Ward Class

An Online Resource Site For Student Nurses

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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.

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The December 2012 PRC Nursing Board Exam Result is already available here at Ward Class and at Pinoy R.N.




Respiratory Disorders: Laryngeal Cancer



  • refers to malignant tumors that develop in the larynx (voice box)
  • may occur on the glottis (true vocal cords), the supraglottic structures, or the subglottic structures
  • most common upper airway malignancy; accounts for 2% to 3% of all malignancies and usually occurs in men during midlife or late adulthood
  • primarily caused by cigarette smoking--> linked directly to the mutation of p53 gene in squamous cell carcinoma (most common malignant tumor of the larynx)
  • other risk factors include excessive alcohol use, chronic laryngitis, vocal abuse, and occupational exposure to asbestos, wood dust, petroleum products, mustard gas, and other noxious fumes
Assessment Findings

a. Glottic tumor
  1. early: voice change, hemoptysis, hoarseness
  2. late: dyspnea, respiratory obstruction, dysphagia, weight loss, pain
b. Supraglottic tumor
  1. early: aspiration on swallowing (esp. liquids), persistent unilateral sore throat, foreign-body sensation, dysphagia, weight loss, neck mass, hemoptysis
  2. late: dyspnea, pain in the throat or referred to the ear
c. Subglottic tumor
  1. early: none
  2. late: dyspnea, airway obstruction, dysphagia, weight loss, hemoptysis
  • diagnostic procedures
  1. direct or indirect laryngoscopy will reveal abnormalities in the vocal cords
  2. panendoscopy will determine the exact location, size, and extent of primary tumor
  3. biopsy (collection of a tissue sample) --> performed if abnormalities are found; sample is then sent to laboratory for testing
  4. imaging studies--> X-ray, MRI, CT scans, and PET scans may be ordered to determine the extent of laryngeal cancer beyond the surface of the voice box.
Medical Management
  1. radiation therapy--> may be effective in cases of localized disease affecting only one vocal cord
  2. chemotherapy--> may be administered preoperatively to reduce tumor size, postoperatively to reduce risk of metastasis, or as palliative treatment
Surgical Management
  • 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
  1. 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
  2. partial laryngectomy--> useful for early intrinsic lesions; client will be able to talk and has a normal airway after surgery
  3. 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.
  4. 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)
Nursing Management
  • for the client with a total laryngectomy
  1. promote optimum ventilatory status
  2. assess for signs of respiratory complications such as dyspnea, tachycardia, restlessness, and tachypnea
  3. suction nose frequently because of rhinitis
  4. provide tracheostomy/laryngectomy, and stomal care; observe for signs of infection
  5. elevate head of bed to decrease pressure on suture lines and to promote lymphatic drainage
  6. support client's back of neck with hands during turning and moving
  7. administer analgesics for pain as ordered
  8. promote nutrition through tube feedings as ordered; increase oral fluid intake as tolerated
  9. 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.
  10. provide referrals to speech therapist if necessary (client may have to use esophageal speech or an artificial larynx)
  11. provide encouragement and support on nutrition, self-care, and adaptation to altered physical status
  12. 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
  • drowning precautions
  • 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
Prognosis

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.

Prevention

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.

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