COMPS: Team Care, Counseling (O11) Flashcards
What should the SLP address regarding medical concerns?
- Laryngeal cancer is highly curable (75-80% of pts will live past the 5 year mark)
- Address the fear of death.
- Information about survival chances are gained during the surgery.
- Tell the pt that he/she has an excellenet doctor who will take great care of them.
- Describe the surgery and give some literature on the subject. “They’re going to remove the larynx, and you’ll breathe through your neck.”
How long is laryngectomy surgery?
3-5 hours
*Tell the pt that they’ll wake up in the ICU
T/F: pain is not usually an issue with laryngectomy, but swelling is more of a problem.
True
The pt will be fed through a ___-tube through the nose for a few days, then graduate to a soft diet and then a regular diet while the tissue heals.
g-tube
FAQ: “Why do they have to remove the whole larynx?”
Because the larynx is a valve, and if part of the valve is removed, it will leak food and liquid and you will choke every time you eat or drink.
Also, the surgeon will be more sure that he has removed all of the cancer, which increases your chances of survival.
FAQ: “Why won’t I be able to speak?”
Because the air will not be coming up through your mouth anymore and because your larynx where the focal folds are will be removed. The larynx is where the voice vibrates, and without the larynx, it’s difficult for any vibration to happen.
What should you teach the pt regarding the mouth and trachea?
Tell the pt that nothing can come out of the mouth any more, including any phlegm from coughing. Phlegm will now come out the stoma in the neck, so tell the patient to get into the habit of covering their stoma instead of their mouth.
What are the two kinds of alaryngeal speech?
- Esophageal speech (UES is vibratory source)
2. Electronic sources for vibration (electrolarynx)
What is a prosthesis?
A small tube that connects the trachea and the esophagus in order for speech to occur.
What are the two ways of producing esophageal speech?
- By injecting air into the esophagus/swallowing air
2. By using a prosthesis
What are the two kinds of electronic sources for vibration?
- “Neck-type-device” that vibrates the neck.
2. Tube held between the teeth that vibrates the air in the mouth.
Diminished ______ and _____ is partly due to radiation therapy.
taste and smell;
This may improve with time
__% of laryngectomees return to previous employment.
70%
*SLPs should encourage pts to get back into their normal lives and activities.
Discuss what you need to counsel your patient on regarding eating after laryngectomy surgery.
Radiation affects movable tissues, and smell may be diminished. The patient will need to eat more slowly and take smaller bites. Some will see improvement over time in their ability to eat, and others will never eat again.
*Talk to pt about going into eating very slowly to make sure that the structures are working and to gradually transition into a normal eating routine.
How often should the stoma be cleaned? How should it be cleaned?
Clean the stoma with soap and water two times daily.
Use a soft washcloth or BIG cue-tips. Do not use cotton balls because they shed cotton. Lean forward when cleaning the stoma.
*Make sure what you’re using to clean it is big enough that it does not fall into the stoma.
What happens if something falls into the stoma?
Tell your patient NOT to panic- they can breathe around the stoma. They will need to be rushed to the ER, where the doctor will put them into a sleep and remove the object. (The carina will stop the object from falling into the lungs)
To prevent the stoma from becoming red and raw, what can the patient put on it?
K-Y Jelly
What type of cover for filtration is best to put over the stoma?
A Heat Moisture Exchange (HME)
*Also suggest using a humidifier at home
What should you advise your male patient about regarding shaving?
Advise him to use an electric razor since it does not require soap or water. (Soap and water can get into the stoma when shaving)
What can your patient use to protect the stoma when showering?
A shower guard
What is a canula?
T/F: Some people will need to wear this for the rest of their lives.
A plastic or metal tube that is put into the stoma in order to stop the body from closing it. There is an inner and outer canula. The inner canula has a locking mechanism to keep it in place, and the outer canula is tied around the patient’s neck.
TRUE- some people’s bodies continually try to close the stoma.
What is an introducer (AKA obturator)?
A device for helping patients put the canula in. The introducer starts small and gets bigger so that patients can get used to the canula.
*Make sure to remove the introducer when the actual canula is in so that you do not cut off the pt’s airflow.
How should the patient clean their canula?
By soaking it in hydrogen peroxide. May also use a small bottlebrush to scrub inside it.
COUNSELING: What are the 5 stages of grief (Kubler-Ross, 1974)?
- DENIAL: pt may deny that they have cancer.
- ANGER: pt may lash out at his/her family members because they are likely angry at themselves. It’s the SLP’s job to tell them that life is not fair to anyone.
- BARGAINING: pt may bargain with God. The SLP can bargain with the patient in this stage.
- DEPRESSION: patient feels helpless, hopeless, and unmotivated. Usually will not hear the SLP or loved ones when they are in this stage.
- ACCEPTANCE: patient develops a positive attitude about the future and begins to listen to instructions.
**The stages of grief shift and go back and forth. Some people skip stages, or switch back and forth depending on the day.
As an SLP, what is your goal with counseling, keeping in mind the 5 stages of grief?
You are not trying to change the stage of grief that your patient is in, but are there to listen and understand where they’re at and where they’re coming from.
What 8 things should an SLP attempt to do when counseling a laryngectomy patient?
- Take a team approach & stay in contact w/the team.
- Address the physical, social, & emotional aspects.
- Provide info about alaryngeal speech rehabilitation & counsel pt. about post-op changes in anatomy and physiology.
- Determine the patient’s communication needs.
- Build a relationship with the pt based on trust, and promise to be there to help.
- Monitor and facilitate a return to normal life.
- Allow the patient his/her own timeline. (“If you want to go fast, go alone. If you want to go far, go with others” -African proverb)
- Remember that you’re helping the pt deal with a diagnosis of CANCER (mortality issues, bucket lists, separation from family)
What is one local laryngectomy support group?
The 49er Lost Chords Club (Sacramento, CA)
What are some international laryngectomy support groups?
The International Association of Laryngectomies (IAL)
WebWhispers online support
What are some benefits of using a Heat Moisture Exchange (HME)?
Moisture retention
Reduction of mucus
Reduction of cough
Reduced stoma cleaning frequency
Why should a laryngectomee wear a bracelet or something that clearly identifies them as having had laryngectomy surgery?
Because if a laryngectomy patient becomes unresponsive and 911 is called, the paramedics may not realize the person has had a laryngectomy. CPR cannot be performed in the same way.
What’s another term for the UES?
Pharyngo-esophageal segment (PE Segment)
What are some functional consequences of permanent tracheostomy? (ASHA PowerPoint)
file:///Users/chelseabrack/Downloads/Benjamin-Bunting-DeLassus%20Gress.pdf
CHANGES:
Coughing Sneezing/Nose blowing Smelling Tasting Gargling Showering Swimming Foreign bodies in the stoma Laughing Balloons, matches, bubbl es & candles CPR Whistling Wind Instruments Yawning Lifting heavy objects Sipping through a straw Cooling soup & coffee Anesthesia Pulmonary function tests Medication delivery Sexuality
