Postoperative Complications

POTENTIAL POSTOPERATIVE COMPLICATIONS

Reference:   Kozier, B., et. al. (2004). Fundamentals of Nursing (5th ed.). Jurong, Singapore: Pearson Education South Asia PTE Ltd.

POTENTIAL POSTOPERATIVE PROBLEMS A. Circulatory 

Hemorrhage – Bleeding internally or externally.

- Cause: Disruption of sutures, insecure ligation of blood vessels. - Clinical signs: Rapid weak pulse, increasing respiratory rate, restlessness, lowered BP, cold clammy skin, thirst, pallor, reduced urine output. - Preventive intervention: Early recognition of signs.

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Thrombus – Blood clot attached to wall of vein or artery (most commonly the leg veins).

- Cause: Venous stasis; vein injury resulting from surgery of legs, pelvis, abdomen; factors causing increased blood coagulability (eg, use of estrogen). - Clinical signs: Sudden chest pain, SOB, cyanosis, shock (tachycardia, low BP). - Preventive Interventions: Early ambulation, leg exercises, antiemboli stockings, adequate fluid intake.

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Embolus – Clot that has moved from its site of formation to another area of the body.

- Cause, Signs, Prevention: Same as thrombus.

B. Urinary 

Urinary retention – Accumulation of urine in the bladder and inability of the bladder to empty itself.

- Cause: Depressed bladder muscle tone from narcotics & anesthetics; handling of tissues during surgery on adjacent organs (rectum, vagina). - Clinical signs: Fluid intake larger than output; inability to void or frequent voiding of small amounts, bladder distention, suprapubic discomfort, restlessness. - Preventive Intervention: Monitoring of fluid intake and output, interventions to facilitate voiding.

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Urinary tract infection – Inflammation of the bladder.

- Cause: Immobilization and limited fluid intake. - Clinical signs: Burning sensation when voiding, urgency, cloudy urine, lower abdominal pain. - Preventive Intervention: Adequate fluid intake, early ambulation, early ambulation, good perineal hygiene.

C. Gastrointestinal 

Constipation – Infrequent or no stool passage for abnormal length of time (eg, within 48 hours after solid diet started).

- Cause: Lack of dietary roughage, analgesics (decreased intestinal motility). - Clinical signs: Absence of stool elimination, abdominal distention, and discomfort. - Preventive Interventions: Adequate fluid intake, highfiber diet, early ambulation.

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Nausea and vomiting

- Cause: Pain, abdominal distention, ingesting fluids or foods before return of peristalsis, certain medications, anxiety. - Clinical signs: Complaints of feeling sick to the stomach, retching or gagging. - Preventive Intervention: IV fluids until peristalsis returns; then clear fluids, full fluids and regular diet when peristalsis returns.

D. Wound 

Wound infection – Inflammation and infection of incision or drain site.

- Cause: Poor aseptic technique; lab analysis of wound swab identifies causative microorganism. - Clinical signs: Purulent exudates, redness, tenderness, elevated body temp., wound odor.

NURSING MANAGEMENT A. Assessing 

Level of Consciousness - Orientation to time, place, and person - Fully conscious but drowsy? - Reaction to verbal stimuli - Ability to move extremities

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Vital signs

- Compare initial finding with Postanesthetic Room data

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Skin color and temperature

- Lips and nailbeds (tissue perfusion) - Pale, cyanotic, cool, moist skin? (circulatory problem)

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Fluid balance

- Type and amount of IV fluids, flow rate, and infusion site - Fluid intake and output

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Position and safety

- Appropriate position according to the physician’s orders

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Dressings and bedclothes

- Excessive bloody drainage on dressings or on bedclothes

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Pain and comfort level

- Location and intensity of pain - Warm and feels comfortable?

B. Nursing Interventions 

Appropriate client positioning

- position as ordered - if otherwise, follow patient’s preference

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Encourage deep-breathing and coughing exercises

- DBE helps remove mucus, which can form and remain in the lungs due to the effects of general anesthetic and analgesics (they depress the action of both cilia of the mucous membranes lining the respiratory tract and the respiratory center in the brain) - DBE prevents pneumonia by increasing lung expansion and preventing the accumulation of secretions - DBE also frequently initiates the coughing reflex; voluntary coughing in conjunction with deep breathing exercises facilitate the movement and expectoration of respiratory tract secretions

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Leg exercises

- muscle contractions compress the veins, a cause of thrombus formation and subsequent thrombophlebitis and emboli - contractions also promote arterial blood flow

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Early ambulation

- turning allows alternating maximum expansion of uppermost lung - early ambulation, as ordered, prevents respiratory, circulatory, urinary, and GI complications; it also prevents general muscle weakness

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Adequate hydration

- IV infusions are given to balance loss of body fluids - sufficient fluids keep the respiratory mucous membranes and secretions moist, thus facilitating mucus expectoration during coughing - also, an adequate fluid balance will prevent dehydration and the resulting concentration of the blood that, along with venous stasis, is conducive to thrombus formation

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Diet

- check client’s postoperative diet ordered by the surgeon

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Promoting urinary elimination

- ensure that fluid intake is adequate - determine whether client has any difficulties in voiding and asses for bladder distention

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Administering analgesics as ordered for pain

- provide comfort measures to relax the client (rest periods)

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Wound care

- clean, dry, intact? - change dressings, using sterile technique as required, when they are soiled with drainage or in accordance with the orders