EN MDC 3 FINAL EXAM 2 STUDY GUIDE QUESTIONS AND ANSWERS (VERIFIED ANSWERS) Neck Cancer - assessment ANSWER IS - Leukoplakia - patchy lesions in mouth Erythroplakia - red velvety lesions in mouth 2 most important risk factors include alcohol and tobacco use Neck Cancer Hist ory ANSWER IS - Difficulty speaking, SOB, tumor bulk, tobacco/alcohol use, acute or chronic laryngitis/pharyngitis, oral sores, difficulty swallowing, lumps in neck, exposure to HPV Neck Cancer Lab assessment ANSWER IS - CBC, bleeding time, urinal ysis, blood chemistries, HPV test Neck Cancer scans ANSWER IS - SPECT CT PET Panendoscopy - examination of the upper aerodigestive tract (pharynx, larynx, upper trachea and oesophagus) EN Neck Cancer Interventions ANSWER IS - 1) Priority is to remove or eradicate the cancer while preserving function 2) Monitor gas exchange by assessing resp rate, breath sounds, pulse ox, and ABG values -Airway obstruction can occur from tumor growth, edema, or both 3) Teach pt to use the fowle r's or semi fowler's position for best gas exchange Neck Cancer education r/t treatment radiation therapy ANSWER IS - 1) After radiation therapy, pt might experience hoarseness, dysphagia, skin problems, impaired taste, dry mouth, sore throat, difficu lty swallowing 2) Voice hoarseness usually improves 4 -6 weeks after completion of radiation therapy 3) For those with sore throat and difficulty swallowing, gargling with saline or sucking on ice may decrease discomfort. Throat sprays with local anesthetic agents such as lidocaine or diphenhydramine may prove temporary relief 4) Skin may become red and tender and may peel during therapy -Instruct pt to avoid exposure to sun, heat, cold, and abrasive actions such as shaving -Wear protective clothing made of soft cotton and wash area gently with a mild soap such as Dove -Use prescribed skin care products 5) If salivary glands are in the path of radiation, the mouth may become dry (xerostomia). This is usually long -term and may be permanent -If this happens, ed ucate on increased need for oral care to reduce risk of caries, bad breath, and oral infections -Heavy fluid intake and humidifiers can help, artificial saliva or saliva stimulant may help1 Neck Cancer education r/t treatment Concurrent radiation therapy with chemotherapy EN ANSWER IS - Intensifies discomfort of radiation alone Educate not to take breaks as this will affect treatment outcome Neck Cancer education r/t treatment Biotherapy with epidermal growth factor receptor inhibitors ANSWER IS - Severe skin reactions are common Peritonsillar abscess ANSWER IS - Rare complication of acute tonsillitis Infection spreads from tonsils to surrounding tissue and forms an abscess Most common cause is beta -hemolytic step Peritonsillar abscess - treat ment ANSWER IS - -Most pts can be treated as outpatients with antibiotics but antibiotics alone are often ineffective -Pt may need steroids to reduce swelling -Pt may need drainage of abscess -Pain control is important Drugs may include topical analges ics, opioids -Pt may need liquid drugs due to inability to swallow -Tonsillectomy may be performed *Stress adherence of treatment *Stress coming to the ER if signs of obstruction (drooling and stridor) appear Laryngectomy EN ANSWER IS - Voice conservatio n procedures are only used if they do not risk incomplete removal of the tumor Entire larynx, hyoid bone, strap muscles, one or two tracheal rings removed Partial laryngectomy ANSWER IS - some voice may be left, tracheostomy is temporary Full laryngectomy ANSWER IS - no natural voice is left, upper airway is separated from the throat and esophagus and a permanent laryngectomy stoma is created in the neck Laryngectomy pre op care ANSWER IS - -Teach patient and family about tumor -Surgeon explains procedure and informed consent -Discuss and interpret implications of consent -Explain about self -management of the airway, suctioning, pain control methods, the critical care environment (including ventilators and critical care routines), nutritional support, feeding tubes, and plans for discharge. -Patient will need to learn new method of speech during the time that mechanical ventilation is used, and depending on surgery type possibly forever *Phrase questions in a yes/no format for tho se who cannot speak Laryngectomy post op care