ENT ppt RPN Student Copy 2023.pdf

Otorhinolaryngology Surgery Surgery in/on the human ear, nose, and throat  Learning Outcomes ▪ Describe the anatomy of the ears, nose, throat ▪ Explain relevant surgical interventions and procedural considerations for ENT procedures Anatomy – Ear  Anatomy - Ear ▪ E...

Otorhinolaryngology Surgery Surgery in/on the human ear, nose, and throat  Learning Outcomes ▪ Describe the anatomy of the ears, nose, throat ▪ Explain relevant surgical interventions and procedural considerations for ENT procedures Anatomy – Ear  Anatomy - Ear ▪ External Ear – Auricle – External auditory canal (cartilage and skin) – Tympanic Membrane ▪ Middle Ear – Eustachian tube – Ossicles (Malleus, Incus, Stapes) ▪ Inner Ear – Cochlea – Vestibular labyrinth  Perioperative Nursing Considerations ▪ Facial nerve monitoring ▪ Position – Supine with shoulder roll ▪ Prepping – Povidone-iodine solution – Chlorhexidine is ototoxic ▪ Draping ▪ Surgical microscope Ear Instrumentation Ear Instrumentation  Ear Surgery ▪ Myringotomy ▪ Mastoidectomy ▪ Tympanoplasty ▪ Cochlear Implant  Myringotomy ▪ Indicated for acute otitis media with no response to antibiotics ▪ Incision in _______________ ▪ Aspiration of fluid under pressure ▪ Myringotomy tube inserted and left in place ▪ Falls out naturally when ear drum heals ▪ Antibiotic drops instilled post-op Myringotomy  Middle Ear Surgery ▪ Tympanoplasty ▪ Mastoidectomy ▪ Stapedectomy  Mastoidectomy ▪ Removal of diseased bone of the mastoid to treat cholesteatoma ▪ Eardrum incised to drain the middle ear ▪ Topical antibiotics are then placed in the ear  Tympanoplasty ▪ Repair of tympanic membrane for ________ hearing loss or perforation ▪ Graft taken from the ear lobe, back of the ear, or tragus ▪ Post op packing of ear with antibiotic ointment ▪ Microscope required  Cochlear Implant ▪ For _________ hearing loss ▪ Hearing aid implant in cochlea – Osseointegrated bone- anchored ▪ External sound processor sits above the skin behind the ear Cochlear Implant  Nasal Surgery Nose ▪ Supported by cartilage and bone ▪ Two external nares for air passage into nasal cavity ▪ Humidifies and filters the air ▪ Nasal septum – Nasal Cartilage – Perpendicular plate of the ethmoid bones – Vomer bone  Anatomy - Nose Nasal Sinuses ▪ Frontal sinus ▪ Ethmoid sinus ▪ Sphenoid sinus ▪ Maxillary sinus  Perioperative Nursing Considerations ▪ Position – Supine – Semi Fowlers or Fowlers in recovery to decreasing swelling, and improve breathing/drainage ▪ Local: Topical epinephrine on patties to control bleeding ▪ Throat pack ▪ Nasal packing ▪ Moustache dressing ▪ MIS approach available – Sinuscope Webrils or Neuro Patties used with topical epinephrine are packed in the nose prior to prepping to allow for effective vasoconstriction of tissues before surgical incision. Rhinosurgery Instrumentation  Rhinosurgery ▪ Functional Endoscopic Sinus Surgery (FESS) ▪ Closed Reduction of Nasal Fracture ▪ Nasoseptoplasty Rhinosurgery Instrumentation  Functional Endoscopic Sinus Surgery (FESS) ▪ Endoscopic surgery through nasal cavity and into sinuses ▪ Goal is to drain sinuses by resecting tissue and creating aeration Purpose: Polyps Sinus Blockages Allergies (many years) FESS  Closed Reduction of Nasal Fracture ▪ Manual realignment without incision ▪ Nasal packing or Denver split applied  Nasoseptoplasty ▪ Deviated septum causing nasal obstruction ▪ Straightening of the cartilaginous or osseous segments of the septum ▪ Goal: Remove obstruction to improve air entry from nasal cavity ▪ Splints insitu for a few days Throat Surgery  Anatomy - Throat ▪ Oral Cavity – Mouth – Salivary Glands ▪ Pharynx – Nasopharynx – Oropharynx – Hypopharynx ▪ Larynx – Laryngeal cartilages, ligaments, and muscles – Trachea Anatomy - Thyroid  Anatomy - Thyroid ▪ Produce and releases hormones into the body ▪ Two lobes, joined by a ridge of thyroid tissue called isthmus ▪ Regulated by the pituitary gland, which sits at the base of the brain – If the level of thyroid hormone decreases, the pituitary gland produces thyroid stimulating hormone (TSH). – If the levels of thyroid hormones are too high, the pituitary attempts to decrease production by shutting off the TSH  Anatomy – Parathyroid Gland ▪ Consists of four small, flat, yellow, ovoid masses ▪ Secretes parathyroid hormone (PTH) – Antagonist to calcitonin ▪ PTH regulates Calcium in the blood – Increase removal from bone storage – Increase absorption of calcium by intestines  Perioperative Nursing Considerations ▪ Position – Supine head in gel ring – Head extended with sandbag/shoulder roll under shoulders ▪ Drain ▪ Lowers, ties (silk) major vessels ▪ Hemoclips ▪ Nerve stimulator ▪ Small scissors ▪ Vessel loops to isolate major vessels  Throat Surgery ▪ Laryngoscopy ▪ Tonsillectomy ▪ Thyroidectomy ▪ Parotidectomy ▪ Radical Neck Dissection ▪ Tracheostomy  Laryngologic Surgeries Laryngoscopy ▪ Visualize the glottis or vocal cords ▪ Use laryngoscope – Rigid, lighted speculum  Oral Cavity Surgeries Tonsillectomy ▪ Removal of tonsils for chronic tonsillitis ▪ Adenoidectomy is often done at the same time  Neck Surgery - Thyroidectomy ▪ Removal of the thyroid gland – Partial (various types) – Total thyroidectomy ▪ Parathyroid glands may be preserved and reimplanted if there is remaining thyroid ▪ Risk of injury to recurrent laryngeal nerves = damage to voice box Thyroidectomy  Parotidectomy ▪ Removal of one or more parotid glands ▪ Usually a benign tumor ▪ Risk of injury to facial nerve ▪ Drain inserted ▪ May experience post op paralysis  Radical Neck Dissection ▪ Removal of malignant head and neck tissues ▪ Right or Left sided ▪ Radical: – Cervical nodes, fascia, the jugular vein, sternocleidomastoid muscle and 11th cranial nerve, mandible, maxilla, thyroid, and/or parotid. ▪ Patient may require reconstructive surgery – Free flap ▪ Non-radical (modified neck dissection) removal of cervical nodes and fascia ▪ Patient may experience facial numbness, difficulty swallowing, or aesthetic changes  Intra-Oral Cancer ▪ Oral resection (mandible) plus radical neck dissection ▪ Commando Procedure ▪ Require Tracheostomy procedure before starting this procedure  Procedure Considerations AIRWAY: Tracheostomy BEFORE the proposed neck dissection ▪ Position: ▪ Count: ▪ Instruments: Basic ENT tray, snaps, mosquitoes ▪ *15 blades ++++ ▪ Hemostasis: hemoclips, silk ties Vessel loops to isolate major vessels while identifying anatomy Nerve Stimulator Specimens Drain  Tracheostomy ▪ Opening of the trachea and insertion of a cannula through the cricoid cartilage ▪ Elective or emergency ▪ Various size obturators & tracheostomy; confirm with surgeon ▪ **Test cuff for leaks with sterile water BEFORE passing to surgeon  Tracheostomy Required for: Prolonged intubation during the course of a critical illness Severe neck or mouth injuries Foreign body occluding airway Inhalation burn Paralysis of the muscles that affect swallowing causing a danger of aspiration Long term unconsciousness or coma Tracheostomy  Instrumentation Tracheal Dilator Tracheal Hook ▪ Absorbable sutures to close ▪ Nylon suture to secure trach tube Trach Tube & Obturator  References ▪ Rothwell, J. (2022). Alexander’s Care of the Patient in Surgery (17th ed.) Mosby Elsevier. ▪ Tighe, S. (2015). Instrumentation for the Operating Room (9th ed.) Mosby. ▪ ORNAC Standards 2023 ▪ Mayo Foundation for Medical Education and Research (2021)