Inpatient surgical and possibly subacute units.
- Psychosocial aspects of care
- Surgical intervention
- Total nutritional support: parenteral/enteral feeding
- Patient Assessment Database (Preoperative)
- Preoperative data presented here depend on the specific type/location of cancer process and underlying complications.
- May report: Feelings of fear about loss of voice, dying, occurrence/recurrence of cancer
- Concern about how surgery will affect family relationships, ability to work, and finances
- May exhibit: Anxiety, depression, anger, and withdrawal
Difficulty swallowing (dysphagia)
- Difficulty handling oral secretions, chokes easily
- Swelling, ulcerations, masses may be noted depending on location of cancer
- Oral inflammation/drainage, poor dental hygiene
- Leukoplakia, erythroplasia of oral cavity
- Swelling of tongue
- Altered gag reflex and facial paralysis
Neglect of dental hygiene
Need for assistance in basic care
- Diplopia (double vision)
- Tingling, paresthesia of facial muscles
- Hemiparalysis of face (parotid and submandibular involvement), persistent hoarseness or loss of voice (dominant and earliest symptom of intrinsic laryngeal cancer)
- Difficulty swallowing
- Conduction deafness
- Disruption of mucous membranes
- Chronic sore throat, “lump in throat”
- Referred pain to ear, facial pain (late stage, probably metastatic)
- Pain/burning sensation with swallowing (especially with hot liquids or citrus juices), local pain in oropharynx
- (Postoperative) Sore throat or mouth (pain is not usually reported as severe following head and neck surgery, as compared with pain noted before surgery)
- Guarding behaviors
- Facial mask of pain
- Alteration in muscle tone
- History of smoking (including cigars)/chewing tobacco
- Occupation working with hardwood sawdust, toxic chemicals/fumes, heavy metals
- History of voice overuse, e.g., professional singer or auctioneer
- History of chronic lung disease
- Cough with/without sputum
- Bloody nasal drainage
- Blood-tinged sputum, hemoptysis
- Dyspnea (late)
- Excessive sun exposure over a period of years or radiation therapy
- Visual/hearing changes
- Lack of family/support system (may be result of age group or behaviors, e.g., alcoholism)
- Concerns about ability to communicate, engage in social interactions
- Persistent hoarseness, change in voice pitch
- Muffled/garbled speech, reluctance to speak
- Hesitancy/reluctance of significant others to provide care/be involved in rehabilitation
- Nonhealing of oral lesions
- Concurrent use of alcohol/history of alcohol abuse
- Discharge plan
- DRG projected mean length of inpatient stay: 5.0–13.0 days
- Assistance with wound care, treatments, supplies; transportation, shopping; food
- preparation; self-care, homemaker/maintenance tasks
- Refer to section at end of plan for postdischarge considerations.
- Direct/indirect laryngoscopy; laryngeal tomography, biopsy, and needle biopsy: Are the most reliable diagnostic indicators for direct visualization or to detect local or regional spread/staging.
- Laryngography: May be performed with contrast to study blood vessels and lymph nodes.
- Pulmonary function studies, bone scans, or other organ scans: May be indicated if distant metastasis is suspected.
- Chest x-ray: Done to establish baseline lung status and/or identify metastases.
- CBC: May reveal anemia, which is a common problem.
- Immunological surveys: May be done for patients receiving chemotherapy/immunotherapy.
- Biochemical profile: Changes may occur in organ function as a result of cancer, metastasis, and therapies.
- ABGs/pulse oximetry: May be done to establish baseline/monitor status of lungs (ventilation).
- Maintain patent airway, adequate ventilation.
- Assist patient in developing alternative communication methods.
- Restore/maintain skin integrity.
- Reestablish/maintain adequate nutrition.
- Provide emotional support for acceptance of altered body image.
- Provide information about disease process/prognosis and treatment.
- Ventilation/oxygenation adequate for individual needs.
- Communicating effectively.
- Complications prevented/minimized.
- Beginning to cope with change in body image.
- Disease process/prognosis and therapeutic regimen understood.
- Plan in place to meet needs after discharge.