MDC3 Exam 2 Key Concept Guide

Exam 2 Key Concept Guide Neck cancer a) The cancer begins as a loss of CELLULAR REGULATION when the mucosa is chronically irritated and becomes tougher and thicker (squamous metaplasia) b) Head and neck cancers can affect breathing, eating, facial appearance and speech. c) They are usually squamous cell carcinomas and are slow-growing tumors that are generally curable when diagnosed and treated early on. d) These lesions may then be seen as white, patchy lesions (leukoplakia) or red, velvety patches (erythroplakia) e) They typically metastasize to the lymph nodes, muscle and bone. f) Hoarseness, lump in neck or mouth sores g) *suspicious *Causes include; tobacco, alcohol, voice abuse, chronic laryngitis, exposure to chemicals, poor hygiene, long-term GERD and oral infections with human papillomavirus. h) Pt may have foul breath, weakened immune system, white patch and jaw pain. i) Diagnosed by a physical examination, x-ray with barium swallow or a panorex x-ray. j) Nursing- impaired gas exchange from tumor or edema, nutrition deficit and aspiration risk. a. The first priorities after head and neck surgery are airway maintenance and GAS EXCHANGE. b. Immediately following surgery the patient will likely need ventilator assistance and a tracheostomy collar following vent weaning. (coughing and deep breathing to clear secretions), alternative ways to communicate and nutrition are of importance. Radiation therapy a) Most patients have hoarseness, dysphagia, skin problems, impaired taste, and dry mouth for a few weeks after radiation therapy. a. Hoarseness may become worse during therapy. i. Reassure the patient that voice improves within 4 to 6 weeks after completion of radiation therapy. b) Urge him or her to use voice rest and alternative means of communication until the effects of radiation therapy have passed. c) Collaborate with the speech and language pathologist to help the patient communicate. d) Most patients have a sore throat and difficulty swallowing during radiation therapy to the neck. a. Gargling with saline or sucking ice may decrease discomfort. b. Mouthwashes and throat sprays containing a local anesthetic agent such as lidocaine or diphenhydramine can provide temporary relief. c. Analgesic drugs may be prescribed. e) Skin irritation may occur and avoiding sun exposure and use mild soap such as dove. f) Mouth may become dry (xerostomia) usually long term and may become permanent. a. dental caries, increased risk for oral infections, bad breath, and taste changes. Fluoride treatments, increasing fluid intake, and humidification and artificial saliva sprays are interventions. Extra information �- aspiration can not occur following surgery after a total laryngectomy because the airway is completely separated from the esophagus. multidimensional nursing strategies a) Semi-fowlers/high-fowlers to promote adequate gas exchange, alternative communication methods, speech therapy, language pathology, respiratory therapy, nutrition emphasis (likely a feeding tube is placed while healing from surgery) sinus cancer a) the onset of sinus cancer is slow and symptoms resemble those of sinusitis. Including persistent nasal obstruction, drainage, blood discharge, and pain that persists after treatment of sinusitis. b) Lymph node enlargement can occur on the side with the mass. c) MAintain a patent airway, monitoring for hemorrhage, providing wound care, assessing nutrition status and performing a tracheostomy if needed. Assess the patient for pain and infection Nasal fracture a) interfere with gas exchange. b) If there is no displacement of bone or cartilage, treatment may not be needed. c) Displacement can cause airway obstruction, cosmetic deformity and is a potential for infection. d) Blood or clear fluid rarely drains from the nose following a simple nasal fracture a. it is an indication of a serious injury (skull fracture). b. Closed reduction is performed using local or general anesthesia within the first 24 hours and that involves moving the bones by palpation. After 24 hours this is difficult because of edema and scar formation. e) Simple fractures do not require surgery. Pain relief and cold compresses to decrease swelling. Post-rhinoplasty care a) reduction and surgery may be needed for fractures that don’t heal properly or severe ones. b) Rhinoplasty is reconstruction of the nose.