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Clinical Pathway For Laryngectomy Patients Rev 3-3-14
Clinical Pathway For Laryngectomy Patients Rev 3-3-14
Time
Teaching points
Pre-Op
Post Op
day 0
Revised: 4/9/15
Incision cares:
Per MD orders, usually clean and apply
ointment to avoid crusting
Stoma cares:
Reinforce importance of patent stoma
Suctioning, saline bullets (as needed
for thick mucous), spraying with
water/saline
Often increased suctioning needs
immediately post-operatively
Make sure to explain what you are
RN
MD
Teaching points
supplies)
Enter comprehensive, clear post-op orders (Post Op
Laryngectomy Order Set to be created) including post op
nausea and pain management
Order appropriate consults: nutrition, speech pathology,
physical therapy
F/u on routine post op labs and CXR
Ensure position of feeding tube as necessary
Post op check and note
Post Op
day 1
Revised: 4/9/15
RN
JP drain output and function - assure patency and
appropriate functioning
Ensure patient is utilizing tracheal mask for humidified air
Ensure stoma is clean and patent
Assess neck for fullness, edema, erythema (signs of
hematoma and/or fistula)
Ensure adequate pain control
Incentive Spirometry or Cough and deep breath 10x/hr
while awake
MD
Assess for active bowel sounds and consider starting tube
feeds slowly
Teaching points
Post Op
day 2
Revised: 4/9/15
SLP
Introduce HME (Heat Moisture Exchange) device
Establish functional means of communication
Reinforce importance of patent stoma
Engage caregiver in education process
Explain and demonstrate stoma cares
Send test script through to insurance to verify which DME
company is covered by insurance
MD
Ambulate at least TID or per PT recommendations
Assess patients tolerance of tube feedings and adjust
accordingly
Assess: neck, stoma, drains, bowel sounds, suctioning
needs, pain control
Foley removal order or document acceptable indication
RN
Encourage patient to participate in own wound and stoma
cares
Encourage patient and family to ask questions if they have
them
Progressive activity:
o Patient should be ambulating by POD #2, advanced
Teaching points
Post Op
day 3 -5
RN
Revised: 4/9/15
Teaching points
Discharge
Day
Swallowing
2-4 weeks
post-op
Revised: 4/9/15
TEP Neophonation
Teaching points
Lymphedema
Revised: 4/9/15
voice training
Monitor for lymphedema and refer to physician as needed.