Question

Case study Iohn Derwent is a 47-year-old man who is being cared for on the ward having undergone ectomy for cancer. He currently has a tracheostomy tube in place and is beginning obilize around the ward, though at present he is sat on the edge of the bed in a 'tripod tion He is frequently visited by his wife and 13-year-old daughter, although his daughter es not seem keen to stay at the bedside and is often to be found in the day room whilst mother stays at her father's bedside. Mr Derwent was a police officer and will not be to work as he has been advised to retire on health grounds. He is depressed and it hard to communicate and thus he can become quite a laryng do her returning anxious about the future, but finds frustrated 577 On careful questioning, Mr Derwent reports that he feels that it is harder to breathe. On his tracheal tube has become encrusted with dried secretions. The inner tube was removed and changed for a new one easing airflow and improving Mr Derwent's ability to breathe. The need for humidification was reinforced to Mr Derwent as it appears that he does not like being attached to a pipe'as it upsets his daughter to see it. Nursing staff were also reminded that the inner tube of Mr Derwent's tracheostomy should be cleaned every two hours for the first 48 hours and every four hours after that. Vital signs The following vital signs were noted and recorded Normal 36.1-38.0°C range 51-90 beats per minute 12-20 breaths per minute 111-219 mmHg (systolic) range Vital sign Observation 37.0C 82 beats per minute 24 breaths per minute 155/90 mmHg 9296 Temperature Respiration: Blood pressure: Oxygen saturations:

Answer 1

1a,.proper hand washing technique should be followed when attend the patient to prevent infection.antiseptic solutions should be used before and qfter each procedure.

b,extra humidity is needed .an ultrasonic nebulizer can use to provide this facility

C,increase the fluid intake to keep the airway moist

d,do suctioning every hourly.

e,clean the nubulizer gtube with warm water to prevent respiratory infectio s

f,stoma should be kept clean dry always to prevent infection

g,oral hygiene daily to prevent foul odour

2)1,contact a community health to assist the patient in home and provide supplies which is needed in home care

2)suction machine should be arranged in home

3)humidified also needed in home

4)suction catheter,sterile saline,syringes,cotton,stoma cleaners should be arranged before discharge

5)prepare the patient do his daily activities by own

6 )give information about the need of continuing medication and follow up

3)encourage him to write messages untill he becomes capable to speak.keep paper and pen beside his bed inorder to pass messages whenever he needs

4)there will be changes in physical,emotional and sexual changes after laryngectomy.they may be worried about their future so society should provide concern and care so that they can accomplish their physiological needs.Treat the patient like common man so that he does not feel isolated from society.encourage the patient to write down his messages and tell him that he can regain speaking ability after few days.teach the family about suctioning,use of humidifier and medication.this will help decrease their anxiety to provide home care.tell them to contact primary health center if there is any emergency.give adequate information about dietry requirements of patient and importance to prevent infections.proper information and knowledge can reduce psychological stress to some extent.