السبت، 25 أغسطس 2018

126-Neck Dissection

About
Removal of cervical lymph nodes , muscles, and internal jugular vein in the neck area which may include reconstruction with a flap.
Assess
Surgical incision, range of motion of neck, understanding of procedure, pain, vitals, respiratory status.
Complications
Nerve damage, Infection, hemorrhage, impaired communication, fistula, respiratory compromise.
Diagnosis
  • Knowledge deficit related to surgical procedure.
  • Ineffective airway clearance related to surgical procedure.
  • Impaired verbal communication related to surgical intervention.
  • Acute pain related to actual tissue damage from surgical procedure.
  • Risk for infection related to surgical procedure.
  • Nutrition less than body requirements related to impaired oral intake.
Goals
  • The client will maintain a patent airway.
  • The client will remain free from infection.
  • The client will state understanding of pre-, intra-, and post-operative plan of care
  • The client will correctly perform coughing and deep breathing exercises.
  • The client will be able to identify alternative ways to communicate during the post-operative period.
  • The client will indicate a pain level less than 4 on a 0-10 scale.
Interventions
  • Assess respiratory status including lung sounds, pulse-ox, and ventilation settings as indicated.
  • Monitor for stridor, which could indicate severe respiratory compromise.
  • Maintain suction equipment at the bedside and perform suctioning frequently to remove excess secretions.
  • Monitor pain levels, surgical incision site ( color, pallor, warmth, capillary refill) for infection and signs of impaired circulation.
  • Administer pain medications as prescribed.
  • Encourage communication via alternative methods if patient unable to speak.
  • Maintain patient on aspiration precautions.
  • Teach client methods to improve mobility, facilitate coughing, enhance communication, and reduce pain.
  • Monitor drainage containers and record output.
  • Initiate and maintain nutritional support.
  • Report any signs or symptoms of complications immediately to physician.

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