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.

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

By: Shuroq Safori

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.

-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

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.

Nasal Septum - a partition dividing between 2 nasal cavities

Sinuses- - It secretes mucus fluid that usually drains into the nose

by: Sherly Reji

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.

L.O.C. - Alert, oriented, ambulatory, on room air

Heart - 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

Patient complained of nasal obstruction

since there was no improvement with

medical treatment, so advised for surgical

treatment

Routine admission procedure done. Fall Risk assessment form completed. Baseline V/S checked:

BP 117/70mmHgPulse Rate 80bpmRespiration 20breaths/min Temp. 37degrees centigradeO2 saturation 98% on room airWeight 103kgHeight 165cm

NORMAL VALUE CBC :Hgb 13.6 g/dL 12.0- 18.0 g/dLHct 39.9 % 37.0- 51.0 %Plt 232 K/dL 140- 440 K/dLRBC 4.73 M/uL 4.20- 6.30 M/uL

Coagulation profile:PT 11.6 sec 10.7- 12.1 secPTT 34.8 sec 32.6- 37.6 secINR 1.0

Blood chemistry was done also. All within normal range.

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.

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.

On 11th August 2009 Day shift:

Injection Zantac 50mg IV and Premosan 10 mg IV

given at 0830h.

NPO maintained.

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.

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.

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.

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.

By: Sindhu Philip

DRUG NAME

DOSE & ROUTE

INDICATION ADVERSE REACTION

Inj. Zantac 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

Inj Primperan 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

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 MEDICINE

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 MEDICINE

by: Ednaly Santiago

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 understood the procedure.

- Patient verbalized she feels better and calm.

NURSING DIAGNOSIS

ASSESSMENT GOAL INTERVENTION RATIONALE EVALUATION

POST-OP:

Alteration in comfort; pain r/t post septoplasty

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.

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.

By: Shuroq Safori

Septoplasty can occasionally lead to a few minor

complications like:

Bleeding

Infection

Septal perforation

Nasal deformity

Adhesions

Numbness of upper front teeth

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.

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.