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Pre-operative and Postoperative nursing management for Septoplasty and FESS Click to edit Master subtitle style

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Septoplasty
is a correctivesurgicalprocedure done to straighten thenasal septum, the partition between the twonasal cavities. Ideally, the septum should run down the center of thenose. When itdeviatesinto one of the cavities, it narrows that cavity and impedes airflow. Often the inferiorturbinate on the opposite side enlarges, which is termedcompensatory hypertrophy. 5/28/12 Deviations of the septum can lead to

Septoplasty
is a reconstructive plastic surgery procedure and is carried out under anaesthesia. The surgery typically takes around 90 minutes and involves the surgeon making an incision in the septum lining to access the cartilage. Excess cartilage is then removed, and the surgeon may fix the septum in a 5/28/12 central position with sutures.

FESS

is the mainstay in the surgical treatment ofsinusitisand nasal polyps, including bacterial, fungal, recurrent acute, and chronic sinus problems. Ample research supports its record of safety and success. FESS is a relatively recent surgical procedure that uses nasal endoscopes(using Hopkins rod lens 5/28/12

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Preoperative Phase: The period of time from when decision for surgical intervention is made to when the patient is transferred to the operating room table.

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Postoperative Phase: Period of time that begins with the admission of the patient to the post anesthesia care unit and ends after follow-up evaluation in the clinical setting or home.

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Pre-operative procedures

The patient should not eat or drink for 6-8 hours before the surgery. It is advisable to inform and check with the doctor about any regular medication being taken, if necessary they should be taken with a minimal sip of water. (No Juice or other liquids). 5/28/12

Routine tests done before the surgeries are 1. Blood tests 2. X-Ray Chest (very important if patient over 45 yrs, smoker, or history of heart/lung disease) 3. ECG The patient is given a consent form, which would explain the procedure, the medication given and the risks involved. 5/28/12

PREOPERATIVE PHASE

The rendering of nursing care to the surgical client as soon as heis admitted & the decision to undergo surgery is made. It ends on the time the client is transferred to the O.R.

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NURSING ACTIVITIES:

Assessment of the client (baseline evaluation of the pt. before the day of surgery-interview) Identification of potential/actual health problems. PREADMISSION TESTING- ensure necessary tests havebeen performed Pre-op teaching involving client 5/28/12 &support persons.

Day of surgery : patient teaching reviewed informed consent confirmed Patients identity& surgicalsite verified IVF started.

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PREPARATION FORSURGERY

Psychological Support: Assess clients fears, anxieties, support systems &patterns of coping.

a)

b) Establish trusting relationship with client &significantothers. c) Explain routine procedures, encourage verbalization of fears & allow client to ask questions.
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d) Demonstrate confidence in surgeon & staff. e) Provide for spiritual care if appropriate.

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PREOPERATIVETEACHING
Frequently done on an outpatient basis.

Assess clients level of understanding of surgical procedure & its implications. Answer questions, clarify & reinforce explanations given by 5/28/12

PREOPERATIVETEACHING

Preoperative experience Preoperative medication Breathing exercises, coughing, incentive spirometer Leg exercises Position changes and movement Pain management Reducing anxietyand fear, support 5/28/12

PreoperativeNursing Interventions
PHYSICAL PREPARATIONS:

Patient safety is a primaryconcern. Obtain history of past medical conditions, surgical procedures, dietary restrictions & medications. Perform baseline head-to-toe assessment, including VS, height 5/28/12 & weight.

1 CBC 2. Electrolytes 3. PT/PTT(Prothrombin Time;Partialthromboplastin time) 4. Urinalysis 5. ECG 6.Blood typing & crossmatch

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NPO - to prevent aspiration Bowel prep and skin prep

- cleansing enema or laxative before surgery to allow satisfactory visualization of the surgical site. - goal ofpre-op skin prepis to decrease bacteri awithout injuring the skin.
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Immediate preoperative preparation


Complete checklist and chart Hospitalgown, voiding, removal of dentures, jewelry,contacts, etc. Preoperative medication Transporting the pt. to the Presurgical area about 30to 60 minutes before anesthetics is to be given.

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LEGAL PREPARATION:

Surgeon obtains operative permit (informed consent)

1. Surgical procedures, alternatives ,possible complications & disfigurements or removal of body partsare explained.

2. It ispart of the nurses roleas client advocate to 5/28/12 confirm that the client

INFORMED CONSENT
is necessary in the following circumstances:

Invasive procedures,such as surgicalincisions, biopsy,cystoscopy orparacentesis. Procedures requiringsedation oranesthesia A non-surgical procedure, such 5/28/12 as arteriography

Adult client (over18 y/o) signs own permit unless unconcious ormentallyincompetent.

1. If unable to sign, relative (spouse or next of kin) or guardian will sign. 2. In an emergency, permission via telephone or telegramis acceptable;have a 2nd

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listener on phone when

3. Consents are not needed for emergency care if all 4 of the ff. criteria are met: a. There is an immediate threat to life. b. Experts agree that it is an emergency. c. Client is unable to consent. d. A legally authorized person 5/28/12

Minors (under 18 y/o) must have consent signed by an adult (i.e.Parent or legal guardian) Emancipated minor (marriedor independently earning his or her own living)may sign his/ her own consent.

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Witness to informed consent may be a nurse, another M.D., clerk or any other authorized person. The nurse witnessing informed consent, specifieswhether witnessing explanation of surgery or justsignature of the client.
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PREOPERATIVEMEDICATION S
PURPOSES:

1. To relieve fear & anxiety. 2. To reduce dose needed for induction & maintenance of anesthesia. 3. To prevent reflex bradycardiathat happensduring induction ofanesthesia.
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4. To minimizeoral secretions.

Post-operative nursing interventions

Begins with the admission of the client to PACU &ends with discharge of client from hospital orfacility providing continuity of care.

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Nursing Management in the PACU

Provide care for the patient untilhe/she has recovered from the effects of anesthesia. Patient has resumption of motor and sensory function, is oriented, hasstableVS, and shows no evidenceofhemorrhage or other complications of surgery. Frequent skilled assessment of the 5/28/12 patient is vital

Vital signs every 30 minutes for 1st 6 hours then after every hour Changing of external pack/moustache dressing every 3 hours or as needed Keep the patient in fowlers position 30-45 degrees to reduce bleeding Start mobilization after 4 hours
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Advised the patient not to blow

Responsibilities of the PACU Nurse

Review pertinent information and baseline assessment upon admission to the unit. Assessments include airway and respirations, cardiovascular function, surgical site, function of the central nervous system; also assess IVs and all tubes and equipment. ReassessVS andpatient 5/28/12 statusevery 15 minutesor more

Outpatient Surgery/Direct Discharge


Discharge planning and discharge assessment

Providewrittenand verbal instructions regardingfollow up care, complications, wound care, activity,medications, and diet. Give prescriptions and phone numbers. Discuss actions totake if 5/28/12

Give instructions to the patient and a responsible adult who will accompany the patient. Patients are not to drive home or be discharged to home alone. Sedation and anesthesia may cloud memory andjudgment and affect ability

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