for surgical protocols and case examples go to: parotidectomy with facial nerve dissection

see also: Parotidectomy - case example and anatomy

ROUTINE PREOPERATIVE TEACHING OF THE ADULT PATIENT

1. Objective:
   1. Patient/family will verbalize understanding of routine preoperative instructions.
2. Content:
   1. Refer to clinic policy Routine Preoperative Teaching for the Adult Patient.

DIET

1. Objective:
   1. Patient/family will verbalize understanding of postoperative diet.
2. Content:
   1. Nausea/vomiting may be present the first 24 hours after surgery as a side effect of general anesthetic agents.
   2. Antiemetics will be ordered on a PRN basis IV/PO/PR.
   3. Postoperative diet will begin with clear liquids and advance as patient tolerates when nausea/vomiting resolves.
   4. Patient may prefer soft diet due to discomfort with chewing after surgery.

ACTIVITY

1. Objective:
   1. Patient/family will verbalize understanding of postoperative positioning and activity.
2. Content:
   1. HOB is elevated 30°.
   2. Patient will be encouraged to ambulate and sit in chair when fully awake and alert (UAL).

PAIN MANAGEMENT

1. Objective:
   1. Patient/family will verbalize understanding of pain assessment and medication administration.
2. Content:
   1. Introduce and explain use of pain assessment scales (Simple Descriptive, 0-10 Numeric). Identify patient's preference.
   2. Establish acceptable level of pain.
   3. Reassure that patient will be assessed frequently for pain.
   4. Pain medication will be administered intravenously on PRN basis while IV access is available.
   5. Oral pain medications will be available when patient is taking PO or when pain level no longer warrants IV medication.

WOUND MANAGEMENT

1. Objective:
   1. Patient/family will verbalize understanding of wound management.
2. Content:
   1. Describe location of incisions: will begin preauricularly and extend down to upper lateral neck.
   2. Closed wound drainage:
      1. Drain surgically placed under skin and attached to suction.
      2. Purpose: to facilitate healing by preventing fluid accumulation under skin flap.
      3. Duration: usually 2 to 4 days; discontinue when drainage decreases.
   3. Pressure dressing may be applied initially or possibly after drains removed.
   4. Suture line care is 2 to 4 times daily when dressing not in place; it is continued until sutures removed postoperative day 5 to 7.

IV SOLUTIONS/MEDICATIONS

1. Objective:
   1. Patient/family will verbalize understanding of IV.
2. Content:
   1. Necessary to administer fluids until oral intake is adequate.
   2. IV necessary to administer antibiotics as needed and to provide access for administration of analgesics and antiemetics.

FACIAL NERVE

1. Objective
   1. Patient/family will verbalize understanding of purpose and method of facial nerve assessment/ophthalmic care.
2. Content:
   1. Purpose: assess functioning of facial nerve and potential need for eye care.
   2. Instruct patient to report any eye irritation or foreign body sensation.
   3. Artificial tears or an ointment may be used to provide moisture to eye.

FREY'S SYNDROME

1. Objective:
   1. Patient/family will verbalize understanding of potential occurrence of Frey's syndrome.
2. Content:
   1. Patient may experience localized facial sweating and flushing over surgical site during mastication of food.

NECK DISSECTION

1. Objective:
   1. Patient/family will verbalize understanding of assessments and interventions related to postoperative neck dissection care.
2. Content:
   1. Skin flap will be monitored for adequate circulation.
   2. Avoid constrictive clothing around neck.
   3. Neck may have sunken or depressed appearance on side of dissection.
   4. Patient may experience loss of sensation to posterior scalp, neck, and shoulder.
   5. Patient may experience weakness, discomfort and limited mobility to shoulder. Patient will be assessed during postoperative clinic visits and may be instructed on exercises or referred to physical therapy.
   6. Postoperative pain manifested primarily by headache.

BODY IMAGE/SENSORY CHANGES

1. Objective:
   1. Patient/family will verbalize understanding of potential alterations in physical appearance/body image/sensory changes.
2. Content:
   1. A depression behind the mandible may result from the surgical resection.
   2. Patient will likely experience residual numbness of the cheek and earlobe. Reinforce safety measures to protect skin from injury:
      1. Use caution with heat-producing appliances such as hair dryers and hot rollers.
      2. Do not use hot water bottles or heating pads on this area.
      3. Use protective covering in cold weather to prevent frost bite.
      4. Use sunscreen (SPF 15 or greater) and protective covering to prevent sunburn.
      5. Use electric razor to avoid cutting skin.
   3. Encourage patient to express feelings regarding body image/sensory changes to nursing staff and other health care providers.

DISCHARGE INSTRUCTIONS

1. Objective:
   1. Patient/family will verbalize understanding of home care instructions.
2. Content:
   1. Discharge instructions per handout B-19b1 — Suture Line Care.   
   2. Discharge instructions per handout B-19b1 — Neck Dissection (if indicated)