Outline 11 Team Care/Counseling

Question 1

Things to remember when working with Larrys:

Answer 1

• Rate of speech
• Placement
• Type of articulation

Question 2

what are two types of speech?

Answer 2

• Electrolarynx

* Esophageal speech

Question 3

what are Pre-op/post-op concerns

Answer 3

• Medical concerns
• Laryngeal cancer is highly curable
• Fear of death
• Ask the patient what s/he’s learned from the doctor/nurse
• Tell people that they have an excellent Dr.
• Describe the surgery and give some literature/printed material on the subject.
• Surgery is 4-5 hours, then a stay in ICU
• Pain is usually not an issue
• Will be fed through a g-tube for a few days, then graduate to a soft diet, then a regular diet while the tissue heals.
• Average stay in the hospital is 5-6 days without complications.

Question 4

An Artificial larynx Or an electrolarynx can learn to be a pretty good speaker _____ weeks

Answer 4

after 8 weeks
oYou have to do a lot of drill and kill they will become a good speaker
oHave people come in and listen to them so they can reinforce what your saying

Question 5

Speech therapy is only done on a ______ basis

Answer 5

o Only done outpatient

o6 weeks post surgery for a tracheoesophageal puncture to be done

Question 6

o If you know a surgeon who wants to do the laryngectomy and esophageal puncture at the same time avoid it. why?

Answer 6

•Tissue migrates after trauma so the puncture may not work at all

Question 7

Cost and number of sessions depends on what?

Answer 7

1. The patient, how quickly do they catch on?
2. Method that you’re using
3. Where are the sessions conducted?

Question 8

What methods can you use?

Answer 8

• Esophageal speech
• TEP speech
• Electronic device

Question 9

What are some general things you should orient the client about post surgery?

Answer 9

•	Diminished taste and smell
           oTaste may get better.
•70% of laryngectomees return to previous employment
•Change in physical activity 
          oWork place 
          oRecreation 
•Encourage them to go back into their normal lives 
•Eating is affected to some degree

Question 10

To what degree is eating affected?

Answer 10

oAll those moveable tissues are affected
oPatients need to pay attention when they start eating
•In the hospital it’s a soft diet to regular diet
oThey need to eat slowly
oCut things into smaller pieces
oFor some people they will see improvement over time in their ability to eat
oSome people will not quite recover
oSome will never eat again
oEating needs to happen slowly!!!

Question 11

Describe things you’ll tell your client about Stoma care

Answer 11

oNeeds to happen especially directly after surgery
oClean the stoma with soap and water at least 2x daily
•But do not scrub it because it is raw tissue and it’s trying to heal but you also need to keep it clear
oThere may be a lot of mucous at first
•The filter, moisture, and warming of air is GONE so they cough up a lot of mucous from the lungs
oMay need to clean the crust from around the stoma with a long pair of tweezers or forceps
•It may need to be soaked off without inhaling any of it
•NEVER cotton balls
•ALWAYS use a soft material that wont shed fibers
like Q tips
-put K-Y jelly on the stoma
To moisturize the raw skin when the stoma reddens
•For showers, shower guards.
•Shaving
oElectric razor with shaving cream
•Sleeping is fine but cant cover the stoma

Question 12

Why is the HME (Heat Moisture Exchange) good?

Answer 12

oFor resistance to the air
oIt’s so much better for long term health
oIt will not be for a while—the tissue needs to heal before it can be placed
oEven a humidifier will help trap moisture

Question 13

Natural Healing response will try to heal the Stoma so a __________ is placed

Answer 13

canula

Question 14

What is a canula?

Answer 14

• a tube made out of plastic or metal that is placed through that hole
• it will go in stoma hole that will hold it open while it heals
• it does not go all the way down the trachea

Question 15

•When a canula is introduced, it is just a tube with edges. But what does it do?

Answer 15

oThey make an introducer that goes down into the canula and is shaped like a bullet so you have a smooth surface
oWhen the introducer goes in it is plugging the canula and it will cause the patient to suffocate
oThe inner canula needs to be cleaned multiple times a day

Question 16

•You may have to teach the patient how to clean and maintain the canula. What would you teach them?

Answer 16

oEvery now and then the out canula needs to be taken out to be cleaned
oCanulas can be soaked in hydrogen peroxide or warm water—but don’t put soap on the canula—if it doesn’t get completely removed, it will burn
oYou can use a a small brush to scrape and clean the canula

Question 17

• The inner canula has a locking mechanism to keep it from what?

Answer 17

from falling out when the patient bends over. The other canula is usually kept on a tie around the neck
oThis stays in place

Question 18

Counseling is a team approach. But who is an important member?

Answer 18

another laryngectomy who loves counseling

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

Question 19

In counseling you need to address

Answer 19

• physical, social, emotional aspects
• Provide information about alaryngeal speech rehab
• 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
• Help dealing with diagnosis of cancer

Question 20

When addressing physical, social, emotional aspects what else should you consider and tell them? (note ____ vs.____)

Answer 20

oAnd the quality of life social issues
oIt’s best to not tell them, but listen to them and bring up topics that may be uncomfortable
oTalk to them about living!
•Sympathy = you don’t really know how they feel vs empathy = listening
•Remind them that they own their condition not the way around

Question 21

When building a relationship based on trust with your client don’t

Answer 21

Don’t promise them things they won’t be able to do

Question 22

What are the 5 stages of grief?

Answer 22

o	Denial 
o	Anger 
o	Bargaining 
o	Depression 
o     Acceptance

Question 23

Which of the 5 stages is the most common?

Answer 23

Despresssion is a big one and most common
•This may be due to a chemical response because the thyroid function was messed up during radiation and is now not functioning
•Get the thyroid checked for sure!

Question 24

It’s difficult to counsel, but you have to. Remember the stages go _________ and ______

Answer 24

can go backwards and forwards