Preoperative Laryngectomy Consultation

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Counseling for the Laryngectomee
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Counseling for the Laryngectomee

• Who is an appropriate Counselor?
• Definition A person who counsels
  an advisor
• Various team members qualify

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5 SLP Attributes to deal w/ the psychological
well being of the Laryngectomee family

1. Respect Consideration for patient
2. Appreciation/Acceptance of the responsibilities
   to the patient
3. Commitment to understanding the individual needs
4. Need to encourage to ensure pt. compliance with
   treatment
5. Acceptance of self feelings willingness to
   express these feelings

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5 Counseling SkillsGilmore -97

1. Allow pt. to express, acknowledge clarify
   feelings concerns
2. Ascertain pts. knowledge, feelings attitudes
   re changes and problems.
3. Promote pt. problem solving
4. Access, provide evaluate needed info
5. Access provide support for pt and spouse/family

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5 Stages of Grief
Both pt and spouse will experience

1. Denial and isolation
2. Anger
3. Bargaining
4. Depression
5. Acceptance

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Preoperative Laryngectomy Consultation
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Pre-op Laryngectomy Consultation

• Who should be present?
• What do you do if they are not present?

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Pre-op Laryngectomy Consultation

• The SLP may be the first person who the patient
  is listening to when explaining the surgery etc.
• When pt. is first told by MD, they often just
  hear CANCER and do not listen or comprehend the
  information re specifics because they are still
  dealing with the term CANCER

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Pre-op Laryngectomy Consultation

• How do you introduce the subject???
• Individually
• Dr has told me of your dx and has asked me to
  talk to you about it
• I am sorry that you have been given some bad
  news.

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Pre-op Laryngectomy Consultation

• Tell the patient the goal of the session and
  encourage the patient and family members present
  to ask questions whenever they want throughout
  the session.
• Frequently ask indirect questions throughout the
  session to assess understanding.

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History

• Educational Background
• Employment Status
• Family Status
• Visual Acuity
• Auditory Acuity
• Writing Skills
• Reading Skills

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Consultation Topics

• Anatomy/Physiology (Use Pictures/Models)
• Preoperative
• Postoperative
• Operative site

• Permanency of
• Voice Loss-Not loss of Speech
• /s-z/ production
• Larynx Removal
• Stoma
• Stomal Respiration

continued
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Consultation Topics

• Alteration of Taste and Smell
• NPO Status
• Swallowing Alterations
• Surgical/Hospital Information
• 4-10 days
• Intensive Care Visit
• Family Information
• Healing

continued
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Consultation Topics

• Hospital stay communication
• Immediate post-operative wake-up and initial
  reaction to speak

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HOSPITAL NON VERBAL COMMUNICATION"Laryngectomee
Needs Chart" Actual size is 8 1/2" x 11".  Makes
communication a little easier.  A small bell for
your bedside will help get attention. A laptop,
if you have one, will let you type messages in
detail or a Magna Doodle from the toy store is
great for write and erase. So is the little magic
slate.
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Laryngectomee Needs Chart
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ADDITIONAL HOSPITAL NON VERBAL COMMUNICATION

• Magna Doodle from the toy store /or Magic
  slate.
• Preferable over a dry erase board as the
  eraser is built in.
• Large pad of paper
• A small bell for your bedside will help get
  attention.
• A laptop
• TELEPHONE USE WITH NO VOICE
• Establish technique prior to surgery
• Have nurse tell caller that pt. can communicate
  by touching a button on the phone, once for yes
  and twice for no, if the caller would ask
  questions.

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Consultation Topics

• Speech and Voice Rehabilitation
• Immediate Post-Op Communication
• Artificial Larynx
• Esophageal Voice
• Variations
• Progression of the Rehabilitation Process

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WHAT TO TAKE TO THE HOSPITAL

• Clothes Shirts that open in the front.
• Take writing materials.
• Take a good book, a small radio, a CD player, or
  a lap top, anything that will stimulate your
  brain and distract you.

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• How much information ????????

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1.Provide Additional Reading Material Book
Samples are

• 2.Possible Provision of Audio and/or Videotape
  Samples

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• Portray Confidence in your medical staff

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PATIENTS VIEW OF WHAT TO EXPECT RIGHT AFTER
SURGERY

• That you will have a feeding tube of some kind.
• That your neck ( ? face) will be very swollen.
• That you will have drains to help reduce the
  swelling in your neck.
• That you will have a humidifier with a tube and
  mask that should lie loosely by the stoma so you
  will be breathing in moist air.
• That they will suction out mucus and most
  hospitals irrigate with saline solution 4 x a
  day.
• That you will be up and walking faster than you
  think.
• That when you buzz for the nurse's station, they
  will answer without realizing you can't talk.
  Ring the bell you have brought and have by your
  bedside to remind them

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Post-operative Laryngectomy Consultation

• Review all information specifically in regards to
  the surgery that occurred.
• Answer all questions
• Oral Exam and Motor Speech Exam
• Artificial Larynx Education and Evaluation Session

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• Its Going To Be ALLRIGHT!!!!!!!!