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Head & Neck Cancer
Terms in this set (11)
The client has experienced neck trauma from a car crash. The airway is patent and the client is hemodynamically stable. For what associated injury should the nurse be particularly alert?
A. Hepatic laceration and hematoma
B. Unilateral hemothorax
C. Cervical spinal injury
D. Crushed pelvis
Cervical spinal injuries often occur at the same time as a neck injury. Anyone experiencing a neck injury should be handled as if a cervical spinal injury were also present until proven otherwise
Which clinical manifestation in a client who smokes two packs of cigarettes per day should be explored further for head and neck cancer?
A. Unplanned weight gain of 15 pounds
B. Decreased sense of taste
C. Difficulty swallowing
D. Persistent bad breath
One of the many common clinical manifestations of head and neck cancer is difficulty swallowing, or the sensation of a "lump" in the throat.
Which conditions or factors in a 64-year-old man diagnosed with head and neck cancer are most likely to have contributed to this health problem?
A. He quit school at age 16 and has worked in a butcher shop for over 40 years.
B. He uses chewing tobacco and drinks beer daily.
C. His father also had head and neck cancer.
D. His hobby is oil painting.
Many environmental risk factors contribute to the development of head and neck cancer, although the actual cause is unknown. There does not appear to be a genetic predisposition to this type of cancer. The two most important risk factors are tobacco and alcohol use, especially in combination. Other risk factors include chewing tobacco, pipe smoking, marijuana, voice abuse, chronic laryngitis, exposure to industrial chemicals or hardwood dust, and poor oral hygiene
Which statement made by the client undergoing radiation treatment for laryngeal cancer indicates the need for continued discussion regarding the effects of therapy?
A. "I will avoid exposing my skin to sunlight during treatment."
B. "I will purchase a wig so that my appearance will be close to normal."
C. "I will rest my voice and communicate by writing for the next two months."
D. "I will not shave until all the redness and peeling of the skin on my face and neck is gone."
Radiation only affects the tissues directly in the radiation path. Scalp hair loss will not occur as a side effect of radiation therapy for cancer of the larynx
Which intervention should the nurse use to help prevent a carotid artery rupture after radical neck dissection surgery?
A. Applying direct pressure to the carotid artery
B. Keeping the carotid artery and the dressing wet with sterile saline
C. Maintaining the stability of the position of the laryngectomy tube
D. Assessing the adequacy of blood flow with a Doppler every 2 hours
If the exposed carotid artery dries, the arterial walls deteriorate and are more susceptible to rupture. Keeping the dressing and the artery moist reduce the risk for this complication.
A nurse observes shoulder drop postoperatively in a client who had a radical neck dissection for cancer 24 hours ago. What is the nurse's best action?
A. Reposition the client on the nonoperative side.
B. Document the observation as the only action.
C. Assess deep tendon reflexes.
D. Notify the physician.
Cranial nerve XI (spinal accessory nerve) is removed during a radical neck dissection. The resulting shoulder drop is an expected side effect. Physical therapy exercises are essential later in the recovery period, but no specific interventions are required at this postoperative stage.
For which client is esophageal speech communication after laryngectomy contraindicated?
A. The client whose native language is not English
B. The client with a permanent tracheostomy
C. The client with a permanent hearing loss.
D. The client who continues to smoke
Successful use of esophageal speech requires that the client be able to hear the sounds he or she makes when shaping the lips, mouth, and tongue for speech.
What instructions should the nurse give to the client for stoma care at home after a laryngectomy?
A. "Gently wash the stoma with soap and water, then apply a water-based lubricant."
B. "Use cotton-tipped applicators to clean out the stoma lumen at least twice per day."
C. "Use a syringe or Water Pik to irrigate the stoma with a solution of sterile normal saline and peroxide."
D. "Gently scrape crusts away from the stoma opening with a tongue blade and apply petroleum jelly to the external stump."
The stoma is now the direct entrance to the pulmonary system. Fluids or oil-based substances should not be introduced into the lumen. Only the external stoma is cleaned.
What health promotion activity should the nurse stress to the client who has xerostomia as a result of radiation therapy for head and neck cancer?
A. Carrying a medical alert card
B. Increasing carbohydrate and fat intake
C. Having a dental examination twice per year
D. Using only water-soluble lubricants on the irradiated skin
Xerostomia is dry mouth. It is common after radiation therapy in which the salivary glands are in the radiation path. The radiation damages these glands and permanently reduces their function. The client makes much less saliva. Some of the functions of saliva are to maintain a specific pH of the mouth and protect against infection by the action of salivary enzymes and immunoglobulins. The reduction in the protection provided by saliva changes the bacterial content of the mouth, increasing the risk for oral infections and dental caries (tooth decay).
The client who is scheduled to have a vertical laryngectomy asks a nurse what changes to expect in voice quality after the surgery. What is the nurse's best response?
A. "You will not be able to speak above a whisper."
B. "Your permanent voice will be hoarse and breathy."
C. "The removal of your larynx results in permanent loss of natural speech."
D. "Speech will be absent immediately following surgery but will return to normal when all swelling has resolved, usually within 6 months."
A vertical laryngectomy allows one true cord, one false cord, and most of the tracheal rings to remain. Speech remains but voice quality is permanently changed because there will not be full cord adduction. The result is a hoarse voice that has a "breathy" sound.
The client preparing to go home after a radical neck dissection for cancer is crying. When the nurse asks why he is crying, the client writes, "I know I shouldn't cry because this surgery may well save my life, but I can't believe how changed my appearance is." What is the nurse's best response?
A. "It is all right to cry. Mourning this loss is important in getting past this point."
B. "You're right. It is silly to carry on like this when the surgery may cure you."
C. "Would you like to talk to someone who also has had a laryngectomy?"
D. "How have you coped with difficult situations in the past?"
Often, cancer surgery involves loss of a body part or a decrease in function. Mourning or grieving for a body image alteration is a healthy part of adapting or adjusting to a new image.
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