27 January 2012

Client with Oral Cancer Nursing Care Diagnosis and Intervention

Client with Oral Cancer
a.Uncommon (5% of all cancers) but has high rate of morbidity, mortality
b.Highest among males over age 40
c.Risk factors include smoking and using oral tobacco, drinking alcohol, marijuana use, occupational exposure to chemicals, viruses (human papilloma virus)

Pathophysiology Client with Oral Cancer
a.Squamous cell carcinomas
b.Begin as painless oral ulceration or lesion with irregular, ill-defined borders
c.Lesions start in mucosa and may advance to involve tongue, oropharynx, mandible, maxilla
d.Non-healing lesions should be evaluated for malignancy after one week of treatment

Collaborative Care
a.Elimination of causative agents
b.Determination of malignancy with biopsy
c.Determine staging with CT scans and MRI
d.Based on age, tumor stage, general health and client’s preference, treatment may include surgery, chemotherapy, and/or radiation therapy
e.Advanced carcinomas may necessitate radical neck dissection with temporary or permanent tracheostomy;  Surgeries may be disfiguring
f.Plan early for home care post hospitalization, teaching family and client care involved post surgery, refer to American Cancer Society, support groups

Nursing Care
a.Health promotion:
1.Teach risk of oral cancer associated with all tobacco use and excessive alcohol use
2.Need to seek medical attention for all non-healing oral lesions (may be discovered by dentists); early precancerous oral lesions are very treatable
b.Nursing Diagnoses Client with Oral Cancer
1.Risk for ineffective airway clearance
2.Imbalanced Nutrition: Less than body requirements
3.Impaired Verbal Communication: establishment of specific communication plan and method should be done prior to any surgery
4.Disturbed Body Image