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NURS 3512 - Class 1-6 > Week 2 - Head, Neck, Oral, and Lung Cancer > Flashcards

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
Q

what is important to help keep secretions loose

A
  • using a humidifier

- drinking fluids

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26
Q

describe a pt’s diet post-op laryngectomy (3)

A
  • NPO for 24-48 hrs (use of parental fluids)
  • then tube feed
  • then oral once ordered
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27
Q

why is physio important post-op larygectomy

A
  • to avoid frozen shoulder and limited range of neck motion
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28
Q

why is emotional support important post-op laryngectomy (4)

A
  • changes in body image
  • loss of speech
  • depression
  • loss of taste & smell

can all impact the pt’s emotional wellbeing

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29
Q

describe nutrition for a pt recieving radiation therapy for laryngeal cancer (4)

A
  • 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
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30
Q

what profession is involved in voice restoration/rehab post laryngectomy

A
  • speech therapust
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31
Q

what are ways to communicate w the pt post laryngectomy (2)

A
  • pen and paper

- communication board

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32
Q

what are 3 possible options for voice restoration

A
  • electrolarynx
  • blom singer voice prosthesis and valve
  • esophageal speech
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33
Q

what is the blom singer voice prosthesis and valve

A
  • 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
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34
Q

describe care for the blom singer (2)

A
  • clean regularly

- replace if blocked w mucus

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35
Q

what is an electrolarynx

A
  • handheld, battery operated device that creates speech using sound waves
  • pt moves their mouth & lips as if talk to create sound
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36
Q

what is a con to the electrolarynx

A
  • speech sounds monotone
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37
Q

what is esophageal speech

A
  • process of swallowing air, trapping it in the esophagus, and releasing it to create sound
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38
Q

what is important discharge teaching for a pt who received a total laryngectomy (5)

A
  • stoma care
  • nutrition
  • resp infection S&S
  • enviro hazards & safety
  • capability of family/pt to handle an emergency
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39
Q

what is important to teach the pt regarding stoma care (5)

A
  • covering it
  • cleaning it
  • suction
  • notes on bathing, showering, and swimming
  • humidification
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40
Q

when and how should a stoma be cleaned

A
  • washed daily w a moist cloth
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41
Q

why should the stoma be covered

A
  • to prevent infection, inhalation of foreign objects (bc it goes straight to lungs)
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42
Q

what can be used to cover the stoma

A
  • scarf
  • loose shirt
  • crocheted shield
43
Q

when should a pt cover their stoma (3)

A
  • when coughing (bc mucus may be expelled)
  • during any activity (ex. shaving, makeup) that could lead to foreign objects entering
  • when dusty, etc.
44
Q

what is important to teach a pt regarding suctioning of the stoma

A
  • maintain high oral intake

- use a humidifier to keep secretions lose

45
Q

can a pt shower and bath post laryngectomy

A

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
Q

can a pt swim post laryngectomy

A
  • no it is contraindicated
47
Q

since a pt who’s gotten a laryngectomy no longer breathes thru the nose, what does this cause the pt to lose

A
  • ability to smell smoke & food

- may also impact sense of taste

48
Q

what enviro hazards and safety measures should you teach a pt about post laryngectomy

A
  • to install smoke & carbon monozide detectors

- wear a medic alert bracelet

49
Q

what should you teach a pt who has had a laryngectomy about nutrition when discharging

A
  • since pt cant smell, their appetite will decrease

- eat calorful, attractively prepared, nutrition, easy to eat, good texture food

50
Q

what should you teach a pt who has had a laryngectomy regarding resp infections

A
  • S&S

- call a dr right away if they experience the symptoms

51
Q

what is the most preventable type of cancer?

A
  • lung cancer
52
Q

what are risk factors for lung cancer (3)

A
  • smoking
  • older than 50
  • inhaled carcinogens
53
Q

describe the symptoms of lung cancer

A
  • usually nonspecific and appear late in the disease process
54
Q

what is the most signficant symptoms of lung cancer

A
  • persistent, productive cough

- may be blood tinged sputum

55
Q

what are other symptoms of lung cancer (9)

A
  • anorexia
  • fatigue
  • weight loss
  • NV
  • hoarseness
  • dysphagia
  • chest pain
  • wheeze
  • palpable lymph nodes
56
Q

what diagnostics are used to diagnose lung ca (8)

A
  • chest xray
  • CT
  • MRI
  • PET
  • sputum for cytological studies
  • bronchoscopy
  • mediastinoscopy
  • fine needle aspiration
57
Q

what is the most effective noninvasive diagnostic for lung cancer

A

CT

58
Q

what a definitive diagnostic for lung cancer

A

sputum specimens to identifying malignant cells

59
Q

how is staging of lung cancer done

A

TNM:

  • tumour size
  • lymph node involvement
  • metastasis
60
Q

how many stages of cancer are there? which is worst?

A

1-4 and 4 is the worst

61
Q

what are types of treatment for lung cancer (5)

A
  • surgery
  • radiation
  • sterotactic radiation
  • chemo
  • biological therapy

all can be used alone or in bomb
& are tailored to pt and disease involvement

62
Q

what is the treatment of choice for lung cancer in stage 1 and 2

A
  • surgery
63
Q

what kind of surgery is done for lung cancer

A
  • partial or total lobectomy (via thoractomy)
64
Q

what must be evaluated prior to surgery for lung cancer

A
  • pt’s cardiopulmonary status to make sure they can withstand the surgery
65
Q

when is radiation used as treatment for lung cancer

A
  • if surgery cannot be done

- or as an adjunct to surgery & chemo

66
Q

what is stereotactic radiotherapy

A
  • type of radiation therapy that uses high doses of radiation delivered very accurately to the tumour
67
Q

who is stereotactic radiotherapy good for (3)

A
  • older adults
  • pts w severe lung or heart disease
  • other pts who arent good candidates for surgery
68
Q

how often is stereotactic radiotherapy done

A

3-5 treatments over 1-2 weeks

69
Q

when is chemo used as the treatment for lung cancer

A
  • if its a nonresectable tumour

- as adjuvant to surgery

70
Q

what is a thoracotomy

A
  • surgical procedure used to gain access to the chest cavity
71
Q

what are 2 types of thoractomy

A
  • open

- video assisted

72
Q

what is an open thoracotomy

A
  • where the surgeon cuts thru the skin & muscle to get to the tumour
73
Q

what is a video assisted thoracotomy

A
  • less invasive and quicker healing approach

- remove bits at a time using little holes

74
Q

what are different types of surgery for lung cancer (4)

A
  • lobectomy
  • pneumonectomy
  • segmental resection
  • wedge resection
75
Q

what is important post-op care after a thoracotomy (9)

A
  • 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
Q

why is it important to monitor resp. status

A
  • pt may be hypoxic (compare w baseline)

- treat w O2

77
Q

what should you assess regarding the chest tube & collection device post thoracotomy (3)

A
  • keep collection bin above chest lvl
  • make sure no air leaks
  • make sure its working, draining, securely attached
78
Q

why are position changes important post-thoracotomy? what care r/t position changes should be done

A
  • 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
Q

what is DB&C ? what is the purpose of it

A
  • deep breathing and coughing
  • increase resp functioning by expanding lungs & preventing alveolar collapse
  • prevent pneumonia
  • encourage exportation of mucus & secretions
80
Q

what is incentive spirometry? what is the benefit?

A
  • device that will help expand your lungs by helping you breathe deeply & fully
  • benefit similar to DB&C, keep lungs active, prevent pneumonia
81
Q

what teaching & nursing care can be do r/t pain management after a thorcotomy

A
  • encourage them to take pain meds
  • teach them how to activities so they are less painful

especially if an open thoracotomy

82
Q

what are some S&S of infection at the incisiion site (4)

A
  • warmth
  • redness
  • pain
  • drainage
83
Q

what would you hear if you listen to the lungs after a total lobectomy

A
  • no A/E there
84
Q

what is important nursing care for a pt with lung cancer (3)

A
  • support & reassurance
  • teaching re individualized plan of care
  • when to call their dr
85
Q

what support and reassurance can we provide to a pt with lung cancer

A
  • smoke cessation programs

- non-judgemental approach (pt may feel guilty)

86
Q

what teaching can we provide to a pt r/t their individual plan of care (6)

A
  • pre-op teaching
  • chemo teaching
  • radiation teaching
  • O2 therapy
  • nutritional needs
  • pain control
87
Q

what nutritional needs might a pt w lung cancer need

A
  • will lose their appetite & have difficulty breathing

= need easy to eat & swallow foods

88
Q

when should a pt w lung cancer call their doctor

A

if experiencing:

  • worsening symptoms
  • airway
89
Q

a client w lung cancer is havig difficulty breathing r/t thick secretions. which action will be best to correct the problem

A
  • offer the client fluids at frequent intervals
90
Q

what is important to discuss during discharge planning for lung cancer

A
  • S&S to watch for
  • safe use of home O2
  • encourage smoking cessation (both pt and family)
  • pain management
  • palliation
91
Q

what S&S should a pt w lung cancer watch for

A

S&S of:

  • progression
  • recurrent disease
  • when to seek help
92
Q

what are some symptoms of recurrent disease

A
  • dysphagia
  • hemopytsis
  • chest pain
  • hoarseness
93
Q

what should be done/taught pre-thoracotomy (5)

A
  • 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
Q

a nursing diagnosis r/t total laryngectomy is anxiety r/t threat to current status and unmet needs (4)

A
  • 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
Q

what is some info to provide about what to expect post total laryngectomy? (7)

A
  • tracheostomy tube
  • stoma
  • incisions
  • alternative communication methods
  • NG tube
  • drainage tubes
  • pain mngmt
96
Q

a nursing diagnosis r/t total laryngectomy is ineffective tissue peripheral perfusion. what nursing interventions can help this (4)

A
  • 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
Q

a nursing diagnosis r/t post-total laryngectomy is imbalanced nutrition. what are some nursing interventions for this (4)

A
  • 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
Q

a nursing diagnosis r/t post-total laryngectomy is disturbed body image. what are some nursing interventions for this (8)

A
  • 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
Q

a nursing diagnosis r/t post-total laryngectomy is acute pain. what are some nursing interventions for this (4)

A
  • 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
Q

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)

A
  • 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
Q

a nursing diagnosis post-thoracotomy is ineffective breathing patterns. what are nursing interventions r/t ventilation assistance (8)

A
  • 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
Q

a nursing diagnosis post-thoractomy is risk for infection. what are some nursing interventions r/t infection protection (6)

A
  • 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
Q

describe tube care post-thoracotomy (8)

A
  • 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

NURS 3512 - Class 1-6 (47 decks)

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