1
MDC 3 Exam 2 Focused Review Guide
Read your required materials and PowerPoints from Modules.
READ YOUR REQUIRED CHAPTERS, INCLUDING THE BOXES AND CHARTS IN
THE CHAPTERS, AND PPT’S. LISTEN TO LIVE SESSIONS AND TAKE NOTES!!
1. Priority Questions
2. Neck Cancer - assessment, interventions, and education related to treatment
a. Starts on page 548 in book
b. Assessment
i. Leukoplakia - patchy lesions in mouth
ii. Erythroplakia - red velvety lesions in mouth
iii. 2 most important risk factors include alcohol and tobacco use
iv. History
1. Difficulty speaking, SOB, tumor bulk, tobacco/alcohol use, acute
or chronic laryngitis/pharyngitis, oral sores, difficulty swallowing,
lumps in neck, exposure to HPV
v. Lab assessment
1. CBC, bleeding time, urinalysis, blood chemistries, HPV test
vi. Scans
1. SPECT
2. CT PET
3. Panendoscopy - examination of the upper aerodigestive tract
(pharynx, larynx, upper trachea and oesophagus)
c. Interventions
i. Priority is to remove or eradicate the cancer while preserving function
ii. Monitor gas exchange by assessing resp rate, breath sounds, pulse ox, and
arterial blood gas values
1. Airway obstruction can occur from tumor growth, edema, or both
iii. Teach pt to use the fowler’s or semi fowler's position for best gas
exchange
iv.
d. Education related to treatment
i. Radiation therapy
1. After radiation therapy, pt might experience hoarseness, dysphagia,
skin problems, impaired taste, dry mouth, sore throat, difficulty
swallowing
2. Voice hoarseness usually improves 4-6 weeks after completion of
radiation therapy
, 2
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
a. Instruct pt to avoid exposure to sun, heat, cold, and
abrasive actions such as shaving
b. Wear protective clothing made of soft cotton and wash area
gently with a mild soap such as Dove
c. 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
a. If this happens, educate on increased need for oral care to
reduce risk of caries, bad breath, and oral infections
b. Heavy fluid intake and humidifiers can help, artificial
saliva or saliva stimulant may help
ii. Concurrent radiation therapy with chemotherapy
1. Intensifies discomfort of radiation alone
2. Educate not to take breaks as this will affect treatment outcome
iii. Biotherapy with epidermal growth factor receptor inhibitors
1. Severe skin reactions are common
3. Peritonsillar abscess – treatment (pg 611)
a. Rare complication of acute tonsillitis
b. Infection spreads from tonsils to surrounding tissue and forms an abscess
c. Most common cause is beta-hemolytic step
d. Treatment
i. Most pts can be treated as outpatients with antibiotics but antibiotics alone
are often ineffective
ii. Pt may need steroids to reduce swelling
iii. Pt may need drainage of abscess
iv. Pain control is important
1. Drugs may include topical analgesics, opioids
v. Pt may need liquid drugs due to inability to swallow
vi. Tonsillectomy may be performed
e. Stress adherence of treatment
f. Stress coming to the ER if signs of obstruction (drooling and stridor) appear
4. Laryngectomy - pre and post-operative care
a. Voice conservation procedures are only used if they do not risk incomplete
removal of the tumor (pg 550)
b. Entire larynx, hyoid bone, strap muscles, one or two tracheal rings removed
, 3
c. Partial laryngectomy - some voice may be left, tracheostomy is temporary
d. Full laryngectomy - no natural voice is left, upper airway is separated from the
throat and esophagus and a permanent laryngectomy stoma is created in the neck
e. Pre-op care (pg 551)
i. Teach patient and family about tumor
ii. Surgeon explains procedure and informed consent
iii. Discuss and interpret implications of consent
iv. 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
1. Phrase questions in a yes/no format for those who cannot speak
f. Post-op care
i. Monitor Airway patency, Vital Signs, hemodynamic status, and comfort
level. Monitor for Hemorrhage and other General complications of
anesthesia and surgery. Take Vital Signs hourly for the first 24 hours and
then according to agency policy.
ii. complications after surgery include Airway obstruction, Hemorrhage,
wound breakdown, tumor recurrence
iii. The first priorities after head and neck surgery are airway management
and gas exchange.
1. Patients may require ventilator assistance.
a. Most are easily weaned from ventilator using a
tracheostomy collar and humidified oxygen to help move
mucus secretions
b. Secretions may remainted blood tinged for 1 to 2 days after
c. Report any increased bleed to surgeon
d. Laryngectomy tube is used for patients who have
undergone a total laryngectomy. These can be changed
daily if needed
iv. Other priorities include wound, flap, and reconstructive tissue care; pain
management; nutrition; psychological adjustment including speech and
language therapy
v. Surgeon may place a closed surgical drain in neck to collect blood and
drainage
vi. Coughing and deep breathing is usually effective in clearing/moving
mucus
vii. Suction away from the surgical site
viii. Perform suture care every 1-2 hours
MDC 3 Exam 2 Focused Review Guide
Read your required materials and PowerPoints from Modules.
READ YOUR REQUIRED CHAPTERS, INCLUDING THE BOXES AND CHARTS IN
THE CHAPTERS, AND PPT’S. LISTEN TO LIVE SESSIONS AND TAKE NOTES!!
1. Priority Questions
2. Neck Cancer - assessment, interventions, and education related to treatment
a. Starts on page 548 in book
b. Assessment
i. Leukoplakia - patchy lesions in mouth
ii. Erythroplakia - red velvety lesions in mouth
iii. 2 most important risk factors include alcohol and tobacco use
iv. History
1. Difficulty speaking, SOB, tumor bulk, tobacco/alcohol use, acute
or chronic laryngitis/pharyngitis, oral sores, difficulty swallowing,
lumps in neck, exposure to HPV
v. Lab assessment
1. CBC, bleeding time, urinalysis, blood chemistries, HPV test
vi. Scans
1. SPECT
2. CT PET
3. Panendoscopy - examination of the upper aerodigestive tract
(pharynx, larynx, upper trachea and oesophagus)
c. Interventions
i. Priority is to remove or eradicate the cancer while preserving function
ii. Monitor gas exchange by assessing resp rate, breath sounds, pulse ox, and
arterial blood gas values
1. Airway obstruction can occur from tumor growth, edema, or both
iii. Teach pt to use the fowler’s or semi fowler's position for best gas
exchange
iv.
d. Education related to treatment
i. Radiation therapy
1. After radiation therapy, pt might experience hoarseness, dysphagia,
skin problems, impaired taste, dry mouth, sore throat, difficulty
swallowing
2. Voice hoarseness usually improves 4-6 weeks after completion of
radiation therapy
, 2
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
a. Instruct pt to avoid exposure to sun, heat, cold, and
abrasive actions such as shaving
b. Wear protective clothing made of soft cotton and wash area
gently with a mild soap such as Dove
c. 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
a. If this happens, educate on increased need for oral care to
reduce risk of caries, bad breath, and oral infections
b. Heavy fluid intake and humidifiers can help, artificial
saliva or saliva stimulant may help
ii. Concurrent radiation therapy with chemotherapy
1. Intensifies discomfort of radiation alone
2. Educate not to take breaks as this will affect treatment outcome
iii. Biotherapy with epidermal growth factor receptor inhibitors
1. Severe skin reactions are common
3. Peritonsillar abscess – treatment (pg 611)
a. Rare complication of acute tonsillitis
b. Infection spreads from tonsils to surrounding tissue and forms an abscess
c. Most common cause is beta-hemolytic step
d. Treatment
i. Most pts can be treated as outpatients with antibiotics but antibiotics alone
are often ineffective
ii. Pt may need steroids to reduce swelling
iii. Pt may need drainage of abscess
iv. Pain control is important
1. Drugs may include topical analgesics, opioids
v. Pt may need liquid drugs due to inability to swallow
vi. Tonsillectomy may be performed
e. Stress adherence of treatment
f. Stress coming to the ER if signs of obstruction (drooling and stridor) appear
4. Laryngectomy - pre and post-operative care
a. Voice conservation procedures are only used if they do not risk incomplete
removal of the tumor (pg 550)
b. Entire larynx, hyoid bone, strap muscles, one or two tracheal rings removed
, 3
c. Partial laryngectomy - some voice may be left, tracheostomy is temporary
d. Full laryngectomy - no natural voice is left, upper airway is separated from the
throat and esophagus and a permanent laryngectomy stoma is created in the neck
e. Pre-op care (pg 551)
i. Teach patient and family about tumor
ii. Surgeon explains procedure and informed consent
iii. Discuss and interpret implications of consent
iv. 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
1. Phrase questions in a yes/no format for those who cannot speak
f. Post-op care
i. Monitor Airway patency, Vital Signs, hemodynamic status, and comfort
level. Monitor for Hemorrhage and other General complications of
anesthesia and surgery. Take Vital Signs hourly for the first 24 hours and
then according to agency policy.
ii. complications after surgery include Airway obstruction, Hemorrhage,
wound breakdown, tumor recurrence
iii. The first priorities after head and neck surgery are airway management
and gas exchange.
1. Patients may require ventilator assistance.
a. Most are easily weaned from ventilator using a
tracheostomy collar and humidified oxygen to help move
mucus secretions
b. Secretions may remainted blood tinged for 1 to 2 days after
c. Report any increased bleed to surgeon
d. Laryngectomy tube is used for patients who have
undergone a total laryngectomy. These can be changed
daily if needed
iv. Other priorities include wound, flap, and reconstructive tissue care; pain
management; nutrition; psychological adjustment including speech and
language therapy
v. Surgeon may place a closed surgical drain in neck to collect blood and
drainage
vi. Coughing and deep breathing is usually effective in clearing/moving
mucus
vii. Suction away from the surgical site
viii. Perform suture care every 1-2 hours
