Nursing Care for Patient with Laryngeal Cancer: Case Study

Abstract

The objective of this study is to examine nursing care for the patient with Laryngeal Cancer (CA. Larynx): case study at Eye Ear Throat Nose Unit (EENT) and Surgical Intensive Care Unit (SICU) at Chaiyaphum Hospital from April 19th 2018 to May 22th 2018. The case study is a 65 years old Thai male. The patient was transferred from Chatturat Hospital with the conditions of hoarse voice, dysphagia, and a tumor in his neck. After the examination using Fiberoptic laryngoscopy, the physician found a 4x3 centimeters tumor in his throat. He was diagnosed with Glottic carcinoma, upper airway obstruction. He admitted at EENT Unit on April 19th, 2018 to do an emergency tracheostomy. The patient was given NPO order and 5%D/NSS/2 1,000 vein drip 100 cc./hr, prior to the operation. After that, he was diagnosed with Laryngeal Cancer. On April 23rd 2018, the examination using Direct laryngoscopy and Biopsy procedure, the physician found Laryngeal Cancer, squamous cell carcinoma of thyroid gland. On April 30th 2018, the surgeon performed total Laryngectomy, right selective neck dissection level II-IV, and total thyroidectomy on the patient. During the operation, he had blood loss about 600 C.C., Hct. 28 % and he was given PRC gr. B 210 C.C. vein drip. After the surgery, he was diagnosed with Laryngeal Cancer stage T3N0M0. The patient was transferred to SICU. The patient was on shiley tube no 8 with ventilator support. On May 1st 2018, he was on callar mask 10 LPM, and then, got transferred to EENT unit. Chvostek's test result showed he had positive level 2 and low serum calcium 6.36mg/dl. 

The following issues were found: 1) upper airway obstruction due to a tumor in the throat 2) anemia due to blood loss during the operation 3) hypocalcemia due to total thyroidectomy 4) discomfort due to pain 5) risk of infection after surgery 6) risk of malnutrition after surgery 7) The patient and family are anxious and depressed.  

The nursing care was performed by following the care procedures. On May 22th 2018, he was recovered from the surgery. He was discharged from the hospital. The total length of stay was 33 days. He was referred to Maharat Nakhon Ratchasima Hospital for radiotherapy. After he finished the radiation therapy at Maharat Nakhon Ratchasima Hospital, he was referred back to Chaiyaphum Hospital for the follow-up.