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 and/or vomiting may be present for the first 24 hours after surgery as a side effect of general anesthetic agents.
   2. Antiemetics may be ordered on a PRN basis IV/PO/PR.
   3. Diet will begin with clear liquids and advanced as tolerated when nausea/vomiting resolves.

PAIN MANAGEMENT

1. Objective:
   1. Patient/family will verbalize understanding of pain assessment and medication administration.
2. Content:
   1. Introduce and explain pain assessment scales (Simple Descriptive, 0-10 Numeric). Identify patient's preference.
   2. Establish acceptable pain level and document.
   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.

ACTIVITY

1. Objective:
   1. Patient/family will verbalize understanding of postoperative activity.
2. Content:
   1. HOB is elevated 30°.
   2. Activity will be UAL.

INTRAVENOUS (IV) SOLUTIONS/MEDICATIONS

1. Objective:
   1. Patient/family will verbalize understanding of IV.
2. Content:
   1. Necessary to administer fluids until oral intake adequate.
   2. IV necessary to administer analgesics/antiemetics and steroids (Decadron) for swelling.

HUMIDITY

1. Objectives:
   1. Patient/family will verbalize understanding of need for postoperative humidity.
2. Content:
   1. Discuss methods of providing supplemental humidity to reduce mouth and throat dryness.

VOICE REST

1. Objectives:
   1. Patient/family will verbalize understanding of voice rest.
2. Content:
   1. Patient may or may not be placed on voice restrictions:
      1. Strict voice rest for 48 hours after surgery is rarely used in our practice, but may be useful for selective cases.
      2. Conservative voice use for 2 weeks is more common, but not always recommended;
         1. The 'Arm's Length Rule": patient not to talk unnecessarily or vocalize any louder than to speak to someone an arm's length away.
   2. Paper and pen or picture board may be provided to assist in communication.

WOUND MANAGEMENT

1. Objective:
   1. Patient/family will verbalize understanding of postoperative wound care.
2. Content:
   1. Neck dressing will be in place and possibly an abdominal dressing if fat is harvested.
   2. Rubber-band drain in the neck incision line.
   3. Suture line care 2 to 4 times daily after dressing is removed, continued until sutures removed postoperative day 5 to 7.

DISCHARGE INSTRUCTIONS

1. Objective:
   1. Patient/family will verbalize understanding of discharge instructions.
2. Content:
   1. Discharge instructions per B-19b1--Vocal Cord Procedure
   2. Discharge instructions per B-19b1--Suture Line Care