Running Head: NURSING CARE PLAN 1

Nursing Care Plan for Post-Operative Septoplasty

Students Name

Institutional Affiliation
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Nursing Care Plan for Post-Operative Septoplasty

Nasal problems could be at times unbearable leading to breathing through the mouth. As

known, there is a remarkable difference between taking air through the mouth and the nose.

Kellys case presented herein shows a deviated septum leading to her breathing through the

mouth rather than the nose. Stevenson (2015) defines deviated septum as a condition in which

the nasal septum that is the cartilage that makes a division between the nasal cavity and the bone

becomes deviated and off-centered thereby increasing the breathing difficulty. It also creates an

imbalance in the air passing through the nose which further contributes to breathing through the

mouth. From observing Kellys problem by use of ISoBAR, the paper intends to develop a

nursing care plan for her post-surgery management.

The conditions Background

Kelly has been experiencing breathing difficulties, particularly when breathing through

the nose. This disrupts various activities she is involved in such as sleep, exercises and any other

activity that would require intense breathing. She uses mouth -breathing techniques to stabilize

her condition but it is important to take note of the problem affiliated with mouth breathing such

as dry mouth and taking in air with many impurities like dust. Also, the mouth lacks olfactory

cells, and the probability of taking impure air is quite high. She undergoes a surgery and

afterward a care plan is devised for her in response to ISoBAR. Nevertheless, it is worth pointing

out that while all the other components of the ISoBAR remain standard, the identity of the

patient seems insufficient as it does not talk much about the environment leading to her

condition. The rest of the components remain informative. For instance, the observations made

are sufficient enough to recommend a nursing care plan as they tend to show no deviation from

the pre-operative phase.

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Management

Effective management of Kellys condition should follow several identified problems.

After the surgery, she is noted to have a pain score of 2/10 while the rest of the conditions

observed in her maintain their status quo, except for a slight variation in Temperature that drops

by 0.2o C and HR from 69-68Bpm. This is still within the required range of performance. So, at

this point, the management plan should encompass the chronic pain management she is

experiencing. The acute pain could be as a result of the nasal fracture in the deviated septum.

Another problem that is worth managing is the bleeding she is currently experiencing from her

nose. Although it is moderate, it is worth noting that it could be as a result of trying to breathe

using her nose. This implies that there is need to normalize her breathing pattern in the post-

operative period. Finally, in the pursuit of managing her conditions, it is important to assist her to

manage any form of anxiety that may arise during the managing process.

Assessment

In the post-operative phase, Kelly is active and alert although she still has a few problems

that still required the attention of a medical practitioner. She has a nasal bolster under her nose,

which is due to septoplasty. The bolster could also be as a result of cartilage removal from nasal

septum to relieve the patient from nose blockage (Hahn, 2017). She also has been found

experiencing the moderate level of sanguineous secretion, which in one way or another could

have caused some bleeding during surgery. Therefore, to stop the bleeding, it will be important

to look for splints or holding tissues as suggested by Moore and Strapp (2015). In post-operative

period, she shows normal temperature of 36.20 C. Her heart rate is normal, i.e. 68 bpm.

Respiration rate is also normal, i.e. 18 pm. Blood pressure is also normalizing, as in the post-

operative period it is 111/73 mmHg. The pain score is gradually improving. Along with these
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results is the ooze of blood that keeps coming through her nose which should be controlled

gradually as time passes. Among other subjective factors, is the likelihood that Ms. Kelly will

have a dry throat and mouth, and difficulty in opening her mouth due to nasal pain. This could

lead to increased difficulty in breathing in the initial post-surgery period, as she has been

breathing from the mouth (Enache et al., 2014).

Nursing

Following the patients data obtained in the post-operation, it is evident that a few issues

require medical management before escalating to worse conditions. Kellys case comprises three

areas of primary concern. Managing the bleeding should have the top priority. This is crucial as

it would improve the patients life since uncontrolled bleeding could lead to decreased blood

quantity which could necessitate blood transfusion. Controlling bleeding is as crucial as restoring

the condition of the patient back to normal. Along with controlling bleeding is the need to

manage the nasal bolster which has a moderate level of sanguineous ooze. In support of the

findings of Marston et al., (2017) administering simple analgesia can be recommended as it will

react and with time heal the bolster. Finally, it is important to pay close attention to any

secondary infection or health condition that would arise during the post-operative phase with

much focus on the nasal cavity as it is the operated part.

Planning

The results and the current condition of the patient necessitate effective planning to

stabilize the prioritized issues in the diagnosis. Firstly, is the need to control the bleeding as

quick as possible. Postoperative bleeding can be as a result of various causes occurring during

the operation such as injury to blood vessels. In a case where it is severe, another surgery may be

done to fix the problem. In this case, however, it does not appear that critical and therefore
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administering antifibrinolytic medicines could be a strategic way of bringing the bleeding to a

halt. Along with the management of bleeding is the need to take proper care of the parts near the

nose bolster to avoid development of secondary infection. As proposed by Rowland (2012) the

use of a clean towel that is sterilized along other items will be ideal to maintain the cleanliness

required. It is important to avoid any form of distraction to the patient during the post-operative

phase as she might be psychologically fearful and worried about her condition and hence it will

be ensured that she does not see anybody until she can speak properly after nasal bolster has

been compressed. Finally, the patient will be monitored at an interval of every 6 hours and all the

observations recorded and assessed for a positive deviation.

Implementation

The quick recovery of the patient will involve various interventions enforced as required.

The nurse will administer all the analgesics as prescribed. Along with this will be the application

of antifibrinolytic medicines to slow down the bleeding. Also, applying ice to the nose will

control bleeding and heal the bolster too. In the process of implementing all health care plan, it

will be crucial to inspect the oropharynx periodically to ensure that there is no bleeding. During

this period, the patient will still be breathing through the mouth although in the gentlest way

possible. This implies that it will be important to maintain higher standards of oral hygiene and

the general cleanliness of the patient as well as the surrounding environment. During the time of

implementing the plan, the patient is expected not to speak to avoid tampering with the operated

nose. Finally, obtaining readings periodically and forming comparison will be an important

component of the implementation as it will ensure that the patient is progressing as anticipated

(Mobley & Long, 2016).

Evaluation
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It is important to keep checking whether the planned outcomes are the desired ones or

there is a need for strategizing. The pain score exhibited by the patient shows a remarkable

decrease from the initial pain realized. The patient is increasingly becoming active, alert and has

a relaxed outlook. She understands that she must remain silent most of the time to facilitate

healing and pain reduction. Respiration rate and heart rate along with blood pressure have

already been under control. Furthermore, owing to the maximum care provided, the result was

that there was no further development in infection and patient appeared to recover with the

passage of time. The main evidence of goals being met according to plan is that observations are

appearing more normal than before (Yadav et al., 2017). This was true in the case of Ms. Kelly

as well. The deformity in her nasal cavity due to deviated septum was now corrected through

surgery, and she was able to breathe through her nose. However, it has been recommended that

she must use her mouth for few days until she begins to breathe again through the nose later on.

Post-operative education

The patient has understood that she must keep on breathing through the mouth until the

operated part is healed completely. Nevertheless, she should be taught on how to open the mouth

to avoid injuring her nose. Ms. Kelly will also be advised to take hot showers more frequently,

and she should also breathe in the steam. The sniffing of water through the nose will ensure any

mucus or clot is not developing within the sinuses in post-operative period (Everett-Gayle &

Naser, 2014). She will also be educated about the whole procedure of how she can better take

care of herself amidst post-operative phase. In this regard, she will further be advised not to blow

her nose until she has been cleared by the doctor to do so. She must also sleep by keeping her

head bit high. Similarly, getting all the medicines prescribed by a doctor on time will also be
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advised to her, and she will be educated about how she can avoid mouth-breathe in future to

improve her nasal breathing.

Potential complication

Several complications could arise in the process of providing nursing care. Of particular

concern to this case is postoperative infections. Failure to maintain high levels of sanitation

around the patient could lead to infection development. Thus, there is need to keep the

environment surrounding the patient clean as well as promoting oral hygiene. Additionally, lack

of care can also cause potential damage to the perforated septum which will further cause

weaknesses in the septum that will resultantly lead to the deformity in future (Linton, 2015).

Finally, another potential complication can arise is hemorrhage due to rupturing. Even a smaller

one will cause bleeding from the nasal vessel.

Involvement of Interdisciplinary

The interdisciplinary will comprise various practitioners. First, there will be the

psychiatrist who will relieve Kelly of any anxiety arising from treatment and make her aware of

the benefits she will derive from the exercise. Secondly, there will be a helper to assist in

maintaining the required level of hygiene. Finally, there will be a doctor who will keep

evaluating the report for the patient for her timely recovery and discharge.

Conclusion

The nursing care plan is an important exercise that can ensure the wellbeing of patients

after going through any medical exercise like Kellys. The case of Kelly seems to be a success

since the desired objectives were achieved. Thus, efficacy in planning, interventions based on

diagnosis, and thorough assessment steered the exercise towards success. The patient recovered

in many aspects that involved pain, improved functioning of the nasal cavity while breathing.
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Hence, it is possible to infer that the desired nursing care plan has been implemented in a

meticulous manner based on following the scientific evidence and previous research.
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References

Enache, A., Lieder, A., & Issing, W. (2014). Nasal septoplasty with submucosal diathermy to

inferior turbinates improves symptoms at 3 months postoperatively in a study of one

hundred and one patients. Clinical Otolaryngology, 39(1), 57-63.

http://dx.doi.org/10.1111/coa.12219

Everett-Gayle, L., & Naser, D. (2014). Effect of Preoperative Education on Postsurgical Pain

Perception (1st ed.). New York: Wiley.

Hahn, S. (2017). Osseous and Cartilaginous Nasal Reconstruction. Facial Plastic

Surgery, 33(01), 043-051. http://dx.doi.org/10.1055/s-0036-1597897

Linton, A. (2015). Introduction to Medical-Surgical Nursing (2nd ed.). [Place of publication not

identified]: Elsevier Saunders.

Marston, A., O'Brien, E., & Hamilton, G. (2017). Nasal Injuries in Sports. Clinics in Sports

Medicine, 36(2), 337-353. http://dx.doi.org/10.1016/j.csm.2016.11.004

Mobley, S., & Long, J. (2016). Extracorporeal septoplasty: assessing functional outcomes using

the validated nasal obstruction symptom evaluation score over a 3-year period. Plastic and

Reconstructive Surgery, 137(1), 151e-163e.

http://dx.doi.org/10.1097/prs.0000000000001885

Moore, Z., & Strapp, H. (2015). Managing the problem of excess exudate. British Journal of

Nursing, 24(Sup15), S12-S17. http://dx.doi.org/10.12968/bjon.2015.24.sup15.s12

Rowland, L. (2012). Making good oral hygiene a priority for all our patients. Nursing

Standard, 26(27), 35-35. http://dx.doi.org/10.7748/ns2012.03.26.27.35.p7767

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Stevenson, R. (2015). Human Malformations and Related Anomalies (5th ed.). New York:

Oxford Univ. Press.

Yadav, K., Ojha, T., Gakhar, S., Sharma, A., Singhal, A., & Kataria, V. (2017). Effectiveness of

Nasal Packing in Trans-Septal Suturing Technique in Septoplasty: A Randomized

Comparative Study. Indian Journal of Otolaryngology and Head & Neck Surgery, 12(7),

434-456. http://dx.doi.org/10.1007/s12070-017-1111-8
 Running Head: NURSING CARE PLAN 1

Appendix A: Nursing Care Plan

No Assessment/Clinical Diagnosis/Identified Goal/Plan (SMART) Implementation/I Rationale Evaluation

. Manifestations Problem ntervention
1 1. Nasal bolster 1. Potential bleeding 1. Control bleeding 1. Apply ice 1. Determines the Patient is more
under nose due to earlier as quick as to the nose healing of the active, alert and
2. Moderate septoplasty and possible using for bolster clean and also has
level of during post- drugs and ice compressio (Rowland, a relaxed outlook
sanguineous operative care. n and 2012).
secretion 2. Control the nasal controlling
3. Observations bolster which has a bleeding.
are normal moderate level of 2. Administer
4. Nose swelling sanguineous ooze. antifibrinol
3. Infection appeared ytic drugs
during the to control
upcoming invasive bleeding.
procedure. 1. Provide maximum 1. Assist the 1. Ensure the Respiration rate
care to the patient patient to status of the and heart rate
in the form of breathe nose is along with blood
close monitoring through maintained pressure have
for any deviation. mouth (Rowland, already been under
gently and 2012). control.
slowly.
1. Provide a separate 1. Maintain 1. Avoid any Hygiene made it
towel for oral form of possible to heal the
maintaining hygiene. infection nose quickly
hygiene. (Rowland,
2012)
1. Keep away 1. Ensure the 1. Speech will Quick recovery
distractors to patient affect the
facilitate the quick does not operated part
healing process. speak. of nose