Week 3: Possible Post-op Complications

1. Hypotension a. Definition: Low blood pressure, or hypotension, occurs when blood pressure during and after 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 lightheadedness ii. Fainting (syncope) iii. Lack of concentration iv. Blurred vision v. Nausea vi. Cold, clammy, pale skin vii. Rapid, shallow breathing viii. Fatigue ix. Depression x. 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 management i. Blood through a needle (IV) ii. Medicines to increase blood pressure and improve heart strength, and other medicines, such as antibiotics 2. Bleeding a. 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 diathesis iii. Consumption coagulopathy iv. Infection damaging vessels at the operation site c. Manifestations: i. Loss of blood pressure ii. Enlarged circumference of the body at the operative site iii. Complete blood count showing decrease in hemoglobin, hematocrit and red blood cells

iv. Increase in heart rate v. Marked pallor of the skin and mucosa under the lower eyelids vi. Increase in respiratory rate d. Nursing Management: i. Ensure good intravenous (IV) access e. Medical management: i. Clotting screen ii. Platelet count iii. Consider surgical re-exploration at all times iv. Fresh frozen plasma (FFP) or platelet concentrates 3. Hypovolemic shock a. 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 injuries iii. Internal bleeding, such as in the gastrointestinal tract c. Manifestations: i. Weakness ii. Lightheadedness iii. Confusion iv. Anxiety or agitation v. Cool, clammy skin vi. Decreased or no urine output vii. Pale skin color (pallor) viii. Rapid breathing ix. Sweating, moist skin x. Unconsciousness d. Nursing Management: i. Raising the patient's legs while fluid is being given ii. 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 warmth iv. 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) line 4. Atelectasis a. Definition: The collapse or closure of the lung resulting in reduced or absent gas exchange. 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 aspirating secretions into the lungs is a major source of infections iii. Any condition that interferes with spontaneous coughing, yawning and sighing iv. Lung disease, such as asthma, bronchiectasis or cystic fibrosis v. Confinement to bed, with infrequent change of position vi. Abdominal or chest surgery vii. Recent general anesthesia viii. Shallow breathing a result of abdominal pain or rib fracture, for example

ix. Respiratory muscle weakness, due to muscular dystrophy, spinal cord injury or another neuromuscular condition x. Obesity fat in the abdomen can elevate your diaphragm and hamper your ability to inhale fully xi. Age being a young child between the ages of 1 and 3 c. Manifestations: i. Cough, but not prominent ii. Chest pain iii. Breathing difficulty iv. Low oxygen saturation v. Pleural effusion (transudate type) vi. Cyanosis (late sign) vii. Increased heart rate viii. Low-grade fever d. Nursing Management: i. Focusing on deep breathing and encouraging coughing ii. Ambulation is also highly encouraged to improve lung inflation e. Medical management: i. Continuous positive airway pressure, which delivers pressurized air or oxygen through a nose or face mask to help ensure that the alveoli do not collapse, even at the end of a breath ii. Mechanical ventilator iii. Incentive spirometer 5. Thrombophlebitis a. Definition: Occurs when a blood clot causes swelling in one or more of your veins, typically in your legs. b. Risk factor: i. Blood clot ii. Injury to a vein iii. Inherited blood-clotting disorder iv. Prolonged inactivity v. Just given birth, which may mean you have increased pressure in the veins of your pelvis and legs vi. Overweight or obese vii. Older than 60 c. Manifestations: i. Warmth, tenderness and pain in the affected area ii. Redness and swelling iii. Red, hard and tender cord just under the surface of your skin iv. Leg may become swollen, tender and painful, most noticeably when you stand or walk v. Fever d. Nursing Management: i. Prescription-strength support hose e. Medical management: i. Injection of a blood-thinning (anticoagulant) medication, such as heparin, will prevent clots from enlarging ii. Thrombolytic iii. Surgically remove varicose veins that cause pain or recurrent thrombophlebitis 6. Paralytic ileus a. 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:

Appendicitis Botulism (poisoning with botulinum, a neurotoxin) Certain medications, such as opiates and sedatives Diabetic ketoacidosis (life-threatening complication of diabetes) Electrolyte imbalance Gastroenteritis (inflammation or infection of the stomach or intestines) Neonatal necrotizing enterocolitis (disease that causes death of intestinal tissue in newborns) viii. Obstruction of the mesenteric artery, which supplies blood to the abdomen ix. Pancreatitis x. Porphyria (metabolic disorder) xi. Surgical complications c. Manifestations: i. Abdominal swelling, distension or bloating ii. Constipation iii. Diarrhea iv. Foul-smelling breath v. Gas vi. Lack of bowel sounds vii. Nausea with or without vomiting viii. 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 through the digestive tract iii. Placement of a nasogastric tube to release the air and drain the fluid iv. Intravenous fluids to provide nutrients 7. Dehiscence a. 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 age iii. Poor nutrition iv. Diabetes v. Smoking vi. Malignant growth vii. Presence of prior scar or radiation at the incision site viii. Non-compliance with post-operative instructions (such as early excessive exercise or lifting heavy objects) ix. Surgical error x. 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 edges iii. Wound swelling iv. Fluid draining from the wound v. Tissue protruding from the wound d. Nursing Management: i. Exposure to the air ii. Frequent dressing

i. ii. iii. iv. v. vi. vii.

iii. Removal of dead, damaged, or infected tissue to improve the healing potential e. Medical management: i. Antibiotic therapy ii. Frequent changes in wound dressing to prevent infection iii. Wound exposure to air to accelerate healing and prevent infection, and allow growth of new tissue from below iv. Surgical removal of contaminated, dead tissue v. Resuturing vi. Placement of a temporary or permanent piece of mesh to bridge the gap in the wound 8. Evisceration a. 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 wounds iii. Work with power tools iv. 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 bandages iii. Use sterile saline to saturate the bandage or towel e. Medical management: i. Immediate emergency surgical closure