Ward Class is an online resource for student nurses.
Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.
direct or indirect laryngoscopy will reveal abnormalities in the vocal cords
panendoscopy will determine the exact location, size, and extent of primary tumor
biopsy (collection of a tissue sample) --> performed if abnormalities are found; sample is then sent to laboratory for testing
imaging studies--> X-ray, MRI, CT scans, and PET scansmay be ordered to determine the extent of laryngeal cancer beyond the surface of the voice box.
radiation therapy--> may be effective in cases of localized disease affecting only one vocal cord
chemotherapy--> may be administered preoperatively to reduce tumor size, postoperatively to reduce risk of metastasis, or as palliative treatment
the goal of surgical intervention for laryngeal cancer are to remove the cancer, maintain adequate physiologic function of the airway, and achieve a personally acceptable physical appearance
laser surgery--> indicated for small tumors as it can preserve much of the glottis, leaving the client with a usable voice; sometimes combined with radiation therapy
partial laryngectomy--> useful for early intrinsic lesions; client will be able to talk and has a normal airway after surgery
total laryngectomy--> involves removal of the entire larynx, hyoid bone, pre-epiglottic space, cricoid cartilage, and 3-4 rings of trachea; the client will have a permanent tracheostomy resulting in a loss of normal speech, breathing, and olfaction.
radical neck dissection--> performed when metastasis is suspected; the larynx, lymph nodes, sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve are removed (note: may also include removal of the mandible, submaxillary gland, and portions of the thryoid and parathyroid gland)
for the client with a total laryngectomy
promote optimum ventilatory status
assess for signs of respiratory complications such as dyspnea, tachycardia, restlessness, and tachypnea
suction nose frequently because of rhinitis
provide tracheostomy/laryngectomy, and stomal care; observe for signs of infection
elevate head of bed to decrease pressure on suture lines and to promote lymphatic drainage
support client's back of neck with hands during turning and moving
administer analgesics for pain as ordered
promote nutrition through tube feedings as ordered; increase oral fluid intake as tolerated
prevent infection--> monitoring of WBC, frequent oral hygiene, frequent temperature checks, maintaining sterile technique during suctioning and tracheostomy care, and monitoring for changes in sputum and wound drainage.
provide referrals to speech therapist if necessary (client may have to use esophageal speech or an artificial larynx)
provide encouragement and support on nutrition, self-care, and adaptation to altered physical status
provide client teaching and discharge planning on:
tracheostomy/laryngectomy and stomal care
administration of tube feedings and care of NGT
gradual return to normal diet as tolerated
mouth care (brushing toungue with soft toothbrush to control crusting and dryness)
need for humidified air
shielding of stoma with towel while showering; use of stoma guards
use of smoke detectors (due to lack of sense of smell)
covering stoma when coughing or sneezing and need to lean forward when expectorating secretions
use of electric razors if facial numbness is present (esp. for clients with radical neck dissection)
use of clothing that do not emphasize chest or neck
information on speech therapy and reconstructive surgery
If discovered early enough, laryngeal cancer is potentially curable. If untreated, laryngeal cancer is fatal; 90% of clients with untreated laryngeal cancer die within 3 years.
Laryngeal cancer cannot be prevented but the risks of acquiring it may be reduced by smoking cessation, avoidance of hazardous fumes, a healthy diet, and limiting consumption of alcohol.