Stapedectomy

  1. General information
    1. Removal of diseased portion of stapes and replacement with a prosthesis to conduct vibrations from the middle ear to inner ear; usually performed under local anesthesia
    2. Used to treat otosclerosis
  2. Nursing interventions: preoperative
    1. Provide general pre-op nursing care, including an explanation of post-op expectations.
    2. Explain to the client that hearing may improve during surgery and then decrease due to edema and packing.
  3. Nursing interventions: postoperative
    1. Position the client according to the surgeon's orders (possibly with operative ear uppermost to prevent displacement of the graft).
    2. Have client deep breathe every 2 hours while in bed, but no coughing.
    3. Elevate side rails; assist the client with ambulation and move slowly (may have some vertigo).
    4. Administer medications as ordered: analgesics, antibiotics, antiemetics, anti-motion-sickness drugs.
    5. Check dressings frequently for excessive drainage or bleeding.
    6. Assess facial nerve function, i.e., ask client to wrinkle forehead, close eyelids, puff out cheeks, smile and show teeth; check for any asymmetry.
    7. Question client about pain, headache, vertigo, and unusual sensations in the ear; report existence to physician.
    8. Provide client teaching and discharge planning concerning
      1. Warnings against blowing nose or coughing; sneeze with the mouth open
      2. Need to keep ear dry in the shower; no shampooing until allowed
      3. No flying for 6 months, especially if an upper respiratory tract infection is present
      4. Placement of cotton ball in auditory meatus after packing is removed; change twice a day.

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