4/7 Team Care & Counseling Continued

Question 1

In terms of taste & smell what does a lary experience?

Answer 1

taste may get a little bit better but smell is always affected!

-diminished taste may be due to radiation (remember, they most often have cancer)

Question 2

What percentage of larys return to previous enrollment?

Answer 2

70%

Question 3

what are some things that people experience when going back to work?

Answer 3

• for those that are working, they may potentially need to find some place else to work (e.g., if it’s a dusty/dirty place to work)
• types of work require you to be hands free, so this may potentially affect you going back to work
• You want to encourage people to get back to their normal lives!

Question 4

Even though some larys have jobs go back to work, what are most larys?

Answer 4

retired. because of this they are more at risk because they don’t have an excuse to get up and talk to people

Question 5

What are some changes larys experience in terms of physical activity?

Answer 5

they generally experience a change in physical activity, but as much as possible you want them to keep doing the activities they alway shave

the activities involving water are an issue (swimming, sailing, water skiing…)

Question 6

Will eating be affected for larys?

Answer 6

YES! To some degree food WILL BE AFFECTED..

there is likely to be something else along with the diminished taste and smell

the radiation causes issues, they have to pay attention when they start eating again. they will need to eat slower, take smaller bites, and for some people, they will see an improvement over time, some may not recover, and some may never eat again

-we need to talk to our patients about eating slowly and progressively

Question 7

In terms of stoma care what must larks do 2x daily?

Answer 7

clean the stoma with soap and water 2x daily

it needs to be cleaned @ least 2x daily. When they leave the hospital, potentially more.

Don’t scrub hard cause you don’t want to have raw tissue but they will be hacking up a lot of mucous

Question 8

What does the nose do?

Answer 8

it filters, moistens, and warms the air, without it it’s just cold air going into the stoma

Question 9

What should they never use to clean the stoma?

Answer 9

cotton balls! they should use a really soft cloth

Question 10

If there is crust around the edges of the stoma, what should the lary do?

Answer 10

it needs to be soaked in water. makes sure they don’t inhale any soap or water!

Question 11

What may they use for raw skin on the stoma?

Answer 11

k-y jelly.

Don’t use vaseline! it’s a petroleum product, it gets warm and it runs!

-make sure no moisturizer is used that is used to burn raw skin.

Aloe is good for dry skin, not so good for raw skin.

Question 12

What must we teach larys that is ABSOLUTELY NECESSARY for the stoma?

Answer 12

a cover!

right away, the client MUST cover their stoma! it’s not an option!

try to talk your patient into getting an HME (heat/moisture exchange) it’s just so much better for long term health

** they can’t get an HME quickly before being discharged…

Question 13

What is something we should warn larys about in terms of mucous?

Answer 13

there may be ALOT of mucous at first

the upper respiratory tract adds 1-2 quarts of water to inspired air every 24 hours

tell them to use an HME!

they could use a humidifier, it’s better for them, and helps the body be more comfortable.

Question 14

What should we educate larys about in terms of showering?

Answer 14

shower guards are something that they should use

it goes around the neck like a choker, and has a front piece that is just a plastic shelter for the stoma.

Question 15

What should we teach them about shaving?

Answer 15

most laryngectomees are men, try to talk your client into an electric razor

Question 16

What should we tell them about sleeping

Answer 16

it’s not a problem, just like other people. when you can’t breathe, you wake up. they won’t have issues with this!

Question 17

Because natural healing response wants to close the stoma, what is necessary to use?

Answer 17

a canula

Question 18

Describe the canula

Answer 18

a canula is a tube that is made out of plastic or metal and it puts it in the stoma hole. The device sits around the stoma, with a tube going hroughthe stoma, just a little way to the trachea. It’s something that holds the stoma open while it heals. Some people may have an issue with stenosis (tissue closure) this is not good when you’re breathing through that hole! the canula is placed into every patient

Question 19

Describe the introducer in the canula

Answer 19

-when a canula is introduced, it is just a tube with edges. They make an introducer that goes down into the canula and is shaped like a bullet so you have a smooth surface. However, when the introducer goes in it, it is plugging the canula, and will cause the patient to suffocate. The inner canula needs to be cleaned multiple times daily, and every now and again the outer canula needs to be taken out to be cleaned.

Question 20

How can canals be cleaned?

Answer 20

they can be soaked in hydrogen peroxide or warm water, (don’t put soap on the canula–if it doesn’t get completely removed, it’ll burn!)

you can use a small bottle brush to scrape and clean the canula

Question 21

What may you have to teach the patient in terms of their canula?

Answer 21

you may have to teach the patient how to clean and maintain the canula

Question 22

Describe the inner canula & the outer canula

Answer 22

the inner canula has a locking mechanism to keep it from falling out when the patient bends over. The outer canula is usually kept on a tie around the neck.

the outer canula stays in, but the patient takes out the inner canula and cleans it

Question 23

Do we ever have to be a counselor?

Answer 23

yes! in general, as a SLP there are several populations where you need to have a good idea about yourself as a counselor. It is within your purview with limitation!

(e.g., transgender population, people who stutter, or who have parkinson’s or huntington’s or CVA’s. Larys are part of this population)

Question 24

What should we always find ways to encourage?

Answer 24

encourage them to continue their life as normal as possible!

Question 25

Laryngectomy is a team approach, who else is part of the team?

Answer 25

one of the most important people of a team may be another lady

be in contact with clubs/groups that can be a support group to your patient

Question 26

What must we address in terms of mental health for larys?

Answer 26

need to address physical, social, emotional aspects. we need to address their quality of life issues.

it’s best to not tell them, but listen to them and bring up topics that may be uncomfortable (e.g., talk to them about their sex lives!

talk to them about living! Remember the difference between sympathy and empathy

Question 27

what’s sympathy?

Answer 27

“I know how you feel” –NO YOU DON’T!

Question 28

What’s empathy?

Answer 28

Listening!

Question 29

In terms of counseling, as SLPs what should we provide information about?

Answer 29

provide information about alaryngeal speech rehab

Question 30

How do we determine a person’s communication needs?

Answer 30

talk to family members and to the patient

Question 31

What should we build a relationship on with our patients?

Answer 31

base it on trust!

don’t promise things they may not be able to do! talk to them about exploring options, working together, give them lots of information!

Question 32

What must we monitor and facilitate?

Answer 32

a return to a normal life

this is a patient population that you will need to call! they’re going to go home and shut the door, ask them “how are you?” “How can I help you?”–you have access to social workers–you may utilize them!

keep your patient engaged in the community!

Question 33

What do we need to teach our patients about post op changes?

Answer 33

teach them the anatomy and physiological changes

Question 34

What should we promise?

Answer 34

promise to be there to help, and then maintain contact and follow through!

Question 35

What should we allow people, and not rush?

Answer 35

we should allow people their own timeline!

some people recover very quickly and be very forward thinking, and others will just take more time to start “swinging” again. allow people their timeline, but encourage them to understand that when they have any kind of journey if you want to go fast, go alone, fi you want to go far, go with others.

there’s a lot of research that therapy groups/community groups make a HUGE difference to groups of people!

Question 36

What should we remember is at the foundation of the laryngectomy procedure? and what should we help them deal with?

Answer 36

-remember that at the foundation these patients that are dealing with cancer. Mortality issues surface, bucket lists, etc.. these are cancer patients that need a lot of support, hope, and ideas on moving on and moving forward.

help them deal with their diagnosis. help yourself deal with the population by understanding the five stages of brief.

Question 37

What are the five stages of grief?

Answer 37

1. Denial
2. anger
3. bargaining
4. depression
5. acceptance

Question 38

describe the denial stage

Answer 38

in denial, a patient isn’t really going to listen to you. they just won’t hear you. They’re not going to follow your instructions… if they’re saying “no,everything’s going to be fine” they’re probably in denial & won’t listen to you. keep talking about the same points until it sinks in!

remember, be aware that some patients may just dry that they have cancer and refuse any form of treatment

Question 39

describe the anger stage

Answer 39

in this stage they may hear you, bu the really tough on you! they’ll say mean things to you and the people around them.

most of the time laryngectomy patients are angry @ themselves b/c they were/are smokers

you should remind them that life isn’t fair, but we’re gonna face the issue and move on

Question 40

Describe the bargaining stage

Answer 40

usually bargaining is with God, but they will still hear you. However, you’re not God, you won’t be able to make the cancer go away, or keep the larynx there

Question 41

Describe the depression stage

Answer 41

this is a big one! this is really common!

patients in depression are difficult to counsel and work with them b/c they are unmotivated. Be familiar with services and talk with their families

DEPRESSION MAY BE A CHEMICAL RESPONSE B/C THE THYROID FUNCTION WAS MESSED UP DURING RADIATION AND IS NOW NOT FUNCTIONING!!! —GET THE THYROID CHECKED!!!!*******

Question 42

Describe the acceptance stage

Answer 42

person says “okay, this is what it is, on we go”

developing a positive view about the future, and they listen to your instructions

Question 43

what must we keep in mind of the progression of the stages of grief?

Answer 43

stages of grief go back and forward! some stages are longer than others…