M. is a 65-year-old male admitted to the ICU following a radical neck dissection and tracheostomy for treatment of laryngeal cancer. P.M. is currently on a mechanical ventilator and sedated. However, he does open his eyes and squeeze your hand on command. Auscultation of his lungs reveals bilateral wheezes. Vital signs are as follows: BP 130/70, heart rate (HR) 116 beats/min, respiratory rate (RR) 18/min, and temperature 36.4°C (97.5°F). The cardiac monitor indicates sinus tachycardia.
Risk Factors Associated with Laryngectomy
Smoking any kind of tobacco (cigarettes, cigars, or pipes) or cannabis greatly increases the risk of a person suffering from laryngeal cancer. Laryngeal cancer risk factors include, but are not limited to, gender and age. Research indicates that men are more susceptible to suffering from laryngitis than women. People above the age of 65 are at an increased risk of developing laryngeal cancer (Hinkle & Cheever, 2018). Individuals who have been exposed to components such as nickel, wood dust, fumes from paint, or asbestos are prone to laryngeal cancer.
Findings from the Assessment
The assessment findings of a patient suffering from laryngeal cancer are based on the clinical manifestation that is presented by the patient. Fatigue, soreness, nausea, fever, rashes, and an increased pulse are some of the most prevalent clinical symptoms of laryngeal cancer. Equally important, other common signs and symptoms include enlarged lymph nodes, airway obstruction, noisy breathing, and difficulty breathing (Hinkle & Cheever, 2018). Based on the case study, the patient presented pertinent positive symptoms of increased pulse rate and wheezing sounds. The cardiac monitor indicated sinus tachycardia, a common clinical manifestation associated with laryngeal cancer.
Evaluation of Diagnostic Studies Results
The evaluation of the results of diagnostic studies for a postoperative patient who has undergone surgery for laryngeal cancer is very important in ensuring that the patient can attain quality medical care. The diagnostic assessment of the patient can be achieved through history and physical examination by assessing the ears, nose, mouth, throat, and neck. The detection of lesions can be investigated through the use of indirect laryngoscopy that involves a laryngeal mirror. Other approaches that can be used comprise a CT scan or MIR, which are necessary for detecting local and regional spread (Hinkle & Cheever, 2018). A mass in the subglottic area and a subglottic lesion with lymph node involvement can be used to diagnose the presence of laryngeal cancer.
Nursing Care Plan
The nursing care plan for the patient will involve a myriad of clinical procedures. It will be crucial to develop a patient airway for the patient to ensure that the patient can breathe normally. Since the patient is on a mechanical ventilator, it is necessary to closely monitor his airways and breathing (Ackley et al., 2019). The healthcare provider needs to ensure that there are no complications that are related to therapy to prevent infection and patient readmission.
Prioritization of Nursing Care
Patients with tracheostomies should get suctioning, oral hygiene, and skin cleansing around the stoma as part of their nursing care. They should also be assessed for any issues that they may develop. The upper airway’s regular tasks include warming, filtration, and humidification of the air (Ackley et al., 2019). To put this into perspective, tracheotomy tends to bypass the nose, which is important in humidification and warming-inspired air. The reduction of humidity of the inspired air will lead to the thickening of secretions.
Delegation of Nursing Activities
A patient with tracheostomies often demonstrates difficulties in speaking. An alternate method of communication must be devised in conjunction with the patient, the patient’s family, and other medical professionals (Ackley et al., 2019). The medical practitioner can only delegate some of the activities of taking care of patients with tracheostomies after gathering enough data and comprehending the health and well-being needs of the patient.
Formulation of Individualized Teaching Plan
As aforementioned, a patient with a tracheostomy struggles with altered verbal communication. This impacts them negatively by instigating anxiety and frustration. Formulating the teaching plan to enable the patient to cope with this issue should include asking yes-or-no questions, offering a communication board, or teaching the patient using a pencil and paper. The patient needs to be educated concerning tracheotomy care (Ignatavicius et al., 2017). The medical practitioner needs to involve the patient in the care of the tracheotomy whenever possible. This will be critical in the process of facilitating discharge planning.
Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook e-book: An evidence-based guide to planning care. Elsevier Health Sciences.
Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters Kluwer.
Ignatavicius, D. D., Workman, M. L., & Rebar, C. (2017). Medical-surgical nursing-e-book: Concepts for interprofessional collaborative care. Elsevier Health Sciences.