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R.T. 76 y.o.- M - Full Code - Coggle Diagram
R.T.
76 y.o.- M - Full Code
Subglottic squamous cell carcinoma
Tobacco use: 70 pack/year
Trach placed 2 years ago
Laryngectomy, total w/ modified radial neck dissection and reconstruction using pectoralis myocutaneous flap (10/19/20)
Surgeon states, appeared to be well around the tumor, w/ possible anterior laryngeal-thyroid cartilage invasion
Risk for further cancer and needed treatment
Increased mortality
Intervention: assist pt and family w/ coping and provide psychosocial support
High risk stoma relapse
Voice box removed
Speech and communication impaired
Intervention: encourage pt to continue meeting w/ SLP; provide resources to pt regarding speech
NPO for 2-3 weeks
PEG tube placed
at risk for impaired nutrition
Ca++ low
Intervention: encourage pt to meet with dietary
Tube feeding required: barrier to D/C
PT and OT recommending pt to d/c home with TF
MD needs to approve
Intervention: talk w/ provider about plans for d/c
Longer hospitalization
At risk for DVT
OOB x2 on 10/21
SCDs in place
H&H low, likely r/t blood loss
Monitor for s/s of internal bleeding: mental status change, rigid abdomen, decreased bp, increased RR, nausea and vomiting, blood in stool
WBC high
Monitor for s/s of infection/sepsis
S/S: mental changes, increased RR, increased HR
Likely d/t inflammation
Continue to monitor
BUN/creatinine elevated
May be r/t to dehydration
Ensure water is being infused into PEG; continue to monitor
Monitor for s/s: fatigue, low urine output, skin color changes, dry skin, low bp
Pain
Acetaminophen given
Aspiration risk
Suction when coughing and producing sputum
X3 10/21
Pathophysiology: Squamous cell are thin, flat cells. Squamous cell carcinoma is a malignant tumor of epidermal keratinocytes that invades the dermis. The subglottis is the lower part of the larynx between the vocal cords and the trachea (windpipe).
Essential Hypertension
amlodipine
do not give if SBP is <100
Impaired perfusion
Increased likelihood of DVT
Monitor respiratory status and cardiac function
Encourage patient to get OOB and to work w/ PT & OT
Hyperlipidemia
atorvastatin administered
COPD
Tobacco use: 70 pack/year
Quit Smoking 1994
Asbestos exposure
Diminished breath sounds, Crackles in LLQ
Monitor for respiratory distress
35% O2 w/ humidification delivered via tracheostomy
Albuterol-ipratropium - Nebulizer treatment
RT administered treatement
GERD
Potential to irritate stoma
Admin lansoprazole
Hypothyroidism
Altered energy and metabolism
Admin Levothyroxine