Week 2 - Head, Neck, Oral, and Lung Cancer Flashcards

1
Q

where could head and neck cancer be located (5)

A
  • larynx
  • pharynx
  • lip
  • tongue
  • oral cavity
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2
Q

what are 5 risk factors for laryngeal cancer

A
  • smoking
  • alcohol
  • exposure to chemicals
  • chronic laryngitis
  • voice strain
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3
Q

what are early symptoms of laryngeal cancer (3)

A
  • lump in neck
  • sore throat
  • hoarseness/change in voice quality
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4
Q

what are late symptoms of laryngeal cancer (5)

A
  • pain
  • dysphagia
  • decreased motility of tongue
  • airway obstruction
  • cranial nerve neuropathies
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5
Q

what should the nurse assess regarding symptoms of laryngeal cancer (5)

A
  • oral cavity
  • floor of mouth
  • tongue
  • bimanually palpate lymph nodes in neck
  • look for white or red patches
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6
Q

how can laryngeal cancer be diagnosed (6)

A
  • exam w laryngoscopy or nasopharyngoscope
  • inspection of larynx and vocal cords
  • CT scan
  • MRI
  • PET scan
  • biopsy
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7
Q

what is the choice of treatment of head and neck cancer based off (5)

A
  • medical history
  • extent of disease
  • cosmetic consideration
  • urgency
  • patient choice
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8
Q

what are different types of treatment for laryngeal cancer

A
  • radiation
  • surgery
  • surgery & radiation
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9
Q

when is radiation used for treatment of laryngeal cancer

A
  • for early vocal cord lesions
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10
Q

what is the benefit of using radiation as treatment for laryngeal ca

A
  • usually successfully eliminates the tumour

- while preserving the quality of voice

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11
Q

when is surgery used for treatment of laryngeal ca

A
  • if radiation is not successful

- or if the lesion is too advanced

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12
Q

what types of surgeries might be done for laryngeal ca

A
  • partial laryngectomy

- total laryngectomy with radical neck dissection

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13
Q

what is a partial laryngectomy

A
  • removal of one or no vocal cords (may be just the tumour)
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14
Q

what is the benefit of a partial laryngectom

A
  • pt can speak & breathe normally
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15
Q

what is a total laryngectomy

A
  • removal of the entire larynx/vocal cords and pre-epiglottic regions
  • and a permanent tracheostomy is performed (to breathe)
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16
Q

what often accompanies a total laryngectomy

A
  • radical neck dissection
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17
Q

what is radical neck dissection? why does it often accompany a total laryngectomy

A
  • when parts of the neck are removed

- to decrease risk fo lymphactic spread

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18
Q

what is a major con to a totaly laryngectomy

A
  • requires an alternate method to talk since there are no vocal cords
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19
Q

describe nursing care post-op laryngectomy (8)

A
  • maintainence of a patent airway
  • VS
  • suction & keep the stoma clear
  • pt positioning
  • physio
  • emotional support
  • diet post-op
  • stoma & suture lines care
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20
Q

why is maintenance of pt airway imp post laryngectomy

A
  • inflammation in the surgical area may compress the trachea
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21
Q

what position should a pt be placed in post-op larygynectomy? why? (2)

A
  • HOB elevated (semi-fowlers) –> to decrease edema & limit tension on sutures
  • position midline to avoid covering the stoma or stretching sutures
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22
Q

why should VS be monitored frequently post laryngectomy (2)

A
  • risk of hemorrhage

- & resp compromise

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23
Q

describe stoma care post-op laryngctomy (2)

A
  • clean BID

- dressing changes

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24
Q

describe suctioning post-op laryngectomy; what should the secretions look like?

A
  • should be done frequently
  • secretions will change in amt and consistency
  • initially have copious blood-tinged secretions that will thicken
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25
what is important to help keep secretions loose
- using a humidifier | - drinking fluids
26
describe a pt's diet post-op laryngectomy (3)
- NPO for 24-48 hrs (use of parental fluids) - then tube feed - then oral once ordered
27
why is physio important post-op larygectomy
- to avoid frozen shoulder and limited range of neck motion
28
why is emotional support important post-op laryngectomy (4)
- changes in body image - loss of speech - depression - loss of taste & smell can all impact the pt's emotional wellbeing
29
describe nutrition for a pt recieving radiation therapy for laryngeal cancer (4)
- high cal & high protein for tissue repair - antiemetics & analgesics before meals - bland foods may be better tolerated - add sauces & gravies to increase cals and make food moist
30
what profession is involved in voice restoration/rehab post laryngectomy
- speech therapust
31
what are ways to communicate w the pt post laryngectomy (2)
- pen and paper | - communication board
32
what are 3 possible options for voice restoration
- electrolarynx - blom singer voice prosthesis and valve - esophageal speech
33
what is the blom singer voice prosthesis and valve
- a soft plastic device inserted into a fistula between the esophagus and trachea - allows air from the lungs to enter the esophagus - pt blocks stoma with finger or is blocked w a valve - voice is produced by air vibrating against the esophagus & is formed into words by the tongue & lips
34
describe care for the blom singer (2)
- clean regularly | - replace if blocked w mucus
35
what is an electrolarynx
- handheld, battery operated device that creates speech using sound waves - pt moves their mouth & lips as if talk to create sound
36
what is a con to the electrolarynx
- speech sounds monotone
37
what is esophageal speech
- process of swallowing air, trapping it in the esophagus, and releasing it to create sound
38
what is important discharge teaching for a pt who received a total laryngectomy (5)
- stoma care - nutrition - resp infection S&S - enviro hazards & safety - capability of family/pt to handle an emergency
39
what is important to teach the pt regarding stoma care (5)
- covering it - cleaning it - suction - notes on bathing, showering, and swimming - humidification
40
when and how should a stoma be cleaned
- washed daily w a moist cloth
41
why should the stoma be covered
- to prevent infection, inhalation of foreign objects (bc it goes straight to lungs)
42
what can be used to cover the stoma
- scarf - loose shirt - crocheted shield
43
when should a pt cover their stoma (3)
- when coughing (bc mucus may be expelled) - during any activity (ex. shaving, makeup) that could lead to foreign objects entering - when dusty, etc.
44
what is important to teach a pt regarding suctioning of the stoma
- maintain high oral intake | - use a humidifier to keep secretions lose
45
can a pt shower and bath post laryngectomy
yes but - a plastic collar should be worn when showerin & face away from water - do not go under the water line in the bath
46
can a pt swim post laryngectomy
- no it is contraindicated
47
since a pt who's gotten a laryngectomy no longer breathes thru the nose, what does this cause the pt to lose
- ability to smell smoke & food | - may also impact sense of taste
48
what enviro hazards and safety measures should you teach a pt about post laryngectomy
- to install smoke & carbon monozide detectors | - wear a medic alert bracelet
49
what should you teach a pt who has had a laryngectomy about nutrition when discharging
- since pt cant smell, their appetite will decrease | - eat calorful, attractively prepared, nutrition, easy to eat, good texture food
50
what should you teach a pt who has had a laryngectomy regarding resp infections
- S&S | - call a dr right away if they experience the symptoms
51
what is the most preventable type of cancer?
- lung cancer
52
what are risk factors for lung cancer (3)
- smoking - older than 50 - inhaled carcinogens
53
describe the symptoms of lung cancer
- usually nonspecific and appear late in the disease process
54
what is the most signficant symptoms of lung cancer
- persistent, productive cough | - may be blood tinged sputum
55
what are other symptoms of lung cancer (9)
- anorexia - fatigue - weight loss - NV - hoarseness - dysphagia - chest pain - wheeze - palpable lymph nodes
56
what diagnostics are used to diagnose lung ca (8)
- chest xray - CT - MRI - PET - sputum for cytological studies - bronchoscopy - mediastinoscopy - fine needle aspiration
57
what is the most effective noninvasive diagnostic for lung cancer
CT
58
what a definitive diagnostic for lung cancer
sputum specimens to identifying malignant cells
59
how is staging of lung cancer done
TNM: - tumour size - lymph node involvement - metastasis
60
how many stages of cancer are there? which is worst?
1-4 and 4 is the worst
61
what are types of treatment for lung cancer (5)
- surgery - radiation - sterotactic radiation - chemo - biological therapy all can be used alone or in bomb & are tailored to pt and disease involvement
62
what is the treatment of choice for lung cancer in stage 1 and 2
- surgery
63
what kind of surgery is done for lung cancer
- partial or total lobectomy (via thoractomy)
64
what must be evaluated prior to surgery for lung cancer
- pt's cardiopulmonary status to make sure they can withstand the surgery
65
when is radiation used as treatment for lung cancer
- if surgery cannot be done | - or as an adjunct to surgery & chemo
66
what is stereotactic radiotherapy
- type of radiation therapy that uses high doses of radiation delivered very accurately to the tumour
67
who is stereotactic radiotherapy good for (3)
- older adults - pts w severe lung or heart disease - other pts who arent good candidates for surgery
68
how often is stereotactic radiotherapy done
3-5 treatments over 1-2 weeks
69
when is chemo used as the treatment for lung cancer
- if its a nonresectable tumour | - as adjuvant to surgery
70
what is a thoracotomy
- surgical procedure used to gain access to the chest cavity
71
what are 2 types of thoractomy
- open | - video assisted
72
what is an open thoracotomy
- where the surgeon cuts thru the skin & muscle to get to the tumour
73
what is a video assisted thoracotomy
- less invasive and quicker healing approach | - remove bits at a time using little holes
74
what are different types of surgery for lung cancer (4)
- lobectomy - pneumonectomy - segmental resection - wedge resection
75
what is important post-op care after a thoracotomy (9)
- monitor resp status - monitor chest tube & collection device - position changes - assist w DB&C, incentive spirometry - encourage mobilit - pain mngmt - monitor surgical site - ABG's - listen to chest
76
why is it important to monitor resp. status
- pt may be hypoxic (compare w baseline) | - treat w O2
77
what should you assess regarding the chest tube & collection device post thoracotomy (3)
- keep collection bin above chest lvl - make sure no air leaks - make sure its working, draining, securely attached
78
why are position changes important post-thoracotomy? what care r/t position changes should be done
- turn q2h, cough, deep breathe - pt may need motivation & assistance to mobilize r/t pain will encourage air entry, prevent pneumonia, help lungs expand
79
what is DB&C ? what is the purpose of it
- deep breathing and coughing - increase resp functioning by expanding lungs & preventing alveolar collapse - prevent pneumonia - encourage exportation of mucus & secretions
80
what is incentive spirometry? what is the benefit?
- device that will help expand your lungs by helping you breathe deeply & fully - benefit similar to DB&C, keep lungs active, prevent pneumonia
81
what teaching & nursing care can be do r/t pain management after a thorcotomy
- encourage them to take pain meds - teach them how to activities so they are less painful *especially if an open thoracotomy*
82
what are some S&S of infection at the incisiion site (4)
- warmth - redness - pain - drainage
83
what would you hear if you listen to the lungs after a total lobectomy
- no A/E there
84
what is important nursing care for a pt with lung cancer (3)
- support & reassurance - teaching re individualized plan of care - when to call their dr
85
what support and reassurance can we provide to a pt with lung cancer
- smoke cessation programs | - non-judgemental approach (pt may feel guilty)
86
what teaching can we provide to a pt r/t their individual plan of care (6)
- pre-op teaching - chemo teaching - radiation teaching - O2 therapy - nutritional needs - pain control
87
what nutritional needs might a pt w lung cancer need
- will lose their appetite & have difficulty breathing | = need easy to eat & swallow foods
88
when should a pt w lung cancer call their doctor
if experiencing: - worsening symptoms - airway
89
a client w lung cancer is havig difficulty breathing r/t thick secretions. which action will be best to correct the problem
- offer the client fluids at frequent intervals
90
what is important to discuss during discharge planning for lung cancer
- S&S to watch for - safe use of home O2 - encourage smoking cessation (both pt and family) - pain management - palliation
91
what S&S should a pt w lung cancer watch for
S&S of: - progression - recurrent disease - when to seek help
92
what are some symptoms of recurrent disease
- dysphagia - hemopytsis - chest pain - hoarseness
93
what should be done/taught pre-thoracotomy (5)
- physical assessment of lungs ( to compare post & preop) - teach abt DB&C and incentive spirometry (practice now makes easier later) - tell pt that adequate pain meds will be given - purpose of chest tubes and drainage systems - diagnostic studies to assess pulmonary function
94
a nursing diagnosis r/t total laryngectomy is anxiety r/t threat to current status and unmet needs (4)
- assess knowledge desired by pt - facilitate discussion of expected alterations in physical appearance and function - encourage sharing of feelings and concerns r/t adjustment and acceptance - provide info abt what to expect after surgery
95
what is some info to provide about what to expect post total laryngectomy? (7)
- tracheostomy tube - stoma - incisions - alternative communication methods - NG tube - drainage tubes - pain mngmt
96
a nursing diagnosis r/t total laryngectomy is ineffective tissue peripheral perfusion. what nursing interventions can help this (4)
- maintain HOB at 30-45 degrees - monitor HR, BP, hgb, hct (to detect excessive bleeding) - maintain patency of drainage tubes and amt & color of drainage to determine if drainage is excessive - clean incision as prescribed to prevent infection
97
a nursing diagnosis r/t post-total laryngectomy is imbalanced nutrition. what are some nursing interventions for this (4)
- provide frequent oral hygeine w saline rinses to provide comfort and remove drainage - admin tube feedings as ordered to provide adequate nutrients while wound heals - when oral feedings begin, give clear liquids and advance as tolerated - monitor caloric intake and weight
98
a nursing diagnosis r/t post-total laryngectomy is disturbed body image. what are some nursing interventions for this (8)
- assess pts body image to identify if high risk for impaired adjustment - provide privact - encourage attention to personal hygeine - encourage socialization w family and friends (acceptance by fam & friends is critical factor in pts own acceptance) - provide info abt measures to help improve appearance (wear clothes w high collars, accessories) - answer questions honestly abt changes in body image - involve pt in self care - assess pt self worth
99
a nursing diagnosis r/t post-total laryngectomy is acute pain. what are some nursing interventions for this (4)
- assess manifestations of pain - admin pain meds as prescribed & response to pain meds - teach use of nonpharmacological techniques to control pain - keep HOB elevated 30-40 degrees to prevent edema
100
a nursing diagnosis r/t post-total laryngectomy is ineffective health mngmt r/t difficulty managing complex healthcare regimen. what are some nursing interventions for this (8)
- provide instructions for pt and family - teach pt and family about laryngectomy tube and stoma care - allow pt and family to perform care in hospital - teach pt to cover stoma before activities like shaving, applying makeup, etc. - teach pt to report changes, such as stoma narrowing, difficulty swallowing, lump in throat to detect tracheal stenosis or recurrence of tumour - teach pt to provide adequate humidity at home using a bedside humidifer or sitting in steamy bathrrom - teach pt to report changes in mucus production or blood tinged secretions - make referall for home health care visit to evaluate self-care
101
a nursing diagnosis post-thoracotomy is ineffective breathing patterns. what are nursing interventions r/t ventilation assistance (8)
- assist w frequent position changes to promote lung expansion and drainage of secretions/fluid - encourage DB&C, turning - assist w incentive spirometer - auscultate breath sounds - initiate and maintain supplemental O2 as prescribed - admin pain med - position to minimize resp efforts - ambulate 3-4 times a day to promote deep breathing and lung re-expansion
102
a nursing diagnosis post-thoractomy is risk for infection. what are some nursing interventions r/t infection protection (6)
- monitor for S&S - inspect condition of surgical incisions/wounds - change thoractomy dressing using strict sterile aseptic technique - encourage increased mobility & exercise to increase circulation and promote healing - obtain blood, wound, and/or urine samples for cuktures as needed - assist pt w DB&C and turn q2h to prevent pneumonia and mobilize secretions
103
describe tube care post-thoracotomy (8)
- document bubbling of suction chamber - ensure are tubing connections are securely attached - keep drainage container below chest lvl - observe volume, color, consistency of drainage - send questionable tube drainage for C&S - cleanse skin around tube insertion site w approp antiseptic - change dressing around chest tube every 48-72 hr - change chest tube drainage bottles or multichamber drain devices as needed