Nursing care plan for nasal fracture

[Drea1713]

Hey everyone here is some info on my pt

46 y/o hispanic female presented to ER with L forhead hematoma, complicated nasal laceration with fracture s/p MVA.

My objective data are : b/p increased 141/99, Hr 89, RR 16, tmp 98.3

She has bilateral nasal packing, sutures to left nares dry and intact, facial edema, dry mucous membranes

Subjective: Dry mouth and throat, difficulting opening mouth d/t nasal pain, difficulty breathing because she is a mouth breather

I am thinking of using 1. Ineffective airway clearance related to nasal fracture and nasal packing manifested by dyspnea, dry mucous membranes, and nasal pain.

Does that seam good? I need four more with a PC.

2. Risk for infection due to nasal laceration

3.Anxiety related to nasal surgery manifiested by nervousness, restlessness, and increasein B/P

4. PC: Septal hematoma

Please feel free to add or suggest other NANDA diagnosis

[Daytonite, BSN, RN]

Symptoms that may or may not occur with nasal fractures and that will help in determining actual and potential nursing problems are:

• epistaxis
  
• nasal swelling
  
• periorbital ecchymosis and edema
  
• pain
  
• nasal deformity
  
• crepitation of the nasal bones
  
• skin lacerations and abrasions over the fracture

Did you look up information about nasal packing and why it gets put in place? Think about the problems that the swelling is causing for this patient. If she has enough swelling perhaps she's going to have difficulty eating and swallowing as well as breathing. With the nasal packing in place a patent airway might be a real problem. You indicated already that one of her symptoms of Ineffective Airway Clearance is that she is having dyspnea (shortness of breath).

This lady has sutures in place. Does she need wound care teaching prior to discharge home? What diagnosis do you need for that nursing problem and interventions?

Complications of having nasal packing include:

• blood loss
  
• infections like otitis media and sinusitis
  
• hypoxemia
  
• airway obstruction
  
• mucosal pressure necrosis
  
• hypotension
  
• septal hematoma perforation
  
• vasovagal episode
  
• migration of nasal packing

Did this lady hit her head during the MVA when she got that hematoma on her forehead? If so, was there any loss of consciousness? Do you think it is important she be monitored for the signs and symptoms of decreased level of consciousness?

[Drea1713]

She did not lose consciousness after the accident. I am was told that the nasal packing was put in place to help control the epitaxsis as well as reduce the swelling to maintain a stable enviornment for healing of the laceration as well as to reduce edema to the area before surgery.

I think it is the biggest problem for her is maintain a patent airway.

For interventions I have

1. Assess respiratory rate, depth, rhythm, effort, and breath sounds every 4 hours. Rationale: Assessing the respiratory status every four hours determines change in status and response to therapy.

2. Position the pt in semi-Fowlers position. Rationale: To facilitate respirations reduce swelling, and control epitaxsis.

• Educate the client and family about the significance of changes in nasal or sputum characteristics, including color, character, amount, and odor. Rationale: The client and family can identify the signs of infection and seek treatment before acute illness occurs.

4. Document the pt teaching and understanding in chart. Rationale: Documentation is in accordance with hospital protocol and for legal purposes.