N
EUROSENSORY•Double vision
•Deafness, involved side
•Tingling, paresthesia of facial muscles
P
AIN/D
ISCOMFORTPreoperative:
•Chronic sore throat, “lump in throat”
•Referred pain to ear, facial pain (late stage, probably metastatic)
•Pain or burning sensation with swallowing, especially with
hot liquids or citrus juices
•Sore throat or mouth
Postoperative:
•Surgical site pain
•Shoulder pain on affected side
R
ESPIRATION•History of tobacco use including cigars and chewing tobacco
•Occupation working with hardwood sawdust, toxic chemicals
and fumes, heavy metals
•History of voice overuse, for example, professional singer or
auctioneer
•History of chronic lung disease
•Cough with or without sputum
•Blood-tinged sputum or nasal drainage
S
AFETY•Excessive sun exposure over a period of years
•Radiation therapy
•Visual or hearing changes
S
OCIALI
NTERACTION•Lack of family or support system—may be result of age
group or behaviors such as alcoholism
•Concerns about ability to communicate, engage in social
interactions
T
EACHING/L
EARNING•Nonhealing of oral lesions
•Concurrent use of alcohol or history of alcohol abuse
D
ISCHARGEP
LANC
ONSIDERATIONS•May require assistance with wound care, treatments, supplies,
transportation, shopping, food preparation, self-care, homemaker and maintenance tasks
➧Refer to section at end of plan for postdischarge
considerations.
•Hemiparalysis of face with parotid and submandibular
involvement
•Persistent hoarseness or loss of voice—dominant and earliest
symptom of intrinsic laryngeal cancer
•Difficulty swallowing
•Conduction deafness
•Disruption of mucous membranes
•Guarding behaviors
•Restlessness
•Facial mask of pain
•Alteration in facial muscle tone
•Hemoptysis
•Dyspnea (late)
•Masses or enlarged nodes
•Persistent hoarseness, change in voice pitch
•Muffled or garbled speech, reluctance to speak
•Hesitancy or reluctance of significant others (SOs) to provide
care or be involved in rehabilitation
D I A G N O S T I C D I V I S I O N
CHAPTER 5
RESPIRA
T
OR
Y—RADICAL NECK SURGER
Y
Diagnostic Studies
B
LOODT
ESTS• Complete blood count (CBC):Battery of screening tests that typically includes hemoglobin (Hgb), hematocrit (Hct), red blood cell (RBC) count and morphology, indices, and distribu- tion width index; platelet count and size; white blood cell (WBC) count and differential.
• Immunological surveys:Measure levels of T cells, natural killer (NK) cells, macrophages, and so on.
• Human papillomavirus (HPV; particularly for type 16) test: To screen for presence of HPV.
• Biochemical profile:Battery of tests including electrolytes, glucose, total protein, amylase, blood urea nitrogen
(BUN)/creatinine (Cr), bilirubin, total CO2, cholesterol, lipids,
and aspartate aminotransferase (AST)/alinine aminotransferase (ALT) to evaluate general status of organ function.
O
THERD
IAGNOSTICS
TUDIES• Direct/indirect laryngoscopy:Provides direct visualization of structures of the mouth and throat by means of either a rigid or flexible endoscope. Allows for biopsy and aspiration of secretions for cytology.
• Laryngeal computed tomography (CT) scan:X-ray procedure that uses a computer to produce a detailed picture of a cross- section of the body.
• Magnetic resonance imaging (MRI) scan:Evaluates tumor status and treatment options.
• Positron emission tomography (PET) scan:Measures the activity or functional level of the brain by measuring its use of glucose.
• Single photon-emission tomography (SPECT) scan:Nuclear medicine procedure in which a gamma camera rotates around the client and takes pictures.
• Laryngography:X-ray examination of the larynx after the insertion of a contrast medium.
• Chest x-ray:Evaluates organs and structures within the chest. • Pulmonary function studies, including spirometry, lung
volumes, and perfusion:Measure how well the lungs take in and release air and how well they move oxygen into the blood.
• Arterial blood gases (ABGs)/pulse oximetry:Blood test or peripheral scan to measure oxygen content and saturation of the blood
May reveal anemia, which is a common problem. Folate defi- ciency is very common in clients with history of alcoholism and malnutrition.
May be done for clients receiving chemotherapy or immunother- apy to determine status of immune system and to assist with use of vaccines for manipulation of cancer-directed immune response therapy.
HPV-related cancers tend to occur on the tonsillar area and the base of the tongue and the oropharynx, whereas non–HPV-related tumors tend to involve the anterior tongue, floor of the mouth, and the mucosa that covers the inside of the cheeks and alveolar ridges where the teeth are located. Changes may occur in organ function as a result of cancer,
metastasis, and therapies.
Visualizes local or regional cancers of the oropharynx and upper airways and allows staging.
Defines tumor extension deep in the laryngeal mucosal surface, cartilaginous invasion, and metastatic disease to the lymph nodes of the neck. Has largely replaced contrast laryngography as the primary method for staging laryngeal carcinoma (Silverman et al, 1984).
MRI is most often used as the primary imaging modality when evaluating tumor spread in nasopharynx, oropharynx, palate, base of tongue, and floor of mouth.
Because cancer cells are dividing rapidly, they break down glucose much faster than do normal cells. The increased activity will show up on a PET scan and can indicate both primary and metastatic tumors. PET scan allows identification of tumor, especially in difficult cases where no obvious mass was seen clinically or on either CT or MRI (American Head and Neck Society, n.d.).
SPECT is particularly useful for detection of occult head and neck tumors and for assessing possibility of recurrence. It may also help stage primary tumors, differentiate metastatic from reactive lymph nodes in the neck, and screen for distant metastases (Olmos et al, 1997).
May be performed to study blood vessels and lymph nodes.
Done to establish baseline lung status and to identify metastases. Chronic obstructve pulmonary disease (COPD) is common in
this group of clients. Abnormal findings may indicate need for additional interventions to improve pulmonary reserve prior to surgery.
May be done to establish baseline and monitor status of lungs.