Timby's MedSurg 14e

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UNIT 5 Caring for Clients With Respiratory Disorders

Client and FamilyTeaching 20-4 Surgery for Nasal Obstruction

Teaching measures for clients having surgery to relieve na sal obstruction include preparing the postoperative client for edema and discoloration around the eyes and nose that will disappear after a few weeks. The nurse also instructs the client to do the following to prevent bleeding:

• Do not bend over. • Do not blow nose. • If sneezing, keep mouth open.

• Avoid contact with nose or surrounding tissue. • Keep head elevated with an extra pillow when lying down. • Avoid heavy lifting. • Do not use aspirin, ibuprofen, alcohol, or tobacco products. a polypectomy , the removal of polyps with a nasal snare or laser under local anesthesia. The polyps are examined mi croscopically to rule out malignant disease. Hypertrophied turbinates are often treated with the application of astringents or aerosolized corticosteroids to shrink them close to the nose. Occasionally, one of the turbi nates may be surgically removed ( turbinectomy ). Nursing Management Surgery for correction of nasal obstruction is usually done on an outpatient basis. The nurse provides thorough expla nations throughout the procedures to alleviate anxiety. It is particularly important to emphasize that nasal packing will be in place postoperatively, necessitating mouth breathing. The application of an ice pack will reduce pain and swelling. Placing the client in a semi-Fowler position promotes drainage, reduces edema, and enhances breathing. The nurse inspects the nasal packing and dressings frequently for bleed ing and asks the client to report excessive swallowing, which can indicate bleeding. Ongoing monitoring of vital signs is necessary, as is providing oral hygiene and saline mouth rinses (when permitted) to keep mucous membranes moist. The nurse tells the client that feeling or hearing a sucking noise when swallowing is normal and will resolve when the nasal packing is removed. Client and Family Teaching 20-4 lists additional teaching measures. TRAUMA AND OBSTRUCTION OFTHE UPPER AIRWAY Fractures of the Nose A nasal fracture usually results from direct trauma. It causes swelling and edema of the soft tissues, external and internal bleeding, nasal deformity, and nasal obstruction. In severe nasal fractures, cerebrospinal fluid, which is colorless and clear, may drain from the nares. Drainage of cerebrospinal fluid suggests a fracture in the cribriform plate. The diagnosis of a nasal fracture may be delayed be cause of significant swelling and bleeding. As soon as the swelling decreases, the examiner inspects the nose internally

Figure 20-3 Large gray nasal polyp in the left nostril. (Shutterstock ID: 483831889)

Hypertrophied turbinates are enlargements of the na sal conchae, three bones that project from the lateral wall of the nasal cavity. The hypertrophy, which results from chronic rhinitis, interferes with air passage and sinus drain age and eventually leads to sinusitis. Assessment Findings Symptoms include a history of sinusitis, difficulty breathing out of one nostril, frequent nosebleeds, and nasal discharge. Clients usually report difficulty breathing through one or both sides of the nose. Inspection with a nasal speculum re veals a left or right deviation of the nasal septum, the number and location of the polyps, or enlarged turbinates. Medical and Surgical Management A submucous surgical resection or septoplasty may be neces sary to restore normal breathing and to permit adequate sinus drainage for the client with a deviated septum. This procedure involves an incision through the mucous membrane and re moval of the portions of the septum that cause obstruction. After this procedure, both sides of the nasal cavity are packed with gauze, which remains in place for 24 to 48 hours. A moustache dressing or drip pad is applied to absorb any drainage. Rhinoplasty , reconstruction of the nose, may also be done at the same time. This procedure enhances the client’s appearance cosmetically and corrects any structural nasal de formities that interfere with air passage. The surgeon makes an incision inside the nostril and restructures the nasal bone and cartilage. As with septoplasty, the nasal cavity is packed with gauze, and the nose is taped. Application of a nasal splint maintains the shape and structure of the nose and re duces edema. The splint remains in place for at least 1 week. Treatment for polyps includes a steroidal nasal spray to reduce inflammation or direct injection of steroids into the polyps. If nasal obstruction is severe, the surgeon performs

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