nurse's notes

EARLY SYMPTOMS:

• hoarseness of voice

LATER SYMPTOMS:

• pain
• obstructed respiration
• difficulty of swallowing
• bleeding and swelling from tumor growth

CAUSES:

• excessive smoking
• too much drinking of alcohol
• vocal straining
• chronic laryngitis

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NURSING MEASURES FOR PREOPERATIVE CARE:

• psychological preparation (try to alleviate worries; explain that he will lose natural voice completely but assure that there are ways in which he can carry on a normal conversation; tell that there are speech rehabilitation centers for speech therapy)
• get the operation consent from the patient or direct relatives
• oral care plus whole bath should be done
• shave the beard or excess hair near the neck down to the nipple lines
• carry out pre-operative medications

POST OPERATIVE CARE

TRACHEOSTOMY TUBE

• close attention for first 24 hours
• alleviate apprehension of the patient
• provide humidification (heavily saturated mist from a tent or ultrasonic fog or inhalation of nebulized water solution or mucolytic agents)
• secretion should be wiped away carefully and quickly before aspirated by the patient
• watch out for any hemorrhage from the tracheostomy site
• proper aspiration of secretion by sterile rubber

NASO-ESOPHAGEAL CATHETER

• intravenous fluids regulated correctly
• oral feeding start as ordered
• speaking deferred until doctor ordered
• observe for any excessive coughing and hemoptysis
• communication can be translated through writing
• naso-esophangeal can be removed by nurse if the doctor ordered
• teach patient how to feed himself with feeding tube
• oral care must be observed after feeding
• oral feeding starts after the wound is healed