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Nursing management of patients with Cancer of the larynx
Cancer of the larynx
Cancer of the larynx(laryngeal cancer), accounts for approximately half of all head and
neck cancers.
Cancer of the larynx is most common in people older than 65 years and is four times
more common in men.
Almost all malignant tumors of the larynx arise from the surface epithelium and are
classified as squamous cell carcinoma.
The incidence of distant metastasis with squamous cell carcinoma of the head and neck
(including larynx cancer) is relatively low.
Pathophysiology and Etiology
Laryngeal cancer is most common in people 50 to 70 years of age.
Men are affected more frequently than are women.
The cause of laryngeal cancer is unknown. Carcinogens, such as tobacco, alcohol, and
industrial pollutants, are associated with laryngeal cancer.
In addition, chronic laryngitis, habitual overuse of the voice, and heredity may contribute.
Most laryngeal malignancies are squamous cell carcinomas, that is, a malignancy arising
from the epithelial cells lining the larynx.
The tumor may be located on the glottis (true vocal cords), above the glottis (supraglottis
or false vocal cords), or below the glottis (subglottis).
RISK FACTORS
Laryngeal Cancer Carcinogens
1-Tobacco (smoke, smokeless, e-cigarettes, hookahs)
2-Combined effects of alcohol and tobacco
3-Asbestos
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4-Secondhand smoke
5-Paint fumes
6-Wood dust
7-Cement dust and Chemicals
8-Mustard gas
9-Leather and metals
Other Factors
1-Nutritional deficiencies (vitamins)
2-History of alcohol abuse
3-Genetic predisposition
4-Age (higher incidence after 65 years of age)
5-Gender (more common in men)
6-Race (more prevalent in African Americans and Caucasian)
7-Weakened immune system
Signs and Symptoms
1. Un explained changes in the voice, such as sounding hoarse or husky
2. Dyspnea (difficulty breathing).
3. complain of earaches.
4. Dysphagia .
5. unilateral nasal obstruction or discharge .
6. Chronic cough ,Hemoptysis .
7. Weight loss owing to poor nutrition .
8. Halitosis owing to tumor necrosis .
9. Mass in the neck from metastatic lymph node .
10.Laryngeal tenderness owing to tumor necrosis or suppuration.
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11.Fullness of the cricothyroid membrane.
Diagnostic procedures
1. Liver function studies to rule out metastatic disease Imaging.
2. Fine-needle aspiration (FNA) biopsy.
3.Bone scan if bone metastasis suspected .
4.A barium swallow, and Endoscopy.
5. CT (Computed tomography) and MRI scan.
6. positron emission tomography (PET) scan.
7. Laryngoscopy.
Treatment
1. Medication (Drugs)
Narcotics may be necessary for pain control during treatment for mucositis secondary
to radiation therapy.
Nystatin mouth rinses for oral thrush.
2. Chemotherapy and radiation therapy in an effort to avoid the morbidity associated with
total laryngectomy.
Side effects of chemotherapy:
1-sore, red skin (similar in appearance to sunburn).
2-mouth ulcers . 3-sore mouth and throat .
4-dry mouth(xerostomia) . 5-loss of taste .
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6-loss of appetite . 7-tiredness .
8-feeling sick .
3. Surgical options (1-vocal cord stripping. 2-cordectomy, 3-laser surgery, 4-partial
laryngectomy, or total laryngectomy)
4. Tracheotomy may be necessary if tumor is large enough to cause upper airway obstruction
5. Nasogastric or gastrostomy feeding may be necessary if tumor involves esophageal inlet.
Sinusitis
Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. Normally, sinuses are
filled with air, but when sinuses become blocked and filled with fluid, germs (bacteria, viruses,
and fungi) can grow and cause an infection.
Types of sinusitis
1. Acute sinusitis: A sudden onset of cold-like symptoms such as runny, stuffy nose and
facial pain that does not go away after 10 to 14 days. Acute sinusitis typically lasts 4
weeks or less.
2. Subacute sinusitis: An inflammation lasting 4 to 8 weeks.
3. Chronic sinusitis: A condition characterized by sinus inflammation symptoms lasting
8 weeks or longer.
4. Recurrent sinusitis: Several attacks within a year.
Causes
Common cold,
Allergic rhinitis (swelling of the lining of the nose),
Nasal polyps (small growths in the lining of the nose), or
A deviated septum (a shift in the nasal cavity).
In children, common environmental factors that contribute to sinusitis include allergies,
illness from other children at day care or school, pacifiers, bottle drinking while lying on
one's back, and smoke in the environment.
In adults, the contributing factors are most frequently infections and smoking.
Signs and Symptoms of Acute Sinusitis
1. Facial pain/pressure.
2. Nasal stuffiness.
3. Nasal discharge.
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4. Loss of smell.
5. Cough/congestion
Additional symptoms may include:
Fever.
Bad breath.
Fatigue.
Dental pain
Diagnostic Procedures
1. Physical examination.
The exam may include feeling and pressing the sinuses for tenderness.
2. mucus culture.
3. nasal endoscopy.
4. X-rays.
5. allergy testing.
6. CT scan of the sinuses, or blood work.
Treatment
Acute sinusitis.
1. decongestants like Sudafed and steam inhalations alone.
2. If antibiotics are given, they are usually given for 10 to 14 days.
Chronic sinusitis.
a. Warm moist air may alleviate sinus congestion.
b. A vaporizer or inhaling steam from a pan of boiling water (removed from heat)
may also help.
c. Warm compresses are useful to relieve pain in the nose and sinuses.
d. Saline nose drops are also safe for home use.
e. Antibiotics or oral steroids may also be prescribed.
Complications of sinus infection include:
1-infection of the eye and its surrounding tissue
2-sinus cavity blood clot (thrombosis)
3-meningitis
4-brain abscess
5-bone infection
Nursing Diagnosis and Interventions for Sinusitis
Acute Pain: head, throat, sinus related to inflammation of the nose
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Interventions:
1. Assess client's level of pain
2. Explain the causes and effects of pain on the client and family
3.Teach relaxation techniques and distractions
4. Observation of vital signs and client complaints.
Anxiety related to lack of client knowledge about diseases and medical procedures
Interventions:
1. Assess client's level of anxiety
2. Show empathy (it comes with a touch client)
3. Give an explanation to clients about the illness slowly, quietly and use of clear sentences,
short easy to understand
4. Get rid of excessive stimulation such as:
Place the room quieter client
Limit contact with others / other clients are likely to experience anxiety
• Ineffective Airway Clearance related to the obstruction (nasal secret buildup) secondary to
inflammation of the sinuses
Interventions:
1. Assess the existing build-secret
2. Observation of vital signs
3. Collaboration with the medical team for cleaning discharge
