2. Objectives
• List and discuss common purposes of surgery.
• List the components of preoperative assessment and
discuss the purposes and nursing responsibilities.
• List the components of preoperative patient preparation and
discuss the purposes and nursing responsibilities.
• List and discuss the potential complications of the
postoperative period and the preventative measures.
• Discuss nursing responsibilities related to the postoperative
care of patients.
3. Common Terms
Perioperative Nursing:
• Includes the preoperative (before), intraoperative (during)
and postoperative (after) periods.
Preoperative period:
• This is an important time to address issues that may come
up during surgery (Screening)
o i.e. assess for bleeding problems, don't want to find out
that someone has a bleeding problem as they
exsanguinate on the operating table
• Also can teach patients and family about what to expect
before, during and after a procedure
o in an emergency, we can prepare the family if the patient
isn't alert
5. Types of Surgeries
Diagnostic: Therapeutic:
• Determination of the • Elimination or repair of the
presence and or extent of pathology
the pathology • Removal of the appendix
• i.e. lymph node bx, when it's inflammed,
bronchoscopy, removal of a localized
exploratory laparatomy cancer
6. Types of Surgeries
Palliative: Preventative:
• Alleviation of symptoms • Surgery to remove tissue
without curing the that has the potential to
underlying disease become pathologic (may
• Rhizotomy (cutting of a not already express a
nerve root) to decrease pathologic problem)
pain, colostomy • Total Colectomy in
placement to bypass an patients with FAP
obstructing colon tumor
7. Types of Surgeries
Cosmetic:
• The surgery is preformed for aesthetic reasons
• Repair of scars from burns or injuries, minor cleft palate
repairs, face lifts, breast augmentation
8. Further Descriptors of Surgery
Elective: Emergency:
• Carefully planned event • arises unexpectedly
• Advanced assessments • can also occur in a wide
are usually attained and variety of settings
pre-operative checks are o ER
in place o OR
o blood draws o Battlefield/Trauma
o physical exam scene
o other necessary studies • Needed within minutes to
• Can be scheduled in some hours
cases as an outpatient or Urgent:
in an ambulatory surgery • delay could be detrimental
center • usually within 24-48 hours
9. Types of Elective Admissions for
Surgery
Ambulatory Surgery:
• Usually outside a hospital setting
• Special prescreening
• Don't use in patient's with multiple problems
Same-Day Surgery:
• Outpatient, can be in the hospital
• Go home the day of the surgery
Early Hospital Admission:
• Patient comes in early (night before or earlier)
• Usually patients with complex medical issues, and increased
risk for poor surgical outcomes
10.
11. Preoperative Nursing Assessment
1. Age
2. Allergies
3. Vital Sign Trend
4. Nutritional Status
5. Habits affecting tolerance to anesthesia
6. Presence of Infections
7. Use of drugs that are contraindicated prior to surgery
8. Physiological Status
9. Psychological state of the patient
12. Preoperative Nursing Assessment
Age: Allergies:
• Elderly are at risk • assess for known drug,
• >65 years of age food and substance
• obtain a detailed medical allergies
history and health • assess what the reaction
assessment to the drug or substance is
• assess for sensory deficits (is it a true allergy, hives or
• assess for overall anaphylaxis?)
functional status • allergies must be clearly
• understand that there is a noted on the chart, and
decreased physiological other steps are usually
reserve taken per
hospital/institutional
protocol
13. Preoperative Nursing Assessment
Vital Signs Trends:
• What is normal for that
patient, and are V/S in
the preoperative period
in line with the norms
or deviating?
14. Preoperative Nursing Assessment
Nutritional Status:
• This can be a situation of deficit or excess
• assess for individuals who are prone to general nutritional
deficiencies:
o Aged
o Cancer patients
o Gastrointestinal problems
o Chronic illness/Chronic steriod use
o Alcoholics/Drug Addicts
• Also assess for excess (Obesity):
o Poor wound healing because of decreased blood supply
o Hard to access surgical site
o Decreased lung capacity
o Anesthesia meds are stored in fat cells
15. Preoperative Nursing Assessment
Habits affecting tolerance to anesthesia:
• Smoking:
o alters platelet function...hypercoagulable
o reduces the amount of functional hemoglobin
carboxyhemoglobin
o cilia in the lung are damaged, more difficult to mobilize
secretions in the patient that smokes
o retards wound healing (especially because of the
decreased functional hemoglobin)
• Alcoholism:
o can have impaired liver function
o B-vitamin deficiencies
• Opioid Addiction
o have a high tolerance for pain meds
16. Preoperative Nursing Assessment
Presence of Infections:
• Biggest indicator is the presence of fever above 101
degrees F (38C)
• If infection is present, likely surgery will need to be delayed
because the risks to the patient are too great.
• Goal will be to find and treat the infection, and then
reattempt surgery once the infection is cleared
17. Preoperative Nursing Assessment
Use of drugs that are contraindicated prior to surgery:
• Drugs like aspirin, heparin, warfarin (Coumadin) should be
stopped prior to surgery
o affect bleeding time
ASA is 2 weeks because of the permanent platelet
affects
heparin, and low molecular weight heparins are usually
stopped 24 preop, unless there are problems with the
liver
warfarin is usually 7 days, but the PT/INR is rechecked
either the day of or the day before the surgery to check
for bleeding
18. Preoperative Nursing Assessment
Use of drugs that are contraindicated prior to surgery:
• current use of medications, over the counter agents and
herbal remedies should be assessed and documented
• some drugs/herbs can interact with the anesthesia
• check about antihypertensives the morning of surgery
• need to be clear about home meds (dose, frequency, timing)
so that any necessary meds are in the postoperative order
as per the MD
o can check with the MD if certain meds should be
restarted
• want to reinforce that if the patient is to take meds the
morning of surgery, they should be taken with sips of water
19. Preoperative Nursing Assessment
Physiological Status: Psychological Status:
• Need to ensure as a • Common behaviors are
preoperative nurse that all fear and anxiety
labs, xrays, EKGs and • fear = pt. knows what they
necessary tests are done are scared of
and in the chart • anxiety = don't tangibly
• Need to notify the know what is scaring you
physician if there is
anything abnormal,
shouldn't assume that
they've already seen it
20. Preoperative Nursing Assessment
Psychological States:
Common Fears:
– Fear of death
– Fear of pain and discomfort
– Fear of mutilation or alteration in body image
– Fear of anesthesia
– Fear of disruption of life functioning or patterns
– Fear due to lack of knowledge regarding the proposed
surgery
– Fear related to previous surgical expriences
– Fear due to the influence of significant others
Remember, for our patients, surgery presents a major lack
of control.
21. Preoperative Nursing Assessment
Psychological States:
Preoperative fear and anxiety can lead to:
1. Need for increased anesthesia
2. Need for increased postoperative pain management
3. Speed of recovery is decreased
Preoperative education of what to expect in clear, common
english can alleviate some fear and anxiety
Remember the role of HOPE for our patients, it is often the
most common coping strategy
22. Patient Preparation for Surgery
1. Operative consent
2. Preoperative learning needs
3. Interventions the day or evening prior to surgery
4. Interventions the day of surgery
23. Operative Consent
This is part of the legal preparation for surgery.
Informed consent: an active, shared decision making process
between the provider and recipient of care. Has 3 components
to make it valid:
1. Adequate Disclosure: of the diagnosis, nature and purpose
of the proposed treatment, probability of successful
outcome, risks and consequences of moving forward with
treatment or alternatives, the prognosis if treatment is not
instituted, and if treatment is deviating from standard for
their condition.
2. Understanding and Comprehension of above: this has to
be assessed before sedating meds can be given (minors
can't give consent, severely mentally ill or severely
developmentally challenged).
24. Operative Consent
Informed Consent (cont):
3. Voluntary Consent: Can't be coerced into going through
with a procedure. This consent can be revoked at any point
leading up to a surgical procedure.
Who can give consent?
• the patient
• next of kin (in order of kinship): Spouse, Adult Child, Parent,
Sibling
o Can be designated with a durable power of attorney in
case of medical incapacitation
25. Who has the legal responsiblity of
obtaining consent?
The Physician
• The nurse is not legally required to obtain consent
• however, the nurse must make sure the consent was signed
o nurse has a primary role as a patient advocate.
• nurse can "witness" the consent, and sign it as such
• if the patient has questions that you can answer to clarify
things, you can do that
• if the patient continues to have questions, or there is a
question that they are not voluntarily giving consent, the
doctor needs to come and speak with them again.
• Very important that patient is consenting voluntarily and
with knowledge of the situation
26. What about emergency treatment?
A true medical emergency may override the need to obtain
consent. When medical care is needed to protect the life
of an individual, the next of kin/POA (Power of Attorney)
can give consent. Also, if there is a known and available
Advanced Directive with healthcare decision making
instructions, that can be used to assist in justifying
consent. If they are not available, and the doctor deems
the procedure necessary for life, the doctor can chart that
it was necessary, and go ahead with the procedure.
• The nurse may need to write up an incident report and state
that the emergency caused a deviation in the normal policy
to obtain consent on everyone.
27. Patient preparation: preoperative
learning needs
• Deep breathing (incentive spirometer), coughing, leg
exercises, ambulation
• Pain control and medications
• Cognitive control to decrease anxiety and enhance
relaxation (deep breathing)
• Recovery room orientation
• Probable postoperative therapies
• Directions for the family
28.
29.
30. Patient preparation: interventions the
day or evening prior to the surgery
• Diet Restrictions
o Historical guidelines to prevent aspiration were NPO after
midnight the night before
o Educating the patient about the reason for NPO status
may help with adherence
• Information of what to wear to the surgery
• Patient will likely need to be there 1 to 2 hours prior to
scheduled procedure
31.
32. Patient preparation: interventions the
day of surgery
This varies based on whether the person is inpatient or
outpatient.
• Encourage the patient to void (empty their bladder) before
they get any sedative medications
• Final preoperative teaching
• Final Assessment and communication of findings to MD
• Ensuring that all preoperative orders have been completed
• Check to chart to make sure that there is:
o a signed consent for the procedure
o laboratory data, Xray reports, EKG
o H&P, and necessary consults
o Baseline vitals
o Nursing notes up until that point
33. Patient preparation: interventions the
day of surgery
• Remove any jewerly, hair pins, clothes (except gown)
o May be able to wear a wedding band taped firmly to the
finger
• Remove contact lens
• No dentures or partial dentures
• If the hearing aides need to be removed, please not that on
the front of the chart.
o glasses or hearing aides need to be returned to the
patient as soon as possible after the procedure
• No makeup or dark nail polish
• Give any preoperative medications
• Note the time the patient leaves the floor
• ID band should be placed, or checked depending on patient
status, and an allergy band per institution protocol
35. Preoperative Medications
• Benzodiazepines/Barbituates: used for their sedative and
amnesic properties
• Anticholinergics: reduce secretions, and can reduce
cramping
• Opioids: decrease need for intraoperative analgesics and
decrease pain
• Antiemetics: decrease N/V
• Antibiotics: to prevent infective endocarditis, or where
wound contamination is a risk (GI surgery) or where wound
infection would cause significant postoperative morbidity
o usually given IV
• Eyedrops: especially with eye surgery (lasik, cataract
surgery)
37. Intraoperative Nursing Issues
• Nursing roles
o Circulating nurse
o Scrub RN
• Perioperative asepsis
• Types of anesthesia
o General
o Regional
• Patient positioning
• Temperature alterations during the intraoperative period
38. Nursing Roles
Circulating Nurse: Scrub Nurse:
• Deal with the management • Is gowned and gloved and
of unsterile activities in the able to handle and pass
operating area sterile items into the sterile
• Document the the nursing surgical field
care of the patient • "Boss" of the sterile field
o assessments • Assists with the actual
o interventions procedure to varying
• movement of unsterile degrees
items out of the surgical
suite
o labeling and
transporting specimens
39.
40. Other Nursing Roles
Registered Nurse First Assistant:
• Work in collaboration with the surgeon to ensure excellent
patient outcomes
• Specialized training and certification
• Handle tissue specimens, use instruments, provide
exposure to the surgical site, assist with hemostatis and
suturing
Nurse Anesthetist:
• minimally masters prepared
• Perform many of the roles that an anesthesiology MD
preform
• manage patient preop assessment, induction, maintenance,
and emergence from anesthesia
41.
42. What's in the Operating Area?
A surgical suite is a controlled environment designed to
minimize the spread of infectious organisms and allow a
smooth flow of patients, personnel, and the instruments
and equipment.
• Unrestricted Area: where personnel in street clothes can
interact with those in scrubs
• Semirestricted Area: peripheral support areas and
corridors, all individuals need to be surgical scrubs and
cover their hair (both facial and on their head)
• Restricted Area: Masks must be worn with above surgical
attire, includes the OR, sinks, and the clean core
43.
44. What does Perioperative asepsis
mean?
It is the creation and maintenance of a sterile field, with the
patient's surgical incision at the center of the sterile field.
45. Proper Technique for scrubbing in to a
surgical field:
1. Team members fingers and hands should be scrubbed first
with progression to the forearm and elbows.
2. The hands should be held away from the surgical attire.
3. The hands should be held up once clean so that no suds or
other bacteria can drift down onto the clean area
4. When waterless gels are used for asepsis, you should first
wash you hands and forearms thoroughly with soap and
water, then dry before putting on the gel
5. Then you can enter the surgical area and put on the surgical
gown and gloves
46.
47. Types of Anesthesia
General: Loss of sensation with the loss of consciousness,
skeletal muscle relaxation, possible impaired ventilatory and
cardiovascular function and elimination of the somatic,
autonomic, and endocrine responses, including coughing,
gagging, vomiting, and sympathetic nervous system responses.
• given IV, inhaled, or rectally
• Technique of choice when:
1.surgical procedures require sig. skeletal muscle
relaxation, last for a long time, require awkward
positioning or control of respirations
2.patient are extremely anxious
3.refuse or have contraindications for local anesthesia
4.are uncooperative (head injury, intoxication, youth,
emotional status, or cannot remain immobile)
48. Endotracheal Intubation
• This is a tube placed into the trachea once IV induction of
anesthesia occurs
• Allows for control of ventilation and airway protection
(specifically from aspiration)
• Complications:
o Sore throat/hoarseness
o injury to the teeth
o failure to intubate
o laryngospasm, laryngeal edema
• Once the tube is placed, an ambu bag is attached and air is
instilled, the chest should rise and fall with the instillation of
air, and you should be able to hear breath sounds
49. Types of Anesthesia
Regional: This is the injection of a local anesthetic in or
around a specific nerve or group of nerves
• Nerve blocks: usually done for the palliation of pain
o celiac plexus block
o brachial plexus block
• Spinal/Epidural Anesthetic: injection of a local anesthetic
into either the subarachnoid space and CSF (spinal) or
epidural space (epidural)
o Spinal blocks: cause autonomic, sensory and motor
blockade, used for lower abdomen, perineal, groin, or
lower extremity
can cause hypotension and vasodilation, also spinal
headaches
o Epidural blocks: anesthetic is given to the epidural space
lower incidence of headache
50.
51. Types of Anesthesia
Local Anesthesia: Usually a topical or injectable agent that
provides sensory blockade to a certain area
Topical: lidocaine spray at the dentist, EMLA Cream for
dermatologic procedures
Injectables: Subcutaneous lidocaine or nerve blocks used
at the dentist
52. Patient Positioning
• Critical part of every procedure and usually occurs once the
anesthesia has been administered.
• Needs to allow for accessibility of the surgical site,
administration of anesthesia, and maintenance of the
airway.
• Must take care to:
• provide correct skeletal alignment
• prevent undue pressure on nerves, skin over bony
prominences, and eyes
• provide for adequate thoracic excursion
• prevent occlusion of arteries and veins
• provide some modesty
• recognize and accommodate for previously assessed
skeletal deformities
53. Patient Positioning
Greatest care must be taken to prevent injury, because:
• anesthesia has blocked the nerve impulses
o the patient can't complain that they have pain or
discomfort
o can cause:
muscle strain
joint damage
pressure ulcers
nerve damage
• Need to also pay attention to the pooling of blood due to
vasodilation, can cause central hypotension
55. Complications of the Intraoperative
Period
Anaphylaxis:
• Most severe form of an allergic reaction, type I
hypersensitivity
• Clinical Manifestations can be masked by anesthesia
• Can be caused by any of the medications, inhaled, IV, or by
the compounds used in the tools of the surgery (iodine
allergy, latex allergy)
• Watch for hypotension, tachycardia, bronchospasm, and
pulmonary edema
56. Complications of the Intraoperative
Period
Postoperative Hypothermia:
• get hypothermia up to 12 hours post surgery, 34.5C
• Direct effect of the anesthesia
• increased risk with longer surgeries
Postoperative Hyperthermia:
• elevated temperatures: 38C or above 24-48 hours post
surgery
• results from inflammatory medications/cytokines that are
released in the post operative period to enhance healing
57. Complications of the Intraoperative
Period
Malignant Hyperthermia:
• Rare metabolic disease in which affected period develop
hyperthermia with rigidity of skeletal muscles that can result
in death
o most often seen when Succinylcholine with inhalent drugs
are given together
• Autosomal dominant with varying levels of penetrance
• Thought to be a derangement of contol of intracellular
calcium, leading to muscle contracture, hyperthermia,
hypoxemia, lactic acidosis, and hemodynamic and cardiac
abnormalities
• Need to assess the patient and the family for any
untoward reactions to anesthesia
• Treatment is administration of dantrolene
58. Postoperative Nursing Care
1. Preparation for admitting the new postoperative patient
2. Initial assessment and interventions upon receiving the
patient
3. Selected data from the chart that is important
4. Post operative nursing assessments and interventions
59. Postoperative Nursing Care:
Preparation
1. Have the postoperative bed ready, linens, extra pillows for
positioning
2. Have the appropriate equipment ready:
1.Suction, set up, tested and ready to hook up
2.antiembolism stockings, set up, tested and ready to hook
up
3.Oxygen hook up
4.if hip replacement, ensure you have the proper hip
abduction pillow
3. Emergency tray (airways, drugs, etc) depending on the type
of surgery
61. Initial Assessment and Interventions
upon receiving the patient
1. Level of consciousness and emotional state
2. Move patient to the bed, placement and positioning,
attachment of equipment as needed
a. quick assessment of A (airway) B (breathing) C
(circulation)
b. proper positioning may be ordered based on the type of
surgery, if semiconscious, side lying with the head of the bed
flat, if fully conscious, semi fowlers (if not contraindicated)
3. Safety Measures: side rails up, brief assessment of
mentation
62. Initial Assessment and interventions
upon receiving the patient
4. Review the postoperative plan of care with the recovery
room nurse to include orders:
• V/S, position, medications, IV fluids, NPO or type of oral
intake, activity, diagnostic tests needed, dressing changes,
etc...
5. Emotional Support for the patient and the family
6. Pain: Assess pain per patient, and location
63.
64.
65. Initial assessment and interventions
upon receiving the patient
7. Objective Data:
a. Vital Signs (TPRBP) q 15min x 4, q 30 min x 4, q 1 hour x
4, then q 4 hours as indicated
Can only move from 15 to 30min, and 30min to q1 hour
when the patient is stable
b. Respiratory Status: Patency of the airway, need for
suctioning if the patient can't move sections, depth of
respirations
C. Neurological Status: Level of consciousness, pupils, gag
and swallowing reflexes
66. Initial assessment and interventions
upon receiving the patient
d. Circulatory Status: note the nailbeds (cap refill), lips,
buccal membranes, palms, and soles for pallor and duskiness
(cyanosis is usually first seen in the buccal membranes)
e. Dressing (s): check the chart and see where they are,
and what they are comprised of
also check the chart for placement of any surgical drains
have been placed and where they exit
f. Drainage tubes: are they free of kinks and draining
properly, check if the tubes need to be attached to suction,
check to ensure it is the proper amount of suction, assess type
and amount of drainage and know when to call the MD.
67. Initial assessment and interventions
upon receiving the patient
g. Urinary output: if there is no foley, the patient must void
within 8-10 hours post-op, if not, notify the MD
if there is a foley, there should be at least 500-700 cc in
the first 24 hours post surgery
h. Safety: Side rails up, instruct the patient not to get out of
bed without help, ensure the call light and phone are within
reach, secure all tubes and lines properly to prevent
dislodgement and injury
As the nurse, make sure to dangle the patient for 1-2
minutes the first time the patient gets up out of bed.
i. Proper positioning and comfort
j. Equipment
68. Selected data from the chart that is
important
1. Surgeon's Orders
2. Surgical Notes and Anesthesia records
3. Recovery Room Summary
69. Postoperative nursing assessment and
interventions
1. Assessment of Risk Factors for postoperative
complications (will review later)
2. Promote comfort: includes the relief of pain, the relief of
restlessness, relief of nausea and vomiting, relief of
abdominal distention, relief of hiccups.
3. Promote wound healing: review wound healing from
earlier lectures...a properly approximated sutured or stapled
surgical wound is healing by primary intention, how strong is
the wound once the sutures are removed?
4. Care of tubes and drains
70. Postoperative nursing assessment and
intervention
5. Ensuring optimal respiratory function: Promote lung
expansion, deep breathing, coughing and use of the incentive
spirometer
(Coughing is contraindicated in head and eye surgeries,
plastic surgery and hernia operations)
6. Maintenance of Adequate Cardiovascular Function
7. Maintenance of adequate F/E balance: monitor for
abnormal electrolytes, monitor v/s, keep an accurate I&O
records, obtain laboratory specimens
71. Postoperative nursing assessment and
intervention
8. Maintenance of nutritional balance: NG tubes for 24-48
hours post GI surgery, post operative diet includes clear liquids
once bowel sounds return, advance the diet based on MD
orders and patient tolerance
9. Return of Normal Urinary Function: assess for bladder
pain and distention (palpation and percussion), assess urinary
output, Notify MD if no urine output 6-8 hours post surgery, If
patient continues on bed rest, assist the patient into the normal
voiding position as possible, provide for adequate privacy (as
much as possible)
72. Postoperative nursing assessment and
interventions
10. Resumption of usual bowel elimination pattern:
assess for abdominal distention, presence of bowel sounds,
assist with ambulation, provide ordered laxatives as needed,
provide for as much privacy as possible, assist in positioning
patient in as natural a position for stooling.
11. Restoration of Mobility: assess the patient for the ability
to ambulate, remember to dangle the patient before walking,
assess the patient before, during and after ambulating, work
with PT, provide for adequate pain medicines if needed prior to
ambulating.
12. Reduction of anxiety and achievement of well-being
13. Discharge Planning: very teaching focused
73. Common postoperative complications
• Hematological • Gastrointestinal
o Hemorrhage o Paralytic ileus
• Respiratory o Constipation
o Atelectasis • Neurological
o Pneumonia o CVA/Stroke
o Pulmonary Embolism • Immunological
• Cardiovascular o Infection
o Hypotension • Wound Healing
o Cardiac Dysrhythmias o Dehiscence
o Venous Thrombosis o Eviserations
• Urinary o Infection
o Urinary Retention • Psychological
o Low urine production o Body image problems
75. Common postoperative complications:
Hematologic
Hemorrhage:
• Often related to ineffective vascular closure or alterations in
coagulation
• Observe for bleeding at the wound site/surgical dressing,
especially in the dependent areas
• monitor the v/s closely (see previous slide), follow the H/H
closely, assess skin closely, report any changes noted
• assess LOC, and mentation (restlessness can indicate
altered cerebral perfusion)
76. Common postoperative complications:
Pulmonary
Atelectasis:
• Common cause of postoperative hypoxemia
• Retained secretions and decreased respiratory excursion
causes blockage of the alveoli
o once all the air trapped in the alveoli is absorbed, the
alveoli collapse
o hypotension and cardiac states can worsen this
• Assess for decreased lung sounds, decreased O2 sats
• Encourage deep breathing, incentive spirometry, coughing,
early mobilization
78. Common postoperative complications:
Pulmonary
Pneumonia:
• Can be a sequela to the atelectasis, can occur from
aspiration
o increased risk post thoracic and abdominal surgery
• the atelectasis builds up, and increased secretions can
continue to block the airways
o microorganisms grow in the trapped secretions
• Proper positioning of patients can assist with this, as well as
q2 hour re-positioning
o ensure that respiratory effort is maximized
o O2 therapy as ordered/needed
o Antibiotics as ordered
• V/S and frequent lung sound assessment
• Cough, IS, deep breathing
79. Common postoperative complications:
Pulmonary
Pulmonary Embolism:
• Caused by a thrombus that is dislodged from the peripheral
circulation, and then gets lodged in the pulmonary arterial
circulation
• See acute tachypnea, dyspnea, tachycardia, hypotension
and decreased O2 saturations
• Start O2 per MD, Anticoagulants as ordered,
cardiopulmonary support
• Preventing DVT is primary to preventing pulmonary emboli:
o Leg exercises
o Compression stockings/anticoagulants per MD
o Deep breathing, coughing, IS (move the air in the lungs
and move the blood)
o Ambulate as soon as possible
80. Common postoperative complications:
Cardiovascular
Hypotension:
• Most common causes are unreplaced fluids during the
surgery and hemorrhage
• Secondary causes include MI, cardiac tamponade,
pulmonary emboli, or effects from the anesthesia drugs
• Show signs of hypoperfusion to the vital organs (heart,
brain, and kidneys)
• have clinical signs of disorientation, loss of consciousness,
chest pain, oliguria, and anuria
• Assess V/S, pulse Ox, peripheral pulses, LOC and report as
necessary
• Assist physician with interventions aimed at correcting the
underlying cause of the hypotension
81. Common postoperative complications:
Cardiovascular
Cardiac Dysrhythmias:
• Usually stems from hypokalemia, hypoxemia, hypercarbia,
acid/base imbalances, underlying heart disease, and
circulatory instability.
• Need to assess V/S, compare peripheral pulse with the
heart sounds heard.
• Treatment involves resolving the underlying cause of the
dysrhythmia
82. Common postoperative complications:
Cardiovascular
Venous Thrombosis:
• Results from venous stasis (inactivity, body positioning,
pressure, dehydration)
• postoperative patients who are eldery or obese are at higher
risk of developing DVTs
• DVTs can embolize and travel to the lung and cause
pulmonary emboli
• Assess for swelling (usually unilateral) in the lower
extremities, redness and pain
• Provide passive ROM of the lower extremities, or encourage
active ROM if the patient is able
• Encourage early ambulation
• Apply compression stockings/sequential compression
devices and give anticoagulants as ordered.
83. Common posoperative complications:
Urinary
Urinary Retention:
• Can occur in the postoperative period because the
anesthesia can depress the nervous system, and impede
the sensation of bladder filling as well as interfere with the
ability to void.
• More likely to occur after lower abdominal or pelvic surgery
• Need to assess for urine output, both color and amount,
urine output should be 0.5ml/kg/hr, and the patient should
urinate within 6-8 hours of surgery
• Nurse should facillitate voiding by normal positioning of the
patient to void
• Provide privacy to void, running water, pouring warm water
over a female's perineum can assist with the ability to void,
and ambulating to the commode/toilet can help
84. Common postoperative complications:
Urinary
Low Urine Production:
• The diminished output of urine can be a manifestation of
renal failure and is less common
• May result from renal ischemia from inadequate renal
perfusion or altered cardiovascular function
• Need to assess urine output, color and amount
• should be 0.5ml/kg/hr, if below that, palpate and percuss the
bladder for fullness and report to MD
85. Common postoperative complications:
Gastrointestinal
Paralytic Ileus:
• This is caused by bowel manipulation, anesthesia affects on
the bowel, immobility, and pain medicines
• Assess for bowel distention, bowel sounds, presence of
flatus, or stool, bowel sounds and nausea or vomiting
• Maintain NPO status is patient is showing signs of paralytic
ileus, teach patient the importance of the NPO status
• May need to place an NG tube if ordered by MD, and
manage per hospital protocol
86. Common postoperative complications:
Gastrointestinal
Constipation:
• Same causes as paralytic ileus
• Assess for bowel distention, bowel sounds, passage of
flatus, stool (color, caliber, form), assess bowel sounds,
assess for nausea and vomiting
• Early ambulation can assist with this
• Use of stool softeners, suppositories and enemas as
perscribed
o Harris flush for gas
o Molasses enemas, soap suds enemas, mineral oil
enemas
o positioning on the right side allows the gas to move up
the transverse colon and out the rectum
87. Common postoperative complications:
Neurological
CVA/Stroke:
• Can be the result of venous stasis and hypercoagulable
states
• Assess LOC, motor and strength, neuro exams, pupils
• Assist with early ambulation, prophylaxis for DVTs/venous
stasis
• Support the patient and the family
88. Common postoperative complications:
Immunologic
Infection:
• This is related to the altered skin integrity, inadequate
nutrition and fluid balance, presence of environmental
pathogens, invasive instrumentation, and immobility
• Assess for s/s of infection (wound, V/S)
• Provide clean or aspetic wound care (wounds and drains)
• Note the characteristics of drainage to determine infection
• Good pulmonary toilet
• Work with the dieticians to provide optimal nutrition for the
patients
89. Common postoperative complications:
Wound Healing
Dehisence:
• Separation and disruption of the previous joined wound
edges, may be preceeded by sudden discharge of pink,
brown, or clear drainage
• Often a complication of an infected wound, or from too much
pressure on a surgical wound (obesity, lifting, bending)
Eviseration:
• See dehisence but there is also protrusion of organs through
the wound opening
• Same risk factors
• Assess the wound frequently, note any changes in d/c or
approximation
• Teach the patient care of the wound and about
postoperative limitations
90. Common postoperative complications:
Wound Healing
Infection:
• This can be caused by altered skin integrity, altered
nutritional and fluid intake, presence of environmental
pathogens, invasive instrumentation, and immobility
• Assess the wound thoroughly: Drainage,
approximation of wound edges, redness, tenderness,
etc.
• Teach care of the wound to the patient and the family
• Provide medically safe wound care based on orders
• Clean the wound appropriately
• Teach about postoperative limitations
91. Common postoperative complications:
Psychological
Body Image Problems:
• Any surgery has the potential to cause body image
disturbances
• Need to provide empathetic support
• Meet the patient where they are at...i.e. if they don't want to
look at their colostomy, that might not be the time to teach
colostomy care
• Support the family, S.O. as well
• provide social work referral where indicated
92. Thank you for your attention
Happy Thanksgiving
Be safe...And full
