Care of patients after operations on ENT organs

After operations on the ENT organs, patients need increased supervision and special care. Particular close monitoring and the most thorough care of postoperative patients are required in the first days after surgery, when the risk of complications is high or emergency care may be required. The nurse of the ENT department must know exactly:

• the number of operated patients;

• what surgical interventions they have been made and in which wards they are located;

• what first of all it is necessary to pay attention to each of the operated patients;

• how to monitor compliance with the prescribed postoperative regimen.

After surgery on the ear( mastoid, radical) after a while patients can complain that the bandage is superimposed very tightly and presses on the neck and the chin area. In these cases, the bandage should be slightly loosened by removing the last bandage moves and overlapping them more loosely, or pruning it under the chin. If the dressing is soaked with blood, but the blood does not continue to appear, it is necessary to pribintovat to this place a lump of cotton wool. If the impregnation of the bandage with blood continues, you should inform the attending physician or the doctor on duty. After surgical interventions on the ear, it is important to pay attention to the patient's face - do not appear signs of asymmetry. Observation of the asymmetry of the patient's face: lowering the angle of the mouth or the inability to close the eye, wrinkling the forehead on the side of the patient's ear is an unfavorable sign. This should be reported immediately to the doctor. Possible dizziness, nausea, vomiting indicate the development of postoperative complications. If necessary, the nurse of the ENT department should help the dressing sitter to make an urgent dressing for the patient or to do this under the supervision of the doctor. In the case of appointing patients after surgery on the ear, ear drops to dig in their ear should always be in a warm form.

After surgical interventions on the paranasal sinuses, it is also necessary to observe the condition of the bandage. With possible bleeding from the postoperative wound or from the nasal cavity, complete impregnation of the dressing with blood is noted. This should immediately be reported to the treating or on-duty doctor. If you need to remove the bandage and check the condition of the wound of the nasal cavity, the sister of the ENT department in the absence of the dressing sitter helps the doctor with the dressing.

Intranasal surgical interventions( in the nasal cavity and on the outer nose) often terminate in the front loop tamponade of the nose in order to stop bleeding. When observing postoperative patients, one must pay attention to the degree of impregnation of the sinus bandage with blood and to the pharynx, where the blood can flow from the nasal cavity in the event of possible nasal bleeding. If necessary, change the bandage nurse department( in the absence of a dressing sister) prepares tools and material for tamponade of the nose and helps the doctor with her. If there is no indication for a new tamponade of the nose, then the sister makes a change only of the outer, sling-like bandage.

Patients after removal of palatine tonsils should be given a semi-sitting position in the bed. If the throat bleeding began, the nurse of the ENT department prepares a set for stopping bleeding on the bedside table.

The sister gives the kidney-shaped basin in the hands of the patient and periodically checks how he behaves. The patient should lie calmly, do not make sudden movements, do not cough, do not swallow, but only spit out what will accumulate in his mouth. If he starts spitting blood, choking with it, you should immediately invite a doctor and help him when stopping throat bleeding in the ward, and if necessary - in the dressing room.

After removal of adenoids, children should be in bed in a semi-sitting position. It is necessary to monitor whether the blood will appear from the nose, whether the child coughs. Bleeding after surgery but removal of adenoids is a relatively rare phenomenon, so when you have a cough or blood, you should invite a doctor. Stop bleeding with a back tamponade. It is recommended that this procedure be performed in a dressing room with the help of a dressing station sister or sister.

Endolaryngeal removal of fibroids and single papillomas of the larynx is a non-severe intervention. However, after these operations, complications are possible: development of reactive edema of the larynx mucous membrane and bleeding. Therefore, such patients need to pay due attention. It is important to observe the breathing of the patients, the nature of the coughing up phlegm( if any), to prevent the intake of hot food and drink.

Patients after tracheotomy need the closest observation. Their position in the bed should be semi-sitting. On the first days of the postoperative period they need to put a suction device for periodic sputum removal. To sputum easier to cough, do not accumulate in the tracheotomy cannula and narrow its lumen, it is necessary to regularly inject into it alkaline drops or paraffin oil and clean the inner tube of the tracheotomy cannula;follow the breathing, the state of the tissues around the tracheostomy. If there is a noticeable swelling of the tissues around the tracheostomy or blood appears from the wound or tracheostomy, the doctor should be called immediately. If necessary, spend an urgent dressing, for which the sister prepares the necessary tools, painkillers, dressings and helps the doctor to restore free breath in the patient and apply a bandage.

After operations for malignant neoplasms of the larynx, most often cancer, complete or partial removal of the larynx, the patients are placed in the ward near the nurse's post, as in the first days of the postoperative period they need constant supervision, care of the tracheotomy cannula, nutrition with the help of personnel. The patient's position in the bed should be semi-sitting. Near the bed, you need to put a suction device with a thin rubber tube to remove excess sputum from the trachea. To facilitate the evacuation of her from the trachea and bronchi, reducing the possibility of thickening, you periodically bury in the cannula alkaline drops or liquid paraffin. Together with this, regularly and with the slightest difficulty in breathing, it is necessary to remove the inner tube from the tracheotomy cannula, clean it of mucus and return it to its place. If mucus removal does not improve breathing, the sister should invite a doctor.

A very important duty of an ENT nursing nurse to care for patients who have undergone the operation of complete or partial removal of the larynx is their nutrition. Within 2-3 weeks after the operation, they are fed with a probe, which is usually inserted into the esophagus through the nose at the end of the operation and is attached to the bandage. The Pean or Koher clamp is superimposed on the free end of the probe. It is necessary to ensure that the probe is in the same position, otherwise it may appear obstruction, pain, hiccough. With a high position of the probe in the esophagus, food during feeding will fully or partially pour into the pharynx, into the oral cavity, and the lowered probe can cause pain and indomitable hiccough due to irritation of the diaphragm.

Feeding through the probe is performed as follows:

• the patient takes a sitting or half sitting position;

• attach the funnel to the free end of the probe, and the clamp is moved slightly below the funnel;

• the dishes of the probe diet( for example, broth, mashed soup, minced meat, milk, kissel, etc.) are placed on the table;

• into the funnel raised to a height of 40-50 cm, pour a little water or tea first, remove the clamp from the probe and observe if they pass freely into the stomach;

• with unhindered entry into the stomach, the food intended for ingestion is slowly poured through the probe;

• During feeding, the probe should be periodically rinsed with a small amount of water, tea or milk, and after washing, rinse it with water or tea, reapply the funnel, clamp the free end of the probe and attach it to the bandage on the head or to the shirt.

In case of not completely free passage of food through the probe, it is necessary to rinse it with a syringe of Janet, and the introduced soup or broth with minced meat should be made more liquid.

In the future, when nursing patients after operations on the ENT organs, the nurse of the ENT department must strictly monitor the condition of the bandage. If the bandage is lost, it should be corrected;when strong wet, impregnated wound detachable - inform the doctor and help to make the dressing. The sister watches, that patients strictly carried out the mode of behavior and a food prescribed by him.

After surgical interventions in the middle ear( mastoid and radical surgery), patients need to stay in bed for several days, and if the operation has been performed for an intracranial complication developed with these diseases, then for a longer period, depending on the general condition and functionthe ear of the labyrinth. With a favorable course of the postoperative period, there are usually no restrictions in the diet.

After the first complete dressing, the patient who has undergone a radical operation in the middle ear usually receives drops from the doctor. Their application is related to the need to comply with the following rules:

• pre-doctor produces an ear toilet, i.e.removes discharge from the external auditory canal, postoperative cavity, then the sister instills in it 8-10 drops of the corresponding solution( for example, 3% boric alcohol, etc.), heated to body temperature;

• To make sure that the ear drops are warmed up to the desired temperature, the sister drips 1-2 drops to itself on the rear of the brush;

• in the position on the side of the patient's ear to the top, the patient should lie for 10-15 minutes, after which the nurse puts a small lump of cotton wool in the ear canal that absorbs excess ear drops.

Patients who underwent surgery on the paranasal sinuses should be kept bed rest for 3-4 days. The duration of this period depends on the severity of the pathological process in the sinus, the extent of surgical intervention, the general condition of the patient, and can be increased or reduced.

After intervention on the maxillary sinus, a mechanically and chemically sparing diet is prescribed for 3-4 days, followed by a transition to a common diet. Food should not be hot. The duration of bed rest after intra-nasal operations is determined by the amount of intervention and the subsequent course of the postoperative period. So, after the septum operation, opening of the cells of the latticed bone, it is usually necessary to observe bed rest for 2-3 days, and after nasal polypotomy, one day may be enough. Because of the danger of bleeding during the first 2-3 days after intranasal surgeries, it is not allowed to take hot food. After removal of tampons from the nose, as a rule, they are appointed to introduce into the nasal cavity those or other drops or ointments. When they are introduced, the nurse must comply with the following rules:

• when burying drops in the nose, the patient should lie on his back or sit with his head thrown back;

• with the thumb of the left hand, the nurse slightly lifts the nosebone and, without touching the pipette of the skin and the nasal mucosa, admits a few drops into each half of the nose;

• in the position of the patient lying on his back, put in fine cotton buds with ointment, with which he must lie for 10-15 minutes.

After tonsillectomy patients must comply with strict bed rest for two days. On the day of surgery, they do not get food;in the absence of bleeding in the evening, they are allowed to drink a glass of cool tea, milk;in the next 2-3 days they are given a non-hot liquid food( the so-called probe diet), and then they are gradually transferred to a common table.

After adenotomy, intra-laryngeal interventions( removal of the fibroid of the vocal fold, papillomas of the larynx) in observance of strict bed rest, there is no need;as a rule, chemically non-irritating cold food is assigned to such patients on the day of surgery.

The length of bed rest for patients who have had a tracheotomy or surgery for a malignant tumor of the larynx is determined individually. In the first days after the operation, tracheotomy patients receive non-flammable, mechanically and chemically sparing food, after which they can gradually be transferred to a common diet. The nurse of the department still watches the breathing of these patients and periodically cleans the inner tube of the tracheotomy cannula. She must remember that great care is taken when removing the inner tube, since removal of the entire tracheotomy can immediately lead to a sharp difficulty in breathing, and the rapid introduction of it back into the trachea is not always easy. Therefore, when removing the inner tube, you must always hold the outer tube behind the shield with an anatomical tweezers or other instrument. Relieving

from mucus, washed and lubricated with sterile vaseline oil, the inner tube is inserted into the outer tube, holding the latter behind the flap to avoid irritation of the tracheal mucosa by displacing the tube. A glazed apron, protecting the dressing from the sputum secreted through the tracheotomy cannula, changes the sister as needed. Just take care of the tracheotomy cannulae and in patients who underwent surgery for a malignant tumor of the larynx. In addition, these patients continue to be fed through the gastric tube until the wound heals so that it can be removed and the patient begins to take food alone.

In the care of patients who underwent an operation on the esophagus, and the wound was left uncleaned, for a better outflow of the discharge from the wound, slightly raise the foot end of the bed;The sister should make sure that the position of the bed does not change. Such patients for some time are fed through a gastric tube.

Feeding rules after operations performed for malignant neoplasms of the larynx are fully applicable to patients after operations on the esophagus.