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.
