Author Question: A patient scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx ... (Read 40 times)

Davideckstein7 · **on:** Jun 25, 2018

A patient scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx asks the nurse, Will I be able to talk normally after surgery? What is the best response by the nurse?

a. You will breathe through a permanent opening in your neck, but you will not be able to communicate orally.
b. You won't be able to talk right after surgery, but you will be able to speak again after the tracheostomy tube is removed.
c. You won't be able to speak as you used to, but there are artificial voice devices that will give you the ability to speak normally.
d. You will have a permanent opening into your neck, and you will need to have rehabilitation for some type of voice restoration.

Question 2

The nurse completes discharge instructions for a patient with a total laryngectomy. Which statement by the patient indicates that additional instruction is needed?

a. I must keep the stoma covered with an occlusive dressing at all times.
b. I can participate in most of my prior fitness activities except swimming.
c. I should wear a Medic-Alert bracelet that identifies me as a neck breather.
d. I need to be sure that I have smoke and carbon monoxide detectors installed.

bobsmith · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: D
Voice rehabilitation is planned after a total laryngectomy, and a variety of assistive devices are available to restore communication. Although the ability to communicate orally is changed, it would not be appropriate to tell a patient that this ability would be lost. Artificial voice devices do not permit normal-sounding speech. In a total laryngectomy, the vocal cords are removed, so normal speech is impossible.

Answer to Question 2

ANS: A
The stoma may be covered with clothing or a loose dressing, but this is not essential. An occlusive dressing will completely block the patient's airway. The other patient comments are all accurate and indicate that the teaching has been effective.