Postoperative (Postop) Complications

Overview

1. Postoperative complications
   1. Issues that occur after surgery
   2. When do they occur?
      1. Immediately
      2. Early postop
      3. Late postop
   3. Due to
      1. Specific surgery
      2. Anesthesia
      3. Pre-existing conditions
      4. Unknown reasons
   4. Key to decreasing
      1. Know
         1. Possible complications
         2. Actions to prevent and treat
      2. Importance
         1. Patient safety

Nursing Points

General

1. Airway obstruction
   1. Common causes
      1. Tongue is relaxed
         1. Anesthesia
         2. Muscle relaxant
   2. Patient presentation
      1. Snoring
      2. Little or no air movement
      3. Decreased O2 saturation
   3. Action
      1. Stimulate patient
      2. Position patient on right side
         1. “Recovery” position
            1. Tongue moves forward opens airway
      3. Chin tilt or jaw thrust
2. Laryngospasm
   1. Irritable airway/obstruction
      1. Muscles of airway contract
   2. Patient presentation
      1. Agitation
      2. Decreased O2 saturation
      3. No breath sounds
      4. Crowing sound
         1. With incomplete obstruction
   3. Action
      1. Calm reassurance to awake patient
      2. Remove irrititating stimulus
         1. Suction secretions
      3. Hyperextend patient’s neck
      4. Oxygenate patient
      5. Notify provider and anesthesia
         1. Prepare to administer
            1. Medications
               1. Aerosals
               2. Midazolam (Versed)
               3. Muscle relaxant
            2. Positive pressure ventilation
      6. Reintubation
         1. Last resort
3. Bronchospasm
   1. Spasms of bronchial tubes
   2. Patient presentation
      1. Wheezing
      2. Dyspnea
      3. Use of accessory muscles
      4. Tachypnea
   3. Action
      1. Inhaled bronchodilators
         1. 1st choice of therapy
4. Hypotension
   1. Blood pressure
      1. 20% less than baseline
   2. Common cause
      1. Hypovolemia
         1. Blood loss during surgery
         2. Inadequate fluid replacement
   3. Patient presentation
      1. Rapid, thready pulse
      2. Disorientation
      3. Restlessness
   4. Action
      1. IV fluids
5. Hypertension
   1. Blood pressure
      1. 20% above baseline
   2. Common causes
      1. Volume overload
      2. Pain
      3. Anxiety
      4. Hypoxemia
   3. Patient presentation
      1. Headache
      2. Mental status changes
   4. Actions
      1. Diuretics
      2. Fluid restriction
      3. Hemodynamic monitoring
      4. Medications
         1. Analgesics
         2. Antihypertensives
6. Postoperative nausea and vomiting (PONV)
   1. Affects 30% of postop patients
   2. Common causes
      1. Female
      2. History PONV/motion sickness
      3. Nonsmoker
      4. Opioids
      5. Nitrous oxide
      6. Pain
   3. Action
      1. Prevention
         1. Antiemetics
            1. Zofran
            2. Scopolamine patch
7. Acute pain
   1. Follow facility guidelines
      1. Priority in PACU
      2. Subjective to patient
      3. Use scale
      4. Reassess
   2. Actions
      1. Pharmacologic
         1. Trend towards nonopioids
            1. Blocks preoperative
      2. Nonpharmacologic
         1. Repositioning
         2. Verbal reassurance
         3. Imagery
8. Urinary retention
   1. Patient presentation
      1. Unable to urinate
   2. Common causes
      1. Anesthesia
      2. Surgery specific
   3. Actions
      1. Catheterization
      2. Encouragement
      3. Medications
9. Hemorrhage
   1. Excessive blood loss
   2. Patient presentation
      1. Dressing saturation
      2. Excessive blood in drain
      3. Hypotension
   3. Action
      1. Notify provider
      2. Possible return to OR
10. Infection
    1. Within 30 days
    2. Patient presentation
       1. Redness
       2. Swelling
       3. Fever
       4. Drainage
       5. Pain
    3. Action
       1. Prevention
          1. Antibiotics
          2. Wound care
       2. Notify provider
11. Embolism
    1. Blocking substance
       1. Blood, air, fat
    2. Deep vein thrombosis (DVT)
       1. Pain
       2. Swelling
    3. Pulmonary embolism (PE)
       1. Shortness of breath
       2. Chest pain
    4. Action
       1. Prevention
          1. DVT protocol
       2. Notify provider
12. Surgical site issues
    1. Wound dehiscence
       1. Separation of surgical incision
          1. Abdomen
       2. Common causes
          1. Increase in abdominal pressure
             1. Coughing, sneezing, bearing down
          2. Infection
          3. Obesity
          4. Improper surgical closure
       3. Action
          1. Notify provider
    2. Wound evisceration
       1. Protrusion of bowel or abdominal organs
          1. Emergency!
       2. Common causes
          1. See wound dehiscence causes
       3. Action
          1. Assess patients vitals
          2. Notify provider immediately
          3. Cover with saline soaked dressing
13. Confusion/agitation/emergence delirium
    1. Common causes
       1. Hypoxemia
       2. Anesthesia
       3. Pain
       4. Anxiety
    2. Patient presentation
       1. Restlessness
       2. Disoriented
       3. Delirious
    3. Action
       1. Oxygen administration
       2. Reorient patient
       3. Remove cause
       4. Pain management
14. Postoperative hypothermia
    1. Temperature less than 96.8 degrees farenheit
       1. Prolongs recovery time
    2. Common causes
       1. Anesthesia
       2. Length of surgery
       3. Fluid shift
    3. Patient presentation
       1. Shivering
    4. Actions
       1. Oxygen administration
       2. Rewarming
          1. Blankets
          2. Warming units

Nursing Concepts

1. Comfort
2. Safety
3. Oxygenation
4. Thermoregulation

Patient Education

1. Teach patient
   1. Express needs
      1. Pain
      2. Discomfort
   2. Ask questions!