Transcript Postoperative Complications

Postoperative Nursing
Postoperative
Complications
Hemorrhage
• Look at dressing
• Look at drains
• Look under patient
• Know s/s of shock
S/S of Shock
• Increased pulse
• Decreased BP
Shock
• Hypovolemic is most
common
• Due to loss of
circulating volume
Shock S/S:
• Decreased BP
• Increased pulse
• Narrowed pulse press.
• Restlessness
• Cold, moist, pale skin
Shock S/S:
• Decreased body temp
- unless septic
• Air hunger
• Pallor, cyanosis
• Ear ringing, spots
Treatment for Shock
• Control hemorrhage
• Trendelenburg
- unless brain surgery
• Warmth
• O2, IVF, Blood
Hypoxia
• Can be due to:
- anesthesia
- narcotics
- mucous
• dec. resp and O2 sat
Hypoxia S/S:
• Dyspnea
• Increased pulse
• Inc then dec. BP
• Cyanosis
• Dizzy (confusion)
Treatment for Hypoxia
• Oxygen
• Trendelenburg
• Pulse oximeter
- should be above 95%
- see page 658
Hypothermia
• Can lead to hypoxia
• S/S: temp < 97.5 rectal
shiver/goose flesh
c/o being cold
• TX: warm blankets, O2
Postoperative
Discomforts
• Not life-threatening
• Common to all types of
surgical cases
• Certain individuals can
be more vulnerable
Pain
• Usually first discomfort
• Give sufficient meds!!
• Check RR and VS first
• Reinforce preoperative
teaching
Thirst
• Esp. with atropine and
other drying agents
• Fluid loss contributes
• Check order for ice,
sips, swabs, etc.
Distention
• Temporary paralysis of
intestinal peristalsis
• accumulation of gas
• gas pains are very
sharp and painful
Distention (cont.)
Due to:
- surgical procedure
- anesthesia
- pain medication
- lack of food/mobility
Distention S/S:
• Abd. Firm to touch
• Pain in abd.
Treatment for
Distention
• Ambulation
• Turning side-to-side
• Relieving distention
will prevent hiccups
• Check bowel sounds!!
Nausea
• If d/t epidural and pain
is controlled:
- consider dec. dose
• If has NG and nausea:
- check tube patency
Nausea TX:
• IM meds can be given:
- Compazine, Inapsine
• Lay on right side
• Slow deep breaths
• Decrease PO intake
Urinary Retention
• Check voiding!!
• Use nsg measures:
- sit up, running water,
hands in water, warm
water to perineum
Urinary Retention
• If no void in 8-10 hours,
check orders and
consider cath order
Constipation
Causes:
• diet change
• inactivity
• pain meds
Constipation:
Prevention:
• Increase fluid intake
• Sit up
• Increase activity
• Meds - supp., laxatives
Restlessness and
Sleeplessness
• Change in environment
• Medications
• Noise / interruptions
• Group care activities
• Meds to aid rest
Prevention of postop
complications
Early ambulation is the
key!!
Respiratory
complications
• Hypostatic pneumonia
- lung infection from
fluid accumulation
- inhibition of normal
clearing mechanisms
Respiratory
Complications
• Atelectasis
- collapse of portion of
lung by mucous plugs
- d/t inactivity and dec.
C & DB from pain
Preventing Resp.
Complications
• Continual assessment
of lungs important!!
• At least every 4 hours
• Encourage IS
• Encourage T, C, DB
Circulatory
Complications
• Thrombophlebitis
- formation of blood
clot in the vein
- any surgical client is
at risk to develop
Thrombophlebitis
• Causes:
- Venous stasis
- Lack of activity
- Dehydration
- Injury to veins
Thrombophlebitis:
• Treatment:
- Elevate
- Bedrest
- Anticoagulants
- Warmth - No rubbing!!
Assessing for
thrombophlebitis
• Check Homan’s sign
- Dorsiflex the foot
- “+” if c/o pain in calf
- report immediately if
positive to r/o DVT
Circulatory
complications
• Embolus:
- clot or thrombus
breaks off and enters
circulatory system
- can travel anywhere
Embolus
• Often goes to heart,
lung or brain
• Pulmonary emboli (PE)
is the most common
Pulmonary Embolus
• S/S:
-pain
-cyanosis, dyspnea
-coughing, hemoptysis
-inc pulse, dec BP
Preventing Circulatory
Problems
• Teds, sequential teds
• Ace wraps
• No knee gatch
• Leg exercises, Amb.
• Hydration
Complications of
Bedrest
• Resp and circ problems
• Pressure sores
• Edema
• Contractures
• Osteoporosis
Complications of
Bedrest
• Balance problems
• Kidney stones
• Constipation
• Decreased appetite
• Depression/disoriented
Wound Infection
S/S:
- pain, edema, erythema,
warmth at incisional
site
- temperature
Prevention of Wound
Infection
• Handwashing
• Sterile dressings
• Sterile technique
Treatment of wound
infections
• Antibiotics
• Increased fluids
• Adequate diet
• Asepsis
Wound dehiscence
• Wound edges separate
• inc risk with:
- obesity, poor nutrition
- age
- diabetic
Prevention of wound
dehiscence
• Have splint incision
with pillow to cough
and deep breath
• Adequate nutrition
Wound Evisceration
• Wound separates and
abd organs protrude
• inc risk with obese,
elderly, DM, poor
nutrition
• “something gave way”
Treatment for wound
evisceration
• Cover with sterile NSS
soaked gauze and call
MD
• Teach wound splinting
• Adequate nutrition