possible postop complications

7/28/2019 Possible PostOp Complications

1/5

Week 3: Possible Post-op Complications

1. Hypotensiona.

Definition: Low blood pressure, or hypotension, occurs when blood pressure during andafter each heartbeat is much lower than usual. This means the heart, brain, and other

parts of the body do not get enough blood.

b. Risk factor:i. Getting up after you sit or lie down. This can cause a quick drop in blood

pressure called orthostatic hypotension.

ii. Standing for a long time.iii. Not drinking enough fluids (dehydration).iv. Medicines, such as high blood pressure medicine or other heart medicines.v. Health problems such as thyroid disease, severe infection, bleeding in the

intestines, or heart problems.

vi. Trauma, such as major bleeding or severe burns.c. Manifestations

i. Dizziness or lightheadednessii. Fainting (syncope)iii. Lack of concentrationiv. Blurred visionv. Nauseavi. Cold, clammy, pale skin

vii. Rapid, shallow breathingviii. Fatigue

ix.

Depressionx. Thirst

d. Nursing Management:i. Increase sodium intake to raise blood pressure.

ii. Increase fluid intake to increase blood volume and prevent dehydration.iii. Wear compression stockings to relieve pain and swelling and prevent pooling of

blood in the lower extremities.

iv. Avoid standing for an extended period of time.v. Eat small portions several times a day and limit high-carbohydrate foods.

e. Medical managementi. Blood through a needle (IV)

ii. Medicines to increase blood pressure and improve heart strength, and othermedicines, such as antibiotics

2. Bleedinga. Definition: Bleeding (hemorrhaging) that occurs after any surgical procedure. The

bleeding may occur immediately after the surgery or there may be a delay. It is blood

loss of 100 200 ml per hour, on average, for the first four hours, or more than 2 liters

in 24 hours following surgery.

b. Risk factor:i. Preoperative anticoagulants

ii. Unrecognized bleeding diathesisiii. Consumption coagulopathyiv. Infection damaging vessels at the operation site

c. Manifestations:i. Loss of blood pressure

ii. Enlarged circumference of the body at the operative siteiii. Complete blood count showing decrease in hemoglobin, hematocrit and red

blood cells


2/5

iv. Increase in heart ratev. Marked pallor of the skin and mucosa under the lower eyelidsvi. Increase in respiratory rate

d. Nursing Management:i. Ensure good intravenous (IV) access

e. Medical management:i. Clotting screen

ii. Platelet countiii. Consider surgical re-exploration at all timesiv. Fresh frozen plasma (FFP) or platelet concentrates

3. Hypovolemic shocka. Definition: Refers to a medical or surgical condition in which rapid fluid loss results in

multiple organ failure due to inadequate circulating volume and subsequent inadequate

perfusion. Most often it is secondary to rapid blood loss (hemorrhagic shock).

b. Risk factor:i. Bleeding from cuts

ii. Bleeding from other injuriesiii. Internal bleeding, such as in the gastrointestinal tract

c. Manifestations:i. Weakness

ii. Lightheadednessiii. Confusioniv. Anxiety or agitationv. Cool, clammy skinvi. Decreased or no urine output

vii. Pale skin color (pallor)viii. Rapid breathingix. Sweating, moist skin

x. Unconsciousnessd. Nursing Management:

i. Raising the patient's legs while fluid is being givenii. Rolling a patient with trauma onto her left side, which displaces the fetus from

the inferior vena cava and increases circulation

iii. Provide blankets to promote warmthiv. Do not give fluids by mouth

e. Medical management:i. High-flow supplemental oxygen should be administered to all patients, and

ventilation support should be given

ii. Intravenous (IV) line4. Atelectasis

a. Definition: The collapse or closure of the lung resulting in reduced or absent gasexchange. It may affect part or all of one lung. It is a condition where the alveoli are

deflated.

b. Risk factor:i. Premature birth, if the lungs aren't fully developed

ii. Impaired swallowing function, particularly in older adults aspiratingsecretions into the lungs is a major source of infections

iii.

Any condition that interferes with spontaneous coughing, yawning and sighingiv. Lung disease, such as asthma, bronchiectasis or cystic fibrosisv. Confinement to bed, with infrequent change of positionvi. Abdominal or chest surgery

vii. Recent general anesthesiaviii. Shallow breathing a result of abdominal pain or rib fracture, for example


3/5

ix. Respiratory muscle weakness, due to muscular dystrophy, spinal cord injury oranother neuromuscular condition

x. Obesity fat in the abdomen can elevate your diaphragm and hamper yourability to inhale fully

xi. Age being a young child between the ages of 1 and 3c. Manifestations:

i. Cough, but not prominentii. Chest painiii. Breathing difficultyiv. Low oxygen saturationv. Pleural effusion (transudate type)vi. Cyanosis (late sign)

vii. Increased heart rateviii. Low-grade fever

d. Nursing Management:i. Focusing on deep breathing and encouraging coughing

ii. Ambulation is also highly encouraged to improve lung inflatione. Medical management:

i. Continuous positive airway pressure, which delivers pressurized air or oxygenthrough a nose or face mask to help ensure that the alveoli do not collapse,

even at the end of a breath

ii. Mechanical ventilatoriii. Incentive spirometer

5. Thrombophlebitisa. Definition: Occurs when a blood clot causes swelling in one or more of your veins,

typically in your legs.

b. Risk factor:i. Blood clotii. Injury to a veiniii. Inherited blood-clotting disorderiv. Prolonged inactivityv. Just given birth, which may mean you have increased pressure in the veins of

your pelvis and legs

vi. Overweight or obesevii. Older than 60

c. Manifestations:i. Warmth, tenderness and pain in the affected area

ii. Redness and swellingiii. Red, hard and tender cord just under the surface of your skiniv. Leg may become swollen, tender and painful, most noticeably when you stand

or walk

v. Feverd. Nursing Management:

i. Prescription-strength support hosee. Medical management:

i. Injection of a blood-thinning (anticoagulant) medication, such as heparin, willprevent clots from enlarging

ii.

Thrombolyticiii. Surgically remove varicose veins that cause pain or recurrent thrombophlebitis

6. Paralytic ileusa. Definition: Paralytic ileus is the occurrence of intestinal blockage in the absence of an

actual physical obstruction. This type of blockage is caused by a malfunction in the

nerves and muscles in the intestine that impairs digestive movement.

b. Risk factor:


4/5

i. Appendicitisii. Botulism (poisoning with botulinum, a neurotoxin)iii. Certain medications, such as opiates and sedativesiv. Diabetic ketoacidosis (life-threatening complication of diabetes)v. Electrolyte imbalancevi. Gastroenteritis (inflammation or infection of the stomach or intestines)

vii. Neonatal necrotizing enterocolitis (disease that causes death of intestinal tissuein newborns)

viii. Obstruction of the mesenteric artery, which supplies blood to the abdomenix. Pancreatitisx. Porphyria (metabolic disorder)xi. Surgical complications

c. Manifestations:i. Abdominal swelling, distension or bloating

ii. Constipationiii. Diarrheaiv. Foul-smelling breathv. Gasvi. Lack of bowel sounds

vii. Nausea with or without vomitingviii. Stomach pain and spasms

d. Nursing Management:i. Dietary restrictions to allow the obstruction to pass

e. Medical management:i. Dietary restrictions to allow the obstruction to pass

ii. Medications to promote peristalsis, the contractions that move food throughthe digestive tract

iii. Placement of a nasogastric tube to release the air and drain the fluidiv. Intravenous fluids to provide nutrients

7. Dehiscencea. Definition: Wound dehiscence is the parting of the layers of a surgical wound. Either the

surface layers separate or the whole wound splits open.

b. Risk factor:i. Overweight

ii. Increasing ageiii. Poor nutritioniv. Diabetesv. Smokingvi. Malignant growth

vii. Presence of prior scar or radiation at the incision siteviii. Non-compliance with post-operative instructions (such as early excessive

exercise or lifting heavy objects)

ix. Surgical errorx. Increased pressure within the abdomen due to: fluid accumulation (ascites);

inflamed bowel; severe coughing, straining, or vomiting

c. Manifestations:i. Failure of the staples or stitches

ii.

Separation of the wound edgesiii. Wound swellingiv. Fluid draining from the woundv. Tissue protruding from the wound

d. Nursing Management:i. Exposure to the air

ii. Frequent dressing


5/5

iii. Removal of dead, damaged, or infected tissue to improve the healing potentiale. Medical management:

i. Antibiotic therapyii. Frequent changes in wound dressing to prevent infectioniii. Wound exposure to air to accelerate healing and prevent infection, and allow

growth of new tissue from belowiv. Surgical removal of contaminated, dead tissuev. Resuturingvi. Placement of a temporary or permanent piece of mesh to bridge the gap in the

wound

8. Eviscerationa. Definition: Evisceration is a rare but severe surgical complication where the surgical

incision opens (dehiscence) and the abdominal organs then protrude or come out of the

incision (evisceration).

b. Risk factor:i. Stabbing

ii. Gunshot woundsiii. Work with power toolsiv. Farm accidents

c. Manifestations:i. Seepage of serosanguineous fluid through a closed abdominal wound

d. Nursing Management:i. Cover the opening and organs with the cleanest sheet or bandage material

ii. Cover the tissue with sterile bandagesiii. Use sterile saline to saturate the bandage or towel

e. Medical management:i. Immediate emergency surgical closure

possible postop complications

Documents