Ca of the tonsils

rileygrl11, BSN, RN · Feb 21, 2003

Meg:

We had a patient on our floor who was just DC'd this week to an ECF after receiving chemo/radiation during the last 7 weeks. Obviously, MUCH psych issues to deal with. This 44 yo male went from crying to denial to absolute hatred towards his caregivers but all understandable. This part alone will require much patience and understanding on your part.

Due to the radiation, this pt's neck became quite red, leading to the appearance of raw blisters. By the time he left his skin had started to heal somewhat and become scaly. His physical appearance caused him much emotional despair and he began to limit his visitors. At times he would walk around the hall with his neck exposed. Other times he would ask for dressings so he could cover it up out of embarrassement. Read up on proper care of skin that is getting radiation treatments.

Then the difficulty swallowing and talking is another set of symptoms for your pt to deal with. I would suggest explaining to him upfront what he can expect to go through (emotional and physically). You will most likely become his lifeline during this tramatic life experience.

renerian, BSN, RN · Feb 23, 2003

Yes much body image things to consider when dealing with head and neck cancers.

renerian

BadBird, BSN, RN · Feb 23, 2003

My Dad had radiation to his neck, it fried his salivary glands, unable to swallow was devestating to him, he could not eat, lost tons of weight, had to have a dobhoff inserted with feedings at home. The dry mouth drove him nuts and he never felt good after that. The radiation therapy was twice a day for 3 weeks, he did not tolerate it well, made him have nausea and vomited constantly. The chemo was actually easier but the outcome was not good, he died less than a year after starting treatment. I really think that the treatment was worse than the disease in his case. I hope your patient does better.

renerian, BSN, RN · Feb 24, 2003

Badbird I agree with you 100%.

renerian

caroladybelle, BSN, RN · Feb 24, 2003

Cancer of the Tonsils is unusual and has a very poor prognosis, much like gallbladder ca (ironic, isn't it). The treatments also are frequently unpleasant, as are with head and neck ca.

Most care is palliative, rather than curative and can /should be altered for excess side effects. Comfort is generally the primary goal.

das · Feb 26, 2003

We have recently tried a new product called Gelclair by Cell Pathways that has worked really well for our head and neck rad pts. No numbing so it does not impair swallowing.

megsquirrel · Feb 26, 2003

Thank you all for your words of wisdom, I really appreciate it. I'm saving them in a file on my computer.

On my day off last week, my agency was told this man no longer needed home care, and he was discharged. He'll be followed by a case manager at his insurance company. He's such a sweetie that he called the agency to tell them to be sure and thank me for all I did for him. (Not that I had a chance to do much, but it's nice to be appreciated!)

Meg

ozzie sue · Mar 9, 2003

Originally posted by renerian
Badbird I agree with you 100%.

renerian

I must also agree with you all. Radiation to this regions has many complications associated with it. Most of which have been discussed. I say make your client well aware of all the risks and outcomes he may expect so that he can make an informed choice. Radiation can reduce QOL issues quite dramatically. :)

ozzie sue · Mar 9, 2003

Originally posted by renerian
Badbird I agree with you 100%.

renerian

ozzie sue: I must also agree with you all. Radiation to this regions has many complications associated with it. Most of which have been discussed. I say make your client well aware of all the risks and outcomes he may expect so that he can make an informed choice. Radiation can reduce QOL issues quite dramatically. :)