Nursing 211

N211: Health Differences Across the Lifespan I

©2012 of 148 Nursing Interventions Include maintaining a patent airway, pain management. Provide adequate hydration and nutrition. Provide an alternate means of communication such as a word or picture board, paper and pencil and plan for permanent means of communication. Monitor respiratory and oxygenation status. Provide supplemental oxygen as needed. Medicate with opioid analgesics. Refer client for speech rehabilitation with artificial larynx. Teach client tracheostomy care which involves cleaning the inner cannula, suctioning and applying a clean dressing. A laryngectomy tube has a larger lumen and is shorter than a tracheostomy tube. Observe client for any signs of bleeding or occlusion, which are the greatest post-operative risks. Fear of choking is a very real for laryngectomy clients. They cannot cough as they could earlier because the glottis is gone. Teach the glottal stop technique to remove secretions (take a deep breath, momentarily occlude tracheostomy tube, cough and simultaneously remove the finger from the tube. The natural humidifying pathway is gone for client, it is imperative to humidify the air entering the lungs to help secretions to be thin. 3.28 Chemotherapy Antimetabolites stop cell protein synthesis for DNA. Side effects are increased myelosuppression, thrombocytopenia, stomatitis and diarrhea. Drugs are 5-FU, Xeloda, Luestatin, Hydrea, FUDR, ara-C and Folex. Nursing Interventions are to monitor CBC, WBC, uric acid, platelets and renal function. Instruct patient to wear sunscreen daily. When taking 5-FU assess cerebellar dysfuntion; with methotrexate encourage client to take folic acid to prevent toxicity. Give “leucovorin rescue” if client becomes toxic. 5-fluorouracil (5-FU) common side effects are weakness or achy, drying or darkening of the skin or nails; tingling in the hands or feet. Azacitidine (Systemic) side effects are pinpoint red spots on the skin, trouble breathing with exertion and voice changes Alkylating agents affect DNA synthesis/inhibit cell reproduction. Side effects include marked myelosuppression, infertility, alopecia, hemorrhagic cystitis, hepatotoxic, hyperuricemia, low potassium, magnesium and calcium; nephrotoxic. Drugs are Nitrogen mustards (Cytoxan, Leukeran, Ifex and Mustargen), Hexalen, Myleran, Paraplatin and Platinol. Nursing Interventions Achieve Page 120

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