Comprehensive Respiratory System Disorders Q 8

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When caring for a male patient who has just had a total laryngectomy, the nurse should plan to:

  

     A. Encourage oral feeding as soon as possible.

     B. Develop an alternative communication method.

     C. Keep the tracheostomy cuff fully inflated.

     D. Keep the patient flat in bed.

    

    

Correct Answer: B. Develop an alternative communication method.

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A patient with a laryngectomy cannot speak, yet still needs to communicate. Therefore, the nurse should plan to develop an alternative communication method. Assess the effectiveness of nonverbal communication methods. The client may use hand signals, facial expressions, and changes in body posture to communicate with others. However, others may have difficulty in interpreting these nonverbal techniques. Each new method needs to be assessed for effectiveness and altered as necessary.

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Option A: After a laryngectomy, edema interferes with the ability to swallow and necessitates tube (enteral) feedings. Typically most patients wait a minimum of 7 days following total laryngectomy before oral feeding is started. 84% of 141 American surgeons reported that they waited until after the seventh postoperative day in a questionnaire survey by Boyce and Meyers in 1989. However, periods of up to three weeks were reported. The choice often depends on the surgeon’s experience and preference and on the patient’s comorbidities and tumor characteristics.

Option C: To prevent injury to the tracheal mucosa, the nurse should deflate the tracheostomy cuff or use the minimal leak technique. Cuff should be deflated if the patient uses a speaking valve. Cuff should be inflated just enough to allow minimal air leak.

Option D: To decrease edema, the nurse should place the patient in semi-Fowler’s position. Early complications after total laryngectomy include bleeding, postoperative edema, and airway compromise. These, especially in the immediate postoperative, should be carefully monitored. Administration of corticosteroids is recommended to minimize postoperative edema and airway compromise.

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