PS2804_198-200 3/12/08 03:26 AM Page 198
Practice Guidelines
Proposed Plastic Surgical Nursing Guidelines
for the Care of the Rhinoplasty Patient
Dawn P. Sagrillo, BSN, RN, CPSN
Sue Kunz, BS, RN, CPSN
As co-authors of the Journal Club,
we would like to introduce a new
focus. This is on a trial basis and
we would appreciate any feedback regarding the usefulness of
the new column. Starting with
this issue, we will take one procedure and provide a template of
practice guidelines. If this is well
received, we will try to provide
two procedures per quarter.
We realize that there are differences in practice styles. Some
practices believe in keeping the
information streamlined; if there
are too many pages of instructions,
the patient may not take the time
to read everything. Other practices
believe in very detailed instructions. You need to decide what
works best in your practice. With
this in mind, the guidelines are
generalized, allowing each practitioner to further develop information tailored to the practice.
PRE-SURGERY GUIDELINES:
RHINOPLASTY (NASAL
SURGERY)
It is essential for optimal healing
that you treat yourself well for
several weeks prior to your surgery as well as several weeks after
surgery. The following guidelines
will assist you in your prepara198
tion for surgery and during your
recovery period.
• Maintain proper skin care: This
includes daily use of a broadspectrum SPF 30 sunscreen,
whether anticipating outdoor
sun exposure or just general
exposure from everyday living.
• Maintain a well-balanced diet:
This is essential for optimal
healing following surgery. Your
practitioner may also recommend the use of specific vitamins and supplements prior to
surgery.
• Stop taking the following for
2–3 weeks prior to surgery
because they can increase your
risk of bleeding and other
complications:
• Aspirin and medications
containing aspirin
• Ibuprofen and anti-inflammatory agents
• Vitamin E
• St. John’s wort
• Gingko
• Garlic supplements
• Green tea or green tea
extracts
• Estrogen supplements
• Other
• Stop smoking: Smoking can
adversely affect your ability to
heal. You must be nicotine and
Plastic Surgical Nursing
❙
smoke free 3 weeks before
surgery. This includes any nicotine-based products (i.e., nicotine patch, gum, chewing
tobacco). Nicotine reduces
blood flow to the skin and can
cause significant complications
during the healing process.
• Stay healthy: Prior to surgery,
maintain optimal health and
hygiene. A cold, virus, or other
illness may require your surgery
to be rescheduled. Contact your
practitioner if any illness or
change in health status arises.
• Plan accordingly: Discuss with
your practitioner the amount
of time off from work necessary and other restrictions such
as driving, lifting, housework,
and exercise. Secure a responsible adult to drive you to and
from surgery and remain with
you for a minimum of 24 hr
following surgery.
Dawn P. Sagrillo, BSN, RN, CPSN, is Vice
President of Aesthetic Advancement, Inc.,
Atlanta, GA, and an Aesthetic Nurse
Specialist, Aesthetic and Reconstructive
Associates, Waukesha, WI.
Sue Kunz, BS, RN, CPSN, is in practice at
the Clinic of Cosmetic Surgery, Milwaukee,
WI.
Address correspondence to Dawn P. Sagrillo,
BSN, RN, CPSN, 23847 Lough Hill Road,
Pewaukee, WI 53072 (e-mail: dsagrillo@
aestheticadvancements.com).
October-December 2008
❙
Volume 28
❙
Number 4
PS2804_198-200 3/12/08 03:26 AM Page 199
• Pre-operative testing: Schedule
any pre-operative testing and
medical clearance examinations
required by your practitioner.
• Prescriptions: Your practitioner
will either provide you with
your prescription for medications prior to the day of surgery
or on the day of the procedure.
You will have pain medication
and possibly antibiotics and
other supplements.
• Follow pre-anesthesia directions: You may not eat or drink
anything after 12:00 a.m. This
includes no candy, gum, or
mints. Only take medications
cleared by your practitioner
the morning of surgery.
Anything more than a small sip
of water as needed to swallow
medication(s) or brush teeth
can result in necessary
cancellation of surgery.
• Shower the night before and the
morning of surgery: Use antibacterial soap. Do not apply
any lotions, makeup, or hair
products on the day of surgery.
• Dress comfortably: Wear comfortable, loose-fitting clothes
that do not have to be pulled
over your head. The best thing
to wear is a button or zip-up top
and elastic-waist pants. You will
want easy-to-slip on flat shoes.
Wear or bring a pair of warm
socks because of the low temperature of the operating room.
• Do not wear makeup, jewelry of
any kind, contact lenses, hair
clips, or body piercing. If there is
an item unable to be removed,
advise the admitting nurse.
• Relax! Although some anxiety
before surgery is common, try
to maintain adequate rest and
avoid unnecessary stress. Contact your practitioner if you are
experiencing any serious stress
or distress over the thought of
surgery or difficulty with sleep.
POSTSURGERY GUIDELINES
To help achieve your optimal surgical outcome as you are healing,
Plastic Surgical Nursing
❙
follow the instructions given by
your practitioner.
There are normal responses to
nasal surgery as well as experiences that may require further
attention by your practitioner.
Expected Postsurgical
Experiences
These include the following:
• Swelling and bruising around
the nose, eyes, and cheeks. You
may also experience a “tight”
sensation in these areas.
• Numbness in the nose and
cheeks.
• Headache and post–nasal drip
• Take the pain medication, as
directed to address any discomfort. If you experience
sharp pain that is consistent
and not relieved by the pain
medication, contact the office
immediately.
• Apply cool compresses over the
eyes and around the nose for
20 min at a time. Avoid applying pressure or anything
frozen directly on the skin on
or around the nose. Avoid
application of heat.
• If you experience any of the
following, call the office
promptly:
• Pain not controlled by the
prescribed medication.
• Bleeding or drainage from
the nose or the mouth
beyond what you have been
told to expect.
• Excessive bruising or sudden swelling that appears to
be present in one area of
your face or nose.
• A temperature higher than
101 F, severe nausea and
vomiting, and continuous
dizziness or unusual behavior.
Splints
Expect to have a splint over your
nose. This provides support and
protection as your nasal bones
and cartilage heal. The splint
should not be removed or adjusted because this may alter your
October-December 2008
❙
Volume 28
❙
Number 4
healing. Contact the office
promptly if it becomes loose or
appears to be coming off.
Packing
This is placed during surgery to
assist in supporting nasal structures that are healing and minimize drainage into your throat.
The packing should not be
removed or cut because this may
cause further bleeding or alter the
delicate structures or stitches in
the nose. Contact the office
promptly if there is a problem
with the placement.
Day of Surgery
• Rest, yet keep moving: It is
important that you rest while
healing, although for very brief
periods of walking inside is
just as important (5–10 min
every couple of hours while
awake).
• Keep your head elevated while
resting: Three to four pillows, a
foam wedge, or recliner chair
will help keep you more comfortable and reduce swelling.
Avoid any bending or straining.
• Fluids and good nutrition:
Drinking plenty of fluids is
important following surgery.
Avoid carbonated, sodium, caffeine, hot, frozen, and, of
course, alcoholic beverages.
Using a sip cup may make
drinking easier. Try to drink a
minimum of 8 ounces every
couple of hours. Eating very
soft foods or nutritious liquids
for the first 24 hr is best.
• Take all prescribed medication,
as directed.
• Change your nasal dressings: It
is typical to have a small gauze
taped below the nostrils. As
blood or drainage will continue to soil the dressing, with the
help of your support person,
this may need to be changed as
often as every couple of hours
in the first 24 hr.
• Stitches: If you have external
stitches, steri-strips/taping, or
199
PS2804_198-200 3/12/08 03:26 AM Page 200
crusting anywhere on the nose
or at any adjacent surgical site,
do not remove them. You may
be directed to clean or apply
ointment to these sites
• Avoid any nose blowing or pressure through the nose: Attempt
to sneeze through your mouth.
• Avoid any pressure on the nose
and splint: Heavy glasses
should be suspended at the
bridge with tape to the forehead to avoid resting on the
nose.
• No smoking: Smoking can
adversely affect your ability to
heal. You must be nicotine and
smoke free 3 weeks after
surgery. This includes any nicotine-based products (i.e., nicotine patch, gum, chewing
tobacco). Nicotine reduces
blood flow to the skin and can
cause significant complications
during the healing process.
Two to 7 Days Following
Surgery
During this period, you will
progress day by day. Slowly move
into your daily activities. You
packing will be removed within
_______ days and, typically, your
splint by ____ days/week.
• Once you have returned for
your postoperative visit, your
practitioner will advise when
you may begin driving and
return to work or a regular
routine at home.
• Continue a soft, well-balanced
diet: You may experience some
discomfort with chewing.
• Sun protection: This includes
daily use of a broad-spectrum
SPF 30 sunscreen, whether
anticipating outdoor sun exposure or just general exposure
from everyday living. Wear a hat
to limit exposure to your nose.
• Caution with skin care: Avoid
glycolic acids, retinols, or
200
•
•
•
•
•
•
other skin care products that
may be irritating until advised
by your practitioner.
Continue with antibiotics or
other medications, as prescribed.
At this time, you may be tapering off any prescription pain
medication to acetaminophen.
Maintain head elevation while
sleeping.
Avoid any nose blowing or pressure through the nose: Attempt
to sneeze through your mouth
for 3 weeks following surgery.
Avoid exercise except for walking. Walking daily will help
prevent the formation of blood
clots.
Continue restriction of no
smoking or alcohol.
Contact lenses may now be
worn. Limit glasses resting on
the bridge of the nose.
One to 4 Weeks Following
Surgery
As you return back to most daily
activities, keep in mind you are still
healing and certain restrictions
and proper care remain a priority.
• Bruising and swelling begin to
improve significantly during
this period. If advised, continue to wear your splint.
• Maintain proper skin care: This
includes daily use of a broadspectrum SPF 30 sunscreen,
whether anticipating outdoor
sun exposure or just general
exposure from everyday living.
The nose and surrounding area
is more sensitive to sunburn or
increased pigmentation. Wearing a hat will also help with
this protection.
• Maintain a well-balanced diet:
This is essential for optimal
healing following surgery.
• Continue restriction of no
smoking.
• Rest or sleep semi-reclined.
Avoid lying flat or on your
Plastic Surgical Nursing
❙
stomach. If it is necessary to
sleep on your side, support
your head/face with two
pillows.
• Remember, same-day surgery
does not mean same-day recovery. Healing is a gradual
process. It is normal to feel
discouraged while waiting for
swelling, bruising, discomfort, and numbness to diminish. Allow yourself to be a
patient! Extra rest, a nutritious diet, and avoidance of
stress are important aids to
recovery.
Four to 6 Weeks Following
Surgery
Overall swelling continues to subside and you will begin to “settle”
into your natural appearance.
• Tenderness, tightness, skin numbness, or bruising (if remaining) will continue to diminish.
• Once cleared through your
practitioner, you may begin to
ease into your workout routine.
Discuss any contact sports and
further protection with your
practitioner before resuming.
The First Year
Continued refinements in your
nasal appearance may take up to
1 year because swelling subsides
and settling has completed its
course. Once the outcome is
complete, your practitioner will
determine whether any further
refinements may be recommended.
Appearances continue to change
with age. Just as other areas of our
face and body may change with
age, so can your nose.
As a final reminder: Please be
sure to call if you have any
questions or concerns. We are
concerned about your physical
and emotional well-being, as
well as want to help in any way
we can.
October-December 2008
❙
Volume 28
❙
Number 4