Environmental damaging

agent: Smoker and

Alcoholic Drinker
(nicotine and alcohol)

Normal cell

Alcohol
suppresses DNA
repair

DNA damage

Environmental damaging
agent: Wood dust, paint
fumes
Occupation: CarpenterExposure to wood dust,
paint fumes

Failure of DNA repair

Mutations in the
genome of laryngeal
cells

Activation of growthpromoting oncogenes

Failure of genes to
regulate apoptosis

Inactivation of
cancer
suppression

Expression of altered gene

products and loss of regulatory
gene products
Clonal expansion
Additional mutations
(progression)

Heterogeneity

Laryngectomy

Malignant neoplasm
Increased
metabolic needs

Chemotherapy
-A
Formation of mass at
supraglottic area

Obstruction at the
larynx B, C

Inflammation of the
larynx
Unable to meet caloric
requirements
Recurrent

laryngitis

Painless
palpable
cervical lymph
nodes

A
Accumulation of Chemotherapy
Hoarseness
of
Docetaxel,
5-fluorouracil,
inflammatory cells in
voice
Carboplatin (six cycles)
nearby lymph nodes

Dysphagia
B- Partial obstruction of
air in the upper airway

Decreased
ventilation

Myelosuppression

Dec.
RBC

Decreased oxygen
uptake

Dec.
hemoglobin

Decreased perfusion
- pale mucous membranes,
pale nail beds

stomatitis
Anemia

Insertion
of
jejunosto

pallor

Malabsorp
Inc. RDW,
tion
of vit.
normal
B12
MCH

Ineffective
Peripheral Tissue

Risk for
Imbalanced
Nutrition:
Less than
Body
C tracheostoma
Air inhaled
not
humidified
Increased
insensible
loss
Risk for
Deficient
fluid volume

Dry mucosal
membranes of
trachea