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Nursing Process Management Proof Reading Services
Kelly Malone is a 49 year old female patient, who went under surgery for obstructive breathing and codeine allergy (Septoplasty and Right Ethmoidectomy). Septoplasty is surgical procedure to straighten and reposition the nasal septum. During this procedure patient nasal septum displaced the bone and cartilage that divides two nostrils. And Ethmoidectomy is the procedure in which excision of cells of the ethmoid sinus or ethmoid bone to be done. She has a medical history of Sensitivity to Codeine. Sensitivity to codeine is an adverse reaction of codeine includes dizziness, shortness of breath, sedation, constipation, drowsiness, vomiting, sweating, nausea, lightheadedness (Ketcham and Han, 2010). She was also not being able to breathe through her nose which causes disruption of her sleep. If she tried to exercise, she was not able to take breathe and had to use her mouth. She does not have any other underlying medical issues. In this assignment we would be critically evaluating the nursing procedure for her.
Background Of Condition
Kelly observations before surgery:
When Kelly was admitted in the hospital, the pre-operative observations were:
Heart Rate – 69 beats per minute. (Normal bps 60-100).
Temperature - 36.4 degree Celsius. (Normal 36.5-37.5).
Respiratory Rate – 18 breathe per minute. (Normal 12-18).
Blood pressure – 119/70 mmHg (Normal 90/60-120/80).
Oxygen Saturation (O2) - 94% RA (Normal 95-100 percent).
Normal result after surgery is patient able to breathe and airflow through nostrils, and outward shape of the nose must be acceptable.
Kelly observations after surgery:
Post-operative observations of Kelly were:
Heart rate – 68 beats per minute
Temperature – 36.2 degree Celsius.
Respiratory Rate - 18 breathe per minute
Blood Pressure – 111/73mmHg
Oxygen Saturation (O2) – 93 percent RA.
Pain score – 2/10.
Compound Sodium Lactate – 4/24 (in her left arm).
Kelly’s observation after surgery found everything quite good. Her HR, RR was fine, temperature of her body; oxygen saturation and blood pressure were little low.
Anesthetist has prescribed some drugs to relief from pain and for recovery.
Paracetamol – 1g IV/PO 6 hourly
Celecoxib – 200 mg PO BD
Tramadol – SR 100mg PO BD
Paracetamol drug prescribed after post-operative of nausea and vomiting. Celecoxib drug used to reduce hormones that cause inflammation and pain in the body of the patient (Hartzell, et all. 2014). Tramadol drug used to relieve moderate to severe pain.
Aftercare of patient includes detailed instruction that focuses on stop trauma to the nose because patient may have risk of allergic reaction to the anesthetics and may also have complications of cerebrospinal fluid leak (Cukurova, Et all, 2012). This could be treated with proper bed rest, use to antibiotic and nasal packing.
The main aim of septoplasty is to improve breathing through nose and also prevent sinus infections. The operation generally takes 30-60 minutes and there are no visible scares after surgery.
After surgery patient feel sleepy because of use of anesthesia. The condition of patient monitored continuously and it is normal to have bleeding because nose has a very rich supply of blood. (Gordon, 2014).
Nursing process starts immediate after doctor send patient home from the hospital. Generally all dressings are removed before patient leaves except nasal packing. Patient have to take breathe through mouth because nasal packing is still in place. Generally antibiotics are not prescribed by ENT surgeon unless the nasal packing is removed. (Urden, et all. 2017).
Nose may feel blocked because of post-operative swelling; it will take minimum one or two week to recover. If any medicine or any nasal drop/ spray prescribed by doctor or ENT surgeon, apply to decongest the nose.
Normal or light diet should be given to the patient.
Staff should review patient history thoroughly.
Nursing staff could advice to douche the nose of the patient if there is scabbing within the nose.
Staff take care that patient does not intake very hot drinks, meals or bath.
Nursing staff should keep an eye on patient that it should avoid smoking and consumption of alcohol because it decrease the body ability to heel fast and it also cause irritation in the nose.
Staff would also have knowledge about the time of dressing also noted for further bleeding.
Nursing staff would show the patient how to perform sinus irrigations.
Staff would keep changing drip pad of patient as and when required.
Patient cloths should be like those which can fasten from front or back.
Antibiotics should be taken with any kinds of liquid or food. And patient should not consume milk or dairy product when taking any antibiotic.
Help patient to take medicines on time.
Staff should help patient in doing basic exercise.
Encourage patient to feel better and calm.
Help patient to lessen fear.
There will be certain visit required to the hospital after surgery. During visits surgeon will clean nose and sinuses of fluid and blood left after surgery. This is important for patient to attempt all the visits to recover soon.
Nursing Diagnosis/ Problems:
Three nursing problems are as follows:
Nurses are already tried to do many thing at times to accommodate staffing issue, but patient always have higher needs and expectations from them (Kaye and Lybrand, 2016). But meeting all the needs and expectations is always difficult. Through this healthcare condition of them become more chronic and also increase in personnel diseases.
With the growth of the technology, the job of the nurses is also becoming tougher. Internet and smartphones plays a huge role in medicals. Now a day’s documentation and databases are also in electronic. So as professional’s knowledge of this advancement is mandatory.
Sometimes conflicts between nurses and their patient occur. So for this nurses also being disrespected by patient and it cause problems. Problems could be with partner physician, co-workers or administrators.
Post-Operative Education To Patient:
1.When patient feel body temperature higher than 101 degree Fahrenheit then immediately call to the doctor or any specific person.
2.After the first week of the surgery patient constantly clear watery discharge.
3.Help patient to understand that after surgery bleeding can be expected for 2-3 days.
4.If patient face any eye swelling or any changes in visual can immediately call to the doctor.
5.If intense headache or diarrhea.
6.Nose bleeding that does not recovering after using Afrin.
7.Patient should avoid the crowded place because there is a possibility of infection in the nose
8.If increased pain in the affected area.
9.Patient should avoid hitting a nose.
10.Avoid sun for few weeks and also use SPF15 sunscreen.
11.Avoid exercise which requires great efforts.
12.During sleep head of the bed must be elevated 45 degree.
13.Patient should stay vertical, keep the body upside.
14.Avoid sports for minimum six weeks.
15.Regularly follow up with appointments.
16.Consult surgeon before taking or starting any medicines.
17.Patient should use nasal saline spray if prescribed by doctor in every two-three hours.
18.Patient should keep the nostril clean.
19.Patient would stop wearing sunglasses and contact lenses.
20.Explain necessity of self-control.
21.Patient should not stop taking medicine because of feeling better.
1.In a rare patient nose bleed, so need blood products or a transfusion.
2.Change in shape of nose.
3.Chronic nasal drainage.
5.Crusting of nose or sinuses.
6.Failure to resolve concurrent respiratory illness.
7.Failure to resolve sinus or nasal headache.
8.May be damage to the eye and its associate’s structure.
9.CSF (Brain fluid) leak.
10.Infection in any body part.
11.Cause permanent numbness of the upper teeth or face.
13.Opening Septal perforation.
14.Worsen the sense of taste
15.Failure to restore sense of smell.
Involvement Of Interdisciplinary Team
Interdisciplinary team work is a composite process. In this team different type of workers who work together to share knowledge and skills (Nawaiseh, and Al-Khtoum, 2010). This interdisciplinary team includes:
The doctor or surgeon, rehabilitation nurses, HSC’s team of physician which includes neuropsychologists, physiatrist, pulmonologists, internists, psychologists, Physical and occupational therapists, Case manager who review the patient’s care plan, Social workers who cooperate with team members and provide counseling and psychosocial support to patient, Dietitians, Respiratory therapists perform diagnostic procedure, Allied health worker who support professional team (Prepageran and Lingham, 2010). Interdisciplinary team faces challenges that are not always encountered by others. Challenges include continuous sharing of roles and expertise.
Septoplasy and Ethmoidectomy is generally done under general anesthesia. septoplasty is a surgery to correct a deviated septum. Prevention of septoplasty and is achieved through good technique. Patient may have packing inside the nose during healing process. It is safe, reliable, effective and low complication technique that yields good results (Gillman, 2014). In this type of surgery pain is generally mild and could be well controlled oral pain medications. The swelling generally starts to improve after one week. Surgeon let patient know whether nasal packing will be placed in patient nose or not. Ethmoidectomy is a process in which surgeon passes a narrow tube called an endoscope into patient nose (Obeid, et all. 2014). This tube contains small camera and a light to excellent view of ethmoid sinuses. Therefore it is concludes that properly perform septoplast and proper care after surgery ensure improving nasal function and patient contentment.
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