Postoperative Complications

RESPIRATORY SYSTEM 1.) Pneumonia and Atelectasis Pneumonia is an inflammation of the alveoli caused by an infectious process that may develop 3 to 5 days postoperatively as a result of infection, aspiration, and immobility. Atelectasis a collapse of the alveoli with retained mucous secretions; the most common postoperative complication, usually occurring 1 to 2 days postoperatively.

Assessment: Assess for factors that may increase the risk of pneumonia and atelectasis Dyspnea and increased respiratory rate Crackles over involved lung area Elevated temperature Productive cough and chest pain Interventions: Assess lung and breath sounds Reposition the client every 1 to 2 hours Encourage the client to deep-breathe, cough, and use of incentive spirometer Provide chest physiotherapy and postural drainage, as prescribed Use suction to clear secretions if the client is unable to cough Encourage fluid intake and early ambulation

2.) Pulmonary Embolism An embolus blocking the pulmonary artery and disrupting blood flow to one or more lobes of the lung; presence of a pulmonary embolism may be life-threatening and requires emergency action.

Assessment: Dyspnea Sudden sharp chest or upper abdominal pain Cyanosis Tachycardia A drop in blood pressure Interventions: Notify the physician immediately Monitor vital signs Administer oxygen and medications as prescribed

CARDIOVASCULAR SYSTEM 1.) HEMORRHAGE Hemorrhage is the loss of a large amount of blood externally or internally in a short period of time.

Assessment: Restlessness Weak and rapid pulse Hypotension Tachypnea Cool, clammy skin Reduced urine output Interventions:

 Provide pressure to the site of bleeding Notify the physician immediately Administer oxygen, as prescribed Administer IV fluids and blood, as prescribed Prepare the client for a surgical procedure, if necessary

2.) HYPOXIA An adequate concentration of oxygen in arterial blood.

Assessment: Restlessness Dyspnea Hypertension Tachycardia Diaphoresis Cyanosis Interventions: Monitor for signs of hypoxia Notify the physicians and eliminate the cause of hypoxia Monitor lung sounds and pulse oximetry Administer oxygen as prescribed Encourage deep breathing, coughing and use of the incentive spirometry Turn and reposition the client

3.) Shock Shock is a loss of circulatory fluid volume, which usually caused by hemorrhage.

Assessment: Restlessness Weak and rapid pulse Hypotension Tachypnea Cool, clammy skin Reduced urine output Interventions: If shock develops, elevate the legs If the client had spinal anesthesia, do not elevate the legs any higher than placing them on the pillow, otherwise the diaphragm muscles could be impaired. Notify the physician Determine and treat the cause of shock Administer oxygen, as prescribed Monitor level of consciousness Monitor vital signs for increased pulse or decreased blood pressure. Monitor intake and output Assess color, temperature, turgor, and moisture of the skin and mucous membranes. Administer IV fluids, blood, colloid solutions, as prescribed.

4.) Thrombophlebitis Thrombophlebitis is an inflammation of a vein, often accompanied by clot formation. The veins in the legs are most commonly affected.

Assessment: Vein inflammation Aching or cramping pain Vein feels hard and cordlike and is tender to touch Elevate temperature Positive Homans sign Interventions: Monitor legs for swelling, inflammation, pain, tenderness, venous distention, and cyanosis and notify the physician if any of these signs are present. Elevate the extremity 30 degrees without allowing any pressure on the popliteal area. Encourage the use of antiembolism stockings as prescribed; remove stockings twice a day to wash and inspect the legs. Use an intermittent pulsatile compression device as prescribed. Perform passive range-of-motion exercises every 2 hours if the client is confined to bed rest. Encourage early ambulation, as prescribed. Do not allow the client to dangle the legs. Instruct the client not to sit in one position for an extended period of time. Administer anticoagulants such as heparin sodium or warfarin (Coumadin), as prescribed.

GASTROINTESTINAL SYSTEM
1.) CONSTIPATION

Constipation is common after surgery and can be a minor or a serious complication. Constipation is an abnormal infrequent passage of stool within 48 hours. Decreased mobility, decreased oral intake, and opioid analgesics contribute to difficulty having a bowel movement.

Assessment: Abdominal distention Absence of bowel movements Anorexia, headache, and nausea Interventions: Assess bowel sounds
Encourage fluid intake up to 3000 mL/day

Encourage early ambulation Encourage consumption of fiber foods unless contraindicated Administer stool softeners and laxatives, as prescribed Provide privacy and adequate time for bowel elimination

2.) PARALYTIC ILEUS

Paralytic ileus is failure of appropriate forward movement of bowel contents. The condition may occur as a result of anesthetic medications or of manipulation of the bowel during the surgical procedure.

Assessment: Nausea and vomiting immediately postoperatively Abdominal distention Absence of bowel sounds, bowel movement, or flatus Interventions: Monitor intake and output Maintain NPO status until bowel sounds return Maintain patency of a nasogastric tube if in place. Encourage ambulation Administer IV fluids of parenteral nutrition, as prescribed Administer medications as prescribed to increase gastrointestinal motility and secretions If ileus occurs, it is treated first nonsurgically with bowel decompression by insertion of a nasogastric tube attached to intermittent or constant suction.

3.) Wound Dehiscence Wound dehiscence is separation of the wound edges at the suture line. Dehiscence usually occurs 6 to 8 days after surgery.

Assessment: Increased drainage Opened wound edges Appearance of underlying tissues through the wound Interventions: Place the client in a Low Fowlers position with the knees bent to prevent abdominal tension on an abdominal suture line. Cover the wound with a sterile saline dressing. Notify the physician. Prevent wound infection through strict asepsis. Administer antiemetics as prescribed to prevent vomiting and further strain on the abdominal incision. Instruct the client to splint the abdominal incision when coughing.

4.) Wound Evisceration Wound evisceration is protrusion of the internal organs through an incision. Evisceration is most common among obese clients, clients who have had abdominal

surgery, or those who have poor wound-healing ability. It usually occurs 6 to 8 days after surgery. Wound evisceration is an emergency case.

Assessment: Discharge of serosanguineous fluid from a previously dried wound The appearance of loops of bowel or other abdominal contents through the wound Client reports feeling a popping sensation after coughing or turning

Interventions: Place the client in a Low Fowlers position with the knees bent to prevent abdominal tension. Cover the wound with a sterile saline dressing. Notify the physician. Prevent wound infection through strict asepsis. Administer antiemetics as prescribed to prevent vomiting and further strain on the incision. Instruct the client to splint the incision when coughing. Monitor for signs of shock.

5.) Wound Infection Wound infection is caused by poor aseptic technique or a contaminated wound before surgical exploration. Infection usually occurs 3 to 6 days after surgery. Purulent material may exit from the drains or separated wound edges.

Assessment: Fever and chills Warm, tender, painful, and inflamed incision site Edematous skin at the incision and tight skin sutures Elevated white blood cell count Interventions: Monitor temperature.
Monitor incision site for approximation of suture line, edema, or bleeding, and

signs of infection (REEDA: redness, erythema, ecchymosis, drainage, approximation of the wound edges); notify the physician if signs of wound infection is present. Maintain patency of drains, and assess drainage amount, color, and consistency. Keep drain and tubes away from the incision line, and maintain asepsis. Change the dressing, as prescribed. Administer antibiotics, as prescribed.

GENITO-URINARY SYSTEM 1.) Urinary Retention

Urinary retention is an involuntary accumulation of urine in the bladder as a result of loss of muscle tone. It is caused by the effects of anesthetics or opioid analgesics and appears 6 to 8 hours after surgery. Assessment: Inability to void Restlessness and diaphoresis Lower abdominal pain Distended bladder Hypertension On percussion, bladder sounds like a drum Interventions: Monitor for voiding. Assess for a distended bladder Encourage ambulation when prescribed. Encourage fluid intake unless contraindicated. Assist the client to void by helping to stand. Provide privacy. Pour warm water over the perineum or allow the client to hear running water to promote voiding.
Contact the physician and catheterize the client as prescribed after all noninvasive

techniques have been attempted.

2.) Urinary Incontinence Urinary incontinence or loss of bladder cintrol is a frequent complication in
the aged.

Assessment: Bladder unable to empty properly Increased abdominal pressure Urethral blockage Bladder oversensitivity from infection Interventions: Dont let incontinence keep you from doing the things you like to do. Absorbent pads or briefs, such as Attends and Depend, are available in pharmacies and supermarkets. No one will know you are wearing one. Avoid coffee, tea, and other drinks that contain caffeine, which over-stimulates the bladder. Do not cut down on overall fluids; you need these to keep the rest of your body healthy. Practice double-voiding. Empty your bladder as much as possible, relax for a minute, and then try to empty your bladder again. Urinate on a schedule, perhaps every three to four hours during the day, whether the urge is there or not. This may help you to restore control. Wear clothing that can be easily removed, such as pants with elastic waistbands. If you have difficulty with buttons and zippers, consider replacing them with Velcro closures. Keep skin in the genital area dry to prevent rashes. Vaseline or Desitin ointment will help. Pay special attention to any medication you are taking, including over-the-counter drugs, since some affect bladder control. Incontinence is sometimes caused by a urinary tract infection. For stress incontinence practice Kegel exercises daily. Ease functional incontinence by placing a portable commode where it can be reached easily, such as by your bed. Dont let incontinence embarrass you. It is not a sign of approaching senility. Take charge and work with your doctor to treat any underlying conditions that may be causing the problem.