Total Laryngectomy
- General information: consists of removal of the entire larynx, hyoid bone, pre-epiglottic space, cricoid cartilage, and 3-4 rings of trachea. The pharyngeal opening to the trachea is closed and remaining trachea brought out to the neck to form a permanent tracheostomy. The result is loss of normal speech and breathing and loss of olfaction.
- Nursing care: preoperative
- Provide routine pre-op care.
- Explain expected procedures after surgery including suctioning, humidification, coughing and deep breathing, IV fluids, nasogastric tube feedings, tracheostomy or laryngectomy tube.
- Reinforce physician's teaching regarding loss of normal speech, breathing patterns, and sense of smell.
- Encourage client/significant others to talk about fears and hopes following surgery.
- Introduce client to changes in modes of communication (esophageal speech, artificial larynx).
- Establish method of communication to be used immediately post-op (Magic Slate, gestures).
- Nursing interventions: postoperative
- Promote optimum ventilatory status.
- Suction nose frequently because of rhinitis.
- Assess function of tracheostomy/laryngectomy tube and suction as needed.
- Promote pain relief.
- Elevate head of bed to decrease pressure on suture line.
- Administer analgesics as needed and monitor effects.
- Assist with moving head and turning by supporting back of neck with hands.
- Promote wound drainage.
- Elevate head of bed to promote lymphatic drainage from head.
- Monitor amount, characteristics of drainage.
- Promote nutrition.
- Institute and monitor tube feedings as ordered.
- Increase fluid intake as tolerated to improve hydration.
- Encourage self-feeding.
- Advance to normal diet as soon as client able to tolerate.
- Prevent infection.
- Assess WBC and report significant increases.
- Take temperature every 4 hours.
- Maintain sterile technique when suctioning and performing tracheostomy care.
- Observe stoma/suture lines for signs of infection.
- Provide frequent oral hygiene.
- Monitor sputum and drainage for changes in color, odor, characteristics.
- Enhance communication.
- Carry out modes of communication determined pre-op.
- Assess nonverbal behavior.
- Allow client time to ask questions and do not anticipate answers.
- Arrange for volunteer laryngectomee to visit client and assist with esophageal speech/artificial larynx.
- Consult with speech therapist if needed.
- Progress to normal diet as soon as possible to regain muscle tone of throat and abdomen.
- Support client during adaptation to altered physical status.
- Encourage client to discuss feelings about changes in appearance, body functioning, and life-style; be aware of nonverbal responses to the changes.
- Assist to identify and use coping techniques that have been helpful in past.
- Suggest flattering clothing styles that don't emphasize chest or neck configuration.
- Monitor for and support behaviors indicative of positive adaptation to changes (e.g., interest in appearance).
- Assess for respiratory complications (dyspnea, cyanosis, tachycardia, tachypnea, restlessness).
- Provide client teaching and discharge planning concerning
- Tracheostomy/laryngectomy and stomal care
- Proper administration of nasogastric tube feedings and maintenance of nasogastric tube (see Nasogastric (NG) Tubes)
- Control of dryness/crusting of tongue by brushing tongue regularly with soft toothbrush and toothpaste and using mouthwashes
- Need for humidified air at home
- Importance of protecting the stoma with a shield or towel while showering, directing shower nozzle away from stoma
- Need to use electric razors only for 6 months after surgery as facial area will be numb
- Need to lean forward when expectorating secretions and to cover stoma when coughing or sneezing
- Snorkle devices to enable swimming (caution is advised since drowning can occur rapidly in these clients)
- Need to wear an identification bracelet indicating that client is a neck breather
- Types of stoma guards available
- Necessity of installing smoke detectors since sense of smell is lost
- Information about prosthetic devices, speech therapy, and reconstructive surgery
Tuesday, May 20, 2008
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respiratory disorder
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This entry was posted on Tuesday, May 20, 2008
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respiratory disorder
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