Question

Conditions I. Laryngectomy A. Removal of larynx B. Indications: C. Pre-operative nursing care: D. Post-operative nursing care 1. No connection between nose and mouth and lungs 2. is only source of air for lungs 3. Establish means of communication a. Written b. Picture board c. Signals, gestures b. Artificial laryn:x C. Esophageal speech Teach re: 4. a. to filter out dust and warm air b. N sports c. Tub bath safer than d. Loss of sense of II. Chronic Obstructive Pulmonary Disease (COPD) A. Pulmonary Emphysema 1. Definition: Chronic disease with excessive inflation of air spaces distal to the terminal bronchioles, alveolar ducts, and alveoli. There is increased

Answer 1

answer :

B. Indications :

• Advanced laryngeal malignancies with extensive cartilage destruction and extra laryngeal spread .
• Involvement of posterior commissure or both arytenoids .
• Circumferential submucosal disease - with or without vocal folds paralysis .
• Subglottic extension to involve cricoid cartilage .
• Completion procedure after failed partial laryngectomy or irradiation.
• Hypopharyngeal tumors originating or spreding to post cricoid area.
• Radiation necrosis of larynx unresponsive to antibiotics or hyperbaric oxygen therapy.
• Severe aspiration following partial or near total laryngectomy .
• Massive nodal metastasis.

C.Preoperative nursing care :

• Assess the knowledge and understanding of diagnosis and proposed surgery .
• Clarify the information and reinforce previous teaching as needed .
• Provide routine preoperative care and teacing of laryngectomy.
• Assess the anxiety levels of patient and family related to diagnosis and proposed surgery .
• Point out that surgery will affect the sense of taste and smell and eating in the initial post operative period .
• Reassure that nutritional and fluid needs will be let with intravenous or enteral feeding untill eating can be resumed.
• If possible and desired by the client and family arrange a visit by a post laryngectomy client who effectively uses an alternate form of verbal communication

Post operative nursing care :

• Provide routine postoperative nursing care.
• Monitor vital signs and frequently monitor airway paytency and respiratory status .
• Encourage For deep breathing coughing excercises
• Elevate the head of bed , upright position promotes effective ventilation .
• Maintain humidification of inspired gases.
• Maintain adequate fluid intake .
• Suction the tracheostomy using sterile techniques.
• Provide tracheostomy care as needed.
• Teach to protect the stoma .
• Place call right within easy reach at all times .
• Instruct to support the head when moving in her.
• Encourage the family members to spend more time with patient .

1. No connection between nose and mouth and lungs : opening from trachea there is no connection between nose , mouth and lungs.

The air directly passes from trachea to lungs through tracheostomy tube by means of mechanical ventilation

2. Mechnical ventilation is only source of air For lungs .

3. There are mainly 3 major ways to communication with laryngectomy such as tracheo esophageal speech , artificial larynx and esophageal speech .