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NSG 331 Final Exam Test Plan
Questions evenly distributed between modules.
Dosage: 2 questions
Review the case studies done by classmates before the final exam
Topics
Disorders
Head and neck cancer
Head and Neck Cancer
• Incidence:
o 2-3% of all malignancies
o Men>women
o May involve
• Nasal cavity
• Para-nasal sinuses
• Nasopharynx
• Oropharynx
• Larynx
• Oral cavity
• Salivary glands
o Most people have advance disease at time of diagnosis
• Risk Factors:
o Cigarette smoking (85% of cancers)
o Alcohol
o Occupational exposure to asbestos, wood dust, mustard gas, petroleum products
o Chronic laryngitis
o Voice abuse
o Genetics
o HPV infection
o Poor oral hygiene
• Manifestations
o Early – vary with location of the tumor
• Oral cavity – white (leukoplakia)/red (erythroplakia) patch in mouth, ulcer that
does not heal, change in the fit of dentures
• Lump in throat, change in quality of voice
• Laryngeal - Hoarseness that lasts for more than 2 weeks
• Sore throat (unilateral), otalgia (ear pain), swelling or lumps in the neck
• Interprofessional Care
o Diagnostic Assessment
• Hx & Physical exam
• Indirect pharyngoscopy and laryngoscopy
• Endoscopy
• Biopsy
• Chest x-ray
• Barium swallow
• CT / MRI / PET scan
o Management
• Surgery
• Vocal cord stripping – removal of outer layer of tissue on vocal cords
, 2
(early stage) – does not change speech
• Laser surgery – inserted to vaporize / remove tumor
, 3
• Cordectomy – part/all vocal cords are removed (changes speech –
hoarse voice(partial); loss of voice (full removal))
• Partial or total laryngectomy – removal (full or partial) of larynx
• Pharyngectomy – part/all of throat is removed
• Lymph node removal with neck dissection
• Tracheostomy – stoma / alternate pathway
• Reconstructive procedures
• Radiation therapy
• Chemotherapy
• Targeted therapy
• Physical therapy
• Occupational therapy
• Speech therapy
Laryngectomy
Laryngeal Cancer
• Manifestations
o Hoarseness
o Pain in throat
o Dysphagia
o Neck masses
• Diagnosis
o Visual exam of larynx
o Biopsy
o CT/MRI
o Chest x-ray
o Barium swallow study
• Treatment
o Early: partial laryngectomy, chemo,radiation, temp. trach., soft voice
o Advanced cancers: total laryngectomy, radical neck, permanent trach. Stoma. No
voice, unable to smell, decr. taste
, 4
Nursing management for laryngectomy
• Watch for complications:
o Airway obstruction
o Hemorrhage – monitor VS
o Carotid artery rupture
o Fistula formation
• Elevate HOB – decreases edema and reduces pressure on esophagus
o NO FLAT BEDS
• Flex neck forward
• Trach/stoma care
• Wound assessment/care
• NG feedings – d/t location of surgery and complications of chemo and radiation
Nursing diagnosis for laryngectomy
o Risk for Aspiration
o Ineffective Airway Clearance
o Risk for Impaired Gas Exchange
o Impaired Nutrition: Less than Body Requirements
o Risk for Infection
Artificial Larynx
• Discharge teaching
o Stoma care
o Self tube feedings
o Fluids
o Humidification
o Suction prn
o No swimming
o Shower with guard
o Carry ID
o Cover stoma when outside
o Continue speech therapy
o No smoking
NSG 331 Final Exam Test Plan
Questions evenly distributed between modules.
Dosage: 2 questions
Review the case studies done by classmates before the final exam
Topics
Disorders
Head and neck cancer
Head and Neck Cancer
• Incidence:
o 2-3% of all malignancies
o Men>women
o May involve
• Nasal cavity
• Para-nasal sinuses
• Nasopharynx
• Oropharynx
• Larynx
• Oral cavity
• Salivary glands
o Most people have advance disease at time of diagnosis
• Risk Factors:
o Cigarette smoking (85% of cancers)
o Alcohol
o Occupational exposure to asbestos, wood dust, mustard gas, petroleum products
o Chronic laryngitis
o Voice abuse
o Genetics
o HPV infection
o Poor oral hygiene
• Manifestations
o Early – vary with location of the tumor
• Oral cavity – white (leukoplakia)/red (erythroplakia) patch in mouth, ulcer that
does not heal, change in the fit of dentures
• Lump in throat, change in quality of voice
• Laryngeal - Hoarseness that lasts for more than 2 weeks
• Sore throat (unilateral), otalgia (ear pain), swelling or lumps in the neck
• Interprofessional Care
o Diagnostic Assessment
• Hx & Physical exam
• Indirect pharyngoscopy and laryngoscopy
• Endoscopy
• Biopsy
• Chest x-ray
• Barium swallow
• CT / MRI / PET scan
o Management
• Surgery
• Vocal cord stripping – removal of outer layer of tissue on vocal cords
, 2
(early stage) – does not change speech
• Laser surgery – inserted to vaporize / remove tumor
, 3
• Cordectomy – part/all vocal cords are removed (changes speech –
hoarse voice(partial); loss of voice (full removal))
• Partial or total laryngectomy – removal (full or partial) of larynx
• Pharyngectomy – part/all of throat is removed
• Lymph node removal with neck dissection
• Tracheostomy – stoma / alternate pathway
• Reconstructive procedures
• Radiation therapy
• Chemotherapy
• Targeted therapy
• Physical therapy
• Occupational therapy
• Speech therapy
Laryngectomy
Laryngeal Cancer
• Manifestations
o Hoarseness
o Pain in throat
o Dysphagia
o Neck masses
• Diagnosis
o Visual exam of larynx
o Biopsy
o CT/MRI
o Chest x-ray
o Barium swallow study
• Treatment
o Early: partial laryngectomy, chemo,radiation, temp. trach., soft voice
o Advanced cancers: total laryngectomy, radical neck, permanent trach. Stoma. No
voice, unable to smell, decr. taste
, 4
Nursing management for laryngectomy
• Watch for complications:
o Airway obstruction
o Hemorrhage – monitor VS
o Carotid artery rupture
o Fistula formation
• Elevate HOB – decreases edema and reduces pressure on esophagus
o NO FLAT BEDS
• Flex neck forward
• Trach/stoma care
• Wound assessment/care
• NG feedings – d/t location of surgery and complications of chemo and radiation
Nursing diagnosis for laryngectomy
o Risk for Aspiration
o Ineffective Airway Clearance
o Risk for Impaired Gas Exchange
o Impaired Nutrition: Less than Body Requirements
o Risk for Infection
Artificial Larynx
• Discharge teaching
o Stoma care
o Self tube feedings
o Fluids
o Humidification
o Suction prn
o No swimming
o Shower with guard
o Carry ID
o Cover stoma when outside
o Continue speech therapy
o No smoking
