Chapter 26

Question 1

Cite the origin of most head and neck cancers.

Answer 1

Most head and neck cancers arise from squamous cells that line the mucosal surfaces of the head and neck

Question 2

Review the risk factors for developing head and neck cancer. (11)

Answer 2

*Tobacco
*alcohol
*>50 yo
*male
*HPV
sun exposure
*asbestos
*industrial carcinogens
*Marijuana use
*radiation therapy
*poor oral hygiene

Question 3

Describe common manifestations of head and neck cancer and how they may vary due to specific location (8)

Answer 3

*lump in the throat
*sore throat
*white or red patches in mouth
*change in voice quality
*ear pain
*ear ringing
*neck swelling
*trouble swallowing, chewing, moving tongue or jaw, breathing

Question 4

List the late signs of heads and neck cancer. (5)

Answer 4

Unintentional weight loss, difficulty with chewing, swallowing, moving tongue or jaw, or breathing, airway obstruction (partial or full).

Question 5

Name 2 instruments used to examine upper airways.

Answer 5

Pharyngoscopy
Laryngoscopy (which involves using a laryngeal mirror)

Question 6

Cite other diagnostic methods used to determine the extent of the disease. (3)

Answer 6

CT and MRI may be done to detect local and regional spread.
PET scan is used in diagnosis.

Question 7

Cite which classification system of cancer is used for head and neck cancers.

Answer 7

TMN (Tumor, Mets, Nodes)

Question 8

vocal cord stripping

Three

Answer 8

• Removal of outer layers of tissue on the vocal cords.
• used for a biopsy or to treat some stage 0 cancers confined to the vocal cords.
• Vocal cord stripping rarely affects speech.

Question 9

cordectomy

one what and three pts on how it effects voice

Answer 9

• Removal of part or all of the vocal cords.
• may be changes in tone of voice.
• Removing part of the vocal cord may lead to a hoarse voice.
• If both vocal cords are removed, speech will no longer be possible.

Question 10

partial/total laryngectomy

(What and how it effects voice; two pts)

Answer 10

• Removal of part or all of the larynx.
• A total laryngectomy will change airflow in and out of the lungs and normal voice production will not be possible.

Question 11

radical neck dissection

two pts

Answer 11

• removal of all the tissue on the side of the neck from the mandible to the clavicle.
  *includes muscle, nerves, salivary glands, and major blood vessels.

Question 12

modified radical neck dissection

three

Answer 12

• most common type of neck dissection for cancer.
• All lymph nodes are removed.
• Less neck tissue is taken out in the radical dissection.
• May spare nerves in the neck and sometimes the blood vessels or muscles. (less intense, while still getting the job done)

Question 13

selective neck dissection

three

Answer 13

• used if cancer has not spread far
• fewer lymph nodes are removed.
• The muscle, nerve and blood vessels in the neck may be saved.

Question 14

Compare laryngectomy and tracheostomy.

Answer 14

*Trach: done to create an alternate pathway for breathing by creating a stoma in the trachea.
*Lary: removal of part of all the larynx, changing the airflow in and out of the lungs and normal voice production will not be possible (not reversible vs reversible?)

Question 15

Cite one advantage of using radiation therapy for early head and neck cancers.

Answer 15

Offers good results with voice preservation

Question 16

Describe the potential of nutritional deficiencies related to head and neck cancer and its treatments.

Answer 16

*Difficulties may be due to surgery (unable to consume nutrients orally bc of swelling, location of sutures, or difficulty with swallowing), s/e of radiation and chemo, painful oral mucositis,
*Tx: prophylactic placement of gastrostomy tube in high-risk pts, enteral nutrition, elevate HOB white pt eats, observe for intolerance and adjust amount, time, and/or formula if n/v, diarrhea, or distention occurs. Offer antiemetics and analgesics before meal, offer bland foods, avoid water, thin fluids.

Question 17

Discuss 3 major approaches to restore oral communication after laryngectomy.

Answer 17

Electrolarynx, tracheoesophageal puncture (TEP) voice restoration, esophageal speech.

Question 18

Review subjective and objective assessment data needed when completing a nursing assessment on a person with head and neck cancer.

Answer 18

*Ones from the notes cuz there’s a ton in the book
*Subjective: important health info (prolonged tobacco use), functional health patterns (mouth ulcer that doesn’t heal)
*Objective: respiratory (hoarseness), gastrointestinal (ulceration of mucosa)

Question 19

Describe 6 overall goals of care when caring for a person with head and neck cancer.

Answer 19

*A patent airway
*An acceptable body image
*No complications related to therapy
*Adequate nutritional intake
*Minimal to no pain
*ability to communication

Question 20

Briefly describe interventions needed for a person who just endured surgery due to head and neck cancer.

(12 listed, name 6)

Answer 20

• Airway management,
• VS,
• bleeding,
• wound/drain care,
• skin flaps,
• NGT,
• nutrition,
• communication,
• psychosocial issues,
• pain control,
• trach care and suction,
• fluids and hydration

Question 21

Describe the side effects of radiation therapy in persons with head and neck cancer.

6

Answer 21

1. Dry mouth (xerostomia),
2. irritation,
3. ulceration
4. pain,
5. reddened and sensitive skin over the irradiated area,
6. fatigue

Question 22

Discuss the expected outcomes for the person who has undergone surgery due to head and neck cancer. (4)

Answer 22

*Have effective coughing and secretion clearance
*Swallowing without aspiration
*Use effective coping strategies
*Communicate effectively with others: written and nonverbal