2. Postoperative Nursing

3. Postoperative Complications Hemorrhage Look at dressing Look at drains Look under patient Know s/s of shock

4. S/S of Shock Increased pulse Decreased BP

5. Shock Hypovolemic is most common Due to loss of circulating volume

6. Shock S/S: Decreased BP Increased pulse Narrowed pulse press. Restlessness Cold, moist, pale skin

7. Decreased body temp - unless septic Air hunger Pallor, cyanosis Ear ringing, spots

8. Treatment for Shock Control hemorrhage Trendelenburg - unless brain surgery Warmth O2, IVF, Blood

9. Hypoxia Can be due to: - anesthesia - narcotics - mucous dec. resp and O2 sat

10. Hypoxia S/S: Dyspnea Increased pulse Inc then dec. BP Cyanosis Dizzy (confusion)

11. Treatment for Hypoxia Oxygen Trendelenburg Pulse oximeter - should be above 95% - see page 658

12. Hypothermia Can lead to hypoxia S/S: temp < 97.5 rectal shiver/goose flesh c/o being cold TX: warm blankets, O2

13. Postoperative Discomforts Not life-threatening Common to all types of surgical cases Certain individuals can be more vulnerable

14. Pain Usually first discomfort Give sufficient meds!! Check RR and VS first Reinforce preoperative teaching

15. Thirst Esp. with atropine and other drying agents Fluid loss contributes Check order for ice, sips, swabs, etc.

16. Distention Temporary paralysis of intestinal peristalsis accumulation of gas gas pains are very sharp and painful

17. Distention (cont.) Due to: - surgical procedure - anesthesia - pain medication - lack of food/mobility

18. Distention S/S: Abd. Firm to touch Pain in abd.

19. Treatment for Distention Ambulation Turning side-to-side Relieving distention will prevent hiccups Check bowel sounds!!

20. Nausea If d/t epidural and pain is controlled: - consider dec. dose If has NG and nausea: - check tube patency

21. Nausea TX: IM meds can be given: - Compazine, Inapsine Lay on right side Slow deep breaths Decrease PO intake

22. Urinary Retention Check voiding!! Use nsg measures: - sit up, running water, hands in water, warm water to perineum

23. If no void in 8-10 hours, check orders and consider cath order

24. Constipation Causes: diet change inactivity pain meds

25. Constipation: Prevention: Increase fluid intake Sit up Increase activity Meds - supp., laxatives

26. Restlessness and Sleeplessness Change in environment Medications Noise / interruptions Group care activities Meds to aid rest

27. Prevention of postop complications Early ambulation is the key!!

28. Respiratory complications Hypostatic pneumonia - lung infection from fluid accumulation - inhibition of normal clearing mechanisms

29. Respiratory Complications Atelectasis - collapse of portion of lung by mucous plugs - d/t inactivity and dec. C & DB from pain

30. Preventing Resp. Complications Continual assessment of lungs important!! At least every 4 hours Encourage IS Encourage T, C, DB

31. Circulatory Complications Thrombophlebitis - formation of blood clot in the vein - any surgical client is at risk to develop

32. Thrombophlebitis Causes: - Venous stasis - Lack of activity - Dehydration - Injury to veins

33. Thrombophlebitis: Treatment: - Elevate - Bedrest - Anticoagulants - Warmth - No rubbing!!

34. Assessing for thrombophlebitis Check Homan’s sign - Dorsiflex the foot - “+” if c/o pain in calf - report immediately if positive to r/o DVT

35. Circulatory complications Embolus: - clot or thrombus breaks off and enters circulatory system - can travel anywhere

36. Embolus Often goes to heart, lung or brain Pulmonary emboli (PE) is the most common

37. Pulmonary Embolus S/S: -pain -cyanosis, dyspnea -coughing, hemoptysis -inc pulse, dec BP

38. Preventing Circulatory Problems Teds, sequential teds Ace wraps No knee gatch Leg exercises, Amb. Hydration

39. Complications of Bedrest Resp and circ problems Pressure sores Edema Contractures Osteoporosis

40. Complications of Bedrest Balance problems Kidney stones Constipation Decreased appetite Depression/disoriented

41. Wound Infection S/S: - pain, edema, erythema, warmth at incisional site - temperature

42. Prevention of Wound Infection Handwashing Sterile dressings Sterile technique

43. Treatment of wound infections Antibiotics Increased fluids Adequate diet Asepsis

44. Wound dehiscence Wound edges separate inc risk with: - obesity, poor nutrition - age - diabetic

45. Prevention of wound dehiscence Have splint incision with pillow to cough and deep breath Adequate nutrition

46. Wound Evisceration Wound separates and abd organs protrude inc risk with obese, elderly, DM, poor nutrition “something gave way”

47. Treatment for wound evisceration Cover with sterile NSS soaked gauze and call MD Teach wound splinting Adequate nutrition