Physiological Adaptation Q 193
The nurse is caring for the client following a laryngectomy when suddenly the client becomes unresponsive and pale, with a BP of 90/40 systolic. The initial nurse’s action should be to:
A. Place the client in Trendelenburg position
B. Increase the infusion of Dextrose in normal saline
C. Administer atropine intravenously
D. Move the emergency cart to the bedside
Correct Answer: B. Increase the infusion of Dextrose in normal saline
Dextrose in normal saline is indicated as a source of water, electrolytes, and calories. Early complications after total laryngectomy are bleeding, postoperative edema, and airway compromise, these, especially in the immediate postoperative, should be carefully monitored.
Option A: In clients who have not had surgery to the face or neck, however, in this situation, this could further interfere with the airway. Increasing the infusion and placing the client in supine position would be better.
Option C: Administration of atropine IV is not necessary at this time and could cause hyponatremia and further hypotension. Administration of corticosteroids is recommended to minimize postoperative edema and airway compromise, hematoma or seroma, that should be prompt surgically evacuated, wound infection related to the perioperative exposure of the wound to bacteria, it could be minimized using a broad-spectrum antibiotic coverage and pharyngocutaneous fistula; total laryngectomy patients are at risk for pharyngeal suture line dehiscence with a resultant pharyngocutaneous fistula.
Option D: Moving the emergency cart at the bedside is not necessary at this time. The primary goal for the treatment of laryngeal cancer is the control of the disease. Preservation of speech, swallowing functions, and avoidance of the tracheostomy are secondary goals. Traditionally the treatment of laryngeal carcinomas has been radiotherapy or surgery or a combination of both.