VIPESA “CARROCERÍAS Y FURGONES”
INFORMACIÓN RESPONSABLE
7. REALIZACIÓN DEL PRODUCTO
41 Nursing management
Reassurance and support.
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Visual examination of the larynx (laryngoscopy) and biopsy confirm the diagnosis and identify the type of malignancy. In addition, computed tomography (CT) scanning and chestradiography are used to detect metastasis and to determine tumor size. The physician also assesses the mobility of the vocal cords. Limited mobility indicates that the tumor growth is affecting the surrounding tissue, muscle, and airway.
Medical and Surgical Management
Treatment depends on factors such as the size of the lesion, the client’s age, and metastasis. Medical treatment may include chemotherapy, which appears to have only minimal effects, and radiation therapy, either alone or with surgery. Surgical treatment includes laser surgery for early lesions or a partial or total laryngectomy. In more advanced cases, total laryngectomy may be the treatment of choice. If the disease has extended beyond the larynx, a radical neck dissection (removal of the lymph nodes, muscles, and adjacent tissues) is performed. Laser surgery may also be used to relieve obstruction in more advanced cases.
A client with a total laryngectomy has a permanent tracheal stoma (opening) because the trachea is no longer connected to the nasopharynx.
The larynx is severed from the trachea and removed completely. The only respiratory organs in use are the trachea, bronchi, and lungs. Air enters and leaves through the tracheostomy. The client no longer feels air entering the nose. Because the anterior wall of the esophagus connects with the posterior wall of the larynx, it must be reconstructed. Tube feeding facilitates healing by preventing muscle activity and irritation of the esophagus. Loss of the ability to speak normally is a devastating consequence of laryngeal surgery. Clients with a malignancy of the larynx require emotional support before and after surgery and help in understanding and choosing an alternative method of speech. Some methods of alaryngeal speech used after a laryngectomy include the following:
• Esophageal speech: requires regurgitation of swallowed air and formation of words with lips; voice quality will be lower-pitched and gruff-sounding, but more natural
• Artificial (electric) larynx: a throat vibrator held against the neck that projects sound into the mouth; words are formed with the mouth.
• Tracheoesophageal puncture (TEP): a surgical opening in the posterior wall of the trachea, followed by the insertion of a prosthesis such as a Blom-Singer device.
43 Air from the lungs is diverted through the opening in the posterior tracheal wall to the esophagus and out the mouth. The client covers the stoma with his or her finger and forces air through the esophagus; this causes the walls of the throat to vibrate as the client speaks. It sounds more natural than an artificial larynx. A speech pathologist works with the client to use an artificial speech device, learn esophageal speech or speak.
LARYNGECTOMYINDICATION POSTOPERATIVE EXP It is a surgical removal of larynx.
Indication: Laryngeal tumour or cancer Types
Partial laryngectomy: The affected vocal cord is removed and other structures remain intact. It is for early stage laryngeal cancer and results into hoarseness of voice. Trachea is intact trachea and is no problem with swallowing.
Total laryngectomy: Both vocal cords removed along withthe hyoid bone, epiglottis, cricoidscartilage, and two or three rings ofthe trachea; the tongue, pharyngealwalls, and trachea remain intact;usually a radical neck dissection isdone on the affected side.Itis done when the cancer extendsbeyond the vocal cords.A permanent tracheal stoma that preventsaspiration is left after the surgery. There is no voice but ability to swallow remains.
Preoperative Care
In addition to routine preoperative teaching, the patient undergoing laryngectomy surgery must be prepared for the loss of ability to breathe through the mouth and nose and the loss of ability to speak. Initial instruction in communication techniques should take place before surgery to prevent the patient from feeling panicky after surgery when he or she is unable to communicate any needs. A variety of techniques and devices are available. Consult the speech therapist before surgery to provide a picture board, magic slate, or paper and pencil. The patient is instructed to point to the picture that corresponds with the need or to write out his or her concern.
A dietary consult is also important before surgery if the patient has been undernourished.
Postoperative Care
Assessment of physical and psychosocial status, comfort, nutritional status, and ability to swallow is important both before and after surgery. After surgery, assessment of airway patency and respiratory function is vital.
Monitor lung sounds, oxygen saturation, and arterial blood gases. In addition, be sure to assess the patient’s understanding of the disease process and self-care needs after surgery. It is important to evaluate the patient’s
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support systems and ability to cope with the partial or total loss of voice after surgery.
4.0 CONCLUSION
Clients with sleep apnea usually are anxious and require reassurance and adequate instruction about their condition. The nurse provides thorough explanations of the disease process, polysomnography, and treatments. He or she refers clients to self-help groups or to appropriate counseling for weight loss or alcohol and substance abuse issues.
5.0 SUMMARY
In this unit, you have learnt that:
• Sleep apnea syndrome is characterized by frequent, brief episodes of respiratory standstill during sleep.
• Epistaxis or nosebleeds are the rupture of tiny capillaries in the nasal mucous membrane.
• A nasal fracture usually results from direct trauma.
• A deviated septum is an irregularity in the septum that results in nasal obstruction.
• Laryngeal obstruction is an extremely serious and often life-threatening condition.
• Persistent hoarseness (longer than two weeks) is usually the earliest symptom of Laryngeal cancer
6.0 TUTOR-MARKED ASSIGNMENT
1. Discuss the pathophysiology of obstructive sleep apnea and the nursing management.
2. Describe the nursing management of a patient with epistaxis. . 3. Discuss the nursing management of a patient with laryngectomy
7.0 REFERENCES/FURTHER READING
Bullock, B.A., &Henze, R.L. (2000). Focus on pathophysiology.
Philadelphia: Lippincott Williams & Wilkins.
Burke, K.M; Mohn-Brown, E.L &Eby, L (2011). Medical-Surgical Nursing Care. (3rded.). Boston: Pearson Education, Inc.
Nettina, S.M (2010). Lippincott Manual of Nursing Practice (9thed). China:
Wolters Kluwer Health Lippincott Williams & Wilkins.
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