Patient Pathways – OMFS (Oral and Maxillofacial Surgery

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Who You’ll Hear

Kati Kleber, MSN RN – Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.

Hannah Schlake, BSN RN CMSRN – ICU nurse in Surgical ICU, preceptor and a charge nurse

What You’ll Learn

• Peg Placemen
• Bilateral Neck Dissection
• Right mendibulectomy
• Fibula free flab
• Trek placed
• Incision Care
• Meds
• Goals

Patient Pathways – OMFS (Oral and Maxillofacial Surgery) Show Notes

• Sample Report
  • Catherine Zeta-Jones is 63
  • Patient of OMFS
  • Full code
  • Allergies to sulfa
  • Past history of hypertension and squamous cell cancer of the mandible. 
  • Came in on 10/1 for scheduled peg placement
  • On 10/2 she went back into the O.R. for bilateral neck dissection, right mandibulectomy and a fibula free flap and she had a trach placed.
  • Went to the ICU after that and on 10/4 was downgraded 
• Bilateral neck incision is from earlobe to earlobe. Drops down around the jaw. Opened up the whole neck. Exposes the entire mandible. 
• A person without a jaw will have a very apparent incision around their neck and jaw. Their jaw will appear very prominent, very large with a lot of swelling. Appears like the patient has a big underbite. Depending on how far cancer has spread some teeth may have been removed, or part of the tongue. May be drooling. 

• Q8 trach care is cleaning around the trach site. Cleaning any dressing on their chest to catch secretions.
  • Half and half is half hydrogen peroxide and half sterile water. This will be in your order of what you are to clean the incision with every 8 hours. 
• The patient is NPO and is receiving tube feeds.
  • Before tube feeds blood sugar is checked to make sure they are adjusting well and that blood sugar hasn’t dropped or gone too high. Blood sugar checks will continue until they are sure that the patient is stable on tube feeds. 
• Peg tube is how the patient is receiving oral medications.
  • Some meds you crush and you dissolve in water and you can push through. You may have liquid medications ordered.
    • Be very careful with the medicines that say DO NOT crush or chew. Those can often be slow-release or blood pressure medications. They need to release on their own time and not all at once. The extended-release is a red flag that it should not be crushed. Call the pharmacy if you are unsure. 
• Goals for the patient;
  • if going home within a few days to educate them about doing their own tube feeds.
  • Where are we in trach progression?
  • Making sure that they’re healing appropriately.
  • If they need home care, making sure they have everything they need for that. 
• Some discharge challenges include making sure they have everything they need at home, that insurance preauthorizations are done,
  • Doctor’s orders are filled.
  • Communication barrier because some cannot speak normally. Others have poor literacy or cannot comprehend what the nurse is saying to them. 
• Doppler is implanted into the skin flap which gives a constant pulse reading in the area within the flap.
  • If you can’t hear the pulse on the doppler during your assessment, call the Doctor immediately. Make sure you have all of the information about the area before speaking with the Doctor.
• Don’t be scared when caring for the patient.
  • Don’t be afraid to take this patient on, even if it is your first patient. You will learn so much.