NURSING PROCESS:

MASTOID SURGERY
RUDI HAMARNO

AssessmenT
The

health history : infection, otalgia,

otorrhea, hearing loss, vertigo.
The duration and intensity, its causes, &
previous treatments.
Other health problems & all medications

 Medication
Physical

allergies and family history

assessment : erythema, edema,

otorrhea, lesions, odor (bau busuk) &
color of discharge.

Audiogram

Nursing Diagnoses
a.

Anxiety r/t surgical procedure, potensial loss of

hearing, pot/ taste disturbance, & pot/ loss of
facial movement

b. Acute pain r/t mastoid surgery

c. Risk for infection r/t mastoidectomy, placement
of grafts, prostheses, electrodes, & surgical
trauma to surrounding tissues & structures

Nursing Diagnoses
d. Disturbed auditory sensory perception r/t ear
disorder, surgery, or packing
e. Risk for trauma r/t balance difficulties or vertigo
during the immediate postoperative period
f. Disturbed sensory perception r/t potential
damage to facial nerve (N VII) & chorda
tympani nerve

Nursing Diagnoses (conti)

g. Impaired skin integrity r/t ear surgery, incisions, &
graft sites
h. Deficient knowledge about mastoid disease, surgical
procedure, & postoperative care & expectations
(Smeltzer & Bare, 2002)

Planning and Goals

The major goals :
Reduction of anxiety
Freedom from pain and discomfort
Prevention of infection
Stable or improved hearing and
communication

 Absence

of injury from vertigo

Absence of or adjustment to sensory or
perceptual alterations
Return of skin integrity
Increased knowledge the disease, surgical
procedure, & postoperative care.

Nursing Interventions
REDUCING ANXIETY
Reinforced information otologic surgeon :
anesthesia, the location of incision, &
expected surgical results
Encouraged

surgery.

to discuss any anxieties & the

RELIEVING PAIN
Analgesic

: the first 24 hours after surgery

Timpanoplasti

: Packing (Tampon) to

stabilize TM
Pain

: 2 to 3 weeks after surgery .

PREVENTING INFECTION
Packing

(tampon) direndam AB before

dipasang.
Prophylactic antibiotics
Prevent

water entering MAE for 6 weeks.

 Incision

should be kept dry for 2 days.

Signs of infection are reported.
Some serosanguineous is normal after
surgery.

IMPROVING HEARING AND

COMMUNICATION
Reducing

environmental noise,
Facing the patient when speaking,
Speaking clearly
Providing good lighting
Using nonverbal clues
Uses assistive hearing devices

PREVENTING INJURY
Antiemetics

or antivertiginous
(eg, antihistamines)
Assisted ambulation
Safety measures at home

PREVENTING ALTERED
SENSORY PERCEPTION
Report

facial nerve weakness

Disturbance in the chorda tympani nerve.
A taste disturbance and dry mouth on the
side of surgery for several months.

PROMOTING WOUND HEALING

a.
b.

Kepala tinggi (2 bantal)

Avoid
Heavy lifting, *Straining (ngejan),
Exertion,
* Nose blowing,
Membungkuk
for 2 to 3 weeks after surgery.

INCREASING KNOWLEDGE
Informasi

: the surgery and operating

room environment.
Discussing postop expectations
Teaching the patient sesuai ahli bedah

PROMOTING HOME AND

COMMUNITY-BASED CARE
Instruction

: medication therapy & effects

instruction : activity restrictions.
Complications : infection, facial nerve
weakness, taste disturbances.

Continuing Care
Require

services of a home care nurse

Require help with ambulation
Scheduling & keeping follow-up

Evaluation

1.

Demonstrates reduced anxiety

a. Verbalizes and exhibits less stress,

tension, and irritability
b. Verbalizes acceptance surgery and
adjustment to hearing impairment

2. Remains free of discomfort or pain

a. No facial grimacing, moaning (merintih),
or crying, & reports absence of pain
b. Uses analgesics appropriately

3. No signs or symptoms of infection

a. Normal vital signs
b. Absence of purulent drainage
c. Describes method for preventing water
from contaminating packing

4. Signs :hearing has stabilized or improved

a. Surgical goal for hearing has been met
b. Verbalizes that hearing has improved
5. Free of injury and trauma
a. Absence of vertigo
b. Experiences no injury or fall
c. Modifies environment

6. Free from altered sensory perception

Reports no taste disturbance, mouth dryness, or
facial weakness
7. Demonstrates no skin breakdown
a. Lists ways to prevent dislodging graft or
prosthesis
b. Aware of limitations in activities

8. Verbalizes : methods of care and

treatment
a. Shares knowledge with family about treatment
protocol
b. Describes treatment & the time frame for
recovery phase
c. Discusses discharge plan : rest periods,
medication, & activities
permitted & restricted
d. Lists symptoms that should be reported
e. Keeps follow-up appointments

PATIENT EDUCATION
After Middle Ear or Mastoid Surgery
Antibiotics

& obat lain k/p

Blow nose : 1 side at a time for 1 week
after surgery.
Sneeze & cough with the mouth open for a
few weeks aftersurgery.
Check with your health care provider
(usually 2 to 3 days postop).

 Avoid

lifting (>11kg), mengejan, &

bungkuk for a few weeks after surgery.
Popping & crackling : 3 to 5 weeks after
surgery.
Be aware that packing in the operated ear,
will cause a hearing loss.
You may also feel that you are talking in a
well or hearing echoes.

 Minor

ear discomfort is normal; use the

analgesics.
Slightly bloody or serosanguineous is
normal after surgery.
Report any excessive or purulent ear
drainage to the surgeon.
Change the cotton ball in the ear as
needed.

 Check

with the surgeon for instructions

regarding air travel.
Avoid getting water in the operated ear for
2 weeks after surgery.
You may shampoo the hair 2 to 3 days
postop
If the postauricular suture line becomes
wet, pat (not rub) the area and cover .

Thank