Transcript Essentials of Medical Surgical Nursing

Ni Ketut Alit A
Nursing Faculty Airlangga University
Surabaya East Java.

Black, J.M. & Matassarin E, (1997). Medical Surgical Nursing: Clinical
Management for continuity of care. J.B. Lippincott.co.

Barbara C.L & Wilma J.P. (2006). Essentials of Medical Surgical Nursing.
Philadelphia: Lippincott Williams & Wilkins.

Smeltzer, S.C., & Bare, B. (2003). Brunner and Suddarth's Textbook of
Medical-Surgical Nursing (10th ed.). Philadelphia: Lippincott Williams &
Wilkins.

Ignativicius & Bayne. (2001). Medical and Surgical Nursing. Philadelphia:
W.B. Saunders Company.

Luckman & Sorensen. (2000). Medical Surgical Nursing. Philadelphia:
W.B. Saunders Company.
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Journals and article related to..
The epithelial lining of the middle ear
<continous>
The epithelial lining of the mastoid air cells
(Embedded in the temporal bone)
Mastoiditis is a secondary disorder resulting
inadequated treated Otitis Media.
Mastoiditis can be either acute or chornic; it
was leading cause of death in children and
hearing lossmin adults
The clinical manifestations
of mastoiditis include:
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Swelling behind the ear
Pain with minimal movement of tragus,
the pinna, or the head.
Cellulitis develops on the skin or external scalp
over mastoid process
Clients withs mastoiditis also have low grade
fever, malaise, and anoreksia
Reveals :
 a red, dull, thick, immobile tympanic
membrane with or without perforation
 Postauricuar lymph nodes are tender and
enlarge.
Non Surgical management:
Antibotic therapy is aimed at preventing the
continued spread of infection from the otitis
media or mastoiditis.
But it has limited use in the actual treatment
of mastoiditis because of the difficulty of
acchieving effective antibiotic levels within
the bony structure of mastoid.
Culture material is obtained from the ear
drainage or by myringotomy.
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Surgical removal of the infected tissue is
necessary if the client does not respond to
antibiotic administrationwithin a few day.
A simple or modified radical mastoidectomy
with tympanoplasty is the most common
treatment.
All infected tissue must be removed so that
the infection doesnot spread to other
structures.
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Reassures the client that operative will relive
pain
Discusses the reason for the prosedure with
the client and relieve anciety
Cleans the exteral canal with a bacteriostatic
solution
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Avoid straining when you have bowel elimination.
Do not drink through a straw for 2-3 wk
Avoid air travel for 2-3 wk
Stay away from people with cold
Avoid getting your head wet, washing hair,and
showering for 1 wk
Keep yor ear dry for 6 wk by placing a ball cotton
change daily
Avoid rapidly moving the head for 3 wk
Change eardressing every 24 hour
Report excessive drainage
Compication arise :
 Infective material has not been removed
completely.
 Contamination of other structure outside the
mastoid and middle ear.
Complication include :
Damage to the abducens (NC VI) and facial
cranial nerves (NC VII)
 Decreasing ability to look laterally
 Dropoping the mouth on the affected side
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Vertigo
Meningitis
Brain abcess
Chronic purulent otitis media
Wound infection
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Early manifestation of mastoiditis
development
PSYCHOSOCIAL ASSESMENT
Fear of losing hearing
Deny that the change occurred
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Pain
Sensory /perceptual alteration (auditory)
Risk of infection
Hipertermi
Anciety
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Write down education guide for client post
surgery with mastoiditis!!