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Questions and Answers
What is the number one nursing priority in the post-operative care of a patient after a radical neck dissection?
Which should be included in the nursing diagnosis for a patient post-radical neck dissection?
What complication should be closely monitored for after a radical neck dissection?
What needs to be readily available at the bedside of a patient following a radical neck dissection?
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What assessment is a priority when a patient arrives post-surgery from the PACU to the SICU?
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What is the primary indication for a total laryngectomy?
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Which symptom is NOT typically associated with cancer of the larynx?
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Which of the following risk factors is associated with the development of cancer of the lung?
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What is a common postoperative communication method for laryngectomy patients?
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Which nursing intervention is essential for a patient with a stoma after a laryngectomy?
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During assessment of a laryngectomy patient, what is a critical area to monitor?
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Which of the following is a potential complication of radiation therapy to the head and neck?
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What is a primary goal when managing a patient with a chest tube?
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What is the main type of lung cancer that is not surgically resectable?
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Which of the following is NOT a clinical manifestation of lung cancer?
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What is the most effective method for diagnosing lung cancer?
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Which type of lung cancer represents the majority of cases?
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What is the recommended management for a lung cancer patient undergoing thoracotomy?
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What is the primary purpose of inserting a chest tube?
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What vital sign change indicates a need to notify the surgeon regarding chest tube drainage?
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Which of the following complications is associated with chest tubes?
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Which assessment finding is most concerning for a patient with a chest tube?
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What is the action of pembrolizumab (Keytruda®) in cancer therapy?
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What does intermittent bubbling in a water seal chamber indicate?
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Which conditions may arise from the use of pembrolizumab?
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Which assessment finding would be most concerning for a patient who has undergone a total laryngectomy?
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What is an appropriate nursing intervention for a patient with a chest tube?
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Which interventions should be prioritized for a patient experiencing SpO2 drop from 95-89%?
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What is the most critical supply to have available at the bedside for a patient post-total laryngectomy?
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Which type of chest tube system utilizes a water seal to prevent air from entering the pleural space?
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If a chest tube is bubbling persistently in the suction chamber, what should the nurse do first?
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Post-op day #1 after a laryngectomy, which lab result should the nurse check for a patient with tingling sensations?
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For a patient with a laryngectomy tube and a dropping SpO2, which action is not advisable?
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When assessing a patient with a potential chest tube air leak, which finding could suggest this complication?
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Study Notes
Cancer of the Larynx
- Risk factors - tobacco, alcohol, asbestos/chemicals/fumes
- Symptoms - hoarseness, sore throat, neck mass, lymphadenopathy
- 5-year survival rate between 32-90%
- 55% of patients have lymph node involvement
- Diagnosis - laryngoscopy and biopsy
- Medical management - includes surgery (varying in tissue removed), radiation (used pre or post surgery, alternative to surgery in early stages), and chemotherapy
Radiation to Head & Neck
- Potential side effects include mucositis, xerostomia, loss of taste, dysphagia, and skin reactions
Total Laryngectomy
- Indicated for cancer spread beyond the vocal cords or recurrence after radiation
- Includes complete removal of the larynx, epiglottis, and partial removal of the trachea
- Results in permanent airway alteration
- Results in the loss of normal speech
Laryngectomy Patient
- At risk for airway issues; loss of upper airway function
- Assessments should include assessing for airway issues, management of secretions, and availability of necessary equipment at bedside
- Management of secretions - sterile suctioning and pulmonary toilet
- Equipment at bedside - laryngectomy tube, suction, ambu bag
- Stoma cover is used to protect the stoma
Speech & Communication Post-Laryngectomy
- Plan for communication using writing, picture boards, and gestures
- Tracheoesophageal voice prosthesis and electrolarynx can be used to aid in communication
Laryngectomy Patient Education
- Educate patient about protection of the stoma, humidification, use of a Medic-Alert bracelet, and resources such as the New Voice or Lost Cord Club
Radical Neck Dissection
- Indicated for metastasis of cancer to the lymph nodes in the neck
- Common complication of laryngeal cancer
- Resection of lymph nodes, muscle, part of the thyroid, parathyroids, and salivary glands
- Modified radical neck dissection may retain some of these structures
Radical Neck Dissection: Nursing Priorities & Assessments
- Number one nursing priority is assessing oxygenation
- Assessments include assessing for subjective complaints, vitals, SpO2 or ABG, color, LOC, respirations, cardiac status, and peripheral circulation
Radical Neck Dissection: Nursing Care
- Care includes management of the laryngectomy tube, dressing/incision care, pain management, aspiration risk, and nutritional support
- Patients may receive tube feeding and be NPO for 7 days post-op
- Prioritize communication and observe for complications
- Potential complications include airway/breathing issues, hemorrhage, nerve damage, and hypocalcemia
Radical Neck Dissection: Nursing Diagnoses
- Potential nursing diagnoses include ineffective airway clearance, impaired verbal communication, pain, imbalanced nutrition, risk for aspiration, and disturbed body image
Case Study: Robert (60-year-old Male with Laryngeal Cancer)
- Pre-arrival supplies - oxygen mask, suction canister, laryngectomy tube, communication board, electrolarynx
- Medications - pain medications, anti-anxiety medications, anti-emetics
- Risk Factors - airway/breathing issues, hemorrhage, nerve damage, hypocalcemia, aspiration, infection
- Priority assessments - airway, breathing, vital signs, circulation, level of consciousness, pain, and respiratory status
Lung Cancer
- Leading cause of cancer death with a 5-year survival rate of 13%
- Caused by carcinogens such as tobacco smoke, asbestos, and radon
- Cell types - small cell (20%, not surgically resectable) and non-small cell (80%)
- Small cell lung cancer is associated with paraneoplastic syndromes:
- SIADH
- Cushing’s Syndrome
- Lambert-Eaton Syndrome
Lung Cancer Screening
- CXR is not effective for screening
- New recommendations include CT screening
Lung Cancer Clinical Manifestations
- Persistent cough
- Later stages - dyspnea, hemoptysis, pleural effusion, and pain
Lung Cancer Diagnosis
- Bronchoscopy, biopsy, CT, MRI, and PET scan
Bronchoscopy
- Direct visualization of airways
- Allows for biopsy
- Pre-procedure - consent, NPO, medications (analgesics, anticholinergics)
- Post-procedure - vital signs, respiratory assessment, NPO until gag reflex returns
Medical Treatment for Lung Cancer
- Surgery (open thoracotomy or video-assisted thoracoscopic surgery (VATS))
- Best chance of cure if tumor is resectable
- Wedge resection, lobectomy, pneumonectomy
- Positioning the patient on the surgical side
- Chemotherapy
- Targeted therapy (e.g., pembrolizumab (Keytruda®)) - PD-1 inhibitors that inhibit the enzyme that inactivates T-cells, allowing them to destroy cancer cells
Thoracotomy Patient
- At risk for - airway/breathing issues, pain, infection, atelectasis, pneumothorax, hemorrhage, fluid overload
- Assessments include - airway, breathing, vital signs, pain, respiratory status, cardiovascular status, perfusion, chest tube function, and surgical incision
Thoracotomy Pre-Operative Teaching
- Pain management plan, incentive spirometer/TCDB, potential need for ventilation, chest tube, expectation for early mobilization, answer questions, address anxiety
Chest Tube
- Inserted in the pleural space
- Purpose - evacuate air or fluid
- 3-chamber system - drainage, water seal, suction
- Assessment - vital signs, SpO2, pulmonary status, COCA (notify surgeon if drainage > 100 mL/hour in immediate post-op period), and pain
- Troubleshooting/Complications - air leak, disconnection, tube dislodgment, subcutaneous emphysema
- Types of chest tube systems - 3 chamber wet system, 3 chamber dry system, Heimlich valve, PleurX tube
Case Study: 68-year-old Patient with Lung Cancer Post Lobectomy
- Potential Complication - Atelectasis
- Assessments - Diminished breath sounds throughout, fine crackles at bases bilaterally, SpO2 86% on 2L O2 by NC
- Interventions - Incentive spirometer/TCDB, positioning
NCLEX Questions:
- Question 1: The most appropriate action when bubbling is noted in the suction chamber of a chest tube is to assess the system for air leaks (C).
- Question 2: Appropriate nursing actions for a patient with a laryngectomy tube who has a decrease in SpO2 include assess breath sounds (A), perform suctioning (B), and check the oxygen flow rate and connections (E).
- Question 3: The nursing supplies needed at the bedside for a patient post-laryngectomy include a suction canister (B), laryngectomy tube (C), and a communication board (D).
- Question 4: The most important lab result to check for a patient post-laryngectomy with numbness and tingling in the lips and fingers is serum calcium (A).
- Question 5: The nurse should assess first the patient who has a decreasing SpO2 after a laryngectomy with a continuous pulse ox monitor (see Question 2).
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Description
This quiz covers essential aspects of laryngeal cancer, including risk factors, symptoms, and medical management strategies. Explore the diagnosis process, treatment options like total laryngectomy, and potential side effects from radiation. Gain vital knowledge about patient assessments and care required for individuals affected by this condition.
