- Cigarette smoking.
- Alcohol abuse.
- Voice abuse.
- Environmental pollutants.
- Chronic laryngitis.
- (+) Family history
Assessment:
- Persistent hoarseness of voice
- Mass on anterior neck
- Dyspnea
- Dysphagia
- Chronic laryngitis
- Burning sensation with hot/acidic beverages.
- Halitosis.
- Hemoptysis
- Severe anorexia
- Severe anemia
- Severe weight loss
Management:
- Surgery: Subtotal/total laryngectomy.
- Subtotal – retains voice
- Total – absolute loss of voice
- Preop care: Psychosocial support
Effects of Total Laryngectomy
- Loss of voice
- Permanent tracheostomy
- Loss of sense of smell
- Inability to blow the nose, sip soup, sips through the straw, whistle, gargle, and do valsalva maneuver ( unable to lift heavy objects, constipation ).
*Establish means of communication to be used postop.
Postop care:
Care of the client with Tracheostomy
1. Establish patent airway.
- Suction as necessary.
- Use sterile technique.
- Semi – Fowler’s position
- Use sterile NSS to lubricate suction catheter tip
- Apply suction during withdrawal of suction catheter.
- Apply suction for 5-10 seconds ( max of 15 sec ).
- Insert 3-5’’ of the suction catheter.
- Instill 2-5 mls. Of sterile NSS to liquefy mucous secretions.
- Cleanse stoma and tracheostomy at regular basis.
- Change dressing and ties as necessary.
4. Provide psychosocial support.
5. Assist during speech therapy
Client Teaching:
- Cover tracheostomy with porous material.
- Avoid swimming.
- Avoid use of powder, spray, aerosol near tracheostomy.
- Regular follow – up care.
