N240 Olol - Test 1 - Laryngeal Cancer - Test 1

Front 1

Cancer of the Larynx

Back 1

Cancer of the head and neck.
Risk factors – prolonged use of tobacco and alcohol.
Contributing risk factors – chronic laryngitis, voice abuse, family history, prior exposure to radiation.

Front 2

Incidence of Laryngeal Cancer

Back 2

11,600 cases diagnosed since 1996.
79.5% are men
Most frequently diagnosed between ages of 55-70
Incidence rising in women since the 1960s

Front 3

Pathophysiology of L. Cancer

Back 3

=Most common is squamous cell carcinoma.
=Grows slowly because of limited lymph circulation and natural divisions created by ligaments and membranes of the vocal cords.
=If involves glottis can metastasize to the nodes of the neck.

Front 4

Symptoms of L. Cancer

Back 4

Early
Hoarseness or voice change.

Late
Dysphagia, dyspnea, cough, hemoptysis, wt loss, pain around the thyroid or Adam’s Apple that radiates to the ear of the affected side. =Enlarged cervical neck nodes.

Front 5

Diagnosis of L. Cancer

Back 5

=History, physical exam, x-ray of the head, neck, chest, and larynx.
=CT scanning
=Laryngoscope may reveal mucousal abnormalities.
Biopsy

Front 6

Treatment of L. Cancer

Back 6

+Early diagnosis and treatment leads to high cure rates – 80-90% for small lesions.
+Treatment based on pt condition, tumor size, type and metastasis, and pt preference.
+Staged according to the American joint commission for cancer 1977 guidelines

Front 7

TNM System-staging L. Cancer

Back 7

+T- tumor size and location (supraglottis, glottis, subglottis)
+N number of nodes found
+M presence of metastasis

Front 8

Treatment of L. Cancer

Back 8

+Radiation – External beam radiation with or without chemotherapy or surgery.
+Goals may be curative or palliative.
+Radiation disrupts DNA structure and causes cells to die.
+May change voice quality
+Complications include laryngeal edema, fibrosis of neck and larynx, esophageal stenosis, nutritional deficiency from pain and changes in taste and dry mouth.

Front 9

Treatment of L. Cancer con't

Back 9

Chemotherapy – followed by radiation
Laser surgery – Very popular, CO2 laser vaporizes tumor. +Can be used with radical neck dissection. Reduced swelling, reduced blood loss, less pain, decreased infection, decreased recovery time, sealed lymphatics and prevents metastasis.

Front 10

Surgical Treatment of L. Cancer

Back 10

Hemilaryngectomy- 1 side
Total laryngectomy
Radical neck dissection- if metastasized to neck

Front 11

Hemilaryngectomy

Back 11

Hemilaryngectomy
Vertical laryngectomy used when tumor is confined to one cord.
One half of the larynx is resected along with the false cord, ventricle, and diseased true cord.
Temporary tracheostomy and feeding tube for immediate post op period
May have prolonged or permanent dysphagia with aspiration. **
Ability to speak and swallow is preserved.

Front 12

Total Laryngectomy

Back 12

+Advanced cancer that involves true vocal cords.
+Epiglottis, thyroid cartilage, larynx, several tracheal rings, and hyoid bone are removed.
+Pt has no voice.
+Requires permanent tracheostomy.
+Smell is impaired, may effect nutritional status. Nutrition Is a major problem
+TF or TPN given for 10-12 days post op.
+Aspiration not a problem trachea sewn closed.
+Antibiotics for 10-12 days.
Post op JP drain used.

Front 13

Radical Neck Dissection

Back 13

Total laryngectomy with removal of the muscles, veins, nerves, and cervical lymph nodes of the neck.
Spinal accessory nerve removed
Sternocleidomastoid muscle removed
Internal jugular vein removed

Front 14

Nursing Mgmt for L. cancer: preoperative

Back 14

Obtain history, habits, living conditions, occupation, and social support.
Identify chronic illnesses such as COPD, alcoholism, smoking
Assess nutritional status. Obtain nutritional consult for caloric requirements and caloric intake. Taking wgts
Discuss post operative communication
Explain feeding tube, tracheostomy, suctioning, JP drain.

Front 15

Nursing Mgmt for L. cancer: postoperative

Back 15

Assess respiratory status abc’s
Airway, breathing pattern, depth, rate.
Assess breath sounds stridor, wheezing, secretions. If smoked, may be problems
Assess vital signs, urine output, hemodynamic status.
Assess surgical incision and stoma site for color, drainage, temperature, and edema.
Assess tubes for patency and position.
Check lab values CBC with diff for blood loss and infection.
Assess swallowing and beginning speech function

Front 16

Rehabilitation for L. cancer

Back 16

Teach pt to perform trach care with mirror.
Speech therapy for swallowing and speech
Adjustment to body image – participates in self care, able to look in mirror, mood readiness to learn, families ability to assist.
Inspection of the home for adequate facilities, cleanliness, patient’s self care ability.
Weight maintenance and nutrition

Front 17

Nursing Diagnosis for L.Cancer

Back 17

Ineffective airway clearance R/T disease process.
Ineffective breathing pattern R/T pain
Pain R/T operative incision
Impaired verbal communication R/T laryngectomy
Risk for infection R/T surgical incision and inadequate nutritional status.

Front 18

Nursing Diagnosis for l. CANCER con't

Back 18

Risk for hemorrhage R/T carotid artery rupture.
Self esteem disturbance R/T mutilating surgery and altered body image
Impaired skin integrity R/T tracheostomy and potential saliva fistula.
Altered nutrition less than body requirements R/T dysphagia.
Knowledge deficit R/T tracheostomy care and suctioning.

Front 19

Nursing Care of L. Cancer

Back 19

Position semi fowlers to promote lung expansion and decrease incisional edema.
Suction tracheostomy PRN. Clean q 8 hrs – but suction b4 cleaning-save u trouble
Monitor amount and consistency of drainage from JP
ROM exercise to shoulder of affected side if had radical neck resection
Nutrition – Tube feeding due to swallowing difficulty and suture line
IV fluid management for 48 hrs, Tf for 10 days

Front 20

Speech Therapy

Back 20

Voice prosthesis – creates fistula btw esoph. & trachea-
Esophageal speech- method of swallowing air and belching up-
Electrolarynx – have to wait until sutures heal- vibs in throat.

Front 21

Voice prosthesis

Back 21

Fistula is created between the esophagus and the trachea. The prosthesis is inserted and air from the lungs enters the esophagus. A one way valve prevents aspiration.
To speak the patient blocks the stoma with a finger. Air vibrates as it moves through the esophagus creating sound. Words are formed by lips and tongue.

Front 22

Electrolarynx

Back 22

Handheld battery powered device that creates speech with the use of sound waves. Used after healing is complete.
Device is held against the neck. Voice is low. Sounds are very mechanical

Front 23

Esophageal Speech

Back 23

A method of speech created by swallowing air, trapping it in the esophagus and releasing it to create sound.
Sounds like a belch, but with practice can produce understandable speech.

Front 24

Stoma Care

Back 24

Area around stoma should be washed daily. If tracheostomy tube is in place, inner cannula should be cleaned daily
Stoma should be shielded by a soft cloth or scarf. Cover the stoma during coughing.
Avoid aspirating soap, shaving cream, makeup.
Use plastic collar when showering.
Bedside humidifier recommended

Front 25

Nursing Education

Back 25

Swimming is contraindicated.
Medic alert bracelet to id patient as neck breather.
Patients loose the ability to smell. Need smoke detectors.
Loose sense of taste. Make food attractive, colorful, nutritious.small frequent meals

Front 26

Psychosocial adjustment for L. Cancer

Back 26

Depression may result from body image distortion related to stoma or mutilating surgery.
Difficulty in speech and swallowing may interfere with social activities.
Diagnosis of cancer always has great psychological impact.
Utilize support groups, speech therapy, PT, OT, psychological support

Front 27

What is the most common squamous cell carcinoma?

Back 27

Laryngeal Cancer

Front 28

The nurse knows that Laryngeal Cancer grows slowly because?

Back 28

there is limited lymph circulation and there are natural divisions created by ligaments and membranes of the vocal cords

Front 29

The nurse knows that an early symptom of Laryngeal cancer is?

Back 29

Hoarseness or voice change

Front 30

The nurse recognizes that the patient in the ER has late signs of Laryngeal Cancer. What are the signs?

Back 30

Dysphagia, dyspnea, cough, hemoptysis, wt loss, pain around the thyroid or Adam’s Apple that radiates to the ear of the affected side. Enlarged cervical neck nodes.

Front 31

After the pt had a Laryngoscope, the findings were?

Back 31

Mucousal abnormalities

Front 32

Is there a high cure rate for Laryngeal cancer?

Back 32

yes with early diagnosis, 80-90% for small lesions

Front 33

The nurse is reading the staging results of a pt with L. cancer. What system is used?

Back 33

TNM system

T- tumor-size and location
N- number of nodes found
M- presence of metastasis

Front 34

The nurse knows that her pt with L.C. will have what type of treatment?

Back 34

Radiation - may be curative or palliative -
Chemo followed by Radiation

Laser surgery- new and popular

Front 35

How does Radiation work to treat Laryngeal cancer?

Back 35

disrupts DNA structure and causes cells to die

Front 36

The patient with Laryngeal cancer is told what complications to expect. These are?

Back 36

May change voice quality
Complications include laryngeal edema, fibrosis of neck and larynx, esophageal stenosis, nutritional deficiency from pain and changes in taste and dry mouth

Front 37

The nurse understands that Laryngeal cancer is the most common type of what cancer?

Back 37

squamous cell cancer

Front 38

Is Laryngeal cancer fast or slow growing?

Back 38

slow

Front 39

A patient shows up at a clinic with a complaint of hoarseness, pain radiating to the ear from his Adam apple, enlarged cervical lymph nodes and a cough. He has a hx of alcohol abuse and smoking. The nurse suspects what type of cancer?

Back 39

Laryngeal

Front 40

Diagnostic procedures are?

Back 40

X-ray,.
CT scan
Laryngoscope
then Biopsy