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Table 5-22

Surgical ProcedureSpecific Nursing Care
TONSILLECTOMYPreoperative: check bleeding and clotting times.
Postoperative:
  • infoImagePosition—place on abdomen or semiprone with head turned to side to prevent aspiration.
  • Observe for most frequent complication—hemorrhage (frequent swallowing, emesis of bright red blood, shock).
Prevent bleeding:
  • Do not suction—may cause bleeding.
  • Do not encourage coughing, clearing throat, or blowing nose—may aggravate operative site and cause bleeding.
  • Minimize crying.
Decrease pain:
  • pillImageOffer ice collar to decrease pain and for vasoconstriction, but do not force.
  • Acetaminophen for pain ( no aspirin, ibuprofen).
foodImageNutrition:
  • NPO initially, then cool, clear fluids such as cool water, crushed ice, flavored icepops, dilute (noncitrus) fruit juice.
  • No red or brown fluids (punch, Jell-O, icepops, colas), citrus juices, warm fluids (tea, broth), toast, milk/ice cream/pudding, carbonated sodas; progress to soft, bland foods; milk products can increase production of mucus.
Teach parents/discharge planning:
  • Signs and symptoms of infection; call physician promptly.
  • foodImage5–10 days postoperatively, expect slight bleeding.
  • Continue soft, bland diet as tolerated.
MYRINGOTOMY (“tubes”)Postoperative:
  • infoImagePosition—place with operated ear down, to allow for drainage. Expect moderate amount of purulent drainage initially.
  • Keep external ear canal clean and dry.
Teach parents/discharge planning:
  • Need to keep water out of ear—use special ear plugs when bathing or swimming.
  • “Tubes” will remain in place 3–7 months and then fall out spontaneously (with healing of eardrum).
APPENDECTOMY(Observe same principles of preoperative and postoperative care as for adult GI surgery.)
  • infoImageNPO until bowel sounds return (24–48 hours).
  • If appendix ruptured preoperatively or intraoperatively, position in semi-Fowler’s and implement wound precautions; administer antibiotics as ordered.
  • pillImageMonitor for signs and symptoms of peritonitis.
  • Typical course: speedy recovery, with discharge in about 2–3 days and excellent prognosis.
HERNIORRHAPHY (umbilical/inguinal)Umbilical: increased incidence in infants who are of African descent.
Inguinal: increased incidence in boys.
Preoperative: monitor for possible complications of strangulation.
Routine postoperative GI surgery care.
Prognosis—excellent, with discharge 24–48 hours postoperatively.