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NURSING CONSIDERATIONS:
Neuro checks will be done q 1 hour with VS X 2, q 2 hr. X 2, and then q 4 hr.
During Neuro checks assess for mental orientation and level of consciousness.
Hypoglossal- ability to position tongue midline. If tongue deviates to one side, call the
surgeon. Assess hypoglossal pharyngeal nerve for swallowing ability
Facial- Ask patient to smile and puff cheeks
Vagus- Ask the patient to speak, if unable to speak or speech is garbled, call surgeon.
Spinal Accessory- bilaterally raise arms and sustain for 3 seconds
Assess pupillary reaction during neuro checks. Assess all four extremities for equal strength,
movement, and sensation.
NURSING CONSIDERATIONS CONTINUED:
Assess that airway is intact. Assess neck for edema and hematomas. Take note of anyu tracheal
deviation, respiratory distress (stridor), drooling, and problems swallowing. Assess breath
sounds. Call surgeon immediately for any airway issues.
Assess incision for approximation of edges and any bleeding, drainage or redness. Assess for
hematoma at neck- Call if increase edema or grapefruit size hematoma.
Assess Vital Signs as ordered. Due to manipulation of baroreceptors close to the carotid artery,
Blood Press control is very important and must be within normal parameters. Call if SBP > 180
or DBP < 100.
Patients with local nerve block anesthesia may have numbness after surgery
extending into the neck/throat area, shoulder and down to the nipple line on side of
surgery. This should wear off in 6-8 hours after surgery.
If the patient has a head ache after surgery due to reperfusion, give Tylenol. If not
relief of headache within 1-2 hours of Tylenol, call surgeon- this may be a sign of an
intracranial bleed and will need an US of the neck and a CT of the head to r/o bleed.
Surgeons do not want these patients to receive Lovenox until cleared by them.
Administration of Lovenox is associated with high risk of bleeding which could cause
respiratory compromise if hematoma develops at incisional site.
Prior to discharge, have patient look into the mirror to see how much swelling is
present in the neck area. Tell the patient to notify the surgeon immediately if the
swelling enlarges.