cancer of the larynx final

8/2/2019 Cancer of the Larynx FINAL

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Perpetual Help College of Manila SECTION A4AA MARCH 2011

Cancer of the larynx is a malignant tumor in and around the larynx (voice box).

Squamous cell carcinoma is the most common form of cancer of the larynx. Adenocarcinoma or

sarcoma of the larynx is diagnosed less often. More than 10,000 new cases of cancer of the

larynx occur annually. Cancer of the larynx occurs more frequently in men and than in women

and it is most common in people between the ages of 50 and 70 years. The incidence of

laryngeal cancer continues to decline, but the incidence in women versus men continues to

increase. The disease is also about 50% more common among African Americans than among

Caucasian Americans.

Carcinogens that have been associated with laryngeal cancer include tobacco (smoke,

smokeless) and alcohol and their combined effects, as well as exposure to asbestos, mustard

gas, wood dust, tar products, leather and metals (Diet, Ramroth, Urban, et al., 2004). Other

contributing factors include straining the voice, chronic laryngitis, nutritional deficiencies

(riboflavin), and family predisposition.

Laryngeal cancer can be classified into three categories: supraglottic (false vocal

cords)), glottic (true vocal cords) and subglottic (downward extension of disease from the vocal

cords) (National Cancer Institute, 2003). Two thirds of laryngeal cancer is in the glottic area.

Supraglottic cancers account approximately one third of the cases, subglottic tumors for fewer

than 1%. Glottic tumors seldom spread if found early, because of the limited lymph vessels

found in the vocal cords.

Approximately 25% to 50% of patients with laryngeal cancer present with involved lymph

nodes. Metastatic disease from the true vocal cords is very rare, because they are devoid of

lymph nodes. The prognosis for patients who have small laryngeal cancers without evidenced of

spread to the lymph nodes is about 75% to 95%. Recurrence occurs usually within the first 2-3

years after diagnosis. The presence of disease after 5years is very often secondary to a new

primary malignancy (National Cancer Institute, 2003)


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DEMOGRAPHIC DATA

Full Name: Mr. XXX

Age: 73 years old

Sex: Male

Address: Quezon City

Date of Birth: August 19 , 1937

Place of Birth: Quezon City

Civil Status: Married (Separated)

Nationality: Filipino

Race: Asian

Religion: Roman Catholic

Occupation: N/A

Date and time of Admission: February 07, 2011 Time: 12:45 pm

Chief Complaint: Difficulty and pain in swallowing

Admitting Diagnosis: Laryngeal Mass t/c malignancy

Final diagnosis: Laryngeal cancer


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HISTORY OF PRESENT ILLNESS

April 2010

The patient started complaining of difficulty of swallowing associated with pain occasionally. No

difficulty of breathing noted. They consulted a doctor. CT scan was requested which revealed

epiglottic mass. Operation was advised; due to financial problem operation was deferred.

Patient was lost to follow up for his check-up, and the client confirmed that his difficulty of

swallowing has lessened.

(+) difficulty of swallowing noted with no other signs and symptoms.

January 2011

The patient experienced episodes of nosebleed & blood in his sputum. Then again patientconsulted medical attention. X-ray was requested and showed with normal findings.

(+) Hoarseness

(+) nosebleed

(+) blood in sputum

3 weeks prior to admission patient started complaining of hoarseness, no difficulty of breathing

noted.

4 days prior to admission patient consulted at OPD and they were advised for admission.


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PAST MEDICAL HISTORY

The patient has incomplete immunization. He had an operation for herniorrhaphy when he was

50 years old. Whenever he experienced an illness they only consulted to an albularyo and no

medical consultation was done afterwards. No known allergies to food and medication.

FAMILY HISTORY

(+) Hypertension

(+) Diabetes Mellitus

(-) Heart Disease(-) Asthma

(-) Cancer

(-) PTB

SOCIAL HISTORY

In the Eriksons stages of Psychosocial Development, he is in the stage of integrity vs.

despair. At this stage, individual looks back over life and accept its meaning. The sense of

integrity and fulfillment is observed. And lastly, the willingness to face death.

The patient belongs to poor family. He is the youngest among four siblings. He got

married at the age of 26 years old; they live in a congested area with a make-shift structured

house. He is a smoker and alcoholic beverage drinker. He does not attend mass on Sundays

and he doesnt consider himself as a religious person.


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LIFESTYLE

The patient sleeps for 6-7 hours a day. He drinks water 6-7 glasses per day. He walked

around outside the house every morning. He watches television in the afternoon for 2-3 hours.

They eat meals three times a day. He does household chores such as washing dishes and

weeping the floor. The patient consumed one pack of cigarettes and three bottles per day as he

stated before his confinement.

OCCUPATIONAL HISTORY

The patient is elementary graduate. He started working at the age of 17 years old as a

construction worker. He was the breadwinner in the family. When he got married he still works

as a construction as his part-time job. Sometimes if there is no offered job for him, he works as

a side walk vendor such as selling water and cigarettes.

ENVIRONMENTAL HISTORY

They live in a congested area, one-story house made up of woods with one window on

the front side of the house. Their area has no good drainage system that is why they easily get

flooded during heavy rains. Their area has no proper disposal of garbage. And has no good

source of water. Left over foods are been kept by covering it by plate.


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A. Assessing appearance and mental status

1. The patient general appearance is not proportionate because of his condition and also

due to aging.

2. He is slightly slouching when standing and doing some activities.

3. He is kempt; his relatives clean him every day.

4. He doesnt have body odor or any minor odor relative and also no breath odor.

5. He has distress noted related to his condition.

6. He doesnt have healthy appearance due to his disease.

7. He cooperates and able to follow instructions but sometimes not.

8. The patients affect is appropriate to the situation.

9. The patient has difficulty in talking because he has tracheotomy tube, uses gestures,

sign language and pointing letters or numbers provided by the student nurse.

10. The patient response has relevance and organization of thoughts.

B. Assessing the Skin

1. The client:

a. The client has no history of itching.

b. There is no presence of lesions except on the site of tracheotomy tube, no bruises,

abrasions or pigmented spots but he has nevis and freckles on some parts of his

body. Most seen in his face and chest area.

c. He has no skin problems.

d. He does not use any medications, lotions or any remedies.

e. The client has dry skin.

f. There is tendency for the client to bruise easily because of dry skin.

2. The color of the skin varies from light to deep brown.

3. The client has no edema.

4. .The client has no lesions.

5. The temperature is in the normal range 36.9 C and moisture in skin folds and axillae.

6. When pinched it easily springs back to normal.


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C. Assessing the Hair

1. Inquire if client has any history of the following:

a. He never used hair dyes, rinses or curling or straightening preparations.

b. Never undergo chemotherapy.

c. The client has no presence of disease.

2. The clients hair is evenly distributed.

3. He has a thin hair.

4. He has a dry hair.

5. There is no presence of infection.

6. The client has thin hair in his body and it is evenly distributed.

D. Assessing the Nails

a. The patient has a history of inguinal hernia.

b. No peripheral circulatory disease

c. No previous injury

d. No severe illness

1. Convex curvature; angle of nail plate about 160 degrees

2. The patient has a light to deep brown color black pigmentation in longitudinal streaks

3. Rough texture with excessive thickness of grooves and furrows and intact epidermis of

finger and toe nails

4. Prompt return of pink or usual color in 3 seconds.

E. Assessing the Skull and Face


a. No lumps, itchiness, and dandruff noted

b. No noted loss of consciousness, dizziness, seizures, headache, facial pain, or injury

2. Patient skull size is 21 inches, rounded and symmetrical.

3. The patient has no nodules, masses and depression noted

4. Symmetric of structure and of the distribution of hair

5. No presence of edema around the eyes

6. Symmetric facial movements

F. Eyes structures and visual acuity

1. a. Positive on family history of Diabetes, Hypertension, but negative in Blood

Dyscrasia.

b. No eyes disease, injury or surgery

c. Never visit an ophthalmologist

d. Never use eye medication

e. Never use contact lenses or eyeglasses


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f. No hygienic practices of eye problems

g. No current symptoms of eye problems

2. Eyebrows hair is equally distributed and symmetrically aligned; skin is intact and

equal movement.

3. Equally distributed, straight and slightly outward

4. Skin intact, no discharged, no discoloration, lids close symmetrically; approximately

14 blinks/minute, bilaterally blinking, when lids are open, no visible sclera above corneas

and upper and lower borders of corneas are slightly covered.

5. Transparent, capillaries sometimes evident and no lesions.

6. Shiny and smooth red in color. No lesions or nodules

7. No edema or tenderness over lacrimal glands

8. Transparent, shiny, smooth and details of iris is visible.

9. Patient blinks when the cornea is touched, indicating that the trigeminal nerve is

intact.

10. Brown in color, round in shape and 4mm symmetry of size

G. Ears and Hearing

1. a. No family history of hearing problem or loss

b. No presence of any ear problems or pain

c. Never complains of ringing in ears. No medication history

d. No hearing difficulty

e. Never use of corrective hearing device

2. Same color as the facial skin, symmetry or size and position

3. Firm and not tender, pinna recoils after it is folded

4. Dry cerumen during inspection, no skin lesion or discharged

H. Assessing the Nose and Sinuses

1. a. The patient has no history of allergies.

b. There is no difficulty of breathing through the nose.

c. The patient has no sinusitis.

d. He has no injuries in nose or even in face.

e. He experience nosebleed before he admitted to the hospital but no changes in

smell.

2. Symmetric and straight, no discharge or flaring and uniform color but presence of

black heads.

3. No lesions and tenderness, or masses in any areas4. Air moves freely on the patient breaths through the nares.

5. There is no presence of redness, swelling growth and discharge.

6. No tenderness during the palpitation of maxillary and frontal sinuses


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I. Assessing the Mouth and Oropharynx

1. Inquire if the client has any history of the following:

a. No routine pattern of dental care.

b. Never been consulted to the dentistc. When the patient having a mouth sore it takes 5-7days, for it to heal but during P.A no

present mouth sore.

d. No dentures

2. Symmetrical contour, dark red in color.

3. Inner lips and buccal mucosa is dark red in color, smooth and wet. No presence of

lesions

4. Upper teeth are 12 and lower teeth are 10, with dental carries, yellow in color with

black in other area. Gums is dark red in color no dentures.

5. His tongue is in the central position, red with white patches/ pigmentation on the

middle. Moves freely and no tenderness

6. Smooth tongue base with prominent veins

7. Smooth with no palpable nodules

8. Same color of buccal mucosa and floor of mouth

9. Using penlight there is no lesions noted dark red in color

In hard palate lighter pink, and more irregular, smooth palate is smooth and soft..

10. Positioned in midline of soft palate

11. Dark red and smooth posterior wall

12. Lightly dark pink in color, no discharged and normal size

The tonsil is color dark pink

13. Patient shows difficulty of swallowing.

J. Assessing the Neck


a. There was no any problems with neck lumps based on the CT scan there is a mass

on the suprahyoid and infrahyoid portions of the larynx

b. There was neck pain but no stiffness. The patient has elective tracheostomy to avoid

unnecessary manipulation of tumor. The patient has never been diagnose with

thyroid problems. The patient has a surgery direct laryngoscopy with biopsy.

2. Neck muscles equal in size; head centered

3. Head coordinated, smooth movements with no discomfort

4. There is no palpable lymph nodes but presence of tenderness on neck.

5. Trachea has in central placement in midline of neck; spaces are equal on both sides

5. Thyroid gland not visible on inspection, and lobes may not be palpable


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K. Assessing the Thorax and Lungs


a. Family has no history of cancer

b. The patient has no allergies

c. There is no history of Tuberculosisd. He is a chain smoker

e. He had medications taken for current problems, he took Robitussin for cough, and

self-medications for other illnesses

2. The shape and symmetry of thorax has an anteroposterior to transverse diameter in ratio

1:2, and chest symmetric

3. Spine is vertically aligned

4. Skin is intact; he also has uniform temperature

5. Posterior chest has full and symmetric chest expansion

6. The patient has bilateral symmetry of vocal fremitus

7. Thorax percussion notes resonate, except over scapula. Lowest point of resonance is at

the diaphragm. Excursion is 2 inches to 2 1/2 inches.

8. Chest auscultation has vesicular and bronchovesicular breath sounds

9. Presence of crackles and hoarseness.

10. Anterior chest is full symmetric excursion; thumbs normally separate 2inches to 2

inches.

11. Same as posterior vocal fremitus

12. Percussion notes resonate down to the sixth rib at the level of the diaphragm but are flat

over areas of heavy muscle and bone, dull on areas over the heart and the liver, and

tympanic over the underlying stomach

13. Adventitious breath sounds (crackles).

L. Assessing the Heart and Central Vessels


a. Patient has a family history of Hypertension and Diabetes

b. No past history of any heart disease.

c. He has no present symptoms indicative of heart disease

d. He has no presence of disease that affects the heart

e. He had a smoking lifestyle habit that is risk factor for heart disease

2. He has no pulsations nor lift or heave in the tricuspid

3. S1: Usually heard at all sitesUsually louder at apical area

S2: Usually heard at all sitesUsually louder at base of heart

Systole: silent interval; slightly shorter duration than diastole at normal heart rate (60 to90 beats/min)Diastole: silent interval; slightly longer duration than systole at normal heart ratesS4: in many older adults


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4. The carotid artery has symmetric pulse volumes; Full pulsations, thrusting quality; Qualityremains same when client breathes, turns head, and changes from sitting to supineposition; Has elastic arterial wall; There is no sound heard on auscultation

5. The jugular veins not visible

M. Peripheral vascular System


a. According to the patient he has no history of any heart disorder, varicosities, arterial

diseases and hypertension.

b. The patient does some household chores.

c. The patient started smoking and drinking since he was 16 years old.

2. Peripheral pulses on both sides are symmetric pulse volumes and have full pulsations.

3. Presence of distension and nodular bulges and valves. When limbs are elevated, veins

collapse.

4. There is no sign of phlebitis. Limbs not tender and symmetric in size.

5. Hands and feet are color brown because of unhygienic. Skin temperature not

excessively warm or cold. No edema.

N. Breast and Axillae

1. inquire if the client has any history of the following:

a. There is no breast mass.

b. No pain or tenderness in the breasts.

c. No discharge/s from the nipple.

d. No history of medication.

e. (estrogen replacement therapy)

f. (mother, sister, auntg. He consumes liquor, 3 bottles/day

h. Ordered diet is clear-liquid

i. N/A

j. N/A

k. N/A

l. N/A

m. N/A

2. The breast is even with the chest wall.

3. The skin of the breasts is uniform in color, smooth and intact.

4. Round oral bilaterally the same, color varies widely. No masses and lesions.5. Both nipples are Rounded, everted, and equal in size; similar in color, soft and smooth,

both nipples point in same direction. no discharge and lesions.

6. Axillary, subclavicular and supraclavicular lymph nodes does not have any palpable

tenderness and masses.

7. Breast has no palpable tenderness, masses, nodules or nipple discharge/s.


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O. Assessing the Abdomen

1. Determine the clients history of the following:

a. No incidence of abdominal pain.

b. Abnormal bowel elimination.

c. He only defecates once in 5 daysd. There are no changes in appetite.

e. No food intolerances.

f. Food ingested in the last 24 hours was only milk.

g. No sign and symptoms

h. No previous problems and treatment.

2. Rounded abdomen, symmetric countour.

3. Symmetric movements on respiration. No visible vascular pattern.

4. Audible bowel sounds. There is absence of arterial bruits and frictions rub.

5. Tympany over the stomach and gas-filled bowels; dullness, especially over the liver and

spleen.

6. 6-12 cm in the mid- clavicular; 4-8 cm at the mid sterna line.

7. No tenderness; relaxed abdomen with smooth, consistent tension. No tenderness.

8. Border feels smooth.

9. Not palpable.

P. Musculoskeletal System


a. There is no muscle pain according to the patient during the physical assessment

done to him.b. The patient has IV lines at the right hand. The patient can only performed less

movement.

c. The patient experiences no any previous sports injury.

2. No fasciculation and tremors and also no muscles and tendon contractures.

3. Normally firm during palpation of muscle at rest.

4. The patient smooth coordinated movements during muscle palpation when he is active.

5. The patient has equal strength on each body side.

6. There are bone deformities at the both small fingers of his hands of the patient.

7. There is no tenderness or any presence of edema in any area of his body.

8. There is no presence of tenderness, swelling or nodules and the joints has lessmovements.

Q. Neurological System Assessment

1. Inquire if the patient has any history of the following:

a. No presence of pain in the head, back or even at the extremeties.

b. The patient is oriented to time, place or persons.

c. The patient cannot speak due to Tracheostomy tube.


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d. No any history of loss of consciousness, fainting, convulsion, trauma, tingling,

tremors or tics, paralysis uncontrolled muscle but there is a presence of

numbness in his feet.

e. Theres no problem in smell, vision, taste but there is presence of numbness in

his both foot and hearing disability.

2. Can hardly speak due to his tracheostomy tube.

3. No disorientation to time place and person.

4. The patient has lapses in memory when answering the questions.

5. Eye opening is Spontaneous, motor response is to verbal command because he can

follow command, and his verbal response is no response because of his tracheostomy.

R. Assessing Female genitals and Inguinal area.

The patient is male.

S. Assessing the Male genitals andInguinal area

1. inquireif the client has any history of the following:

a. the patient voids 6 times before and now 4 times only.

b. no history of abdominal pain

c. none symptoms of sexually transmitted disease

d. the patients has history of hernia when he was 50 years old,.

e. no family history of nephritis, malignancy of prostate or mali1gnancy of the kidney.

2. Refused.

3. Refused

4. Refused

5. Refused

6. Refused

7. Refused

8. Refused

T. Assessing the rectum and anus

1. Inquire if the client has any history of the following

a. The client defecates after 5 days because he ate small amount of food.

b. There is no history of colorectal cancer

c. Never experience to defecate with occult blood.

d. Not assessed because the client refused.

2. The client refused.

3. The client refused.


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U.

Vital signs Normal Actual

Findings

Interpretation/Analysis

Blood

pressure

120/80

mmHg

140/100

mmHg

On the disease process, any condition that may

affect the cardiac output, blood volume, blood

viscosity has direct effect on the blood

pressure. The patient was in distress during the

assessment

(Kozier, B. (2004). Fundamentals of Nursing p.

510).

Temperature 36.5-37.5 C 36.9 C Febrile

Inflammation is a local, nonspecific defensive

response of the tissues to an injurious or

infectious agent. It is an adaptive mechanism

that destroys or dilutes the injurious agent,

prevents further spread of the injury, and

promotes the repair of damaged tissue.


634).

Pulse rate 60-100 cpm 82 cpm Normal Range


496).

Respiratory

rate

16-20 bpm 19 bpm Several factors that increase respiratory rate

include stress and increase environmental

temperature.(Kozier, B. (2004). Fundamentals

of Nursing p. 506).


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V.

Serum type

Entered: 02/7/11 (08:12)

Report Printed: 03:34

Test Result Normal Values Analysis InterpretationALT 39 u/L 30-65 u/L Normal - The result is

within normal

range

---------------------------------------------------------------------------------------------------------------------

Serum type

Entered: 02/7/11 (08:12)

Report Printed: 03:34

Test Result Normal Values Analysis InterpretationTotal Protein 77.8 g/L 64-82 g/L Normal - The result is

within normal

range

Albumin 37.7 g/L 34-50 g/L Normal - The result is

within normal

range

Globulin 40.1 g/L 30-32 g/L HIGH -High globulin is

found in many

types of

inflammation,certain infections

and in chronic

liver disease and

infections.

A/G Ratio 0.9 1.1-1.6 LOW A/G Ratio may

be decreased

due to liver

dysfunction.

Blood UreaNitrogen 3.6 mmol/L 2.50-6.1 mmol/L Normal - The result iswithin normal

range

Creatinine 71 umol/L 53.00-115.0umol/L

Normal - The result is

within normal

range

Sodium 133 mmol/L 135-148 mmol/L LOW -Low sodium

level are


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uncommon and

most often occur

as a side effect

of taking meds

that make you

urinate more,

such as diuretics.

Potassium 3.8 mmol/L 3.60-5.20mmol/L


within normal

range

AST 31 u/L 15.00-37.00 u/L Normal - The result is

within normal

range

-------------------------------------------------------------------------------------------------------------------------------

-----------Serum type

Entered: 02/8/11 (08:29)

Report Printed: 21:12:33

Test Result Normal Values Analysis InterpretationGlucose 5.8 mmol/L 3.9-6.1 mmol/L Normal - The result is

within normal

range

Cholesterol 3.7 mmol/L 0-5.2 mmol/L Normal - The result is

within normalrange

Triglycerides 1.3 mmol/L 0.4-1.7 mmol/L Normal - The result is

within normal

range

HDL Cholesterol 1.01 mmol/L 0.91-1.56mmol/L


within normal

range

LDL 2.1 mmol/L 1.89-3.09mmol/L


within normal

range


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---------------------------------------------------------------------------------------------------------------------

BLOOD TYPING

February 7, 2011

Result: B POSITIVE

---------------------------------------------------------------------------------------------------------------------

HEMATOLOGY

Februaruary 7, 2011

Test Result Normal Values Analysis InterpretationHemoglobin 121 120-170 g/L Normal - The result is

within normalrange

Hematocrit 0.354 .40-.57 LOW -Decreasedhematocritindicates vitaminor mineral

deficiency,recent bleedingand livercirrhosis.

WBC Count 9.4 5-10^g/L Normal - The result iswithin normalrange

Segmenters .699 .50-.70 Normal - The result iswithin normalrange

Lymphocytes .227 .20-.40 Normal - The result iswithin normal

rangeMonocytes .070 0-0.07 Normal - The result is

within normalrange

Eosinophils .003 0-0.05 Normal - The result iswithin normalrange

Basophils 0.001 0-0.2 Normal - The result iswithin normalrange

MCV 86.4 80.9-99.9 fl Normal - The result iswithin normal

rangeMCH 29.6 27-31 pg Normal - The result is

within normalrange

MCHC 34.2 33-37 Y Normal - The result iswithin normalrange

Platelet Count 362 150-400 10^g/L Normal - The result is


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within normalrange

---------------------------------------------------------------------------------------------------------------------

April 6, 2010Age/Sex: 73

Dx: Supraglottic mass T/C malignancy

STUDY: CT SCAN OF THE NECK WITH EMPHASIS ON THE LARYNX PLAIN AND WITH

CONTRAST

Findings:

There is a soft tissue mass seen in the suprahyoid and infrahyoid positions of the epiglottis

protruding into the laryngeal vestibule with indefinite extension into the left aryepiglottic fold. Itmeasures about 3.6x3.0x2.1 cm (length x width x height)

The preepiglottic space, paralaryngeal, anterior and posterior commisures appear intact.

The true and false vocal cords are not unusual

No evident of the hyoid bone, laryngeal cartilages are noted

The parotid and submandibular glands are normal

The rest of the cervical spaces and its facial planes are intact

No evident cervical lymphadenopathy is seen

IMPRESSION: EPIGLOTTIC MASS AS DESCRIBED, MALIGNANCY CONSIDERED

Examination Requested: CHEST PA

Date: 1/14/11

Radiographic No. 4007-11

RADIOGRAPHIC REPORT:

BOTH LUNG FIELDS ARE CLEAR

HEART IS NOT ENLARGED

NO OTHER REMARKAABLE CHEST FINDINGS

IMPRESSION: NORMAL CHEST


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The patients general appearance is disproportionate because he is slightly slouching

when standing and doing some activities due to aging. He has distress noted related to his

condition and due to hospital bills increasing and threat of death. The patient has difficulty of

talking because he has tracheostomy tube. The patiet has dry skin with possible tendency to

bruise easily. The patient has thin and dry hair due to aging. He experiences nosebleed before

he was admitted to the hospital. He experienced epistaxis and hemoptysis due to dry nasal

passages because of hoarseness of voice. Patients mouth has dark red in color, inner lips and

buccal mucosa is dark red in color with crakes due smoking, patient verbalizes difficulty of

swallowing. Upper teeth are 12 and lower are 10, with dental carries, also due to smoking. He

underwent Elective tracheostomy to avoid unnecessary manipulation of tumor. On CT scan

there was a mass on the suprahyoid and infrahyoid portions of the larynx. There was neck pain

but no stiffness noted. He had a smoking lifestyle for 47 years, 1 pack of cigarette per day.

Patients bowel elimination is abnormal and usually defecates after 5 days. Patients laboratory

shows that his globulin and WBC is high, because he has infection and inflammation. The

patients A/G ratio is low which means patient is most likely to have liver dysfunction as

evidenced by high intake of alcohol, with 21 bottles per week. Sodium level is low because low

sodium levels are uncommon and most often occur as a side effect of taking meds. Hematocrit

level is low due to as being anemia. There are many reasons for anemia. Patients CT scan

impression is epiglottic mass as described, malignancy considered.
http://www.medicinenet.com/script/main/art.asp?articlekey=2015http://www.medicinenet.com/script/main/art.asp?articlekey=2015http://www.medicinenet.com/script/main/art.asp?articlekey=2015


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POSSIBLE NURSING DIAGNOSIS:

Ineffective airway clearance related to retained secretions as evidenced by crackles.

Constipation related to irregular bowel dysfunction as evidenced by clients

verbalization.

Infection related to post operative procedure as evidenced by increased WBC and

decrease hemoglobin.

Impaired swallowing related to mechanical obstruction as evidenced by tracheostomy

tube.

Anxiety related to situational crises such as hospital bills & threat of death as evidenced

by restlessness.


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ACTUAL NURSING CARE PLAN

ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUASubjective:

Objective:(+) Crackles(+) Cough(+) Excessivesputum

(+)Restlessness

RR 24

(+) NasalFlaring

Ineffectiveairway

clearancerelated toexcessivemucusproductionasmanifestedbyadventitiousbreathsounds

Surgicalalteration in

the airway

Excessivemucussecretion

Blocking of

airway

Difficulty ofbreathing

GOAL:After 8 hours

of nursinginterventionthe patientwill be abletodemonstratetechniquesin performingairwayclearanceand promotewellness

OBJECTIVE:After 1 hourof nursinginterventionthe patientwill maintaina patentairway andbe able toexpectoratesecretions

1. Monitorrespirations and

breath sounds,noting rate andsounds.

2. Position client infowlers position

3. Suctionsecretions PRN

4. Encourage deepbreathing andcoughing exercises

5. Increase fluidintake at least 2-3liters

6. Supportreduction/cessationof smoking

1. Indicative ofrespiratory

distress oraccumulationof secretions

2. To open andmaintainairway and totake advantageof gravitydecreasingpressure on

the diaphragmand enhancingdrainage ofventilation todifferent lungsegment.

3. To clearairway whenexcessive orviscoussecretions are

blocking orwhen client isunable tocougheffectively

4. To maximizeeffort

5. Properhydration canhelp liquefysecretions andimproveclearance

6. To improvelung function

GOAL:After 8 h

of nursininterventhe patiebe able demonstechniquperformiairwayclearancpromotewellness

OBJECTAfter 1 hnursinginterventhe patiemaintainpatent aand be aexpectosecretio

.


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7. Provideinformation aboutthe necessity of

expectoratingsecretion versusswallowing

8. Demonstrate/assist client inperforming specificairway clearancetechniques

9. Encourage andprovideopportunities forrest and limitactivities to level ofrespiratorytolerance

10. Giveexpectorants/bronchodilators as

ordered

7. To reportchanges incolor and

amount in theevent thatmedicalinterventionsmaybe needed

8. Forcedexpiratorybreathing(Huffing)

9. Preventsand reducesfatigue

10.Expectorantshelps in

improvingclearance ofsecretion andbronchodilatorsaids in propergas exchange


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POTENTIAL NURSING CARE PLAN

ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUATIOSubjective:

Objective:

Risk foraspiration

OBJECTIVE:After 1 hour

of nursinginterventionthe patientwill maintaina patentairway andbe able toexpectoratesecretions

1. Assess clientsability to swallow

and strength ofgag reflex andevaluate amountand consistencyof secretions.

2. Observe forneck and facialedema

3. Maintainoperationalsectionequipment at

bedside

4. Suction ETtube as neededand avoidtriggering of gagmechanismwhen performingsuction

5. Avoid keepingclient in supineposition when onmechanicalventilation

1. Helpdetermine

presence andeffectivenessof protectivemechanism

2. Client withhead/necksurgery ortracheal/bronchialinjury is at

risk forairwayobstructionand inabilityto handlesecretion.

3. Facilitateclearingairway inemergencysituations

4. TO clearsecretionswhilereducingpotential foraspiration ofsecretion

5. Supineposition havebeen shownto beindependentrisk factorsfor thedevelopmentof aspirationpneumonia

OBJECTIVEAfter 1 hour

nursinginterventionthe patient wmaintain apatent airwaand be able expectoratesecretions


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February 14, 2011

Sir/Maam:

Good Day!

We the nursing students from Perpetual Help College of Manila, NCM 204 section A4AA

would like to ask for your consent to conduct our physical assessment, this will be used for our

grand case presentation this coming march 01, 2011. This case presentation will serve as our

preparation and added knowledge for our nursing career. We wish to have your time for today

and with cooperation. Although you may not receive direct benefit from your participation, others

may ultimately benefit from the knowledge obtained in this study.You will not be identified in

any reports on this. Records will be kept confidential to the extent provided by the hospital.

However, the list of panel responsible for monitoring this study will review the datas collected. If

significant new knowledge is obtained during the course of this study which may relate to your

willingness to continue participation, you will be informed of this knowledge.

Your participation in this study is voluntary. Even after you sign the informed consent

document, you may decide to leave the study at any time without penalty or loss of benefits to

which you may otherwise be entitled. One copy of this document will be kept together with the

records of this study.

I have read the information given above. I hereby consent to participate in the study.

Printed Name and Signature


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Modifiable Risk Factors:

Combined effects of

alcohol and tobacco

use Paint fumes

Food dust

Cement dust

Chemicals

Straining of voice

Chronic Laryngitis

Non-Modifiable Risk Factors:

Age

Gender (more

commonly male) Stress

Hereditary -obese

Exposure to chemical

carcinogen

Cellular

Transformation

Normal cell transform

into cancer cells

Accumulation of

squamous cell

carcinoma

Laryngeal Mass

Formation of mass on

laryngeal area

Metastasis

develops

Carcinoma of true

vocal cords (Glottis)

Laryngeal Cancer

Spread of

Carcinoma


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DISCHARGE PLANNING

Medications- Patient is for discharge, with the following take home medicine such as:

Tramadol 50mg/ 1 tab PRN for moderate pain

Ranitidine 150 mg/ twice a day at bedtime

Metronidazole 375 mg/ 1 tab per day

Instruct the patient to religiously take the ordered medications at the right time, dosage,

and frequency.

Exercise - Once home, it is possible to tire more easily than usual to begin with, so it is

important to take it easy. Strenuous exercise and lifting should be also avoided. Light

exercise such as walking, deep breathing and coughing exercise are recommended. Normal

activities, including returning to work, can usually be resumed after about a week.

Treatment. For tracheostomies older than 1 month, clean technique is used for tracheostomy

care. Stress the importance of good hand washing technique to the care giver. Tap water may

be used for rinsing the inner cannula. Teach the care giver the tracheostomy care procedure

and observe a return demonstration. Inform the caregiver of the signs and symptoms that may

indicate an infection of the stoma site or lower airway. Consequently, to prevent other

complications, she must have his lifestyle and diet modified.

Health Teaching - Explain to patient what to expect afterwards. As the anesthetic wears off,

there is likely to be some pain. The anesthetist will prescribe painkillers. Suffering from pain can

slow down recovery, so it's important to discuss any pain with the doctors or nurses.

On discharge, patient must advise about caring for the tracheostomy, hygiene and

bathing, and will arrange an outpatient appointment for the tracheostomy to be removed,

if necessary. Some people which do not need to be removed.


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Instruct patient to comply with the take home medications that would be given by his

physician. Remind him to complete the full course of the antibiotic treatment.

Encourage patient to do the recommended light exercises such as walking. Avoid doing

strenuous activities which could slow down his recovery.

Encourage him to comply with the dietary modifications.

Explain to patient to refer for unusual signs and symptoms of any untoward feelings

immediately regarding to her condition.

OPD Follow-up Remind patients that regular check-ups are important to ensure that the

patient condition is constantly monitored by the doctor. If any of the following symptoms are

noted, he should contact her doctor:

the stoma start to bleed

stoma become more painful, red, inflamed or swollen

pain is not relieved by the prescribed painkillers

a fever develops.

These could be signs of an infection that may need to be treated with antibiotics

Diet- Patient must remember, most importantly, stops smoking and reduce drinking, if you

currently have these habits. However, according to this study, greatly increasing your intake of

fiber, in particular fiber from vegetables, may be helpful for protecting against laryngeal

cancer. Amazingly, even for those who have a long history of smoking and drinking, eating more

fiber still helps reduce risk of laryngeal cancer.

Spiritual- Provides emotional support coming from family. Encouraged the patient to participate

in the community services to promote social supportive relationship.


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PRESENTED BY:

Mayo, Raissa May

Meneses, Millete

Miculob, Van joseph

Nebrida, Karen

Osite, Caroll

Panilo, Ma. Angelica

Pascual, Maria Lorena

Quijano, Maris Angela

Saspa, Darwin

cancer of the larynx final

Documents