# A nurse is caring for a client who underwent a total laryngectomy 3 days ago for laryngeal cancer. Which nursing intervention is most appropriate to promote effective communication? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540742 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a client who underwent a total laryngectomy 3 days ago for laryngeal cancer. Which nursing intervention is most appropriate to promote effective communication? ## 보기 1. Encourage the client to whisper softly to preserve remaining vocal function 2. Provide a magic slate or writing materials for all communication needs 3. Teach the client to use an electrolarynx device and provide practice time **✔ 정답** 4. Suggest that family members interpret the client's lip movements **정답: 3** ## 해설 Teaching the client to use an electrolarynx device promotes independence and effective communication while supporting psychological adjustment to the loss of natural speech. Other options are less effective or inappropriate for immediate communication needs. ## 심화 해설 Understanding the Postoperative Context A total laryngectomy involves the complete removal of the larynx, which permanently separates the trachea from the esophagus. After this surgery, the client breathes through a permanent tracheostoma in the neck and no longer has a connection between the lungs and the mouth. This means the client cannot speak, whisper, or produce any vocal sound because there is no airflow through the vocal cords—they have been surgically removed. In the immediate postoperative period, specifically around 3 days post-surgery, the client is facing significant anatomical and physiological changes that directly impact communication. As noted in the provided research, this period is marked by limited options for speech rehabilitation, leading to communication difficulties and patient frustration [1]. Analysis of the Options Evaluating each option against this physiological reality reveals why some interventions are inappropriate or less effective. - Option 1: Encourage the client to whisper softly. This is physiologically impossible. Whispering still requires air to pass through the glottis to create sound. After a total laryngectomy, there is no glottis, and the airway is permanently diverted to the neck. Encouraging this would be futile and could increase the client's frustration. - Option 2: Provide a magic slate or writing materials for all communication needs. While writing is a valid communication method, relying on it as the sole primary intervention is limiting. It is often slow, cumbersome, and does not allow for hands-free communication. The research highlights a novel mobile app (SRAVI) that uses lip-reading, indicating that more advanced and efficient methods are being actively explored to improve communication beyond simple writing [1]. - Option 4: Suggest that family members interpret the client's lip movements. This places an unrealistic and stressful burden on the family. Without structured training, lip-reading is highly inaccurate and leads to frequent misunderstandings, which can heighten the client's sense of isolation and frustration. This is not a reliable or therapeutic communication strategy. Why an Electrolarynx is the Most Appropriate Intervention Teaching the client to use an electrolarynx is the most appropriate intervention because it directly addresses the physiological deficit and provides a reliable, independent method of verbal communication. An electrolarynx is a battery-operated device placed against the neck or under the chin. It generates a mechanical sound vibration that is transmitted through the tissues of the neck into the oral cavity. The client then articulates this sound into words using their mouth, tongue, and lips—structures that remain intact. This allows for the immediate production of understandable speech, which is crucial for reducing postoperative frustration and enabling the client to actively participate in their care. The study on the SRAVI app supports the critical need for effective communication tools in the immediate post-laryngectomy period, and an electrolarynx serves this exact purpose by restoring a form of audible speech [1]. This intervention empowers the client, promotes safety by allowing them to call for help or express needs clearly, and is a standard, evidence-based first step in alaryngeal speech rehabilitation.References (research sources) - [1]Utility of a Novel Mobile Lip-Reading Application for Patients After Total Laryngectomy.Research articleFassler CA, Krishnapura SG, Sharbel D, Rosenthal E, Netterville J, Mannion K, Langerman A, Sinard R, Rohde S, Topf MC. (2026) · DOI: 10.1002/ohn.70098 ## 임상 시나리오 Post-Laryngectomy CommunicationInitiating Verbal Communication with an Electrolarynx A total laryngectomy permanently separates the airway from the mouth, making natural speech or whispering impossible. The most effective early verbal communication method is the electrolarynx. Introduce the device as soon as the client is medically stable, typically within the first postoperative week. Teach the client to place the device firmly on the neck or under the chin to find the best vibration point for clear sound. Instruct the client to articulate words normally with their mouth while activating the device. This produces a mechanical-sounding but functional voice, reducing frustration and promoting independence. CautionDo not encourage whispering or using a writing board as the sole communication method. These approaches ignore the physiological reality or delay the restoration of verbal communication, increasing patient distress. ## 핵심 개념 - **Total Laryngectomy** — Surgical removal of the entire larynx, permanently separating the trachea from the esophagus and resulting in a permanent tracheostoma with loss of natural voice. - **Electrolarynx** — A battery-operated device placed against the neck that produces vibrations transmitted to the oral cavity, allowing the user to articulate words without vocal cords. - **Tracheostoma** — A permanent surgical opening in the neck that connects the trachea directly to the outside environment for breathing after a total laryngectomy. - **Speech Rehabilitation** — The process of helping a laryngectomy patient regain verbal communication through methods like electrolarynx, esophageal speech, or tracheoesophageal puncture (TEP). ## 같은 주제 문제 - [A nurse is assessing a 58-year-old male client who has been diagnosed with laryngeal cance…](https://mymerci.kr/pages/nclex_q.php?qn_id=540740) - [A nurse is assessing a 58-year-old male client who has been diagnosed with laryngeal cance…](https://mymerci.kr/pages/nclex_q.php?qn_id=540741) - [A nurse is caring for a client who underwent a total laryngectomy 48 hours ago for larynge…](https://mymerci.kr/pages/nclex_q.php?qn_id=540743) - [A nurse is caring for a client who underwent a total laryngectomy 3 days ago for laryngeal…](https://mymerci.kr/pages/nclex_q.php?qn_id=540744) - [A nurse is caring for a client who underwent a total laryngectomy 1 week ago for laryngeal…](https://mymerci.kr/pages/nclex_q.php?qn_id=540745) - [A nurse is caring for a client who underwent a total laryngectomy 2 days ago. 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