Question

ACTIVE LEARNING TEMPLATE: System Disorder STUDENT NAME DISORDER/DISEASE PROCESS Laryngeal clue REVIEW MODULE CHAPTER Alterations in Health (Diagnosis) Pathophysiology Related to Client Problem Health Promotion and Disease Prevention ASSESSMENT SAFETY CONSIDERATIONS Risk Factors Expected Findings Laboratory Tests Diagnostic Procedures PATIENT-CENTERED CARE Complications Nursing Care Medications Client Education Therapeutic Procedures Interprofessional Care ACTIVE LEARNING TEMPLATES

Answer 1

Diagnosis:

It is a disease in which malignant (cancer) cells form in the tissues of the larynx.Health alteration occur in the form of pain while swallowing or drinking, ear pain, A lump in the neck or throat. Or a change or hoarseness in the voice.

pathophysiology

On getting exposed to risk factors, Cell behaviour in the larynx changes leading to non-cancerous (benign) conditions like chronic laryngitis, vocal cord nodules, vocal cord polyps and laryngeal papillomatosis. but sometimes precamcerous changes in laryngeal cells occur ie dysplasia which causes a higher chance that they will become cancer. Most often, laryngeal cancer starts in flat, thin cells called squamous cells, called squamous cell carcinoma of the larynx. It can develop anywhere in the larynx most often in the middle of the larynx, proximal to the vocal cords.

health promotion and disease prevention

• Stop smoking or don't start smoking
• Drink alcohol only in moderation, if at all.
• Choose a healthy diet full of fruits and vegetables.
• Protect yourself from HPV.

risk factors

• Tobacco use, including smoking and chewing tobacco
• Excessive alcohol drinking
• human papillomavirus (HPV) Infection
• A diet lacking in fruits and vegetables
• Gastroesophageal reflux disease

lab tests

no specific blood lab tests

diagnostic procedures

• Laryngoscopy. A laryngoscopy can be performed in 3 ways:Indirect laryngoscopy, Fiber optic laryngoscopy and Direct laryngoscopy

• triple endoscopy to examine the ear, nose, and throat area, as well as the trachea and the bronchus, which are located next to the lung and the esophagus.

• Videostroboscopy to view the vocal folds and can detect motion abnormalities and other changes in vibration that are often important for finding a tumor. It helps in-determining  the location and size of a tumor, as well as how the tumor has affected the function of the larynx and hypopharynx.

• Biopsy is the removal of a small amount of tissue for examination under a microscope for making a definite diagnosis.

• Molecular testing of tumor to identify specific genes, proteins, and other factors unique to the tumor which helps in determinimg treatment options.

The following imaging tests may be used to determine the spread of  cancer:

• Computed tomography (CT or CAT) scan

• Magnetic resonance imaging (MRI).

• Positron emission tomography (PET)

• Bone scan

• Ultrasound

• X-ray/barium swallow.

patient centered care

nursing care

• The nurse assesses the patient for the sign and symptoms:
• The patient’s ability to hear, see, read, and write is assessed.
• the nurse determines the psychological readiness of the patient and family.
• The nurse evaluates the patient’s and family’s coping methods to support them effectively both preoperatively and postoperatively.

nursing interventions in postoperative respiratory discomfort:

• Monitor vital sign respiratory rate and depth note ease of breathing. Auscultate breath sounds. Investigate restlessness, Dyspnea, and development of cyanosis.
• Elevate head of bed 30 to 45 degrees.
• Encourage swallowing, if client is able.
• Encourage and teach effective coughing and deep breathing.
• Suction laryngectomy and tracheostomy tube and oral and nasal cavities
• Maintain proper position of laryngectomy or tracheostomy tube.
• Observe tissues surrounding tube for bleeding. Change client’s position to check for pooling of blood behind neck or on posterior dressings. Rationale bleeding or sudden eruption of uncontrolled hemorrhage presents a sudden and real possibility of airway obstruction and suffocation.
• Provide supplemental humidification
• Resume oral intake with caution.
• Monitor serial ABGs or pulse oximetry and chest x-ray

therapeutic procedures

Surgery is a common treatment for all stages of laryngeal cancer. The following surgical procedures may be used:

• Cordectomy: Surgery to remove the vocal cords only.
• Supraglottic laryngectomy: Surgery to remove the supraglottis only.
• Hemilaryngectomy: Surgery to remove half of the larynx (voice box). A hemilaryngectomy preserves the voice.
• Partial laryngectomy: Surgery to remove part of the larynx (voice box). A partial laryngectomy also preserves the voice.
• Total laryngectomy: Surgery to remove the whole larynx. During this operation, a hole is made in the front of the neck to allow the patient to breathe. This is called a stoma.
• Thyroidectomy: The removal of all or part of the thyroid gland.
• Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.

Chemotherapy

The use of anticancer drugs to shrink or kill cancerous cells and reduce cancer spreading to other parts of the body.

Radiation therapy

The use of high-energy radiation to kill or shrink cancer cells, tumors, and non-cancerous diseases.

Transoral laser microsurgery (TLM)

A surgical approach that uses a highly specialized carbon dioxide (CO2) laser beam is used instead of a scalpel to cut through the tissue.

patient education

• Before partial or total laryngectomy, instruct the patient in good oral hygiene practices. If appropriate, instruct a male patient to shave off his beard to facilitate postoperative care.
• Explain postoperative procedures, such as suctioning, NG tube feeding, and laryngectomy tube care. Carefully discuss the effects of these procedures (breathing through the neck and speech alteration, for example).
• After surgery Teach and encourage client to begin self suction procedures as soon as possible. Educate client in “clean” techniques. To Reduces anxiety associated with difficulty in breathing or inability to handle secretions when alone.
• Also, prepare the patient for other functional losses. Forewarn him that he won’t be able to smell aromas, blow his nose, whistle, gargle, sip, or suck on a straw.
• Reassure the patient that speech rehabilitation measures (including laryngeal speech, esophageal speech, an artificial larynx, and various mechanical devices) may help him communicate again.
• Encourage the patient to take advantage of services and information offered by the American Speech-Language-Hearing Association, the International Association of Laryngectomees, the American Cancer Society, or the local chapter of the Lost Chord Club.

Complications

• Salivary fistula may develop after any surgical procedure that involves entering the pharynx or esophagus. (Monitor for saliva collecting beneath the skin flaps or leaking through suture line or drain site. Management NG tube feeding, meticulous local wound care with frequent dressing changes, promotion of drainage)
• Hemorrhage (carotid artery rupture) or hematoma formation. A major postoperative complication (e.g. skin necrosis or salivary fistula) usually precedes carotid artery rupture. Management immediate wound exploration in operating room.
• Stomas stenosis.
• Aspiration.
• Long-term complications: Chest infections (from repeated aspiration), Recurrence of cancer in stoma