Nursing Management For Kelly Post Surgery

Background Conditions

Discuss about the Nursing Management for Kelly Post Surgery.

This essay is based on a case study of Kelly Malone who is 49 years old female patient suffering from breathing problem because of nasal blockage during her sleep. Septoplasty also called nasal septum repair refers to a medical operation which corrects defect of the nasal septum, the part which separates the two cavities in the nose (Gillman, Egloff & Rivera?Serrano, 2014). There are cases in which nasal cavities get partially blocked as result of a deformity of the nasal septum. Nasal septum can collapse on either side of the nostril hence making the process of breathing difficult. Ethmoidectomy is the surgical procedure in which ethmoid sinus cells are dissected to treat infection and sinus obstruction which makes a patient suffers from chronic sinus complications. Ethmoidectomy targets to open of airways. Before performing ethmoidectomy, a patient needs to meet certain conditions. For instance, the diagnosis must reveal obstruction of airways, septal spur headache as well as frequent nose bleeding, and septal deformity (Obeid, et at., 2014).

Kelly Malone, who is the patient, has been diagnosed with the problem of not breathing well when she is sleeping. Post- operative conditions of Kelly do not show large deviation. Her respiratory rate remains at 18 beats per minute. But her body temperature, blood pressure, heart beat rates, and oxygen saturation drops slightly compared to the values observed before the operation. The primary goal of performing Saploptasty and ethmoidectomy is to align nasal septum to avoid blocking air during the process of inhalation. Usually after a surgical operation; a nasal bolster is inserted above the nose to support septum recovery by exerting pressure on the skin. It prevents fluid accumulation in the region grafted hence facilitates healing in the skin underneath. 

Nursing process entails step by step procedures which nurses follow so as to improve provision of quality health care to different patients with varying needs. The processes are majorly divided into five stages which include assessment, diagnosis, planning, evaluations, and implementation. The discussion hereafter therefore provides management of septoplasty and right ethmoidectomy by employing the five nursing processes.

Kelly preliminary report after surgery shows that her heart rate, oxygen saturation in the blood, body temperature, and blood pressure are not exposing her to any major risk. The two medical surgeries, septoplasty, and ethmoidectomy enhance patient’s chances of breathing regularly hence enough oxygen saturation in the blood. The patient does not indicate a big deviation in her post-operative conditions. Nonetheless her body temperature, oxygen saturation, heartbeat, and blood pressure slightly dropped, her respiratory rate is still 18 beats per minute. 

Nursing Process

Excessive bleeding is one of the major complications which Kelly may face.  Ethmoidectomy operation requires that a surgeon makes some incision in the delicate tissues (Younes & Elzayat, 2016). So, Kelly will experience counts of nose bleeding which is normal. Damages to tissues around in the nostrils are more likely to cause a free flow of blood to the open nasal cavities.  However, after a few days, nose bleeding may reduce significantly.

The procedures involved in septoplasty or nasal septum repair results into destroying blood vessels in the nasal cavity. Though blood vessels will finally reconnect back, before then, some level of bleeding will occur. It is, therefore, critical for a nurse taking care of Kelly to monitor blood oozing from the skin beneath and the surgical region inside the nasal cavity (Morgan, & Stanik-Hutt, 2015). Consequently, the use of splints to hold tissues in the nostril will reduce the intensity of nose bleeding. In some more pressure exerted to the nose can lead to nose bleeding, especially after post -operation (Obeid, et at., 2014). Patients, therefore, need to avoid activities which create pressure on the delicate areas operated. For examples, during release bowel, muscles strain around the face.

Planning to manage Kelly’s post-operative situation focuses on reducing wound infection as well as inflammation of nasal cavity, minimizing further relapse nasal blockage, and preventing nose bleeding. It is important to note that postoperative care will depend on to an extent the approach used (Kadam & Danesh, 2016). Kelly will receive constant antibiotic therapy and pain medication.  Ethmoidectomy can adversely result to damage of right medial rectus muscles and iatrogenic orbital hemorrhage. Destruction of rectus muscles can severely affect a patient. For instance, it leads to a limitation to ocular motility, diplopia, and eyelid bruising; nevertheless, physical injury to rectus muscle does not affect patient’s visual functioning (Schneider, et al., 2015). Patients who show severe cases of iatrogenic orbital hemorrhage can re-undergo surgery to stop bleeding. Post-operative research conducted on patients who had received ethmoidectomy treatment reveals, some level, interference with optic nerves as well as blood vessels linked to the dura matter in the brain (Zhu, et al., 2014). Therefore, in some rare cases, a patient suffers blindness or even death, when the level of damage to nerves is extreme.

The second post-surgery care concerns infections. Kelly in the process of healing can experience swelling on her wound. It is therefore significant to have appropriate plan to manage swelling on Kelly’s wound.  The swelling occurs because of the damaged to blood vessels during the surgical procedures (Suzuki et al., 2016). Again, discharge iatrogenic orbital discharge, and other fluids from mucous membrane in the septum may accumulate hence enhancing chances of bacterial infections. It is, therefore, significant to monitor her 24 hours after the medical operation, to check the possibility of any form of hemorrhage (Kilicaslan, Acar, Tekin, & Ozdamar, 2016). Bleeding from ethmoid vessels and nasal blood vessels can expose the patient to micro-bacterial infections. Disinfecting nasal bolster is critical in the management of Kelly’s septum wound. Moreover, she is more prone to sinus infection because of trapping of air and mucus to the mucous membrane (Nguyen, et al., 2016). High level of hygiene by cleaning of the nose using 3% of hydrogen peroxide can reduce the possibility of infections on Kelly’s wound.     

Assessment

The other major issue which will require nursing concern is relapsed nasal obstruction. For the first few days after surgery, Kelly’s respiratory system may not function normally. However, after sometimes, when the healing will have occurred successfully, her breathing system can eventually assume normal breathing operations. Inflammatory in the nostrils after surgical treatment can contribute to blocking of the nose which limits continuous flow of air through the nasal cavity (Parahoo, 2014). Whereas the primary objective of conducting septoplasty and ethmoidectomy is to release congestions for air particles to move freely along respiratory, there are incidences when relapse occurs. Massive hemorrhage and swelling of the blood vessels in the nose is one of the causes of chronic blockage, especially after surgery. Moreover, the accumulation of mucus from mucous membrane wall can further complicate the situation. A patient should adversely ensure that nasal cavity remains moist after treatment.

Kelly’s post-operative medical conditions reflect that she is completely out of any danger. Her body temperature of 36.2 o C is slightly below the normal body temperature of a healthy individual. Since she is under medications, her post-operative drugs consist of pain relievers, antibacterial doses, inflammatory treatment, and fluid resuscitation in the body. The use of Compound Sodium Lactate is to restore the level of fluid loss as a result of surgery and bleeding  (Morgan, & Stanik-Hutt,2015).While Celecoxib 200mg PO BD reduces the degree of swelling in the nasal cavity which can cause Kelly more pain. Kelly’s post-operative care aims at reducing the level of the pain which most patient face after surgery. Similarly, she must have lost some body fluids hence intravenous injection restores the amount of electrolyte in her blood (Dougherty & Lister, 2015). The patient’s blood pressure after post-operation is not alarming, however, her respiratory rate call for closer monitoring. 

Prevention of wound infection, recurrent nasal blockage, and bleeding are some of the concern that a nurse managing Kelly’s post-operative will address. Therefore, it is important to evaluate the success of various mechanisms used to assist Kelly recovers completely. The nurse requires removing nasal bolster 48 to 72 hours after the operation. Again topical nasal decongestants are used for the first three days and then stopped. Nasal decongestant helps patient to breathe regularly since it prevents nasal blockage (Potter, Perry, Stockert & Hall, 2016). Subsequent use of ice cube on the outside parts of the nose will also help Kelly to reduce pain. Similarly, the use of two pillows to support her head region so as to prevent septum from leaning on either side of the nostril is advisable to facilitate smooth recovery

Nursing Diagnosis

Potential Nursing problems concerning Kelly’  condition involve preventing wound infection, secondly helping her maintain appropriate oxygen saturation in the blood, and finally managing her respiratory rate. Ethmoid discharge can facilitate infection within the surgical part. Likewise; the use of nasal bolster to an extent may obstruct nasal discharge.  Nasal bolster exerts some excessive pressure on the septum hence leading to accumulation of fluids beneath (Moorhead, Johnson, Maas, & Swanson, 2014).Consequently, as the Kelly recovers from post-operation, the air cell in the sinus may temporarily get blocked. The outcome which most patient can feel is the low amount of oxygen saturation hence feeling of dizziness and occasionally fainting when the situation I severe. Again, the because of limited space for passage of air in the nostrils, Kelly rate of breathing will increase alarmingly (Nguyen, 2015). The nurse in charge of her must continuously assist her to inhale desirably well.

Post-operative education for Kelly quick recovery addresses how she will manage her wound to avoid further nasal blockage and bleeding. The surgery is a day care procedure since patients get admitted and discharged few hours after the Surgery to go home (Gillman, Egloff  & Rivera?Serrano,2014). The ENT patients, therefore, play a critical role in the process to recover.   Kelly needs to remain in the hospital for 8 to 10 hours as the effect of anesthesia fades.  She requires not blowing her nose for the period of seven days after the operation (Kilicaslan, 2016). Additionally, Kelly must avoid holding her breath tightly during the bowel movement because the can strain nasal muscles hence nose bleeding. Similarly driving a car or swimming within the first one week after treatment may impair Kelly process of recovery. She must not participate in strenuous activities. Finally, Kelly will have to visit hospital one week after the operation to remove clots through suction to get better relief.

Septoplasty and ethmoidectomy surgery may lead to loss of sensitivity to smell, feeling of numbness as well as a sinus headache. Whichever the case, management of complications relies on the interdisciplinary team. Treatment involving septoplasty and ethmoidectomy requires a multidisciplinary approach. Various health personnel perform different roles. For instance, anesthetist will prepare the patient before the operation begins (Gillman, Egloff & Rivera?Serrano, 2014). Again the anesthetist will also monitor the patient during the post-operative period. Anesthetist discusses with the patient the side effects of anesthesia and how the client can overcome (Kadam & Danesh, 2016).  Similarly, ENT surgeon plays a critical role to ensure that the patient surgical procedure is complete. Additionally, a nurse who provides post-operative care to recovering patient has also a vital role as part of the medical team towards recovery process.

Planning

Conclusions

Chronic sinus complication and collapse septum can impair a person respiratory system. Patients who experience uncontrolled nose bleeding and persistent nasal obstruction are likely to undergo septoplasty and ethmoidectomy. The two medical procedures open nasal airway to enable a patient breaths efficiently (Schneider, et al., 2015). However, post-operative care is very critical to avoid the relapse of nasal obstruction or massive nasal hemorrhage. Similarly, as part of nursing procedures, it is significant to evaluate patient pre-operative and post-operative medical conditions (Jiménez-Chobillon, et al., 2016). The two conditions enable health service providers to understand the progress which a client is making. Nonetheless, patients require postoperative education to help them successfully manage the process of efficient recovery. 

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