POST-OPERATIVE complications

Surgical Drains

Reasons for applying a surgical drain:

1. To collapse surgical dead space

2. To drain abscess3. To provide early warning

notice of a surgical leak

4. To control an established fistula

leak

JP Drain

Penrose DrainNephrostomy Tube

General Management postopeartive

Liquid Diet Vs Soft diet

Clear liquid Full liquid Soft diet

CoffeeTeaCarbonated drinkBouillonClear fruit juicePopsicleGelatinHard candy

Clear liquid PLUS:Milk/Milk prodVegetable juicesCream, butterYogurtPuddingsCustardIce cream and sherbet

All CL and FL plus:MeatVegetablesFruitsBreads and cerealsPureed foods

Chest Physiotherapy

Post Operative Care

Objectives of Postop CareRe-establishment of physiologic equilibrium

Prevention of pain and complication

Goal of Care for Post-operative Patients

1.Promotion of

respiratory function

Goal of Care for Post-operative Patients

2. Promote cardio-

vascular function and

tissue perfusion

Goal of Care for Post-operative Patients

3. Promotion of fluid and electrolyte

balance

Goal of Care for Post-operative Patients

4. Promotion of nutrition

and elimination

Goal of Care for Post-operative Patients

5. Promotion of renal function

Goal of Care for Post-operative Patients

6.Promotion of comfort,

rest and freedom

from pain

Goal of Care for Post-operative Patients

7. Promotion of wound healing

Goal of Care for Post-operative Patients

8. Promotion of early

movement and ambulation

Goal of Care for Post-operative Patients

9. Prevention of post-

operative complications

Post-operative Complications

POST OP COMPLICATIONS

CIRCULATORY COMPLICATIONS:

a. Shockb. Hemorrhagec. Thrombophlebitis / deep

thrombophlebitis

PULMONARY COMPLICATIONSa. Atelectasisb. Pneumonia

URINARY DIFFICULTIES

a. Urinary retention

GASTROINTESTINAL COMPLICATIONS

a. Paralytic ileusb.Gas painc. Intestinal obstructiond.Hiccups

Rule of ThumbFever 1st 24 - Pulmonary infection

Within 48 - UTI Within 72 - wound infection

A. Pulmonary (48 hrs PO)

1. Pneumonia

A. Pulmonary (48 hrs PO)

2.Atelectasis

B. Cardiovascular

1. 2.Hemorrhage

Bleeding Hemorrhage

B. Cardiovascular

2.Shock

B. Cardiovascular

3.Thrombophlebitis (7-14days PO)

C. Wound complication

1.Wound infection

C. Wound complication

2.Wound Dehiscence

Wound dehiscence

Wound evisceration

D. Urinary Retention

inability to void (voiding

should return 6-8hrs

PO)

E. Gastrointestinal

1. Abdominal distention or

paralytic ileus

E. Gastrointestinal

2. Hiccups

G. Hypothermia

Immobility

Summary of Complications Respiratory

Atelectasis Pneumonia

(aspiration, hypostatic, infectious)

Embolism Cardiovascular

Hemorrhage-shock Cardiac arrest DVT Thrombophlebitis

Musculoskeletal System Muscle atrophy Contractures Osteoclast – Fx -

↑Ca Nervous System

Coma Paralysis

GIT Nausea and

vomiting Constipation Ulcer (Cushing’s) Adynamic ileus

GUT Urinary retention UTI

Wound Wound infection Wound dehiscence Wound evisceration

Integumentary Bed sore

Psychologic Depression

Postop Discharge Teaching

Assess readiness for HTAssess the need for home careWound careFollow up (sutures are removed 7-14 days)

Resume normal activities gradually

Avoid lifting for 6 weeks (>10 lbs.)

Can return to work 6-8 weeks after

Teach the s/sx of complications

To emphasizeThe over-all goal of nursing care during the PRE-OPERATIVE phase is to prepare the patient mentally and physically for the surgery

To emphasizeThe over-all goal of nursing care during the INTRA-OPERATIVE phase is to maintain client safety

To emphasizeThe over-all goals of nursing care during the POST-OPERATIVE phase are to promote healing and comfort, restore the highest possible wellness and prevent associated risk