Question

65-year-old male was admitted for evaluation of pain on swallowing and a sore throat that has persisted for the past year. The discomfort has not changed with the use of various over-the-counter cold remedies. The client has lost weight due to a decrease in appetite and difficulty swallowing. He has smoked 3 packs of cigarettes a day for 40 years.

A laryngoscopy showed a subglottic mass. The client had a total laryngectomy with tracheostomy to manage laryngeal cancer. He also has a nasogastric tube in place.

You will be providing care for this client during his first 72 hours after surgery.

Initial Discussion Post:

There are multiple nursing diagnoses that are applicable to this client during the time when you will be providing care.

• Select one NANDA-I nursing diagnosis and describe why it is a priority for this client.
• What is the cause or related factor for this NANDA-I nursing diagnosis?
• Identify an outcome for this NANDA-I nursing diagnosis. The outcome must be patient-centered and measurable.
• Identify two (2) nursing interventions that will help this client achieve the outcome.
• Describe how each intervention will help the patient achieve the outcome..

Answer 1

1 Nursing diagnosis -Ineffective airway clearance related to excess mucus production secondary to surgical alterations in the airway.if a tracheostomy tube without an inner cannula is used,humidification and suctioning of this tube is essential to prevent formation of mucous plugs.The presence of mucus plugs cause obstruction to the airway due to copious secretions.

2 Complete removal of the larynx can provide the desired cure,but it also leaves the patient with significant loss of natural voice and the need to breath through an opening created in the lower neck.Alcohol is a risk factor for cancer of the larynx ,it is essential to assess the patients pattern of alcohol intake.Patients who are accustomed to daily consumption of alcohol are at risk for alcohol withdrawl syndrome when alcohol intake is stopped suddenly.

3 The patient maintains a clear airway and handles own secretion ;also demonstrates practical,safe and correct technique for cleaning and changing the laryngectomy tube.

4

• The nurse promotes a patent airway by positioning the patient in the semi-Fowlers or Fowlers position after recovery from anaesthesia.This position decreases surgical edema and promotes lung expansion.
• The nurse reassures the patient the frequent coughing episodes and brassy-sounding,mucus-producing cough will diminish in time ,as the tracheobronchial mucosa adapts to the altered physiology.