Week 2 - Head, Neck, Oral, and Lung Cancer Flashcards
where could head and neck cancer be located (5)
- larynx
- pharynx
- lip
- tongue
- oral cavity
what are 5 risk factors for laryngeal cancer
- smoking
- alcohol
- exposure to chemicals
- chronic laryngitis
- voice strain
what are early symptoms of laryngeal cancer (3)
- lump in neck
- sore throat
- hoarseness/change in voice quality
what are late symptoms of laryngeal cancer (5)
- pain
- dysphagia
- decreased motility of tongue
- airway obstruction
- cranial nerve neuropathies
what should the nurse assess regarding symptoms of laryngeal cancer (5)
- oral cavity
- floor of mouth
- tongue
- bimanually palpate lymph nodes in neck
- look for white or red patches
how can laryngeal cancer be diagnosed (6)
- exam w laryngoscopy or nasopharyngoscope
- inspection of larynx and vocal cords
- CT scan
- MRI
- PET scan
- biopsy
what is the choice of treatment of head and neck cancer based off (5)
- medical history
- extent of disease
- cosmetic consideration
- urgency
- patient choice
what are different types of treatment for laryngeal cancer
- radiation
- surgery
- surgery & radiation
when is radiation used for treatment of laryngeal cancer
- for early vocal cord lesions
what is the benefit of using radiation as treatment for laryngeal ca
- usually successfully eliminates the tumour
- while preserving the quality of voice
when is surgery used for treatment of laryngeal ca
- if radiation is not successful
- or if the lesion is too advanced
what types of surgeries might be done for laryngeal ca
- partial laryngectomy
- total laryngectomy with radical neck dissection
what is a partial laryngectomy
- removal of one or no vocal cords (may be just the tumour)
what is the benefit of a partial laryngectom
- pt can speak & breathe normally
what is a total laryngectomy
- removal of the entire larynx/vocal cords and pre-epiglottic regions
- and a permanent tracheostomy is performed (to breathe)
what often accompanies a total laryngectomy
- radical neck dissection
what is radical neck dissection? why does it often accompany a total laryngectomy
- when parts of the neck are removed
- to decrease risk fo lymphactic spread
what is a major con to a totaly laryngectomy
- requires an alternate method to talk since there are no vocal cords
describe nursing care post-op laryngectomy (8)
- maintainence of a patent airway
- VS
- suction & keep the stoma clear
- pt positioning
- physio
- emotional support
- diet post-op
- stoma & suture lines care
why is maintenance of pt airway imp post laryngectomy
- inflammation in the surgical area may compress the trachea
what position should a pt be placed in post-op larygynectomy? why? (2)
- HOB elevated (semi-fowlers) –> to decrease edema & limit tension on sutures
- position midline to avoid covering the stoma or stretching sutures
why should VS be monitored frequently post laryngectomy (2)
- risk of hemorrhage
- & resp compromise
describe stoma care post-op laryngctomy (2)
- clean BID
- dressing changes
describe suctioning post-op laryngectomy; what should the secretions look like?
- should be done frequently
- secretions will change in amt and consistency
- initially have copious blood-tinged secretions that will thicken
what is important to help keep secretions loose
- using a humidifier
- drinking fluids
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
why is physio important post-op larygectomy
- to avoid frozen shoulder and limited range of neck motion
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
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
what profession is involved in voice restoration/rehab post laryngectomy
- speech therapust
what are ways to communicate w the pt post laryngectomy (2)
- pen and paper
- communication board
what are 3 possible options for voice restoration
- electrolarynx
- blom singer voice prosthesis and valve
- esophageal speech
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
describe care for the blom singer (2)
- clean regularly
- replace if blocked w mucus
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
what is a con to the electrolarynx
- speech sounds monotone
what is esophageal speech
- process of swallowing air, trapping it in the esophagus, and releasing it to create sound
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
what is important to teach the pt regarding stoma care (5)
- covering it
- cleaning it
- suction
- notes on bathing, showering, and swimming
- humidification
when and how should a stoma be cleaned
- washed daily w a moist cloth
why should the stoma be covered
- to prevent infection, inhalation of foreign objects (bc it goes straight to lungs)
what can be used to cover the stoma
- scarf
- loose shirt
- crocheted shield
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.
what is important to teach a pt regarding suctioning of the stoma
- maintain high oral intake
- use a humidifier to keep secretions lose
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
can a pt swim post laryngectomy
- no it is contraindicated
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
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
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
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
what is the most preventable type of cancer?
- lung cancer
what are risk factors for lung cancer (3)
- smoking
- older than 50
- inhaled carcinogens
describe the symptoms of lung cancer
- usually nonspecific and appear late in the disease process
what is the most signficant symptoms of lung cancer
- persistent, productive cough
- may be blood tinged sputum
what are other symptoms of lung cancer (9)
- anorexia
- fatigue
- weight loss
- NV
- hoarseness
- dysphagia
- chest pain
- wheeze
- palpable lymph nodes
what diagnostics are used to diagnose lung ca (8)
- chest xray
- CT
- MRI
- PET
- sputum for cytological studies
- bronchoscopy
- mediastinoscopy
- fine needle aspiration
what is the most effective noninvasive diagnostic for lung cancer
CT
what a definitive diagnostic for lung cancer
sputum specimens to identifying malignant cells
how is staging of lung cancer done
TNM:
- tumour size
- lymph node involvement
- metastasis
how many stages of cancer are there? which is worst?
1-4 and 4 is the worst
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
what is the treatment of choice for lung cancer in stage 1 and 2
- surgery
what kind of surgery is done for lung cancer
- partial or total lobectomy (via thoractomy)
what must be evaluated prior to surgery for lung cancer
- pt’s cardiopulmonary status to make sure they can withstand the surgery
when is radiation used as treatment for lung cancer
- if surgery cannot be done
- or as an adjunct to surgery & chemo
what is stereotactic radiotherapy
- type of radiation therapy that uses high doses of radiation delivered very accurately to the tumour
who is stereotactic radiotherapy good for (3)
- older adults
- pts w severe lung or heart disease
- other pts who arent good candidates for surgery
how often is stereotactic radiotherapy done
3-5 treatments over 1-2 weeks
when is chemo used as the treatment for lung cancer
- if its a nonresectable tumour
- as adjuvant to surgery
what is a thoracotomy
- surgical procedure used to gain access to the chest cavity
what are 2 types of thoractomy
- open
- video assisted
what is an open thoracotomy
- where the surgeon cuts thru the skin & muscle to get to the tumour
what is a video assisted thoracotomy
- less invasive and quicker healing approach
- remove bits at a time using little holes
what are different types of surgery for lung cancer (4)
- lobectomy
- pneumonectomy
- segmental resection
- wedge resection
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
why is it important to monitor resp. status
- pt may be hypoxic (compare w baseline)
- treat w O2
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
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
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
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
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
what are some S&S of infection at the incisiion site (4)
- warmth
- redness
- pain
- drainage
what would you hear if you listen to the lungs after a total lobectomy
- no A/E there
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
what support and reassurance can we provide to a pt with lung cancer
- smoke cessation programs
- non-judgemental approach (pt may feel guilty)
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
what nutritional needs might a pt w lung cancer need
- will lose their appetite & have difficulty breathing
= need easy to eat & swallow foods
when should a pt w lung cancer call their doctor
if experiencing:
- worsening symptoms
- airway
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
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
what S&S should a pt w lung cancer watch for
S&S of:
- progression
- recurrent disease
- when to seek help
what are some symptoms of recurrent disease
- dysphagia
- hemopytsis
- chest pain
- hoarseness
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
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
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
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
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
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
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
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
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
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
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
