1. Nursing management for ear problems and care during ear surgeries

3. Nursing diagnosis
Anxiety related to potential loss of hearing, potential taste disturbance, and potential loss of facial movement
Acute pain related to mastoid surgery
Risk for infection related to mastoidectomy, placement of grafts, prostheses
Disturbed auditory sensory perception related to ear disorder or surgery
Risk for trauma related to impaired balance or vertigo during the immediate post operative period
Disturbed sensory perception related to potential damage to facial nerve
Deficient knowledge about disease condition and surgery

4. Nausea related to inflammation of labyrinth of ear
Hyperthermia related to inflamed ear
Disturbed sensory perception related to altered sensory reception secondary to inflammatory response
Risk for deficient fluid volume related to nausea and vomiting
Risk for injury related to dizziness
Insomnia, disturbed sleep pattern
Impaired physical mobility related to vertigo
Activity intolerance related to dizziness
Acute pain related to inflammation of ear
Impaired verbal communication related to deafness
Deficient knowledge related to disease condition or self management of ear disorder
Hopelessness related to impaired hearing
Disturbed personal identity
Low self esteem

5. Planning and goals
The major goals of caring for a patient undergoing surgery are
Reduction of anxiety
Reducing pain
Prevention of infection
Improving hearing and communication
Preventing injury
Preventing altered sensory perception
Promoting home and community based care

6. Reducing anxiety
Explain information's regarding anesthesia, the location of the incision, expected surgical results
Encourage the patient to discuss any anxieties and concerns about the surgery
Provide psychological support

7. Relieving pain Aural fullness or pressure after surgery is common
Analgesic may be taken for the first 24 hours.
External auditory canal packing is used if tympanoplasty was performed.
Constant throbbing pain accompanied by fever may indicate infection – report to doctor.

8. Preventing infection
External auditory canal packing with an antibiotic solution
Prophylactic antibiotics
Prevent water from entering the auditory canal for atleast 6 weeks
Cotton ball with a water insoluble substance (petroleum jelly)
The post auricular incision should be kept dry for the first 2 days

9. Improving hearing and communication
Hearing in the operated ear may be reduced for several weeks because of edema, accumulation of blood and tissue fluid in the middle ear and dressings or packing
Reducing environmental noise
Facing the patient when speaking
Speak clearly without shouting
Provide good lighting

10. Preventing injury Vertigo may occur
Antiemetic or antihistamines medications – for balance disturbances
Assisted ambulation
Avoid heavy lifting, straining, exertion and nose blowing fro 2 to 3 weeks after surgery

11. Preventing altered sensory perception
Report immediately if any evidence of facial nerve weakness, drooping of mouth, slurred speech, decreased sensation and difficulty swallowing
Promoting home and community based care
Teaching patients self care (refer previous notes)
Follow up