PRESENTED BY: NORILAH BT ABD WAHAB PB 1/2013 - 0566

What is PREURICULAR SINUS?

Preauricular Sinus is a malformation of the

preauricular soft tissues. It is a congenital disease of external ear. It is commonly seen at the root of helix and is due to incomplete fusion of tubercles. It may get repeatedly infection causing purulent discharge. Abscess may also form. Treatment surgical excision of the track will be done if the sinus gets repeatedly infected.

Pathophysiology

A 6 week old embryo

A 6 week old embryo

Primitive ear

Objective
To give acknowledge skills and confidence among

nursing skills in caring for infected of Preauricular Sinus. To provide the quality of Nursing Care for the patient pre and post operation. To give health education for patients before discharge about a high risk of recurrence of infected Preauricular Sinus.

Patients Data
Name : Nurul Nazirah Bt Rozali
Age : 21 Adress : Kg Puah Seberang Sentul

She lives with her mother and work as a tailor.

She has two siblings She has no medical and past surgical history.

Present History
From the interviewed and data collection,patient

complained had a intermittent discharge from sinus. She had four episodes of infection with classical signs and symptom of pain,erythema,discharge from pit,each time treated with antibiotic and steroids taken from private clinic. She had already completed oral antibiotic for 10 days. She came to Hospital Kuala Lumpur (HKL) clinic on 22nd February 2013. She presented with increase swelling and painful. However,she had no otorrhoea and no fever. She was admitted at HKL ward (SW20) for l/V antibiotic Incision and Drainage under Local Anaesthesia was done.

1. Eye

2. Nose

7.
Elimination and Skin

Assessment Tool

3. Ear

6.
Auscultation

5. Neck

4. Oral Cavity

Treatment
I/V antibiotic (I/V zinacef 750mg stat & tds)
I/M Tramal 50mg (before dressing) Dressing with Normal Saline packed with

ribbon gauze.

Type of Operation Planned

Incision and Drainage under Local Aneashesia.

Definition Type of Operation

Incision and drainage and clinical lancing are minor

surgical procedure to release pus or preasure built up under the skin. It is performed by treating the area with antiseptic, such as iodine-based solution, and then making a small incision to puncture the skin using a sterile instrument such as sharp needle, a pointed scalpel or lancet.

Preparation
1. Psychological
2. Consent 3. Investigation

4. Care of patient

1. Psychological
Explanation about the surgery will do by experience

specialist and will do under Local Anaesthesia. Patient must understanding of the purpose, benefits and risk of planned surgical procedure. Given emotional support to the patient.

2. Consent
Explanation from doctor regarding purpose, procedure

and complication of operation under Local Anaesthesia.

3. Investigation
To make sure all blood investigation normal

4. Care of Patient
Make sure patient take off all jewellers and value

property before send patient to operation. Vital sign taken to detect any abnormalities before send patient to operation theatre.

Technique of Operation
Inciscion & Drainage

Excision

Click Here

Post Operation Complication

1.
2. 3.

4.
5. 6.

Bleeding Erythema Fever Purulent drainage (uncommon) Seroma Keloid

Progress Report of Patient

st 1

March 2013

Nurul Nazihah was admitted to ward HKL (SW20).

She was accompanied by her mother. She looks alert but anxious due to hospitalization. Clerking was done by doctor plan for IV antibiotic and dressing. After interview and physical examination, a few Nursing Diagnosis was identified.

Nursing Diagnosis :
1. Anxious due to hospitalization
Goal : To reduce anxiety

Nursing Intervention a. Asses the level of anxiety through the patients expression complains. b. Provide orientation to the patient regarding the ward structure, ward staff such as doctor, nurse, medical assistant and other staff. c. Encourage patient to ask and answer the question in a right manner. d. Explain all the treatment procedures to the patient in order to reduce anxiety. e. Encourage relative to accompany patient to avoid loneliness. Evaluation Patient looks calm and cheerful.

Nursing Diagnosis :
2. Knowledge deficit to the disease.
Goal : Patient verbalize an increase knowledge level

regarding disease process. Nursing Intervention a. Asses patients level of acknowledge about the disease and treatment to plan for appropriate Nursing care. b. Encourage patient to ask question and allow time for discussion to increase patients knowlegde. c. Explain clearly to patient regarding the disease process and treatment.

d. Reinforce the importance of taking regular analgesic

to minimize pain. e. Provide booklet or pamphlet to patient regarding the disease and management. f. Teach patient on non-pharmacological method of relief pain for example relaxation and breathing exercise. Evaluation Patient understood and looks comfortable.

Nursing Diagnosis : 3. Pain related to the operation site

Goal : To reduce pain

Nursing Intervention a. Asses level of pain through facial expression and patients complaint. b. Be with patient to encounter the problem. c. Lie on the unaffected ear to prevent pressure that can cause pain, advise patient to rest and help assume comfortable position during pain. d. Advise patient on diversion therapy for example reading magazine, watching television to divert the pain. e. Give analgesic as ordered by doctor too reduce the pain and reassess the effectiveness of analgesic after 30 minutes. f. Refer to doctor if pain not relieved and have to change to different analgesic if necessary. Evaluation Pain reduce and patient looks comfoortable.

Second day

nd (2

March 2013)

Patient looked comfortable. Vital sign stable. Afebrile.

Reviewed by ORL specialist and medical official team. Wound inspection to the left ear was done. Wound is clean and no infection seen. ORL suggested to do daily dressing with normal saline packed with ribbon gauge. Continue I/V antibiotic. (I/V Zinacef 750mg tds)

Nursing Diagnosis :
1. Potential for infection related to incision site
Goal : To reduce the infection

Nursing Intervention a. Assess the incision site and monitor for redness and swelling for early detection of infection. b. Dressing must be done under aseptic technique to prevent infection. c. Advise patient to avoid touch the wound to prevent infection. d. Monitor temperature and white blood count. This may indicate and infection. e. Administer antibiotic as prescribed. Antibiotic may be given post operatively to reduce the like hood of infection. Evaluation Wound clean and no infection seen.

Third day

rd (3

March 2013)

Patient looked comfortable. Vital sign stable. Afebrile.

Reviewed by ORL specialist and medical official team. Wound inspection to the left ear was done. Wound is clean and no infection seen. Plan by ORL team. Patient discharge and have to come again (TCA) two weeks later which is on 13th March 2013 to ORL clinic for review.

HEALTH EDUCATION
Assess the level of patient and parents knowledge in

order to ease them understand and accept all the given information from nurse. Advise patient to take a healthy meal for wound curing process. Advise patient to take medicine in accordance to the list given by doctor to make sure patient get effective treatment.

 Advise patient do not touch wounded incision side to

avoid further infection. Inform patient the symptoms of infection such as fever, swollen and redness at incision wound. Advise patient to immediately get a treatment if there is any bleeding or any infection to avoid severe complication. Advise patient to attend follow-up treatment to justify the effectiveness of treatment.

CONCLUSION
Preauricular sinuses are present in front of the ear with

small skin lined tracks that lead from the skin surface to deep within the tissues in front of the ear. This case study was implemented to patient who suffered with this disease. Throughout this treatment, several intervention has been given to patient under the nursing diagnose. Nursing intervention help patient to gain information about the disease and know how to manage this problem from recurrence in long term of period.