Perioperative Nursing Care: Post-Op Complications

Introduction

• Focus: Post-op complications and prevention
• Builds on previously covered recordings on Canvas
• Emphasis on assessment and prevention by nurses

Respiratory Complications

• Common Issues: Airway obstruction, hypoxemia, atelectasis, aspiration, pneumonia, PE, bronchospasms
• Assessment:
  • Lung sounds
  • O2 sats
  • Coughing, sputum production
  • Dyspnea
  • Temperature and WBC count
• Prevention:
  • Keep patient NPO until GI motility/swallowing return
  • Administer O2 to maintain sats >92%
  • Ensure adequate hydration
  • Encourage turning, coughing, deep breathing, use of incentive spirometer
  • Suction as needed
  • Mobilize patient and change positions
  • Monitor response to narcotics
  • Educate patient on importance

Cardiovascular Complications

• Common Issues: Hypotension, hypertension, dysrhythmias, VTE, syncope, hemorrhage
• High-Risk Patients: History of respiratory/cardiovascular disease, older adults, debilitated or critically ill
• Assessment:
  • Monitor for PE signs
  • Check extremities for color, temp, pain, edema
  • Vital signs comparison
  • ECG monitoring for cardiac patients/older adults
• Prevention:
  • Early and frequent ambulation
  • Leg exercises, discourage leg crossing
  • Use of TED hoses, SCDs, heparin or Lovenox
  • Ensure adequate hydration
  • Educate on importance of movement

GI Complications

• Common Issues: Nausea, vomiting, delayed gastric emptying, ileus, constipation
• Assessment:
  • Monitor bowel sounds and function
  • Assess for nausea, vomiting, abdominal discomfort
• Prevention:
  • Keep NPO until gag reflex/bowel sounds return
  • Advance diet slowly
  • Manage nausea with antiemetics
  • Position sideline to prevent aspiration
  • Encourage mobilization
  • Use NG tube if needed

Genitourinary Complications

• Common Issues: Oliguria, retention, catheter-associated UTIs
• Assessment:
  • Urine output (≥0.5 mL/kg/hr)
  • Look for bladder distension, pain
• Prevention:
  • Monitor intake/output
  • Encourage hydration and ambulation
  • Position patient for normal voiding
  • Use aseptic technique for catheterization

Surgical Site Complications

• Common Issues: Dehiscence, evisceration, wound infection
• Assessment:
  • Check for sensations of popping/tearing
  • Monitor incision for swelling, redness, heat
  • Watch for foul-smelling or purulent drainage
• Prevention:
  • Pre-op skin prep and antibiotics
  • Follow SKIP protocol
  • Hand hygiene for nurses and patients
  • Ensure adequate nutrition/hydration

Conclusion

• Complications include respiratory, cardiovascular, GI, genitourinary, and surgical site issues
• Importance of patient education and adequate pain management throughout
• Next: Final section of post-op and periop content