post-op Care (partial or total laryngectomy)
A.v.1. Assess respiratory status and report changes to physician
A.v.2. Encourage coughing and deep breathing and suction to
clear secretions
A.v.3. Elevate HOB High Fowlers to Semi-Fowlers to decrease
tissue edema
A.v.4. Provide frequent oral hygiene
A.v.5. Administer tube feedings as ordered; advance to clear
liquids and assess for swallowing difficulties. Remember
aspiration will be a risk for only partials. Totals cannot aspirate
A.v.6. Monitor daily weight and caloric intake
A.v.7. Monitor amount and character of drainage
A.v.8. Perform incision care
A.v.9. Provide emotional support to client and family members
A.v.10. Consult speech therapist regarding client’s needs
A.v.11. Educate client and family members regarding home care Nursing Diagnoses & Care Ineffective Airway Clearance Suction the client’s mouth,
throat, and/or airway as needed. Position the client upright to
facilitate ventilation. May have lots of secretions (risk for mucous
plug) Impaired Swallowing tube feeds immediately after due to
swelling in neck, progress as tolerated. Crush pills & liquid
suspensions to aid in swallowing. Properly cut up food. Only risk
for aspiration if partial larygectomy, not total. Totals may have
trouble swallowing immediately post-op, but as swelling subsides,
no risk for aspiration (remember, things aren’t connected) Infection- trach care (totals will always be trached
afterwards), suctioning, nutrition, oral care Anxiety- anti-anxiety meds, education, emotional support
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