Postoperative complication and nursing management

Welcome to CNE
PRESENTED BY:
MRS. HEERA KC PARAJULI, BN
10/20/2016
on
Postoperative
Complications
And
Nursing
Management

Objectives
 At the end of this session participants
will be able to
 Identify common postoperative complications
 Provide nursing care accordingly.
 Strengthen the nursing practices.
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Surgical classification
• IMMEDIATE / Urgent – Immediate life, limb or organ-saving
intervention –resuscitation simultaneous with intervention.
Normally within minutes of decision to operate.
• EXPEDITED – Patient requiring early treatment where the
condition is not an immediate threat to life, limb or organ
survival. Normally within days of decision to operate.
• ELECTIVE – Intervention planned or booked in advance of
routine admission to hospital.
3

Methods of surgical approaches
1. Laparoscopic surgery
2. Robotic surgery
3. Ambulatory surgery
4. Private surgical offices

Post operative Complications
Post operative complications can range from
minor, self limiting problems to major life
threatening ones depending on the nature of the
surgery and the organ operated upon.
Complication can be due to anesthesia or surgery
or a reaction to the stress of surgery itself. Some
complications are general and apply to all
procedures and some are specific that apply to
only that procedure.

Types of postoperative Complications
• Postoperative complications generally
fall in one or more of the three broad
categories
1. Anesthesia related complications
2. Complications common to any procedure
3. Complications common to specific
procedure.

• Depending on the severity of the
complications they can again be broadly
categorized as Major or Minor.
Minor Complications :
Dryness of the mouth and throat, sore throat,
drowsiness, shivering, vomiting, dizziness, and
giddiness are common side effects of the medicines
used during anesthesia.
They are self-limiting and do not persist beyond an
hour or two.

• Fatigue, feeling weak, headache are also
common and could be attributed to the fasting
that is often required before and after a surgery.
Under normal circumstances these symptoms
vanish in a day or two.
• Some people also experience bloated feeling,
constipation and urine retention following an
operation and these resolve spontaneously.
• Fever can occur as a reaction to the intravenous
fluid transfused during an operation.

Major Complications :
These complications can be serious and
sometimes even life threatening.
• They prolong the recovery period and
stay in the hospital. The complications
may happen during surgery or in the
postoperative period. Some of these
include:

1. Pulmonary thromboembolism
Clots formed in the deep veins of the legs
or thigh can get detached from the leg
veins and travel to the lungs and get stuck
in the major artery supplying the lungs
causing a fatal collapse.
These clots are formed in the leg veins
when a patient is in prolonged
immobilization following a surgery

2. Aspiration of stomach contents into the
LUNG
• This can happen during the initiation of
anesthesia if a patient has eaten a meal before
the surgery. The food and acidic contents of
the stomach can be inhaled into the lungs
setting up a severe near fatal pneumonia of the
lung.

3. Anaphylaxis
Is a severe allergic reaction to either the
anesthetic agents or antibiotics or certain
substances used during the operation
4.Cardiac arrest
Is possible as an end result of any of the
above events. Prompt cardiopulmonary
resuscitation can help revive the person.

• Other possible complications may
occur and be related to preexisting
medical illness.
• A person who suffers from ischemic heart
disease, diabetes, high blood pressure,
asthma, kidney disease, liver disease,
epilepsy, psychosis can expect an
exacerbation of these problems in the
postoperative period.

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10/20/2016
16
Systemic Postoperative complications

Wound Dehiscence
Wound eviscerance
Kelloid
formation

Nursing Care of the client during
postoperative Period
Assessment
Planning
Implementation
Evaluation/
Outcome

ASSESSMENT
• Verify patency of airway and maintain oxygenation.
• Establish baseline vital signs.
• Determine level of consciousness.
• Observe tube for patency and placement and drainage
for characteristics.
• Inspect dressing if needed.- mark border of dressing.
• Determine if client has sufficient urinary output.
• Assess for sign of wound healing and complications.
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PLANNING/ IMPLEMENTATION
A.Maintain airway and
breathing.
(anesthesia depress respiratory
functions.) Suction if needed.
I. Position client on one side with neck slightly
extended to prevent aspiration.
II. Monitor rate rhythm symmetry of chest movement,
breathe sound, pulse oxymter,behavior and color of
mucus membrane.
III. Suction artificial airway and oral cavity as needed.
IV. Maintain oxygen saturation.
V. Encourage coughing and deep breathing exercises.

B. Circulatory needs
a) Monitor heart rate and rhythm as well as
bloodpressure at frequent intervals.
b) Monitor peripheral circulation by noting the color,
temperature, capillary refill, presences of pulses to
ensure tissue perfusion, and motor and sensory
function.
c) Monitor for hemorrhage measuring Bp, pulse rate
wound drainage, frequent swallowing and
expectoration of blood with surgery. Report ASAP.

C. Neurological Needs
(medications and anesthetic agents depress CNS)
• Monitor clients’ level of consciousness.
• Monitor pupillary blink and gag reflexes.
• Monitor motor and sensory status of
extremities.
• Call client by name.
• Answer questions as honestly and simply
as possible.

b.Circle drainage on the dressing and mark time and date
to allow the objective assessment.
c. Protect the integrity of surgical incision.(sitting,
splinting and maintaining clean and dry incision site)
d. Protect client if dehiscence, evisceration present)
supine position, cover site with sterile towel, moisten
with N/S.
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24
a) Note the location and size of
the wound. Color, amount
and consistency of drainage.
D.Wound Care

E. Care of drain and tubes
• Maintain patency of tubing.
Attach tubing to appropriate collection containers,
maintain negative pressure in portable in portable
wound drainage system.(empty when half full and
compress before closing port; maintin surgical
asepsis.)
Monitor drainage for amount
and color.

1. Maintain I/V therapy as needed.
2. Record intake and output accordingly.
3. Monitor for electrolyte imbalances.
F.

G. Comfort needs.
• Assess clients’ pain(location, duration,
intensity, precipitating factor and
effectiveness of pain management)
• Medicate as ordered and increase post
operative activity.

2. Ongoing post operative care
• Protect client from injury.
• Use pharmacological and non
pharmacological measures to reduce
pain.
• Turn frequently. Encourage deep
breathing and coughing exercises.
• Use of spirometry to prevent atelectasis.

• Encourage range of motion exercise,
(leg exercises)early ambulation to
prevent phlebitis, paralytic ileus and
venous stasis. Notify physician of
complications.
• Maintain patency of tubing. To promote
drainage and maintain decompression to
reduce pressure on suture line.

• Use surgical aseptic techniques when
changing dressing to prevent infection.
• Monitor intake and output to prevent
dehydration, electrolyte imbalances ,
urinary retention. Client must void in 8
to 12 hours after surgery or catheter may
be inserted.
• Encourage client to void. Provide privacy.

• Prevent constipation with fluid, fiber
and exercise. Observe for abdominal
distension. Rectal tube(30 mins) or
Harris flush may be inserted.
• Regulate I/V therapy to prevent overload
or circulatory collapse. Maintain
hydration.

• Encourage client to support and splint
the incisional site when coughing,
moving or turning to prevent tension on
suture line.
• Keep client flat for specified period.(6 to
12 hours after spinal anesthesia)

• Provide emotional support. Assist
client to cope with change in body
image.
• Provide nutritional needs.
(permitable 6-12 hours after spinal
anesthesia)
• Postoperative and discharge teaching.

C Evaluation/Outcome
• Avoids respiratory complication.
• Remain free of infection.
• Relief from pain.
• Maintain fluid and electrolyte balance.
• maintain adequate intake and output.
• Demonstrate ability to self care.
• Cope with changes resulting from surgery.

THANK YOU
For More slides Log On
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Postoperative complication and nursing management

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