# A nurse is caring for a client who underwent a total laryngectomy 3 days ago for laryngeal cancer. Which nursing intervention is the priority for this client?

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## 문제

A nurse is caring for a client who underwent a total laryngectomy 3 days ago for laryngeal cancer. Which nursing intervention is the priority for this client?

## 보기

1. Establish an effective communication method with the client **✔ 정답**
2. Monitor the tracheostomy site for signs of infection
3. Encourage deep breathing and coughing exercises
4. Assess the client's pain level using a numeric scale

**정답: 1**

## 해설

Establishing effective communication is the priority to address the client's immediate psychosocial needs and anxiety, enabling assessment of other care areas. Other interventions (monitoring, breathing exercises, pain assessment) are important but require communication first.

## 심화 해설

Understanding the Priority: Airway and Communication After Total Laryngectomy

For a client who is 3 days post-operative from a total laryngectomy, the priority nursing intervention is to establish an effective communication method. While all listed interventions are important components of post-operative care, the unique anatomical and psychological impact of this specific surgery makes communication the most immediate safety and psychosocial need.

Pathophysiology and the Communication Barrier

A total laryngectomy involves the complete removal of the larynx, which permanently separates the upper airway (pharynx) from the lower airway (trachea). The client now breathes exclusively through a permanent tracheostomy stoma and can no longer produce laryngeal speech. This creates a sudden and complete loss of voice, which is a terrifying experience. In the immediate post-operative period, the inability to verbalize needs, especially regarding pain, suctioning requirements, or feelings of breathlessness, represents a critical safety risk. The client’s primary means of summoning help or expressing a physiological crisis has been eliminated. Establishing a reliable alternative communication system, such as a call bell, writing pad, or picture board, is essential to ensure the client can always alert the nurse to urgent needs, making it the foundational priority upon which other care aspects depend [1,3].

Psychosocial Impact and Fear of Recurrence

Beyond physical safety, the psychological trauma of voicelessness is profound. Research indicates that patients undergoing total laryngectomy experience a significant fear of cancer recurrence (FCR), which is closely linked to their functional losses. A randomized controlled trial found that structured communication models, including patient-to-patient interaction, can effectively reduce this fear and improve swallowing-related quality of life (SWAL-QOL) [3]. By prioritizing communication immediately, the nurse does more than just facilitate requests; they validate the client’s personhood and provide a crucial outlet for emotional distress. A client who cannot communicate is at high risk for anxiety, hopelessness, and an inability to participate in their own recovery, which can directly impede physical healing and rehabilitation [3,4].

Why Other Options Are Not the Priority

While monitoring the surgical site for infection (Option 2), encouraging pulmonary hygiene (Option 3), and assessing pain (Option 4) are all vital, they are secondary to the ability to communicate. A client with a developing infection or increased secretions needs a way to report the initial symptoms of discomfort or congestion. Similarly, a client in pain requires a reliable method to convey its severity and quality, which is a prerequisite for effective pain assessment using a numeric scale. The functional outcomes after laryngeal surgery, particularly the loss of voice, are reported by patients as the main limitation of procedures that alter the larynx, underscoring that voice loss is the most devastating functional deficit from the patient’s perspective [2,4]. Therefore, addressing this loss through an immediate communication strategy is the nurse's first and most impactful action.References (research sources)

- [3]The effect of structured patient-to-patient communication on fear of cancer recurrence in total laryngectomy patients: A randomized controlled trial.RCT/clinical trialLiu Y, Li W, He C, Xu L, Teng Y, Zhang L, Zhao Y, Zhang J, Tian L, Yin M. (2026) · DOI: 10.1016/j.anl.2026.01.006

## 임상 시나리오

Post-Laryngectomy Communication PriorityEnsuring Safety Through Alternative Communication
Following a total laryngectomy, the client has a permanent tracheostomy stoma and a complete loss of voice. The top priority is establishing a reliable communication method because the inability to verbalize pain, dyspnea, or other urgent needs is a critical safety risk.

Immediately post-op, provide a call bell with a pressure-sensitive adapter if needed, along with a writing pad, picture board, or communication app. Ensure the client can always summon help before addressing other needs.

CautionDo not encourage deep breathing and coughing exercises after a total laryngectomy. The airway is permanently separated from the mouth and nose, and forceful coughing can disrupt the fresh suture line and increase the risk of a pharyngocutaneous fistula.

## 핵심 개념

- **Total Laryngectomy** — Surgical removal of the entire larynx, resulting in permanent separation of the trachea from the pharynx and a permanent tracheostomy for breathing.
- **Tracheostomy Stoma** — The permanent surgical opening in the neck that connects the trachea directly to the outside air, serving as the sole airway after a total laryngectomy.
- **Alaryngeal Communication** — Methods of speaking without a larynx, including esophageal speech, electrolarynx devices, or tracheoesophageal puncture (TEP), typically introduced later in recovery.

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