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

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

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