Which is the priority in the immediate postoperative period for a laryngectomy?

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You had a procedure called laryngectomy. This is surgery to remove your voice box (larynx). The larynx is located in the throat. It connects the upper part of the airway (mouth and throat) with the lower part of the airway (trachea). Here's what you need to know about home care after surgery.

Incision and stoma care

• Check your incision site daily for 1 week after discharge. Change the dressing according to the directions you were given.

• Bathe in shallow water. If any water enters your stoma, it will make you cough.

• Use a waterproof bib to cover your stoma when you shower.

• Don’t swim.

• Learn to care for your stoma. This includes cleaning and suctioning.

• Wear a stoma cover to keep moisture from being lost when you breathe.

• Use a cool-mist humidifier by your bedside. Be sure to clean the humidifier regularly.

Activity

• Plan frequent rest periods to avoid shortness of breath.

• Don’t drive until you are off your pain medicine and free of pain. This may take 2 to 4 weeks.

• Do deep breathing and controlled coughing exercises. Ask your healthcare provider for instructions.

Break the smoking habit

• Enroll in a stop-smoking program to increase your chances of success.

• Ask your doctor about medicines or other methods to help you quit.

• Ask family members to quit smoking as well.

• Don’t allow smoking in your home or around you.

Other home care

• Wear a medical alert pendant or bracelet to alert others to your condition. It should say “Neck Breather—Resuscitate Through Stoma.”

• Use pain medicine as needed.

• Don't go back to an oral diet until your doctor says it's OK. When you do start an oral diet, pay careful attention to your neck and wound. If you have any saliva or drainage from the wound, or if you have increased neck pain or redness of the neck or wound, stop the oral diet right away and contact your doctor. These may be signs of a possible fistula or breakdown in the wound healing process. This can happen as long as 3 or 4 weeks after the operation.

• Plan a diet that helps you avoid choking. You may get tube feedings and progress to soft foods and liquids as your swallowing reflex returns.

• Keep a pad of paper and a pen close at hand to communicate with others.

• Develop a plan for learning to speak again. Ask your doctor about the options available to you.

• Keep in mind that your sense of smell will be severely affected by the operation. This is because you will be breathing through your neck. Because of this, you may be at increased risk for things like food poisoning. Consider labeling all the foods in your refrigerator with expiration dates, since you may not be able to smell spoilage. Also double check your smoke alarms to be sure they are working since you may not be able to smell smoke in the event of a fire.

Follow-up care

• Make a follow-up appointment as directed by our staff.

• Arrange to see a speech pathologist.

• Ask about reconstructive surgery, if needed.

• Talk with your provider if you feel depressed or anxious. This is a difficult surgery, and many people have serious emotional issues after it.  Ask your provider for a referral to a counselor who has experience in this area. Also ask for a list of support groups.

  Which nursing action is the highest priority when caring for a patient with laryngeal trauma?

  Management of patients with laryngeal injuries consists of assessing the airway and monitoring vital signs (including respiratory status and pulse oximetry) every 15 to 30 minutes. Maintaining a patent airway is a priority.

  What should I expect after a laryngectomy?

  If you have had some or all of your larynx removed (laryngectomy), it's likely that you'll need to spend 1 or 2 days in an intensive care unit until you have recovered. You will not be able to eat until your throat has healed, which for most people takes at least 1 or 2 weeks.

  What are the complications seen after total laryngectomy?

  Wound infection and pharyngocutaneous fistula are most common complications after total laryngectomy. 3. Preoperative radiotherapy and low postoperative haemoglobin level (less than 11 gm/dl) are important risk factors for development of pharyngocutaneous fistula in total laryngectomy patients.

  Which instructions should the nurse give to a client who is being discharged with a laryngectomy?

  Incision and stoma care.

  Check your incision site daily for 1 week after discharge. ... .

  Bathe in shallow water. ... .

  Use a waterproof bib to cover your stoma when you shower..

  Don't swim..

  Learn to care for your stoma. ... .

  Wear a stoma cover to keep moisture from being lost when you breathe..

  Use a cool-mist humidifier by your bedside..