Laryngeal pt with trach..

nursing management:
airway
edema
Body image
teaching drain/trach care
Drain care:
JP drain
Hemovac
Pen Rose ..tube that hangs out o wound
Jac!son Pratt..sel suctioning drain..with pump..."press pump# cap to create suction..$
Laryngeal cancer is usually a primary cancer..has high incidence o
spreading..metastasis to liver# brain# !idney etc
Lymph nodes..i spread ..chemo and radiation will be done
%hemo drug combos..mi&ed regimen to reduce to&ic eect o drugs and to target
dierent cycles o the cell
cisplatin# do&ycetil
can have 'L(P with laryngeal cancer# breast cancer
'L(P...perfussion is main concern... temp) should be warm otherwise there is no
blood low# color)pin!# ... "can use dopler to chec! blood low..artery pulse will be
stronger than venous$..doppler needs to remain near bedside with pts that have
'L(P*..tell patient to report discomort# numbness etc# monitor or e&cess blood
Breast 'L(P can be done with abdominal muscle "+R(, 'L(P p.-./0$ ...now you also
have abdominal surgical wound to also monitor in addition to 'L(P site
'L(P muscle can also be ta!en rom the butt
%isplatin"used or lung cancer$ ) causes bone marrow supression# pancycytopenia# wbc
*upraglottic *wallow ) learning how to swallow.. give patient chart or pamphlet to
learn the steps necessary
JP drain..to re-establish suctioning after emptying ..you have to first SQUEEZE.....
then re-cap
self care to prevent aspiration: sit up before eating or drining !p."#$%
&ultiple &yeloma - 'harge nurse taling (ith staff about patient e)periencing
bone destructtion..(hat (ould be in plan of care to treat: *ypercalcemia !because
of bone breado(n%
Patient (ith lung cancer that has undergone several rounds of chemo..refuses
further treatment: listen carefully and encourge e)perssion of thoughts and
feeling ..
pt (ith stage + &etastatic lung cancer ..pt states im going to die..(hat do you
say,: it must be difficult feeling lie there is no hope!therapeutic communication%
-ischarge teaching for a pt (ho has undergone stem cell transplant.... cant have
live virus vaccines..
.urse has completed trach care for pt (hose tube has nondisposable inner
canula..(hat is priority,... obstruction from secretions.... trach care: sterile
techni/ue- clean gloves to remove gau0e1 tae off gloves1 don sterile gloves1 ......
ho( far do(n (ith suction catheter,..as deep as u can until u feel resistance1 go
do(n (ith no suction...intermittent suction t(irling (hile coming out !23 SE'S% ...
hypero)ygenate before and after suction...eep hand holding catheter sterile
reusable trach: clean in half strength pero)ide and then in saline ...tap dry..don4t
shae
trach ties: some are velcro..if not velcro mae a tight not on both sides!cut for
removal if necessary% if not velcro may need 5 people
Pt (ith leuemia undergoing induction therapy - could be surgery or blast of
chemo ...then consolidation stage: continuing stage!to get cells that cant be seen%
can be (orst-high doses of chemo....then maintenence stage:can go months1
years depending on type of cancer!E6. 78&96:;E. ;9< =<E8S7 '8.'E< ;9< "
>E8<S%