After being discharged from the hospital after laryngeal cancer surgery, what issues should be paid attention to in daily care?

Author: Liu Yongling, deputy chief nurse, Beijing Tongren Hospital, Capital Medical University

Reviewer: Wang Lixiang, Chief Physician, Third Medical Center, PLA General Hospital

The 10th Chairman of the Science Popularization Branch of the Chinese Medical Association

As the saying goes, 30% treatment and 70% care. For laryngeal cancer patients, daily care is also very important after they are discharged from the hospital after surgery.

Let’s talk about related issues today.

1. What issues should family members pay attention to after laryngeal cancer patients undergo laryngectomy?

Both psychological and physical issues require attention.

Psychologically, it mainly depends on the degree of acceptance of the patient. Especially in the early stage, after suffering from laryngeal cancer, the patient will be nervous and afraid, but there will still be a certain fluke mentality, because after the operation, the final pathological results will be seen. But once the larynx is cut off, the patient will have a process of re-acceptance. Many patients will be depressed or irritable in terms of psychological manifestations.

Psychological problems require joint efforts from medical staff and family members to encourage patients so that they have the confidence to overcome the disease and accept follow-up treatment.

Physiologically, patients will have swallowing and pronunciation disorders, and may have to wear a tracheal tube for life. Some patients may also develop olfactory disorders. These are some of the difficulties that patients may face in the future.

Figure 1 Original copyright image, no permission to reprint

Because of the swallowing problem, the patient will experience changes in the eating process and dietary structure in the early stages, but the body's compensatory ability is also very strong. With functional training and gradual adaptation to food, the patient will recover well.

After discharge, patients need to adapt to tracheotomy as soon as possible, that is, to wear a tube. In addition, from the perspective of wound observation, early attention should be paid to wound healing and airway management. Only after the wound has healed in the first stage can the patient receive subsequent treatment smoothly.

The care of the tracheal tube mainly includes the cleaning, disinfection, dressing change, etc. of the tracheal tube, as well as the safety guidance of the tracheal tube, etc. These all require targeted guidance from medical staff so that family members can do it well.

2. How can laryngeal cancer patients keep their airways open after being discharged from the hospital after surgery?

Airway patency is the most important safety issue for patients after they return home. From the perspective of overall care, the most important issue is to prevent airway obstruction, and the main cause of airway obstruction is sputum crust. There are several ways to prevent sputum crust from blocking the airway:

First, the home environment should be suitable, such as the indoor relative humidity should be around 60%, and the room temperature should not be too high, such as 18-22℃. The key point is that when there is heating in winter, the temperature is often higher and the air evaporates faster, which is still easy to form sputum scabs.

Second, normal saline can be sprayed into the airway to keep it moist. In addition, a small wet gauze can be placed on the tracheostomy opening.

Third, more exercise can also promote the discharge of phlegm. For example, normal walking and daily home activities are fine. It is not recommended for patients to lie in bed every day. Long-term bed rest is not conducive to the discharge of phlegm. After the exercise, the lungs and airways are vibrated, which is very effective in promoting the discharge of phlegm.

Fourth, suction sputum in time. Normal adults use a No. 12 suction tube. Generally, you can buy a disposable adult suction tube. Be careful to avoid repeated use to avoid infection and pneumonia symptoms such as coughing. Now, suction emphasizes suctioning at any time to keep the patient's airway open at all times. Most people still use suction inside the tracheal tube, and the suction time is required to be within 15 seconds, which means that the suction time inside the tube cannot be too long to avoid hypoxia in the patient.

Fifth, the auxiliary treatment of nebulizer. The nebulizer inhaler can directly provide airway humidification, soften sputum, and promote the discharge of sputum, which can effectively keep the airway open.

Overall, if the patient follows the instructions, there should be no blockage by sputum scab.

3. After laryngeal cancer patients are discharged from the hospital after surgery, what safety issues should be paid attention to in family care?

First, prevent airway obstruction, which is the biggest safety issue. Usually, airway humidification and other methods can be used to keep the airway open.

Second, to prevent wound infection, each dressing change must be strictly performed. Some patients may not change the dressing after returning home, or simply wipe it with some saline, which is not in line with the requirements.

Third, patients who have undergone total laryngectomy should be careful not to get water in their necks when bathing because of the stoma in their necks. When washing your hair, you should lie on your back to avoid getting water in your hair.

Because there is a fistula opening on the neck, which is not very beautiful, it is recommended that patients buy a small laryngeal mask and tie it there. In addition, some patients will wear a small square scarf, which is not only beautiful, but also can prevent small dust, small leaves, and small sand particles from entering the neck when going out, such as when it is windy. It can also isolate some bacteria and has a local protection effect when coughing.

Figure 2 Original copyright image, no permission to reprint

Here is a reminder that laryngeal cancer patients should pay attention to personal protection and also protect others. In public places, especially when coughing, we can use a small mask or a tissue to protect ourselves from coughing secretions onto other people.

Fourth, elderly patients should be given different attention than other patients because they may be weaker, so they should avoid crowded places and try to avoid going out when the air environment is bad to reduce the occurrence of pneumonia.

It is also recommended that if the elderly are illiterate and cannot speak in the early stages, you can bring a family contact card with you when you go out so that your family can be contacted directly in case of special circumstances.

If the elderly have a change in sense of smell after surgery, it is recommended that they have family members accompany them in their daily lives, especially when they cook with gas alone, they must be careful.