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40 Cards in this Set
- Front
- Back
Cancer of the Larynx
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Cancer of the head and neck.
Risk factors – prolonged use of tobacco and alcohol. Contributing risk factors – chronic laryngitis, voice abuse, family history, prior exposure to radiation. |
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Incidence of Laryngeal Cancer
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11,600 cases diagnosed since 1996.
79.5% are men Most frequently diagnosed between ages of 55-70 Incidence rising in women since the 1960s |
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Pathophysiology of L. Cancer
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=Most common is squamous cell carcinoma.
=Grows slowly because of limited lymph circulation and natural divisions created by ligaments and membranes of the vocal cords. =If involves glottis can metastasize to the nodes of the neck. |
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Symptoms of L. Cancer
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Early
Hoarseness or voice change. Late Dysphagia, dyspnea, cough, hemoptysis, wt loss, pain around the thyroid or Adam’s Apple that radiates to the ear of the affected side. =Enlarged cervical neck nodes. |
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Diagnosis of L. Cancer
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=History, physical exam, x-ray of the head, neck, chest, and larynx.
=CT scanning =Laryngoscope may reveal mucousal abnormalities. Biopsy |
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Treatment of L. Cancer
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+Early diagnosis and treatment leads to high cure rates – 80-90% for small lesions.
+Treatment based on pt condition, tumor size, type and metastasis, and pt preference. +Staged according to the American joint commission for cancer 1977 guidelines |
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TNM System-staging L. Cancer
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+T- tumor size and location (supraglottis, glottis, subglottis)
+N number of nodes found +M presence of metastasis |
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Treatment of L. Cancer
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+Radiation – External beam radiation with or without chemotherapy or surgery.
+Goals may be curative or palliative. +Radiation disrupts DNA structure and causes cells to die. +May change voice quality +Complications include laryngeal edema, fibrosis of neck and larynx, esophageal stenosis, nutritional deficiency from pain and changes in taste and dry mouth. |
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Treatment of L. Cancer con't
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Chemotherapy – followed by radiation
Laser surgery – Very popular, CO2 laser vaporizes tumor. +Can be used with radical neck dissection. Reduced swelling, reduced blood loss, less pain, decreased infection, decreased recovery time, sealed lymphatics and prevents metastasis. |
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Surgical Treatment of L. Cancer
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Hemilaryngectomy- 1 side
Total laryngectomy Radical neck dissection- if metastasized to neck |
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Hemilaryngectomy
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Hemilaryngectomy
Vertical laryngectomy used when tumor is confined to one cord. One half of the larynx is resected along with the false cord, ventricle, and diseased true cord. Temporary tracheostomy and feeding tube for immediate post op period May have prolonged or permanent dysphagia with aspiration. ** Ability to speak and swallow is preserved. |
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Total Laryngectomy
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+Advanced cancer that involves true vocal cords.
+Epiglottis, thyroid cartilage, larynx, several tracheal rings, and hyoid bone are removed. +Pt has no voice. +Requires permanent tracheostomy. +Smell is impaired, may effect nutritional status. Nutrition Is a major problem +TF or TPN given for 10-12 days post op. +Aspiration not a problem trachea sewn closed. +Antibiotics for 10-12 days. Post op JP drain used. |
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Radical Neck Dissection
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Total laryngectomy with removal of the muscles, veins, nerves, and cervical lymph nodes of the neck.
Spinal accessory nerve removed Sternocleidomastoid muscle removed Internal jugular vein removed |
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Nursing Mgmt for L. cancer: preoperative
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Obtain history, habits, living conditions, occupation, and social support.
Identify chronic illnesses such as COPD, alcoholism, smoking Assess nutritional status. Obtain nutritional consult for caloric requirements and caloric intake. Taking wgts Discuss post operative communication Explain feeding tube, tracheostomy, suctioning, JP drain. |
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Nursing Mgmt for L. cancer: postoperative
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Assess respiratory status abc’s
Airway, breathing pattern, depth, rate. Assess breath sounds stridor, wheezing, secretions. If smoked, may be problems Assess vital signs, urine output, hemodynamic status. Assess surgical incision and stoma site for color, drainage, temperature, and edema. Assess tubes for patency and position. Check lab values CBC with diff for blood loss and infection. Assess swallowing and beginning speech function |
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Rehabilitation for L. cancer
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Teach pt to perform trach care with mirror.
Speech therapy for swallowing and speech Adjustment to body image – participates in self care, able to look in mirror, mood readiness to learn, families ability to assist. Inspection of the home for adequate facilities, cleanliness, patient’s self care ability. Weight maintenance and nutrition |
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Nursing Diagnosis for L.Cancer
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Ineffective airway clearance R/T disease process.
Ineffective breathing pattern R/T pain Pain R/T operative incision Impaired verbal communication R/T laryngectomy Risk for infection R/T surgical incision and inadequate nutritional status. |
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Nursing Diagnosis for l. CANCER con't
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Risk for hemorrhage R/T carotid artery rupture.
Self esteem disturbance R/T mutilating surgery and altered body image Impaired skin integrity R/T tracheostomy and potential saliva fistula. Altered nutrition less than body requirements R/T dysphagia. Knowledge deficit R/T tracheostomy care and suctioning. |
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Nursing Care of L. Cancer
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Position semi fowlers to promote lung expansion and decrease incisional edema.
Suction tracheostomy PRN. Clean q 8 hrs – but suction b4 cleaning-save u trouble Monitor amount and consistency of drainage from JP ROM exercise to shoulder of affected side if had radical neck resection Nutrition – Tube feeding due to swallowing difficulty and suture line IV fluid management for 48 hrs, Tf for 10 days |
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Speech Therapy
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Voice prosthesis – creates fistula btw esoph. & trachea-
Esophageal speech- method of swallowing air and belching up- Electrolarynx – have to wait until sutures heal- vibs in throat. |
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Voice prosthesis
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Fistula is created between the esophagus and the trachea. The prosthesis is inserted and air from the lungs enters the esophagus. A one way valve prevents aspiration.
To speak the patient blocks the stoma with a finger. Air vibrates as it moves through the esophagus creating sound. Words are formed by lips and tongue. |
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Electrolarynx
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Handheld battery powered device that creates speech with the use of sound waves. Used after healing is complete.
Device is held against the neck. Voice is low. Sounds are very mechanical |
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Esophageal Speech
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A method of speech created by swallowing air, trapping it in the esophagus and releasing it to create sound.
Sounds like a belch, but with practice can produce understandable speech. |
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Stoma Care
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Area around stoma should be washed daily. If tracheostomy tube is in place, inner cannula should be cleaned daily
Stoma should be shielded by a soft cloth or scarf. Cover the stoma during coughing. Avoid aspirating soap, shaving cream, makeup. Use plastic collar when showering. Bedside humidifier recommended |
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Nursing Education
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Swimming is contraindicated.
Medic alert bracelet to id patient as neck breather. Patients loose the ability to smell. Need smoke detectors. Loose sense of taste. Make food attractive, colorful, nutritious.small frequent meals |
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Psychosocial adjustment for L. Cancer
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Depression may result from body image distortion related to stoma or mutilating surgery.
Difficulty in speech and swallowing may interfere with social activities. Diagnosis of cancer always has great psychological impact. Utilize support groups, speech therapy, PT, OT, psychological support |
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What is the most common squamous cell carcinoma?
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Laryngeal Cancer
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The nurse knows that Laryngeal Cancer grows slowly because?
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there is limited lymph circulation and there are natural divisions created by ligaments and membranes of the vocal cords
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The nurse knows that an early symptom of Laryngeal cancer is?
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Hoarseness or voice change
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The nurse recognizes that the patient in the ER has late signs of Laryngeal Cancer. What are the signs?
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Dysphagia, dyspnea, cough, hemoptysis, wt loss, pain around the thyroid or Adam’s Apple that radiates to the ear of the affected side. Enlarged cervical neck nodes.
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After the pt had a Laryngoscope, the findings were?
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Mucousal abnormalities
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Is there a high cure rate for Laryngeal cancer?
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yes with early diagnosis, 80-90% for small lesions
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The nurse is reading the staging results of a pt with L. cancer. What system is used?
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TNM system
T- tumor-size and location N- number of nodes found M- presence of metastasis |
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The nurse knows that her pt with L.C. will have what type of treatment?
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Radiation - may be curative or palliative -
Chemo followed by Radiation Laser surgery- new and popular |
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How does Radiation work to treat Laryngeal cancer?
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disrupts DNA structure and causes cells to die
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The patient with Laryngeal cancer is told what complications to expect. These are?
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May change voice quality
Complications include laryngeal edema, fibrosis of neck and larynx, esophageal stenosis, nutritional deficiency from pain and changes in taste and dry mouth |
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The nurse understands that Laryngeal cancer is the most common type of what cancer?
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squamous cell cancer
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Is Laryngeal cancer fast or slow growing?
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slow
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A patient shows up at a clinic with a complaint of hoarseness, pain radiating to the ear from his Adam apple, enlarged cervical lymph nodes and a cough. He has a hx of alcohol abuse and smoking. The nurse suspects what type of cancer?
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Laryngeal
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Diagnostic procedures are?
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X-ray,.
CT scan Laryngoscope then Biopsy |