As you can see from the brief this case study must have 2 potential or actual problems. Each should have its own heading with c.900 words each. The patient in question is a 56 year old gentleman called John (not his real name, due to patient confidentiality). He presented to the emergency department with a GP referral with ongoing horseness of voice, shortness of breath, difficulty swallowing and recurrent respiratory tract infections unresolved with a course of antibiotics. These symptoms had been ongoing for two months. He denies any previous medical history, he is a current smoker 30/day and drinks 6 units of alcohol/day. Lives alone and works as a caretaker in a local school. Referral for MRI scan which showed a 4.1cm glottic/supraglottic mass most consistent with laryngeal cancer. Based on these findings he was reviewed by ENT and scheduled for a panedoscopy and biopsy. He was reviewed by anesthesic consultant prior to surgery and it was decided that a tracheal intubation would be difficult due to the position of the tumor. It was decided due to this difficult airway that an awake fibre-optic intubation would be performed. A layngoscopy was performed, biopsy taken and a microdebrider was used to debunk the tumor and improve airway. Actual problem: Difficult airway, awake fibre-optic intubation. Focus on the nurses role in building a therapeutic relationship, communication skills and preparation of patient and equipment. Potential problem: Due to patients poor oral intake-he is visibly underweight, smoking status and consumption of alcohol he is at risk of pressure area injury. Focus on the nurses role and the importance of a skin assessment both before and after operation, selection of pressure relieving devices, caution while transfering to the table. Communicating any skin concerns to the recovery nurse
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