Potential complications of the Postoperative Patient.
A. Postanesthesia Care Unit (PACU)
o where patient recovers from anesthesia.
 Care at PACU include:
 Prevention of postoperative complication
 Wound healing and wound care.
 Post-operative management.
B. Fast-tracking: patient transferred from operation room to PACU phase II bypassing
phase I.
o Phase I: focuses on recovery of physiological homeostasis and protective
mechanisms.
o Patient requires intensive observation and care.
o Phase II: patient becomes alert and more functional.
o Less intensive care required
o Patient prepared for discharge if not transfer to inpatient unit.
C. Surveillance: systematic and continues assessment of the patient.
Nurse is prepared to respond to patient’s physiological response to surgery
and anesthesia.
Nurse performs assessment of:
LOC
Cardiovascular
Respiratory
Pain management
Gastrointestinal
Genitourinary
Skin integrity
Temperature
Incision
Activity/movement
Psychosocial
Intravenous fluids
Drains and other tubes
D. Sanguineous: blood in drainage
E. Serosanguineous: Blood and serum in drainage
o Nurse needs to have a sense of expected amount and type drainage in order
to responds quickly to increase amount of drainage.
o Nurse recognizes signs of internal bleeding.
 Bruise or hematoma
 Drop in blood pressure if blood loss is large enough
 Increased Heart rate (early sign of internal bleeding)
 Drop in oxygen saturation.
 Patient appears pale, cold and clammy or cyanotic.
F. Hypoxemia


Defined as insufficient oxygen in blood.
Common cause of hypoxemia in early postoperative period
1. Airway obstruction:
o Results because anesthesia causes muscles to relax.
o When tongue relaxes, falls backward and blocks airway.
o Signs of obstructed airway:
 snoring
 stridor
 retraction of intercostal muscles
 Fall in O2 sat. level
o Nursing Intervention:
 Position pt on the side
 Encourage pt to take deep breaths
 Turn up oxygen level if necessary.
2. Hypoventilation
 Report RR < 10 breaths/min
 O2 sat <93%
3. Laryngospasm: when muscles of larynx contract forcefully
 Nurse must suction secretion
 Administer Oxygen
 Administered aerosolized epinephrine solution or in re cases,
reintubation.
G. Diuresis (457): Increased excretion of urine to decrease the amount of fluid in third
space. (caused by tissue injury during surgery)




Often occurs when body attempts to correct fluid balance 48-72 hours after surgery.
Nurse carefully assess fluid balance to prevent overhydration by monitoring IV
administration closely.
Nurse understand that clients at risk for fluid overload include patients with
preexisting:
o cardiac
o pulmoniary
o and renal disease.
Nurse is aware of early signs and symptoms of fluid retention:
 Edema on hand and feet.
 swollen eyelids
 weight gain
H. Cardiac schemia:





Restriction of blood flow to coronary arteries
Often indicated by abnormal cardiac rhythm after surgery.
Apical pulse is more reliable measure of heart rate and rhythm in post-op patients.
Nurse is aware of parameters that specify vital signs to report.
Tachycardia: HR > 100 beat/min.
 Most common dysrhythmia
 Caused by fever, anxiety, pain, hypovolemia, anemia, and hypoxia.
 Bradycardia: HR < 60 beats/min.
 In persistently tachycardiac pt, nurse assess for:
 vertigo
 syncope
 hypotension
 hypoxemia
 chest pain
I. Hemostasis: Stopping bleeding.
o Surgical dressing supports the process of hemostasis.
o Nursing Interventions: (this refers to PACU nurse)
 Do not remove dressing.
 Examines dressings for sings of bleeding every hour or more
frequently if bleeding found.
 Nurse makes an area on dressing w/ pen and monitors enlargement.
 Examine sheets under pt. for evidence of bleeding.
 Nurse observes for early sings of internal bleeding
 Low BP
 Increased HR
 Change in LOC
J. Hypothermia:
o Core body temperature of less than 36 C.
o Or sings of shivering, vasoconstriction, piloerection (goosebumps), and feeling cold
regardless of body temperature.
o Nursing interventions:
o Maintain temperature between 20 and 24 degrees calcium( 68-75 degree F)
o Apply warm cotton blankets, socks, and head covering
o Achieving normothermia (normal body temperature) reverses the
immediate effects of hypothermia.
K. Postoperative nausea and vomiting (PONV)
o Significant problem and more debilitating than surgical procedure.
o Contributes to electrolyte and fluid imbalances, poor nutrition intake, and
discomfort.
o Interventions:
 Early administrations of antiemetic drugs during preoperative or
intraoperative period.
 Hydration
 Acupressure
 Aromatherapy
L. Midriasis: pupil dilation
Major side effect Scopoline, a drug used as prophylaxis of Postoperative nausea
and vomiting (PONV)
Nurse is aware of midriasis as side effect.
Nurse must understand that drug and that is used as prophylaxis and of limited use
in rescue because of delayed action.
M. Ileus
o Defined as hypoactive bowel with delayed peristalsis.
o Ileus can be prevented by controlling pain.
o Controlling pain promotes mobility and prevents
o Ileus
o DVT
o Atelectasis
o Poor wound healing.
Preventing Postperative Complications
N. Atelectasis:
Refers to collapse of alveoli and surrounding airways.
Collapsed alveoli:
o
o
o
o
Reduce lung volume
Mucus accumulation, resulting in airway obstruction
If untreated, leads to fever and hypoxia
Increases risk of pneumonia
Nursing Interventions: interventions aim at decreasing pulmonary complications.
Place pt in semi-Fowler’s or High semi-Fowler’s position (unless contraindicated)
Encourage lung expansion therapies:
Deep breathing
Incentive spirometer
Nasal positive airway pressure
Ambulation
O. Dihiscence: opening of an incision
Likely to occur 4-5 days postoperatively.
o Nursing intervention:
 Support wound with large sterile dressing soaked with NS.
 Place client in bed with knees bent to decrease pull on incision.
P. Intermittent pneumatic compression devices
o Used to decreased DVT
o This apply intermittent compressions to calves.
 Nurse is aware that IPCS are not used on patients that have been
immobilized for more than 72 hours or more without prophylaxis.
Rationale: IPC device can dislodge a clot if it has already formed.
 Nurse promotes early ambulation
 Leg exercise are perfomed while pt in bed or chair.
Q. Graduated Compression Stockings (GCSs)
GCS apply pressure to lower leg and increase venus return and velocity.