O11 Team Care & Counseling EXAM 2

Question 1

Alaryngeal care is _______ ________.

Answer 1

TEAM CARE

Question 2

True or false - Laryngeal cancer is highly curable.

Answer 2

TRUE

Question 3

What is the percentage of patients who will survive past the 5 year mark after undergoing laryngectomy surgery?

Answer 3

75-80% of all patients.

Question 4

During the diagnosis and after being diagnosed with cancer, what is in the forefront of an individual’s mind?

Answer 4

Fear of death

Question 5

Why is an individual’s chance for survival hard to estimate pre-operatively?

Answer 5

Because once the surgeon starts making incisions, he or she may see more of the tumor than what originally showed up in the scans. There may be more cancer than what was originally thought.

Question 6

What should you remember to ask the patient?

Answer 6

Ask the patient what s/he’s learned from the doctor/nurse. (But take what they say with a grain of salt, because what they tell you the doctor said, may not exactly be what they truly said)

Question 7

*Important!! What should you tell people about their doctor?

Answer 7

Tell people that they have an excellent Dr. who will take excellent care of them.
o People are comforted when they feel that they’re in good hands, and state-of-mind is everything when it comes to cancer.

Question 8

What 5 things should you tell the patient about the surgery beforehand? (How much should you tell them)?

Answer 8

1. Describe the surgery and give some literature/printed material on the subject: “They’re going to remove your larynx, and you will breathe through your neck.”
2. Tell the patient where they will wake up after surgery so that they don’t panic (see flashcard #10)
3. Explain to them that when they wake up, they will not have a voice and will have to communicate through writing but that they WILL learn to talk again.
4. Tell them that they will be fed through a g-tube (through the nose) for a few days, then graduate to a soft diet (everything goes through a blender), then a regular diet while the tissue heals.
5. Tell them that the average stay in the hospital is 5-6 days.

Question 9

How long does laryngectomy surgery typically take?

Answer 9

3-5 hours

Question 10

Where will the patient wake up after surgery?

Answer 10

In the ICU (this is standard procedure)

Question 11

Is pain an issue usually?

Answer 11

No. However, don’t mention this to patients because if they have any pain, they might worry that its something serious when its not. Compared to other surgeries, laryngectomy is not highly painful.

Question 12

What is usually a bigger issue than pain after a laryngectomy surgery?

Answer 12

Swelling

Question 13

What is the average stay in the hospital after undergoing laryngectomy surgery?

Answer 13

5-6 days

Question 14

What is CRUCIAL to understand about laryngectomies?

Answer 14

There is no longer a connection between the mouth, nose, and trachea. Your patient will NEVER breathe through his/her nose and mouth again.

The trachea is no longer connected to the oral cavity; he/she will NEVER aspirate food or liquid, and NEVER speak through the mouth and nose powered by lung air again.

Question 15

FAQ: Why do they have to remove the whole larynx? Why not just part of it or just the tumor?

Answer 15

Two reasons:

• The larynx is a valve; if a valve is broken, it either constantly leaks or it does not allow anything through it → with the larynx, if you remove part of it, it will always leak and you will aspirate and die. Thus, the larynx will no longer protect the airway. It will constantly leak, so you will breathe your food and liquid for the rest of your days, which will kill you.
• The surgeon will be more sure that he/she removed all of the cancer, thus increasing your chances of survival

Question 16

FAQ: Why won’t I be able to speak?

Answer 16

• Because the trachea is no longer connected to your mouth and nose, air will not be coming up through your mouth anymore. Without that air going through the larynx (that you also don’t have anymore), there is no way to produce speech.
• The larynx is where the voice vibrates, and without the larynx, it’s difficult for any vibration to happen.

Question 17

What do you need to teach the patient about the stoma?

Answer 17

• After the laryngectomy, the trachea is turned forward in the neck, and you breathe through a stoma.
• Nothing will EVER come out of the mouth anymore; e.g., when they cough, phlegm will come out through the stoma (they will no longer be able to swallow phlegm), so they need to cover the stoma instead of the mouth!

Question 18

What is one issue regarding air that is breathed through a stoma in the neck?

Answer 18

The nose and mouth filter, warm, and humidify the air before it travels to the lungs, but when you have a stoma, you’re bringing colder, less humid, potentially more dirty air into your lungs.

Question 19

What are the two kinds of alaryngeal speech?

Answer 19

1. Esophageal speech

2. Electronic sources of vibration.

Question 20

What is the vibratory source in esophageal speech?

Answer 20

The upper esophageal sphincter

Question 21

What are the two types of of esophageal speech?

Answer 21

1. Injecting air into the esophagus by swallowing some air/tongue pumping.
2. Prosthesis through a tube inserted into a tracheal-esophageal puncture (TEP) that connects the esophagus and trachea

Question 22

What is a small tube connecting the trachea and esophagus used to produce speech?

Answer 22

A prosthesis

Question 23

What are the two types of electronic sources of vibration (electrolarynx)

Answer 23

1. “Neck-type-device”

2. Tube that you hold between your teeth that vibrates the air in your mouth

Question 24

For speech therapy, how many sessions you can see your client for depends on what? (also, the cost of the sessions)

Answer 24

Insurance. Speech therapy is done on an outpatient basis.

Question 25

Note: always remember to check your patient’s __________!

Answer 25

HEARING

Question 26

What are some quality of life (QOL) issues that you must remember for these patients?

Answer 26

• Diminished taste and smell, partly due to radiation therapy
• Many people who undergo laryngectomy are older and thus already retired; this makes it more dangerous because they have no reason to get out of bed in the morning.
• Change in physical activity
• Eating is affected to some degree → talk to patients about this.

o Radiation can affect all the movable tissues
o Sense of smell is diminished
o Patient needs to eat more slowly and cut bites into smaller pieces
o Some people will see an improvement over time in their ability to eat, whereas others will not quite recover, and others will never eat again.
o Talk to patient about going into eating very slowly, taking time to make sure structures are working – gradual transition into normal eating routine.

Question 27

Talk about general stoma care.

Answer 27

1. Clean the stoma with soap and water 2 times daily
2. May need to clean the crust from around the stoma with a long pair of tweezers or forceps
3. May put K-Y jelly on the stoma - Mucous will make the stoma red and raw
4. A cover for the stoma is necessary for filtration – heat moisture exchanger (HME) is best.
5. There may be a lot of mucous at first - upper respiratory tract adds 1-2 quarts of water to inspired air every 24 hours!

Question 28

What else can a patient use to help humidify the air he/she breathes?

Answer 28

Can use a humidifier, or a heat moisture exchanger (HME) on the stoma.

Question 29

What can a laryngectomee use in the shower to prevent water from getting into the stoma?

Answer 29

A shower guard.

Question 30

What can you recommend your client to use for shaving purposes?

Answer 30

An electric razor because it does not require water, soap, or shaving cream.

Question 31

True or false: sleeping is more of a problem for laryngectomees because they have a higher chance of suffocation during sleep from covering their stomas with the blankets.

Answer 31

False. They will wake up if they cannot breathe just like a person without a stoma.

Question 32

What is a “canula”?

Answer 32

A tube made of plastic or metal that is put in the stoma hole in order to prevent the body’s healing mechanisms from closing the hole.

Some people will have to wear a canula for the rest of their lives because their bodies constantly try to close the hole for the stoma. (Then they would not be able to breathe)

Question 33

What is “stenosis”?

Answer 33

Tissue closure

Question 34

What is the “introducer” and what is it used for?

Answer 34

This is something to help the laryngectomee get used to the canula. It starts small and gets bigger.

NOTE: the introducer must be removed before inserting the canula because otherwise, the patient’s airflow will be cut off.

Question 35

How should you advise your patient to clean his or her canula?

Answer 35

Soak it in hydrogen peroxide and use a small bottlebrush to clean it out.

Question 36

True or false: it is not within your scope of practice to do some counseling.

Answer 36

FALSE! - stroke patients, transgender clients, Parkinson’s disease patients, laryngectomees, among others will all need some counseling by you, the SLP.

Question 37

When counseling and giving therapy to a laryngectomee, you need to talk to his or her entire team. Who is one important member of this team that should not be forgotten?

Answer 37

Another laryngectomy patient. Also, help your lary get in contact with The Lost Cords club or some other support organization.

Question 38

What do you need to address when counseling a laryngectomee?

Answer 38

• Need to address physical, social, emotional aspects such as:
o Talk about his/her sex-life – it’s not over!
o Food issues, people-who-look-at-you-weird issues, etc…
o Talk about work, healing, and practicing your speech

Question 39

What are some other things you can talk about/provide info about?

Answer 39

• Determine the patient’s communication needs
• Build a relationship with the patient based on trust
• Monitor and facilitate a return to a normal life
• Needs to know about post-operative changes in anatomy and physiology
• Promise to be there to help
• Allow people their own timeline – “If you want to go fast, go alone. If you want to go far, go with others” – African proverb

Question 40

What are the five stages of grief?

Answer 40

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Note* These stages can go back and forth, skip a stage, etc…

Question 41

Talk about the five stages of grief.

Answer 41

1. Denial – “No, everything is going to be fine. Everything is going to work out.”
   o May deny that they have cancer at all, and may die in this stage.
2. Anger – easier in getting people to hear you but will say mean things to you and their family members.
   o Most of the time, laryngectomy patients are angry at themselves → you respond by telling them that life isn’t fair to anyone.
3. Bargaining – you can bargain with your patient in this stage
   o Usually bargaining is with God, not with you, but they will still hear you.
4. Depression – client will not necessarily hear you
   o Patient feels helpless, hopeless, and unmotivated.
   o Patients who are in depression are difficult to counsel.
   o Thyroid function! Thyroid probably got broiled during radiation and thus the depression is likely due to hormone imbalance.
5. Acceptance – developing a positive attitude about the future, and listening to instructions.

Question 42

What should you remember when you are counseling a patient through these stages of grief?

Answer 42

That you are not trying to change the stage of grief that your patient is in - you are simply there to listen and understand where they’re at and where they are coming from.