2.
Define septoplasty and related terms.
Understand patient’s history and diagnosis.
Review the anatomy of nose.
Discuss the disease condition.
Describe related nursing interventions.
Identify the health education given to the patient.
3. ⚫
⚫
⚫
⚫
Deviated- to turn aside from a regular course
Cartilage- a tough elastic connective tissue
Nasal septum- partition between two nasal cavities
Incision- the act of cutting
5. ⚫ Septoplasty - a surgical procedure to correct the
shape of the deviated septum of the nose.
⚫ It is done to correct defects or deformities of the
septum.
⚫ It is performed to correct obstructions related to
the nasal septum.
6.
7. -Nasal airway obstruction
- Can lead to mouth breathing, chronic nasal
infection, or obstructive sleep apnea.
Nasal septal deformity
Headaches caused by septal spurs
Chronic and uncontrolled nosebleeds
Chronic sinusitis associated with a deviated septum
Tumor excision
8.
9. ⦿ The goal of septoplasty is to improve breathing
through the nose and also to prevent sinus
infections.
⦿ The procedure usually involves an excision of a
portion of the cartilage and bone.
⦿ An incision is made in the lining of the septum to
reach the cartilage.
⦿ The septum may then be stabilized with small
plastic tubes, splints or nasal packs to prevent
bleeding.
10.
11. ⦿ Nasal Septum - a
partition dividing
between 2 nasal
cavities
⦿ Sinuses- - It
secretes mucus fluid
that usually drains
into the nose
15. On 10th August 2009 at 1400H, a 26 y/o
female Saudi patient admitted from ENT
out patient department with known case
of Deviated Septum.
Scheduled for Septoplasty on 11th August
2009 at 0900H under DR. Hossam.
16. L.O.C.
Heart
- Alert, oriented, ambulatory, on room air
- Normal heart sound
Abdomen - soft, lax, non-tender
, + bowel sounds
Admission and surgical consent signed by father. As
per protocol, DVT form, general history and physical
assessment filled by admitting physician
17. Patient complained of nasal obstruction
since there was no improvement with
medical treatment, so advised for surgical
treatment
18. Routine admission procedure done. Fall Risk
assessment form completed. Baseline V/S
checked:
BP
Pulse Rate
Respiration
Temp.
O2 saturation
Weight
Height
117/70mmHg
80bpm
20breaths/min
37degrees centigrade
98% on room air
103kg
165cm
19. CBC :
Hgb
Hct
Plt
RBC
13.6 g/dL
39.9 %
232 K/dL
4.73 M/uL
NORMAL VALUE
12.0- 18.0 g/dL
37.0- 51.0 %
140- 440 K/dL
4.20- 6.30 M/uL
Coagulation profile:
10.7- 12.1 sec
32.6- 37.6 sec
PT
PTT
INR
11.6 sec
34.8 sec
1.0
Blood chemistry was done also. All within normal
range.
20. On 10th August 2009 Evening shift:
⚫ Consent for surgery checked and confirmed.
⚫ Routine evening care done.
⚫ Anesthesia evaluation done at 2100h, with pre-
anesthesia checklist completed.
21. ⚫ Patient was instructed Nothing Per Orem after 12
midnight as ordered. Re-assured.
⚫ IV cannula G22 inserted on Rt Metacarpal vein at
0530H. NPO re-iterated.
⚫ IV fluid D5 Water 500ml hooked and regulated at
100ml/hr rate at 0600H.
22. On 11th August 2009 Day shift:
⦿
⦿
Injection Zantac 50mg IV and Premosan 10 mg
IV given at 0830h.
NPO maintained.
23. ⦿ Pre-op V/S checked and recorded.
⦿
⦿
Pre-operative checklist as per protocol checked,
done and completed.
Patient reassured and to Operating room on call
for septoplasty.
24. ⦿
⦿
⦿
⦿
Patient was propped in reclined position.
V/S checked as per protocol.
Patient was instructed not to blow in the nose.
Dressing was assessed for further bleeding.
25. ⦿ Sips of water served and when tolerated, normal
diet served.
⦿
⦿
Pain assessed and analgesic given as prescribed.
Kept rested with siderails up in comfortable
position.
26. ⦿ Nasal pack was removed by ENT surgeon on 12th
August 2009 at 0800H.
⦿ Dressing was changed and noted for further
bleeding.
⦿
⦿
Tolerated normal diet.
Discharged at 1400H with discharge and home
meds instructions given.
28. DRUG
NAME
DOSE &
ROUTE
INDICATION ADVERSE
REAC TION
I
nj. Z
antac 50 mg IV stat -Duodenal ulcer,
gastric ulcer including
that associated with
non- steroidal anti-
inflammatory agents
- post- operative ulcer
-Diarrhea and
other gastro-
intestinal
disturbances,
altered liver
function tests,
headache,
dizziness, rash
I
njPrimperan 10mg IV stat Nausea and vomiting,
dyspeptic manifestation
due to a digestive
mobility disorder
Extrapyramidal
reactions,
drowsiness,
vertigo, dizziness,
headache,
depression, GI
disturbances and
HTN
29. DRUG
NAME
DOSE &
ROUTE
INDICATION ADVERSE
REACTION
Tab Klacid 500mg BD per
orem
Treatment of infections:
-Lower respiratory tract
infection
- Upper respiratory
tract infection
- Nausea,
headache,,
dyspepsia,
diarrhea,
vomiting,
abdominal pain
and paresthesia
Tab Sapofen 400mg BD per
orem
Anti- inflammatory and
analgesic effects.
- To relive pain in post-
operative cases
- Gastrointestinal
disturbances,
skin rash,
nervousness,
headache,
tinnitus.
POST-OP MEDIC INE
30. DRUG
NAME
DOSE &
ROUTE
INDICATION ADVERSE
REACTION
Tab Sapofen 400mg BD per
orem
Anti- inflammatory and
analgesic effects.
- To relive pain in post-
operative cases
- Gastrointestinal
disturbances,
skin rash,
nervousness,
headache,
tinnitus.
POST-OP MEDIC INE
32. NURSING
DIAGNOSIS
ASSESSMENT GOAL INTERVENTION RATIONALE EVALUATION
Fear and
anxiety r/
t
upcoming
invasive
procedure
S - “ Ana fi
kouf
sister”as
verbalized
by patient.
O- uneasy
feeling,
facial
expression
Patient will
be able to
control and
reduce the
level of fear
and anxiety
pre and
post
operatively
-Clear and
concise
explanation was
given regarding
procedure .
- Encouraged
patient to
verbalize
feelings and
reassured.
-To lessen
patient’s
fear
-Patient
verbalized
that she
understoo
d the
procedure.
- Patient
verbalized
she feels
better and
calm.
33. NURSING
DIAGNOSIS
ASSESSMENT GOAL INTERVENTION RATIONALE EVALUATION
POST-OP:
Alteration
in
comfort;
pain r/t
post
septoplas
ty
S- “ Ahlam
sister” as
claimed by
patient.
O- slght
swelling
noted over
patient’s
nose
To promote
comfort by
minimizing
pain.
-Post-op V/S
monitored
according to
protocol.
-Analgesic
administered as
prescribed.
To
monitor
level of
pain and
lessen
pain
Patient
verbalized
relief and
minimal
tolerable
pain.
34. NURSING
DIAGNOSIS
ASSESSMENT GOAL INTERVENTION RATIONALE EVALUATION
Potential
for
bleeding
r/t post-
op
procedure
S- “ Fi dam
etla”
O- nasal
dressing
was
minimally
soaked
with blood
- To
minimize
and
prevent
further
bleeding on
the
operated
site
-Patient’s head
was kept
elevated and
rested in
reclined
position.
- Dressing
checked every
now and then
for further
bleeding.
Head
elevation
reduces
further
bleeding
and
swelling .
No further
bleeding or
swelling
noted.
Bleeding
and
swelling
minimized.
36. Septoplasty can occasionally lead to a few minor
complications like:
⦿
⦿
⦿
⦿
⦿
⦿
Bleeding
Infection
Septal perforation
Nasal deformity
Adhesions
Numbness of upper front teeth
37.
38. Patient was instructed and taught:
⦿
⦿
⦿
⦿
⦿
To expect blood stained/ pinkish discharge for a few
days
That she will be breathing through mouth until
swelling is gone.
Not to hit or move any part of the nose.
Not to hold back a sneeze. Sneeze with the mouth
open.
To expect a crusting in the nose for not more than 6
weeks while the incision is healing.
39. ⦿ She can eat and drink normally although soft diet
are best.
⦿ To avoid all moderate and heavy physical activity,
including sport for ten days after the operation and
avoid bending.
⦿
⦿
⦿
Avoid smoky, dusty and dry atmospheres.
If develops a temperature and increasing nasal /
facial pain a few days after the operation, to consult
doctor.
Improvement in nasal breathing may take a few
weeks.
