Impaired Verbal Communication | Nursing Care Plan for Radical Neck Surgery

Nursing diagnosis: impaired verbal communication related to anatomical deficit—removal of vocal cords; physical barrier—tracheostomy tube; required voice rest

Possibly evidenced by

Inability to speak

Change in vocal characteristics

Desired Outcomes/Evaluation Criteria—Client Will

Communication

Communicate needs in an effective manner.

Identify and plan for appropriate alternative speech methods after healing.

Nursing intervention with rationale:

1. Review preoperative instructions and discussion of why speech and breathing are altered, using anatomic drawings or models to assist in explanations.

Rationale: Reinforces teaching at a time when fear of surviving surgery is past. Note: Following NTL procedure and the passage of time, the client may experience voice and ease of swallowing, although this depends entirely on multiple factors, including type and invasiveness of cancer, type and success of reconstructive surgery, and response to radiation and chemotherapy.

2. Determine whether client has other communication impairments, such as hearing, vision, and literacy.

Rationale: Presence of other problems influences plan for alternative communication.

3. Provide immediate and continual means to summon nurse, for example, a call bell. Let client know the summons will be answered immediately. Stop by to check on client periodically

without being summoned. Post notice at central answering system or nursing station that client is unable to speak.

Rationale: Client needs assurance that nurse is vigilant and will respond to summons. Trust and self-esteem are fostered when the nurse cares enough to come at times other than when

called by client.

4. Prearrange signals for obtaining immediate help.

Rationale: May decrease client’s anxiety about inability to speak.

5. Provide alternative means of communication appropriate to client need, such as pad and pencil, magic slate, alphabet or picture board, and sign language. Consider placement of

intravenous (IV) line.

Rationale: Permits client to express needs and concerns. Note: IV positioned in hand or wrist may limit ability to write or sign.

6. Allow sufficient time for communication.

Rationale: Loss of speech and stress of alternative communication can cause frustration and block expression, especially when caregivers seem “too busy” or preoccupied.

7. Provide nonverbal communication, such as touching and physical presence. Anticipate needs.

Rationale: Communicates concern and meets need for contact with others. Touch is believed to generate complex biochemical events, with possible release of endorphins contributing to

reduction of anxiety.

8. Encourage ongoing communication with “outside world,” such as newspapers, television, radio, calendar, and clock.

Rationale: Maintains contact with “normal lifestyle” and continued communication through other avenues.

9. Refer to loss of speech as temporary after a partial laryngectomy, as appropriate, for instance if client may have return of voice, or be candidate for voice prosthetics or vocal cord transplant.

Rationale: Provides encouragement and hope for future with the thought that alternative means of communication and speech are available and possible. Note: Some procedures allow for return of voice function, either by means of an artificial larynx (neck or intraoral); a tracheoesophageal puncture (TEP) and prosthesis, which allows lung-powered speech; or a form not requiring a prosthesis—esophageal speech through air forced into the top of the esophagus.

10. Caution client not to use voice until physician gives permission.

Rationale: Promotes healing of vocal cord and limits potential for permanent cord dysfunction.