Care of patients after operations on the upper respiratory tract
After operations in otolaryngology patients need to improve monitoring and special care.Particularly close monitoring and the most meticulous care for post-operative patients needed during the first days after surgery, when there is a risk of complications and may need emergency care.Nurse ENT department should know exactly:
• the number of operated patients;
• any surgery they made and what they are wards;
• on in the first place should pay attention to each of the patients operated on;
• how to monitor compliance with the prescribed post-operative mode.
After surgery on the ear (mastoidalnoy, radical) after a certain time, patients may complain that the bandage is imposed very tight and the pressure on the neck and chin area.In these cases, the bandage should be a little ease by removing the last turns of the bandage, and overlay them more loosely, or having cut her under the chin.If the bandage is soaked with blood, but the blood does not continue to appear, you need to bandage to this place wad
after surgery on the paranasal sinuses is also necessary to monitor the state of the dressing.When possible bleeding from surgical wounds or the nasal cavity is marked complete soaking bandages blood.It must immediately inform the treating or duty doctor.If necessary, remove the bandage and check the condition of the nasal cavity wounds, ENT department in the absence of sister sisters dressing helps your doctor if ligation.
intranasal surgery (in the nasal cavity and the outer nose) often end with the front loop of the nose tamponade to stop the bleeding.When monitoring postoperative patients should pay attention to the degree of impregnation sling bandage with blood on his throat, where blood can flow from the nasal cavity in the event of a possible epistaxis.If necessary, change the bandage nurse offices (in the absence of sisters dressing) is preparing tools and material for the tamponade of the nose and helps the doctor with her.If readings for a new nose tamponade not, the sister makes changing only the outside, sling bandage.
patients after removal of the tonsils must be given in the semi-sitting position of the bed.If the throat started bleeding, then a nurse ENT department prepares the bedside set to stop the bleeding.
Sister gives reniform basin in the hands of the patient and periodically check how it behaves.The patient must lie still, do not make sudden movements, do not cough, do not swallow and spit out only what it will accumulate in the mouth.If he starts to spit blood, to choke it, it is necessary to immediately invite the doctor to help him stop at the throat bleeding in the House, and if necessary - in the dressing.
after adenoidectomy children should be in bed in a semi-sitting position.Care should be taken if the blood from the nose appear, if the child coughs.Bleeding after surgery but the removal of the adenoids - a relatively rare phenomenon, so when a cough or blood is necessary to invite the doctor.Stop the bleeding with the help of tamponade back.It is recommended that the procedure be carried out in the dressing room with the help of the sisters or sisters dressing room.
endolaryngeal removal of fibroids and single papillomas of the larynx is a mild interference.However, after these operations are possible complications: development of reactive swelling of the mucous membrane of the throat and bleeding.Therefore, such patients should be given due attention.It is important to monitor the breathing of patients, cough up phlegm (if available), avoid hot meal and drink.
after tracheotomy patients in need of the most closely supervised.Their position in the bed should be a semi-sitting.In the early days of the postoperative period it is necessary to put a suction device for periodic removal of phlegm.To expectorate sputum easier, not accumulate in the tracheal cannula and the lumen is not narrowed it must be regularly bury it alkaline drops or mineral oil and clean the inner tube tracheal cannula;monitor the breathing status of the tissues around the tracheostomy.If there is a noticeable swelling of the tissues around the tracheostomy or receive blood from a wound or tracheostomy, it is necessary to seek medical advice immediately.If necessary, carry out an emergency dressing, for which sister prepares the necessary tools, solutions painkillers, bandages, and helps the doctor to restore free breathing of the patient and apply a bandage.
after surgery for malignant laryngeal tumors, most commonly cancer, complete or partial removal of the larynx, patients are placed in the chamber in the vicinity of the post of the nurse on duty, as in the early days of the postoperative period, they require constant monitoring, care of tracheal cannula, using the powerpersonnel.The position of the patient in the bed should be a semi-sitting.Next to the bed, you need to put a suction device with a thin rubber tube to remove excess mucus from the trachea.In order to facilitate the evacuation of it from the trachea and bronchi, reduce the possibility of condensation need to periodically dig into the cannula alkaline drops or liquid paraffin.At the same time on a regular basis, and at the slightest difficulty in breathing, you must remove the inner tube from the tracheal cannula to clear it of mucus and return to the place.If mucus removal does not improve breathing, sister must bring in a doctor.
very important duty nurse ENT department of nursing who underwent total or partial removal of the larynx, is their food.Within 2-3 weeks after surgery they are fed with a probe, which is typically introduced into the esophagus through the nose at the end of the operation and is attached to the sling.On the free end of the probe superimposed clamp Pean or Kocher.Make sure that the probe is in the same position, otherwise it may cause obstruction, have pain, hiccups.With the high position of the probe in the esophagus food during feeding whole or in part will result in the pharynx, oral cavity, and fallen low probe may be the cause of pain and indomitable hiccups due to the irritation of their diaphragm.
gavage as follows:
• patient takes a sitting or half-sitting;
• the free end of the probe is attached funnel and clamp is moved slightly below the funnel;
• put on the table, warmed to body temperature food probe diet (eg, broth, pureed soup, minced meat, milk, pudding, etc.);
• the funnel, raised to a height of 40-50 cm, initially poured some water or tea, is removed from the probe clip and watch whether they pass freely into the stomach;
• when the unhindered flow of the stomach is slowly poured through a tube designed to receive food;
• during feeding need to periodically wash the tube with a little water, tea or milk, and after feeding rinse it with water or tea, sleep funnel, apply the clamp to the free end of the probe and attach it to a headband or a shirt.
If not fully free passage of food through the probe it is necessary to wash it with a Janet syringe and administered a soup or broth with meat make it more liquid.
Later in the care of patients after operations on otolaryngology nurse ENT department must strictly follow the state of the dressing.If you got off the bandage, it should be corrected;with a strong wet impregnation of wound - inform your doctor and help to make the dressing.Sister ensures that patients strictly fulfill the prescribed mode of behavior and nutrition.
After surgery patients need to stay in bed a few days in the middle ear (mastoidalnoy and radical surgery), and if the operation was performed on the intracranial complications that developed in these diseases, then for a longer period, depending on the general condition andthe function of the ear labyrinth.With a favorable postoperative period any restrictions in the diet usually does not happen.
After the first complete dressing patients who underwent radical surgery on the middle ear, usually the doctor prescribes drops.Their application is related to the need to comply with the following rules:
• pre-doctor produces a toilet of the ear, ieremoves discharge from the external auditory canal, postoperative cavity, then sister buries him in the appropriate solution 8-10 drops (eg, 3% boric alcohol, etc.), pre-heated to body temperature;
• to ensure that the ear drops preheated to the right temperature, the sister dripping 1-2 drops himself on the rear of the brush;
• in position on the side of the patient's ear up the patient should lie down for 10-15 minutes, after which the sister puts in the ear canal a little ball of wool, which absorbs excess ear drops.
patients who underwent surgery on his sinuses, should comply with bed rest for 3-4 days.The duration of this period depends on the severity of the pathological process in a sinus, surgical volume, the general condition of the patient, and may be increased or reduced.
After the intervention of the maxillary sinus is appointed for 3-4 days a mechanically and chemically gentle diet with a subsequent transition to the overall diet.The food should not be hot.The duration of bed rest after the inside of the nasal operations is determined by the volume of intervention and the subsequent course of the postoperative period.So, after the septum surgery, autopsy ethmoid cells usually need to comply with bed rest for 2-3 days, and after nasal polipotomii may be enough and one day.Because of the risk of bleeding during the first 2-3 days after intranasal surgical interventions are not allowed to take hot food.After removal of the tampon from the nose usually are assigned for administration to the nasal cavity of one or more drops or ointments.With the introduction of the nurse should observe the following rules:
• with instillation into the nose drops of the patient should lie on your back or sitting with his head thrown back;
• left thumb sister gently lifts the nose and tail bones, pipette without touching the skin and the mucous membranes of the nose, admits in each half of the nose, a few drops;
• patient in the supine position is invested in the shallow nose cotton tamponchiki ointment with which he has to lie down for 10-15 minutes.
After tonsillectomy patients must comply with strict bed rest for two days.On the day of surgery, they do not receive food;in the absence of bleeding in the evening they are allowed to drink a glass of ostuzhennoy tea, milk;in the next 2-3 days they are given unheated liquid food (the so-called diet the probe), then they were gradually transferred to the common table.
After adenotomy, endolaryngeal interventions (removal of fibroids vocal fold, laryngeal papillomas) in compliance with strict bed rest is not necessary;As a rule, such patients on the day of the operation is assigned is not chemically irritating ostuzhennoy food.
duration bed rest for patients who underwent tracheotomy or surgery for malignant tumors of the larynx, is defined individually.In the first days after surgery patients receive traheotomirovannye unheated, mechanically and chemically gentle food, then they can gradually be transferred to the general diet.Nurse department still watching the breathing of these patients and periodically clean the inner tube tracheal cannula.It should be remembered compliance great care when removing the inner tube, as the removal of the entire tracheal cannula can directly lead to a sharp shortness of breath, and rapid introduction of it again into the trachea is not always easy to manage.Therefore, when you remove the inner tube it is necessary to hold the outer tube of the guard anatomical forceps or other instrument.
erate cleared of mucus, washed and oiled sterile liquid paraffin inner tube is inserted into the outer, holding the last of the plate to avoid irritation of the mucous membranes of the trachea tube displacement.Oilcloth apron, protecting bandage on released through a tracheal cannula, sputum, sister changes as needed.Just take care of tracheal cannula in patients undergoing surgery for malignant tumors of the larynx.In addition, these patients continue to feed through a gastric tube until the wound has healed so that it can be removed, and the patient will start to eat on their own.
When caring for patients who underwent surgery on the esophagus, and the wound left nezashitoy, for better outflow discharge from the wound slightly lift the foot end of the bed;sister must make sure that the situation did not change the bed.Such patients for a time fed by gavage.
Terms feeding after surgery, produced by malignant neoplasms of the larynx, are fully applicable to patients after operations on the esophagus.