Week 3 - PostOp Complications Flashcards
what are common and potential post-operative complications for neuro-psychological?
- delirium
- fever
- hypothermia
- pain
- postoperative cognitive dysfunction
what are common and potential post-operative complications for respiratory?
- airway obstruction
- aspiration
- atelectasis
- bronchospasm
- hypoventilation
- hypoxemia
- pneumonia
- pulmonary edema
- pulmonary embolus
what are common and potential post-operative complications for cardiovascular?
- dysrhythmias
- hemorrhage
- hypertension
- hypotension
- superficial thrombosis-phlebitis
- venous thrombo-embolism
what are common and potential post-operative complications for gastro-intestinal?
- delayed gastric emptying
- distension/ flatulence
- hiccups
- nausea/ vomiting
- postoperative ileus
what are common and potential post-operative complications for urinary?
- infection
- retention
what are common and potential post-operative complications for integumentary (incision site)?
- dehiscence
- hematoma
- infection
what are common and potential post-operative complications for fluid and electrolytes?
- acid/ base disorders
- electrolyte imbalances
- fluid deficit
- fluid overload
when looking at vital signs you just took which of them are indicators that the pt could be in pain?
- increased HR
- increased BP
what are the main things to be aware of in regards to pain crisis?
- 10 or > out of 10
- occur gradually or slowly over time
- often pt will be extremely still
what are some risk factors for hypothermia?
- effects of anesthesia
- stress response
- body temp loss in OR
what might you find in your assessment of a pt experiencing hypothermia?
- shaking
- appeal pale or cyanotic
what are some interventions the nurse can do to help a hypothermic patient?
- warmed blankets
- warm fluids
- forced-air warmers
for a pt with thermoregulation issues what are common findings that would happen with a mild fever (<38) during days 0-2?
- inflammatory response to surgical truama
- hematoma
for a pt with thermoregulation issues what are common findings that would happen with a persistent fever (>38) during days 0-2?
- atelectasis
- specific infections related to surgery
- dehydration
for a pt with thermoregulation issues what are common findings that would happen during days 3-5?
- pneumonia
- UTI
- sepsis
- wound infection
- phlebitis
- abscess formation
- DVT
what are signs and symptoms of sepsis?
- fever
- increased HR
- decreased BP
pt are at an increased risk of dizziness and fainting in the first what?
24-48hrs post surgery
which pts are at the highest risk of dizziness and fainting?
- spinal epidural
why are pts who had a spinal epidural at the highest risk of dizziness and fainting?
- freezes motor, sensory and autonomic nerves
- pt stands vessels don’t contract so blood pools in feet and BP drops > pt faints
- vaso-vagal response can occur
for pt’s experiencing post op delirium what do you use to assess them?
CAM scale
is post-op delirium an emergency?
yes
delirium is different than dementia and has rapid onset and cluster symptoms. What are they?
- acute onset
- fluctuation throughout day
- difficulty focusing attention
- disorganized thinking
- altered LOC
post-op delirium can be ____ or _____
hypoactive or hyperactive
what do you use to treat post-op delirium?
- PRISME
- may need a 1:1 CCP
respiratory complications can occur after what?
major surgery
what are some risks for an airway obstruction?
- spasm of bronchus and larynx
- tongue falling back
what assessment data do you expect to gather for an airway obstruction?
- stridor
- tachypnea
- shallow/ wheezing breaths
- dyspnea
- gasping
- increase pulse
- irritability
what interventions should then nurse implement if the pt has an airway obstruction?
- stimulation
- positioning
- artificial airway
what are some risk factors for aspiration?
- GERD
- pregnancy
- H hernia
- ulcers
- trauma
what assessment data do you expect to gather for a pt experiencing aspiration?
- coughing
- crackles
- rattling chest
- decreased SpO2
what are some interventions the nurse can do for a pt experiencing aspiration?
- sit up for feeding and drinking
- protection of airway
what are some risk factors for atelectasis?
- airway obstructed by bronchial secretions
- trapped air absorbed and alveolar collapse
what assessment data do you expect to gather for a pt experiencing atelectasis?
- slow recovery
- poor color
- mild tachypnea
- tachycardia
- sometimes increased temp
- decreased air entry heard to lung fields
what are some interventions the nurse can do for a pt with atelectasis?
pre and postoperative physiotherapy
what are some risk factors for bronchospasm?
- asthma
- COPD
- intubation
- aspiration
what assessment data do you expect to find with a pt who has bronchospasm?
- wheezing
- dyspnea
- tachypnea
- decreased SpO2
what are some interventions a nurse can do for a pt who has bronchospasm?
- administer O2
- bronchodilators
what are some risk factors for hypoventilation?
- respiratory depression from narcotics/ opioids
- poor muscle tone
- pain
- mechanical restriction
if a pt is experiencing hypoventilation what assessment data does the nurse expect to find?
- Decreased RR
- shallow resps
- decreased SpO2
- increased PaCO2
what interventions can a nurse do for a pt experiencing hypoventilation?
- administer O2
- ventilator assistance
- stimulation
- positioning
what are some risk factors for pneumonia?
- hypoventilation
- immobility
- aspiration
- resp issues
If a pt has pneumonia what assessment data does the nurse expect to find?
- infection from stasis or secretions
- dull/ productive cough
- fever
- chills
- pleuritic pain
- WBC
what are some interventions the nurse can implement for a pt with pneumonia?
- antibiotics
- physiotherapy
how can you prevent pneumonia from developing post surgery?
get the patient mobile at least 3 times a day
what are some risk factors for pulmonary edema?
- fluid overload
- left ventricular failure
- prolonged airway obstructions
- sepsis
- aspiration
if a pt has pulmonary edema what assessment data does the nurse expect to find?
- crackles on auscultation
- infiltrates on CXR
- fluid overload
- decreased SpO2
- productive cough with clear to pink sputum
what interventions can the nurse implement for a pt with pulmonary edema?
- diuretics
- increased O2
- fluid restriction
what are some risk factors for a pulmonary embolism (PE)?
- DVT
- other peripheral thrombosis
- AFib
- fat emboli
- air emboli
what assessment data should the nurse expect to find for a pt with a pulmonary embolism?
- acute tachypnea
- dyspnea
- chest pain
- hypotension
- decreased SpO2
what are some interventions a nurse can implement for a pt with a pulmonary embolism (PE)?
- O2 therapy
- CVS support
- anticoagulations
what are some risk factors for hemorrhage/ bleeding?
- truama
- long surgical time
- blood thinners
what assessment data should the nurse expect to find in a pt with a hemorrhage/ bleeding?
- assess dressing
- VS and lab values
- increase pulse
- symptoms of shock for internal bleeding
what interventions can the nurse implement for a pt with a hemorrhage/ bleed?
- change dressing prn after 24-48hrs postop unless directed otherwise
- hold pressure/ call for help if needed/ notify doctor
- empty/ measure drains
where do you expect to see a hematoma post surgery?
area immediate to surgical site that continues to swell, filling with blood
what are some risk factors for a hematoma?
- trauma
- long surgical time
- blood thiners
what assessment data should the nurse expect to find if a pt has a hematoma?
- firmness
- swelling
- discolouration/ bruising
- mark it with a pen
what are some interventions the nurse can implement for a pt with a hematoma?
- apply pressure to dressing
- call surgeon if continues
- occasionally needs to be drained
what are some risk factors for hypotension?
- fluid/ blood loss
- fluid deficit
- peripheral pooling of blood
- vasodilation from anaesthetic
- medications
what assessment data should the nurse expect to find in a pt with hypotension?
- decreased LOC
- decreased BP
- dizzy
- nausea
- pale
- hypovolemic shock
what would you expect to find in a pt with hypovolemic shock?
- decreased BP
- increased pulse
- cold
- clammy
- pale
patient’s can develop orthostatic hypotension when changing from ____ to ____ to quickly
lying to standing
what intervention can a nurse implement for a pt with hypotension?
- replace lost fluids
- insure strick I&O measuring
what are some causes of hypertension?
- pain
- delirium
- hypoxia
- gastric or bladder distention
- fluid overload
what should the nurse assess for a pt with hypertension?
- PRN BP
- pulse
- cap refill
- absence of chest pain
- RR
- extremities
- crackles
- edema
what are some different cardiac dysfunctions?
- myocardial infarctions/ ischemia
- CVA/ TIA
- dysrhythmias
- hypo/hypertension
- pulmonary embolism
what causes cardiac dysfunctions ?
- effects of drugs
- prolonged surgical time
- trauma
- comorbidities
- acid/base imbalances
- fluid/ electrolyte imbalances
what should you assess for pts with cardiac dysfunctions?
- monitor VS
- telemetry/ ECG monitor
- CWMS
- I&O balance
what interventions can be done for cardiac dysfunctions?
- DVT heparin protocol
- replace/ excrete fluids and electrolytes
what are different types of fluid and electrolyte imbalances?
- hypo/hypervolemia
- hypo/hypercalcemia
- hypo/hyperkalemia
- hypo/hypernatremia
what causes fluid and electrolyte imbalances?
- trauma
- blood loss
- to much fluid replaced in OR
- prolong surgical time
- drugs
- gastric losses
what do you need to assess for fluid and electrolyte imbalances?
- monitor for S&S
- full CVA assessment
- lab values
- telemetry/ ECG monitoring
- monitor I&O
what are some interventions that can be put in place for fluid and electrolyte imbalances?
treatment based on:
- levels of fluid replacement
- diuretics
- electrolyte replacement/ excretion
what causes nausea and vomiting post surgery?
- anesthetic
- drugs
- pain
- NPO status
what should you assess for pts with nausea and vomiting?
- monitor VS
- monitor pain level
- monitor I&O
what are some interventions that can be put in place for pts experiencing nausea and vomiting?
- administer anti-emetics
- HOB elevated
- slow progression of diet
what causes a paralytic ileus?
delayed return of GI peristalsis
what should the nurse assess for pts with a paralytic ileus?
- presence of bowel and abdomen sounds
- distension
- abdomen pain
- N/V
what are some interventions that can be put in place for pts with paralytic ileus?
- encourage ambulation
- use splinting for any abdominal surgeries
- start bowel protocol
- NP tube for severe vomiting
define urinary retention
inability to void 6-8hours post-op
what causes urinary retention?
- anesthesia
- drugs
- not voiding for prolonged period
- ureter trauma
- spinal/ epidural anaesthesia
what should the nurse assess for a pt with urinary retention?
- distended bladder
- discomfort
- bladder scan
what interventions can a nurse implement for a pt experiencing urinary retention?
- regular toileting
- fluids
- decrease use of narcotics
- catheter if needed
what interventions can a nurse implement for a pt experiencing urinary retention?
- regular toileting
- fluids
- decrease use of narcotics
- catheter if needed
define dehiscence
- opening of wound edges
- wound wont close
what can cause dehiscence?
- coughing/ vomiting
- distention
- decreased circulation
- internal hematoma formation under incision
is dehiscence a serious completion? what is the mortality rate? When does it occur?
- yes
- up to 30%
- occurs between 7-10 days postoperatively
what causes dehiscence ?
- obesity
- malnutrition
- older age
what are some interventions that can be done for dehiscence?
- sterile dressing to wound
- opiate analgesia
- fluid resuscitation
- early return to OR
what can the nurse do to decrease the likelihood of dehiscence occurring?
remove/ alternate sutures/ staples during removal
define evisceration
protrusion of bowel through incision
what causes evisceration?
- malnutrition
- obesity
- older age
what interventions can be done for evisceration ?
- cover entire area with sterile NS soaked dressing and cover dressing
- monitor for shock
- place pt in bed with knees to chest
- call surgeon ASAP
what is considered a pre-high BP?
systolic between 121-139
OR
diastolic between 81-89
what is considered a high BP?
systolic 140 or above
OR
diastolic 90 or above
