A nurse for a patient subjected to total laryngectomy should plan for?

Daman & Diu Staff Nurse - 2018

Medical & Surgical Nursing

Medium

Appeared in: Daman & Diu Staff Nurse - 2018

Explanation

A total laryngectomy involves the complete removal of the larynx, including the vocal cords, leading to a permanent inability to produce voice (aphonia).
Establishing a method for communication is the highest priority to ensure patient safety, reduce anxiety, and allow the patient to express their needs.
Immediate post-operative communication relies on non-verbal methods like writing boards, picture charts, or hand gestures.
Long-term options, planned with a speech therapist, include an electrolarynx, esophageal speech, or a tracheoesophageal puncture (TEP).

Option A: In a total laryngectomy, the airway and esophagus are completely separated. Therefore, a cuff is not needed to prevent aspiration of oral secretions. Keeping a cuff inflated can cause tracheal irritation, necrosis, and stenosis.
Option B: Patients are kept NPO (nothing by mouth) for approximately 7-10 days after a total laryngectomy to allow the pharyngeal suture line to heal without contamination or stress. Nutrition is provided via enteral feeding tubes.
Option D: The supine (flat on back) position is contraindicated. It can increase edema (swelling) at the surgical site, compromise lymphatic drainage, and make breathing more difficult.

Clinical Relevance

Nursing practice connection: Use the key finding related to Post-operative nursing care planning for a patient undergoing total laryngectomy to guide bedside assessment, documentation, and the next nursing action.
The loss of voice is a profound psychosocial event. The nurse's role in facilitating communication is critical for the patient's emotional well-being and active participation in their care.
Patient and family education is paramount. The nurse must teach stoma care, safety precautions (e.g., preventing water from entering the stoma during bathing), and emergency resuscitation (which requires mouth-to-stoma breathing).
What if? If the patient had a partial laryngectomy instead of a total one, the priorities would shift. Voice might be preserved (though hoarse), and the primary concern would be managing a high risk of aspiration, as the airway and esophagus would still be connected.

How to Approach the Question

First, identify the core procedure mentioned in the question: 'total laryngectomy'.
Recall the primary and most significant consequence of this specific surgery. The removal of the 'larynx' (voice box) means the permanent loss of voice.
Evaluate each option based on this primary consequence. An 'alternative communication method' directly addresses the loss of voice.
Analyze the other options based on the pathophysiology of a total laryngectomy. Remember that the airway and esophagus are separated.
Eliminate the incorrect options: Cuff inflation is unnecessary for aspiration and harmful. Oral feeds are withheld initially. Supine position is contraindicated.
Conclude that planning for communication is the most critical and immediate nursing action.

Concept Tested & Keywords

Concept Tested: Post-operative nursing care planning for a patient undergoing total laryngectomy.
Stem keywords: total laryngectomy, nurse, plan for
Lead-in keywords: should plan for