Post-Op Complications Flashcards
List 10 Assessments that need to be completed post-op.
- LOC
- Vital signs
- Pain Assessment
- Airway patency
- Effectiveness of respirations
- Presence of an artificial airway
- Fluid balance
- Wound condition
- Circulatory status
10.
What is the Aldrete scale? How is the Aldrete scale used?
The Aldrete Scale: Determines how the client is recovering from anesthesia post-op
It is used by:
- Rating client’s mobility, respiratory status, circulation, consciousness, and pulse oximetry
- Score of 9 or greater indicates client has recovered from anesthesia
How does the nurse monitor for external hemorrhage after surgery? Internal hemorrhage?
External (Evident)
- Inspect dressings frequently for signs of bleeding and check bedding under client
- Inspect drains frequently and be aware of the type and amount of drainage expected
Internal (Concealed)
- Monitor vitals for signs of shock:
• Pallor
• Fall in BP
• Weak pulse
• Tachycardia
• Restlessness
• Cool, moist skin - Physical examination for S&S of internal bleeding:
• Edema
• Bruising
• Distention of the abdomen
• Pain - Monitor fluid balance
• Decrease in urine output may occur as body shunts blood away from the kidneys
List potential causes of aspiration in the early post-anesthetic time period.
Potential causes of aspiration in the early post-anesthetic time period include:
- saliva
- mucus
- vomit
- blood
Risk for aspiration exist until the client is fully awake and can swallow without difficulty.
List complications of aspiration:
- Aspiration pneumonia
- Acute Respiratory Distress Syndrome (ARDS)
- Abscesses
- Airway obstruction
- Impaired gas exchange
What should the nurse assess prior to giving anything by mouth in the postop period?
Nurse should first asses:
- Recovery from anesthesia
- Ability to swallow
- LOC
- Ability to sit upright
The nurse should then monitor for:
- coughing
- choking
- dyspnea
- stridor
- hoarseness
- wheezing
- tachycardia
- nasal flaring
- chest retractions
Define atelectasis.
Atelectasis:
- A condition that occurs when capillaries surrounding the alveoli become engorged
- Alveoli collapse (collapse of part of the lung)
List potential causes of atelectasis in the post-operative recovery phase.
- Hypoventilation / restricted ventilation - due to opioids, anesthesia, pain and limited mobility
- Compression of lung tissue by tumour or fluid accumulation
- Prolonged bed rest – reduces lung expansion and promotes secretion buildup
- Obstruction - by mucous, blood clots, or tumors
- Pulmonary edema – fluid accumulation in the lungs
- ARDS – Inflammatory response affecting lung function
- Aspiration – Inhalation of food, liquid, or secretions can block airways
- Fibrosis – scarring of lung tissue can restrict expansion
- Impaired Cough Reflex – Leading to ineffective clearance of secretions
What are some signs and symptoms that would indicate atelectasis?
Small areas may cause few symptoms.
Larger areas:
- Cyanosis, Hypoxia
- Asymmetrical chest expansion
- Absent lung sounds in area collapsed
- Chest pain
- Dyspnea
- Increased pulse (Tachycardia)
- Respiratory rates (Tachypnea)
- Increased pulmonary secretions
List signs and symptoms of paralytic ileus. Which is most definitive?
Paralytic ileus: Occurs when the intestines are paralyzed and, thus, peristalsis is absent.
Signs and symptoms include:
- Absent bowel sounds
- Abdominal pain (colicky)
- Abdominal distention and rigidity
- Nausea and vomiting
- Absence of stool and flatus
- Restlessness, diaphoresis
- S&S of dehydration, hypovolemic shock
The most definitive S&S is the absence of bowel sounds.
Give 4 reasons why paralytic ileus is a risk after abdominal surgery.
- Manipulation of the intestines during abdominal surgery
- Immobility after surgery
- Interruption of normal food and fluid intake
- Swallowing large quantities of air
- Anesthetics and medications given during or after surgery
Explain the pathophysiology of bowel obstruction using the following words: peristalsis, distention, constipation, vomiting, dehydration, fluid shift, ischemia, necrosis, and peritonitis.
- Peristalsis tries to push contents through the intestines, but the passage is blocked.
- The section of bowel before the obstruction becomes distended (enlarged and swollen) due to the accumulation of gas and fluids.
- Stool cannot move past the obstruction, leading to a buildup of fecal matter I.e., constipation.
- Distention and buildup of contents can cause nausea and vomiting which can include undigested food, bile and fecal matter.
- Vomiting and inability to absorb fluids and electrolytes properly can lead to dehydration.
- Third spacing?????
- Increased pressure from distention can compromise blood flow to the affected bowel segment I.e., ischemia
- Prolonged ischemia can lead to tissue death I.e., necrosis in the affected bowel segment.
- Dead tissue can lead bowel wall to perforate. If the bowel wall perforates, it can lead to intestinal contents spilling into the abdominal cavity, causing peritonitis, which is inflammation of the peritoneum (lining of the abdominal cavity).
Define the following wound terms: infection, dehiscence, evisceration, hypertrophic scars, keloid formation, excess granulation tissue, adhesion, fistula, contracture, obstruction.
Infection: Invasion of the body with pathogens or their toxins.
Dehiscence: Partial or total rupturing of a sutured wound without the protrusion of organ.
Evisceration: Protrusion of organs through a separated surgical wound.
Hypertrophic scars: A large, raised, red scar caused by excess deposit of collagen that is confined to wound edges.
Keloid formation: A form of hypertrophic scarring. Excessive collagen growth that results in scar tissue that protrudes beyond wound edges. Especially common in those with darkly pigmented skin.
Excess granulation tissue: Proud fresh; granulation tissue grows above the the wound.
Adhesion: Bands of scar tissue that join two surfaces; may cause issues with movement of structures and make subsequent surgeries more difficult. Healing has connected surfaces that are not normally connected.
Fistula: Channel from an organ to the surface of the body or from one organ to another; may allow movement of unsterile substances into sterile areas.
Contracture: Caused by shrinking of scar tissue; a permanent tightening of the muscles, tendons, skin, and nearby tissues that causes the joints to shorten and become very stiff.
Obstruction: Caused by shrinking of scar tissue; may shorten or narrow a tube or duct e.g. esophageal stenosis.
