PREOPERATIVE CARE                                                          ures such as written messages as needed for effective com-
• Review Chapter 7 for routine preoperative care.                          munication with the hearing-impaired client. Reassure the
• Assess the client’s hearing or verify documentation of preoper-          client that decreased hearing acuity immediately after sur-
  ative hearing assessment. These data are important in evaluat-           gery is expected. Hearing improvement, if an expected result of
  ing the results of the surgical procedure.                               the ear surgery, typically does not occur until ear plugs are re-
• Agree on a means of communication to be used after surgery.              moved, and edema and drainage at the operative site have re-
  Hearing may be impaired after surgery.                                   solved. If no reconstruction of the middle ear is done or the
• Explain that blowing of the nose, coughing, and sneezing are             cochlea is involved, permanent hearing loss in the affected ear
  restricted to prevent pressure changes in the middle ear and             may be an expected result.
  potential disruption of the surgical site. If the client needs to      • Remind client to avoid coughing, sneezing, or blowing the
  cough or sneeze, leaving the mouth open minimizes pressure               nose. These increase pressure in the middle ear.
  changes in the middle ear. Providing teaching and the opportu-
                                                                         Client and Family Teaching
  nity to practice before surgery promotes the client’s cooperation in
                                                                         • Provide instructions for home care.
  the postoperative period.
                                                                           a. To prevent contamination of the ear canal, avoid showers,
                                                                              shampooing, and immersing the head until the physician
                                                                              says you can do so.
• Review Chapter 7 for routine postoperative care.                         b. Keep the outer ear plug clean and dry, changing it as
• Assess the client for bleeding or drainage from the affected ear.           needed. Do not remove inner ear dressing until the physi-
  Infection and hemorrhage are possible complications.                        cian so orders.
• Administer antiemetics as ordered to prevent vomiting.                   c. Avoid blowing the nose; if you need to cough or sneeze,
  Vomiting may increase the pressure in the middle ear, disrupting            keep the mouth open.
  the surgical site.                                                       d. Do not swim or dive without physician approval.Check with
• Elevate the head of bed and have the client lie on the unaf-                the physician regarding air travel.
  fected side.This position minimizes the pressure in the middle ear.      e. Meclizine hydrochloride (Antivert) or other antiemetic/
• Assess for vertigo or dizziness, especially with ambulation or              antihistamine medication may be necessary for up to 1
  movement in bed. Avoid unnecessary movements such as                        month following surgery.
  turning.Take measures to ensure safety when the client gets up           f. Fever, bleeding, increased drainage, increased dizziness, or
  and ambulates. Surgery on the ear may disrupt the client’s equi-            decreased hearing after discharge may indicate a complica-
  librium, increasing the risk of falling.                                    tion. Notify the physician if any of these occur.
• Assess the client’s hearing postoperatively. Stand on the
  client’s unaffected side to communicate and use other meas-

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