Introduction
ENT surgery is necessary as a treatment for conditions that affect the ear, nose, or throat. Post surgery, the process of recovery of the patient from the effect of anesthesia and surgery is crucial. The patient should have adequate ventilation, stable hemodynamics, pain control, etc.
Definition
It refers to the preoperative and postoperative care provided to the patient undergoing surgical procedure of the ear, nose, or throat and includes management of symptoms, wound care, prevention of complications, and health education.
Indications
- Sinusitis.
- Acute otitis media with bulging of the tympanic membrane.
- Nose infections and injuries.
- Ear infection.
- Tonsillitis.
- Malignant tumor.
- Nasal septum deviation.
- Lesions.
Contraindications
- Perforation of the tympanic membrane.
- Unilateral deafness.
- Upper respiratory tract infection.
- Atrophic rhinitis.
- Adhesion.
Preoperative Care
- Obtain consent from the patients.
- Identify the patient’s problem and do risk assessment.
- Explain the patient and relatives regarding the admission 1 day prior to surgery and premedication, preoperative, intraoperative, and postoperative care.
- Educate the patient and family regarding temporary hearing impairment after surgery.
- Instruct the patient not to eat or drink anything, including water, from midnight till the surgery. Essential medications (antiarrhythmic, antihypertensive) may be taken with a sip of water.
- Wear loose-fitting clothes that fasten in the front or back.
- Avoid slipover clothing.
- Leave all valuables at home, do not wear jewelry.
- Do not wear any facial or eye makeup and remove nail polish.
- The patient should take a head bath on the day of surgery.
- Collect complete health history and ask about the current medication and allergy.
- If the patient is older than 30 years, all routine investigations such as blood investigations, X-ray, and ECG must be done.
- Skin preparation is done based on the surgical site.
- Vitals signs must be monitored.
- Premedications and test dose for xylocaine and antibiotics can be given based on the doctor’s order.
- Educate the patient to avoid bowling of the nose, coughing, and sneezing after the surgery to prevent pressure changes in the middle ear.
- Advise the patient to practice by keeping the mouth open during coughing or sneezing to minimize pressure in the middle ear.
Postoperative Care
- Assess the general condition of the patient.
- Monitor vital signs, specifically BP, pulse, SpO2 every 15 minutes for the first 2 hours.
- Assess for bleeding or drainage from the affected ear and observe for infection and hemorrhage.
- Administer oxygen, fluid, and antiemetic if ordered by the physician.
- Elevate the head of the bed and position the patient on the unaffected site.
- Assess for vertigo or dizziness while ambulating the patient.
- Take measures to ensure safety during ambulation to avoid risk of falling.
- After the dressing is removed, apply bacitracin ointment to the incision lines three times daily for 2-3 days.
General Post surgery Instructions
Ear
- Instruct the patient not to lie on the affected ear after surgery.
- Instruct the patient to avoid strenuous activity such as swimming, sports, gym, heavy exercising, or playing musical instruments that require blowing (trumpet, clarinet, trombone, saxophone, etc.) for at least 1 month after surgery.
- Instruct the patient to take clear liquids at first and if tolerated a light food diet can be started on the same day.
- A low-grade fever (101°F or less) following surgery may occur and should be treated with paracetamol.
- Patients will have mild to moderate pain for a few days after surgery and can be treated with paracetamol and ibuprofen.
- Instruct the patient to avoid tub bath, swimming, and showering for 6 days.
- Patients may experience dizziness, ringing, and dark red, bloody drainage from the ear. Feeling popping and crackling is normal after surgery.
- Revisit the doctors for appropriate management.
Nose
- Instruct the patient to lie on the back with the head elevated.
- Instruct the patient that bloody discharge is normal after surgery for 3-5 days. If bleeding occurs after surgery, the patient should tilt the head back slightly. Also, advise the patient to breathe through his or her nose after surgery and avoid blowing the nose. Dab the nose gently with tissues to absorb any leaked fluids.
- Instruct the patient to avoid straining, heavy lifting, and nose blowing for at least 10 days after surgery.
- Advise the patient not to control the urge to sneeze. Advise him or her to keep the mouth open while sneezing to avoid pressure on the surgical site.
- Instruct the patient to avoid aspirin and NSAIDs for at least 2 weeks after sinus surgery.
- Advise the patient to use nasal decongestants for no more than 2-3 days to prevent rebound congestion.
- Patients can take clear liquids at first and if tolerated a light food diet can be started on the same day.
Throat
- Instruct the patient to sit upright and place an ice collar on his or her neck.
- Instruct the patient to avoid vigorously coughing, clearing the throat, straining, and heavy lifting for at least 10 days after surgery.
- Patients can take clear liquids at first and if tolerated a light diet and ice cream can be started. Avoid warm/hot foods for a few days to prevent bleeding from the surgical site.
- Instruct the patient that bleeding is unusual, but it can occur up to 2 weeks after surgery.
- Watch and report if symptoms such as coughing or vomiting of blood exist.
- Patients will have mild to moderate pain for a few days after surgery which can be treated with paracetamol and ibuprofen.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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