A nurse is implementing nursing care measures for patients' special communication needs. Which patient will need the most nursing care measures?

A) The patient who is oriented, pain free, and blind
B) The patient who is alert, hungry, and has strong self-esteem
C) The patient who is cooperative, depressed, and hard of hearing
D) The patient who is dyspneic, anxious, and has a tracheostomy

Facial trauma, laryngeal cancer, or endotracheal intubation often prevents movement of air past vocal cords or mobility of the tongue, resulting in inability to articulate words. An extremely breathless person needs to use oxygen to breathe rather than speak. Persons with high anxiety are sometimes unable to perceive environmental stimuli or hear explanations. People who are alert, have strong self-esteem, and are cooperative and pain free do not cause communication concerns. Although hunger, blindness, and difficulty hearing can cause communication concerns, dyspnea, tracheostomy, and anxiety all contribute to communication concerns.