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Care of the Head and Neck Surgical Patient
Kaokangkue Moua RN, BSN Surgical ICU
CN III Project
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
1
Background of the Project
Head and Neck Surgical patients were inconsistently cared for by SICU and SSDU RN due to lack of knowledge of this patient population
Nurses did not feel confident caring for this patient population and carrying out MD orders per nursing judgement
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Background of the Project
Lack of communication among nurses and physicians have resulted to complications such as: – Bleeding – Failed grafts – Impaired circulation – Obstructive airway
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
3
Indicators for Project
Inconsistent patient care with head and neck surgical patients due to knowledge deficit
Ineffective communication and collaboration among nurses and physicians
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Goal
Improve the delivery of patient care Provide further education regarding head
and neck surgical patients to staff nurses, new hires and new grad nurses
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Components of the Project
Provided a 4 ½ hour education seminar to all SICU and SSDU staff – 98% participation – Another class April 11, 2011
Follow up assessment – Self evaluations – Patient audits – LOS audits
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Outcomes Measures
Improve the delivery of patient care
•No adverse events of airway •Decreased hospitalization, LOS in ICU •Decreased complications
•Rare Carotid Blowout •Unable to assess actual LOS and hospitalization •Longest LOS: 37 Shortest LOS: 1.5weeks •Decreased complications & infection
Provide further education
•Provide on going education as needed •Develop a ENT education resource binder on all SICU and SSDU wings • Consider Educational Tool
•Provide on going in-services as needed •Resource binder on SICU and SSDU units and on PDF Share Point • Annual Educational seminar to new grads, nurses, registry and SPPO staff
Objective Goal Outcome
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Case Study 69 y.o. male with Hx: T2N0 Laryngeal squamous cell
carcinoma s/p RT in 10/07. He had a T4aN0 recurrence in 12/09 and underwent a total laryngectomy. Dysphagia developed and recurrence in the left posterolateral hypopharynx was identified in 06/10.
On 08/24/10, he underwent a left MRND, right neck exploration, total pharyngectomy, esphagectomy, G-tube placement, right ALT free flap with reconstruction of the stoma, pharynx, esophagus, neck skin and soft tissue. Post-operatively, the patient had episodes of hypertension, uncontrolled diabetes and brief episodes of Atrial Fibrillation.
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Case Study
Tachycardia & tachynpea
Reflux Gtube EKG-nonspecific
changes Echo CT r/o PE
Neck dishissence Emesis-laryngectomy
tube, oral cavity & right neck
Right neck exploration I&D Left neck wound
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Case Study POD #28
Copiously bleeding right neck
CODE BLUE Pressure applied Laryngectomy tube
inflated, neck, oral cavity packed
Increase blood loss
OR-innominate vein and artery dissected and clamped
Right neck-large defect Carotid artery and IJ
clamped and ligated SICU-Continue to bleed Care withdrawn:
09/21/2011 @1632
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Suctioning
-20
0
20
40
60
PrePostSelf
Pre 0 1 0 20 40 0
Post 0 0 1 11 49 0
Self 1 0 2 19 39 0
Srongly Disagree
Disagree Neutral Agree Strongly Agree
N/A
How confident do you feel suctioning Head and Neck surgical patients?
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Tracheostomy Care
-100
1020304050
PrePostSelf
Pre 0 0 2 27 32 0
Post 0 1 1 17 42 0
Self 1 0 3 18 39 0
Srongly Disagree
Disagree Neutral Agree Strongly Agree
N/A
How confident do you feel providing trach care to head and neck surgical patients?
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Flap Care and Management
-10
0
10
20
30
40
PrePostSelf
Pre 0 5 15 24 17 0
Post 0 1 1 24 35 0
Self 1 1 7 25 27 0
Srongly Disagree
Disagree Neutral Agree Strongly Agree
N/A
How confident do you feel caring and managing head and neck patients with a flap?
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Patient Education
-100
1020304050
PrePostSelf
Pre 0 2 9 31 19 0
Post 0 0 1 21 39 0
Self 1 1 6 22 31 0
Srongly Disagree
Disagree Neutral Agree Strongly Agree
N/A
How confident do you feel providing head and neck surgical patient education materials with trach care, drain management, surgical wound care and tube
feeds?
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Communication with MD and Chain of Command
-20
0
20
40
60
PrePostSelf
Pre 0 0 7 25 29 0
Post 1 0 0 14 46 0
Self 1 0 4 23 33 0
Srongly Disagree
Disagree Neutral Agree Strongly Agree
N/A
How confident do you feel communicating with the physicians regarding the patient’s plan of care?
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Outcomes: Patient Audits
September 2010-present day: only four major head and neck surgical procedures were done
Avg LOS varies depending on CA diagnosis – SICU: as short as 5 days to as long as several
weeks – SSDU: 4 days to several weeks
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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Outcomes: Patient Audits
Some physicians orders such as tracheal suctioning/care, or stripping JP drains was not being carried out, per flowsheet audit – New grad or traveler nurse
Patient Education: inconsistent, not indicated consistently if patient education on trach care or tube feed administration was done on flowsheet or teaching plan
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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CN III project
Continue to assess, monitor and evaluate patient care and management
Meet with HNS team, collaborate and work together to improve patient outcomes
In-services with SICU/SSDU nursing staff Join SOHN, start California Chapter? Annual Head and Neck Surgical Education
Seminar with HNS physicians
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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References National Cancer Institute. (2005). http://www.cancer.gov/cancertopics/factsheet/Sites-
Types/head-and-neck Rodriguez, C. S., & Blischak , D. M. (2010, May). Communication needs of nonspeaking
hospitalized postoperative patients with head and neck cancer. Applied Nursing Research, 23. Retrieved from http://www.nursingconsult.com/das/journal/view/212977272-2/N/23250713?ec=true&ja=745467&PAGE=1.html&sid=1034181565&source=EM&summaryresults=true&SEQNO=1
Scarpa, R. (2009, August). Surgical Management of Head and Neck Carcinoma. Seminars in Oncology Nursing, 25(3), 172-182.
Shaari, C. M., Buchbinder, D., Costantino, P. D., Lawson, W., Biller, H. F., & Urken, M. L. (1998, April). Complications of Microvascular Head and Neck Surgery in the Elderly . Archieves Otolaryngology Head and Neck Surgery , 124, 407-411.
Thompson, J. M., McFarland, G. K., Hirsch, J. E., & Tucker, S. M. (2002). Cancers of the Head and Neck. In Mosby’s Clinical Nursing. Retrieved from
Thompson, J. M., McFarland, G. K., Hirsch, J. E., & Tucker, S. M. (2002). Ear, Nose and Throat. In Mosby’s Clinical Nursing. Retrieved from http://www.nursingconsult.com/das/book/body/1012316913/1043/137.html?printing=true
Tucker, S. (2000). Laryngectomy: Radical Neck Dissection. In Patient Care Standards: Collaborate Planning and Nursing Interventions. Retrieved from http://www.nursingconsult.com/das/book/212977272-2/view/1337/258.html/4-u1.0-B0-323-00996-4..50019-8--cesec118_5013?sid=1034175261&SEQNO=1&bookft=true&bookftset=1&bbSearchType=single
SE5EOa, Care of the Head and Neck Surgical Patient Education.pdf
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