An important postoperative care for a patient who has undergone stapedectomy?

VSSC Nursing Officer - 2021

Medical Surgical Nursing

Hard

Appeared in: VSSC Nursing Officer - 2021

Explanation

A stapedectomy is a microsurgical procedure where the stapes bone in the middle ear is replaced with a delicate prosthesis to improve hearing.
Blowing the nose, sneezing, or coughing with the mouth closed creates a sudden spike in pressure within the nasopharynx.
This pressure is transmitted directly to the middle ear via the Eustachian tube.
A sudden increase in middle ear pressure can easily dislodge the newly placed, unsecured prosthesis, leading to surgical failure and hearing loss.
Therefore, teaching the patient to avoid nose blowing and to keep their mouth open when sneezing or coughing is a critical safety measure.

Option A: Checking the gag reflex assesses the function of cranial nerves IX (glossopharyngeal) and X (vagus), which is not directly impacted by middle ear surgery. It is not a specific priority for stapedectomy.
Option C: Positioning the patient on the operated side is contraindicated as it increases pressure, swelling, and fluid accumulation at the surgical site, which can dislodge the prosthesis.
Option D: The phrase 'To frequently' is an incomplete, vague, and nonsensical statement. It does not represent a valid nursing intervention.

Clinical Relevance

Nursing practice connection: Use the key finding related to Postoperative nursing care following stapedectomy to guide bedside assessment, documentation, and the next nursing action.
Patient education is a primary nursing responsibility to prevent postoperative complications. For stapedectomy, successful outcomes are highly dependent on the patient's adherence to activity restrictions.
Failure to provide and reinforce these instructions can lead to prosthesis dislodgement, requiring revision surgery and causing significant distress to the patient.
What if? If the patient reports seasonal allergies with frequent sneezing, the nurse must emphasize the technique of sneezing with the mouth wide open and notify the surgeon, who may prescribe antihistamines or decongestants to manage symptoms and reduce risk.

How to Approach the Question

First, identify the key procedure in the question: 'stapedectomy'. Recall that this is a surgical procedure involving the middle ear.
Think about the anatomy and physiology of the ear. The middle ear is connected to the back of the nose and throat by the Eustachian tube.
Analyze the options in terms of their potential to affect the surgical site. Consider actions that could cause pressure changes or physical disruption.
Evaluate 'Instruct the patient not to blow the nose'. Realize that blowing the nose creates significant pressure that is transmitted to the middle ear, which could dislodge a delicate prosthesis.
Assess the other options: 'Check gag reflex' (related to throat/swallowing, not the middle ear), 'Position on the operated side' (increases pressure, so it's incorrect), and 'To frequently' (incomplete phrase).
Conclude that preventing pressure changes is the most critical and specific intervention for stapedectomy, making the instruction to avoid nose blowing the correct answer.

Concept Tested & Keywords

Q_9___L97mgOCTkGuvml_m

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 pp. 69-71, 70-72