PERIOPERATIVE

NURSING


Is the use of instruments during an operation
to treat injuries, diseases, and deformities

Is a stressful, complex event

The branch of medicine concerned with
diseases and trauma requiring operative
procedures

Surgical procedures are named according to
(1) the involved body organ, part, or location
and (2) the suffix that describes what is done
during the procedure

Physicians who perform surgery include
surgeons or other physicians trained to do
certain surgical procedures

SURGICAL PROCEDURE SUFFIXES


-ectomy - Removal by cutting

-orrhaphy - Suture of or repair

-oscopy - Looking into

-ostomy - Formation of a permanent artificial
opening


-otomy - Incision or cutting into

-plasty - Formation or repair



CLASSIFICATION OF
SURGERY
ACCORDING TO URGENCY

Emergent - Patient requires immediate
attention; disorder may be life threatening;
immediately without delay to maintain life or
organ, remove damage, stop bleeding

Urgent/ Imperative - Patient requires prompt
attention; within 24 30/48 hours

Required/ Planned - Patient needs to have
surgery; plan within a few weeks or months

Elective - Patient should have surgery;
failure to have surgery not catastrophic;
planned/scheduled with no time
requirements

Optional - Decision rests with patient; at the
preference of patient



ACCORDING TO PURPOSE

Aesthetic - Requested by patient for
improvement

Diagnostic - To obtain tissue samples,
make an incision, or use a scope to make a
diagnosis

Exploratory - Confirmation or measurement
of extent of condition


Preventive - Removal of tissue before it
causes a problem

Curative (Ablative) - Removal of diseased or
abnormal tissue

Reconstructive - Correction of defects of body
parts

Palliative - Alleviation of symptoms without
curing disease


ACCORDING TO EXTENT

Major - Extensive surgery that involves
serious risk and complications, as it involves
major organ

High risk, extensive, prolonged, large amount
of blood loss, vital organs may be handled or
removed, great risk of complications




Minor - Involves minimal complications &
blood loss

Generally not prolonged, leads to few serious
complications, involves less risk

PRINCIPLES OF SURGICAL
ASEPSIS

MOISTURE CAUSES CONTAMINATION

Prevent splashing of liquids in the sterile fields

Place wet objects on sterile, water-
impermeable surfaces, such as sterile basin

Rationale: microorganisms travel more easily
through moist environment. When sterile
surface becomes moist, microorganisms from
the unsterile surface may be transmitted into
the sterile surface

NEVER ASSUME THAT AN OBJECT IS STERILE

Ensure that it is labeled as sterile

Always check the integrity of the packaging

Always verify the expiration date on the
package

Whenever in doubt of the sterility of an
object, consider it unsterile


Rationale: commercially prepared products
are labeled as sterile on their packaging;
special indicators are used to show that
objects have completed their sterilization
process; packages that are torn, punctured,
or moist are considered unsterile

ALWAYS FACE THE STERILE FIELD

Rationale: objects that are out of the line of
vision may be inadvertently contaminated

STERILE ARTICLES MAY TOUCH ONLY STERILE
ARTICLES OR SURFACES IF THEY ARE TO
MAINTAIN THEIR STERILITY

Rationale: anything considered unsterile
may transfer microorganisms to the sterile
object it touches
STERILE EQUIPMENT OR AREAS MUST BE KEPT
ABOVE THE WAIST AND ON TOP OF THE STERILE
FIELD

Waist level is the limit of good visual field.
Maximum visibility of all sterile objects
prevents inadvertent contamination

PREVENT UNNECESSARY TRAFFIC AND AIR
CURRENTS AROUND THE STERILE AREA

Close doors

Unfold drapes or wrappers properly

Do not sneeze, cough, or talk excessively
over the sterile field
Do not reach across sterile fields

Move around a sterile field to reach for an
object, if necessary

Rationale: microorganisms cannot be
completely excluded from the air;
overreaching across sterile fields will render
sterile objects unsterile

OPEN, UNUSED STERILE ARTICLES ARE NO
LONGER STERILE AFTER THE PROCEDURE


Rationale: once protective wrapping have
been removed, the article is being
contaminated by air so, it must be discarded
or sterilized before it is used; liquids opened
during the procedure that remain in the
container are also considered contaminated

A PERSON WHO IS CONSIDERED STERILE WHO
BECOMES CONTAMINATED MUST REESTABLISH
STERILITY

Rationale: if a scrubbed person punctures
the gloves or is contaminated by touching an
unsterile object, he or she must change the
contaminated articles; if a scrubbed person
leaves the area of the sterile field, he or she
must go through the procedure of
rescrubbing, gowning, and gloving

SURGICAL TECHNIQUE IS A TEAM EFFORT

A collective and individual sterile
conscience is the best method of enhancing
sterile technique

Rationale: staff members must rely on one
another to maintain sterile technique;
periodic review of procedures and infection
control surveillance reports enhance
everyones sterile technique

FOUR MAJOR TYPES OF
PATHOLOGIC PROCESSES
REQUIRING SURGICAL
INTERVENTION (POET)


P PERFORATION
rupture of an organ
O OBSTRUCTION
impairment to the
flow of vital fluids
e.g. blood, urine,
CSF, bile
E EROSION
wearing off of a
surface or
membrane

T TUMORS
abnormal new
growths

Stress response is elicited

Defense against infection is lowered

Vascular system is disrupted

Organ functions are disturbed

Body image may be disturbed

Lifestyles may change


NUTRITIONAL AND FLUID STATUS

Optimal nutrition is an essential factor in
promoting healing an resisting infection and
other surgical complications

obesity, undernutrition, weight loss,
malnutrition, deficiencies in specific
nutrients, metabolic abnormalities, and the
effects of medication on nutrition

Nutritional needs may be measured
through BMI and waist circumference

Nutritional deficiency should be corrected
before surgery

Nutrients important for wound healing are:
protein, arginine, carbohydrates and fats,
water, vitamin C, vitamin B complex,
vitamin A, vitamin K, magnesium, copper,
zinc

DRUG OR ALCOHOL USE

The person with a history of chronic
alcoholism often suffers from malnutrition
and other systemic problems that increase
surgical risk

AGE

very young

very old
PRESENCE OF DISEASE/S

Respiratory
Renal/urinary
Cardiovascular
Endocrine
Hepatic
CONCURRENT OR PRIOR PHARMACOTHERAPY

A medication history is obtained from each
patient because of the possible effects of
medications on the patients perioperative
course, including the possibility of drug
interactions

Document all medications
Stop aspirin 7-10 days before surgery

Currently it is recommended that the use of
herbal products be discontinued 2 to 3 weeks
before surgery

OTHER SURGICAL RISK FACTORS

Nature of condition
Location of the condition
Magnitude and urgency of the surgical
procedure
Mental attitude of the person toward surgery
Caliber of the professional staff and health
care facilities



THE CIRCULATING NURSE

Also known as the circulator

manages the OR and protects the patients
safety and health by monitoring the
activities of the surgical team, checking the
OR conditions, and continually assessing
the patient for signs of injury and
implementing appropriate interventions

verifying consent, coordinating the team,
and ensuring cleanliness, proper
temperature, humidity, lighting, safe function
of equipment, and the availability of
supplies and materials

Monitors aseptic practices to avoid breaks
in technique

surgical or pre-procedure pause or time-
out
THE SCRUB ROLE

Performs a surgical hand scrub

Setting up the sterile tables

Prepares sutures, ligatures, and special
equipment

Assists the surgeon and the surgical
assistants during the procedure by
anticipating the instruments and supplies
that will be required

As the surgical incision is closed, the scrub
person and the circulator count all needles,
sponges, and instruments
Standards call for all sponges to be visible
on x-ray and for sponge counts to take
place at the beginning of surgery and twice
at the end

Tissue specimens obtained during surgery
are labeled by the scrub person and sent to
the laboratory by the circulator



THE SURGEON

Performs the surgical procedure and heads
the surgical team

THE ANESTHESIOLOGIST AND ANESTHETIST

An anesthesiologist is a physician
specifically trained in the art and science of
anesthesiology

An anesthetist is a qualified health care
professional who administers anesthetics

They assess the patient before surgery,
selects the anesthesia, administers it,
intubates the patient if necessary,
manages any technical problems related to
the administration of the anesthetic agent,
and supervises the patients condition
throughout the surgical procedure



Known for its stark appearance and cool
temperature

Access is limited to authorized personnel

The OR must be situated in a location that is
central to all supporting services

The OR must have a specific air filtration
devices to screen out contaminating
particles, dust, and pollutants

the unrestricted zone (street clothes are
allowed); the semi restricted zone (attire
consists of scrub clothes and caps); and the
restricted zone (scrub clothes, shoe
covers, caps, and masks are worn)

Shirts and waist drawstrings should be
tucked inside the pants
Wet or soiled garments should be changed

Masks are worn at all times at the restricted
zone

Upper respiratory tract infections and skin
infections in staff and patients are sources
of pathogens and must be reported


PREOPERATIVE PHASE
Extends from the time the client is a admitted
in the surgical unit, to the time he/she is
prepared physically, psychosocially,
spiritually, and legally for the surgical
procedure, until he is transported into the
operating room

Begins when the decision to proceed with
surgical intervention is made and ends with
the transfer of the patient onto the OR table

involves establishing a baseline evaluation of
the patient before surgery by carrying out a
preoperative interview

ensuring that necessary tests have been or
will be performed

arranging appropriate consultations; and
providing education about recovery from
anesthesia and postoperative care

On the day of surgery, patient teaching is
reviewed, the patients identity and surgical
site are verified, informed consent is
confirmed, and an IV infusion is started

GOALS

Assessing and correcting physiologic and
psychologic problems that might increase
surgical risk

Giving the person and significant others
complete learning/teaching guidelines
regarding surgery

Instructing and demonstrating exercises that
will benefit the person during post operative
period

Planning for discharge and any projected
changes in lifestyle due to surgery


PHYSIOLOGIC ASSESSMENT OF THE CLIENT
UNDERGOING SURGERY

Age
Presence of pain
Nutritional status
Fluid and electrolyte balance
Infection
Cardiovascular function



Pulmonary function
Renal function
Gastrointestinal function
Liver function
Endocrine function
Hematologic function
Use of medication
Presence of trauma
PSYCHOSOCIAL ASSESSMENT AND CARE

Causes of fears of the preoperative clients
Fear of the unknown
Fear of anesthesia, vulnerability while
unconscious
Fear of pain
Fear of death
Fear of disturbance of body image
Worries loss of finances, employment, social
and family roles

Manifestations of fears
Anxiousness
Bewilderment
Anger
Tendency to exaggerate
Sad, evasive, tearful, clinging
Inability to concentrate
Short attention span
Failure to carry out simple directions
Dazed

NURSING INTERVENTIONS TO MINIMIZE ANXIETY

Explore clients feelings

Assist client to identify coping strategies that
he or she has previously used to decrease
fear

Allow client to speak openly about
fears/concerns

Give accurate information regarding surgery

Give empathetic support

Consider the persons religious preferences
and arrange visit by priest/minister as
desired

Music therapy

INFORMED CONSENT (OPERATIVE
PERMIT/SURGICAL CONSENT)

necessary before non emergent surgery can
be performed

permission obtained from a patient to
perform a specific test or procedure

PURPOSES:

to ensure that the client understands the
nature of the treatment including the potential
complications and disfigurement (explained
by AMD)

to indicate that the clients decision was
made without pressure



to protect the client against unauthorized
procedure

to protect the surgeon and hospital against
legal actions by a client who claims that an
unauthorized procedure was performed


CIRCUMSTANCES REQUIRING A PERMIT:

any surgical procedure where scalpel,
scissors, or sutures may be used

any invasive procedure such as surgical
incision, a biopsy, a cystoscopy, or
paracentesis


a nonsurgical procedure, such as an
arteriography, that carries more than slight
risk to the patient

procedures involving radiation

procedures requiring sedation and/or
anesthesia



REQUISITES FOR VALIDITY OF INFORMED
CONSENT

written permission is best and is legally
acceptable

signature is obtained with the clients
complete understanding of what is to occur
adults sign their own operative permit
obtained before sedation

secured without pressure or duress

a witness is desirable nurse physicians or
authorized persons

in an emergency, permission via telephone or
telefax is acceptable


for minor (below 18), unconscious,
psychologically incapacitated, permission is
required from responsible family member
(parent/legal guardian)

INFORMED CONSENT SHOULD CONTAIN THE
FOLLOWING:

explanation of procedure and its risks

description of benefits and its alternatives

an offer to answer questions about procedure

instructions that the patient may withdraw
consent

a statement informing the patient if the
protocol differs from customary procedure

PHYSICAL PREPARATION
Before Surgery
Correct any dietary deficiencies

Reduce an obese persons weight

Correct fluid and electrolyte imbalances

Restore adequate blood volume with blood
transfusion

Treat chronic diseases

Halt or treat any infectious process

Treat an alcoholic person with vitamin
supplementation, IVFs or oral fluids if
dehydrated


TEACHING PREOPERATIVE EXERCISES

Deep breathing exercises
Practice in the same position client would
assume in bed after surgery

Allow hands in a loose fist position to rest lightly
on the front of the lower ribs with your finger tips
against lower chest to feel the movement

Breathe out gently and fully as the ribs sink
down and inward toward midline

Take a deep breath your nose and mouth,
letting the abdomen rise as the lungs fill with air

Hold this breath for a count of five

Exhale and let out all the air through your nose
and mouth

Repeat this exercise 15 times with a short rest
after each group of five

Practice twice daily preoperatively

Incentive spirometry

Let client sit upright, at 45 degrees minimum

Take two normal breaths. Place mouthpiece of
spirometer in mouth

Inhale until target, designated by spirometer
light or rising ball, is reached, and hold breath
for 3 to 5 seconds

Exhale completely

Perform 10 sets of breaths each hour

Coughing exercises

Have client sit up and lean forward

Show client how to splint incision with hands,
pillow, or blanket

Have client inhale and exhale deeply three
times through mouth

Have client take in deep breath and cough out
the breath forcefully with three short coughs
using diaphragmatic muscles. Take in quick
deep breath through mouth, cough deeply, and
deep breathe

Turning exercises

Turn on your side with the uppermost leg flexed
most and supported on a pillow

Grasp the side rail as an aid to maneuver to the
side

Practice diaphragmatic breathing and coughing
while on your side



Foot and leg exercises
Lie in a semi-Fowlers position

Bend your knee and raise your foot hold it a
few seconds, then extend the leg and lower it to
the bed

Do this five times with each leg

Then trace circles with the feet by bending them
down, in toward each other, up, and then out


PREPARING THE PERSON BEFORE SURGERY

Preparing the skin
Have full bath to reduce microorganisms in the
skin

Preparing the GI tract
NPO; cleansing enema as required

Preparing for anesthesia
Avoid alcohol and cigarette smoking for at least
24 hours before surgery


Promoting rest and sleep
Administer sedatives as ordered

PREPARING THE PERSON ON THE DAY OF
SURGERY

Early morning care
Awaken one hour before preoperative
medications

Morning bath, mouth wash

Provide clean gown

Remove hairpins, braid long hairs, cover hair
with cap

Remove dentures, foreign materials (chewing
gum), colored nail polish, hearing aid, contact
lens

Take baseline vital signs before preoperative
medication

Check ID band and skin preparation

Check for special orders enema, GI tube
insertion, IV line



Check NPO

Have client void before preoperative medication

Continue to support emotionally

Accomplish preoperative care checklist



PREOPERATIVE MEDICATIONS/ PREANESTHETIC
DRUGS

Goals:

To facilitate the administration of any anesthetic

To minimize respiratory tract secretions and
changes in heart rate

To relax the client and reduce anxiety

Narcotics
Morphine sulfate

Fentanyl (Sublimaze)

Meperidine (Demerol)

Analgesia; enhancement of postoperative pain
relief


Antianxiety and sedative hypnotics
Diazepam (Valium)
Hydroxyzine hcl (Vistaril)
Lorazepam (Ativan)
Midazolam (Versed)
Phenobarnital sodium
Sedation; anxiety reduction
Anticholinergic

Atropine sulfate

Scopolamine hydrobromide

Secretion reduction
Antiemetic

Ondansetron (Zofran)

Metoclopramide (Reglan)

Promethazine hcl (Phenergan)

Control nausea and vomiting; may be effective
into the postoperative period
H2 antagonist

Cimetidine (Tagamet)

Ranitidine (Zantac)

Famotidine (Pepcid)

Reduction of acidic gastric secretions in case
aspiration occurs
Antibiotic

Cefazolin (Ancef)

Ampicillin (Omnipen

Prevention of postoperative infection
INTRAOPERATIVE PHASE

Begins when the client is transferred onto
the OR table and ends with admission to the
PACU

Extends from the time the client is admitted
to the operating room, to the time of
administration of anesthesia, surgical
procedure is done, until he/she is
transported to the recovery room/PACU

Nursing activities include: providing safety,
maintaining an aseptic environment, ensure
proper functioning of equipment, providing
the surgeon with specific instruments and
supplies for the surgical field, and proper
documentation

GOALS OF CARE (HASH)

H homeostasis

A asepsis

S safe administration of anesthesia

H hemostasis

POSITIONS DURING SURGERY

Dorsal Recumbent hernia repair,
mastectomy, bowel resection

Trendelenburg lower abdomen, pelvic
surgeries



Lithotomy vaginal repairs, D and C, rectal
surgery

Prone spinal surgeries, laminectomy

Lateral kidney, chest, hip surgeries



Explain purpose of position

Avoid undue exposure

Strap the person to prevent falls

Maintain adequate respiratory and
circulatory function

Maintain good body alignment
TYPES OF ANESTHESIA

General
Anesthesia is a state of narcosis, analgesia,
relaxation, and reflex loss

Clients under general anesthesia are not
arousable, not even to painful stimuli

Produces amnesia

Can be administered through IV or inhalation
Gas anesthetics are administered by inhalation
and are always combined with oxygen

Nitrous oxide is the most commonly used gas
anesthetic agent

When inhaled, the anesthetics enter the blood
through the pulmonary capillaries and act on
cerebral centers to produce loss of
consciousness and sensation

General anesthesia consists of four stages
Stage I (beginning anesthesia)
extends from the administration of anesthesia to
the time of loss of consciousness

The client may have a ringing, roaring or
buzzing in the ears, and although still conscious,
may sense an inability to move the extremities
easily

During this stage, noises are exaggerated

During this stage, noises are exaggerated.
Unnecessary noises and motions are avoided
when anesthesia begins.
Stage II (excitement/delirium)
extends from the time of loss of consciousness
to the time of loss of lid reflex

It may be characterized by shouting, struggling,
talking, singing, laughing, or crying of the client
but often avoided if anesthetic is administered
smoothly and quickly

Assist anesthesiologist/ anesthetist if needed to
restrain client. Client should not be touched
except for purposes of restraint.
Stage III (surgical anesthesia)
extends from the loss of lid reflex to the loss of
most reflexes. Surgical procedure is started

Stage IV (medullary depression)
it is characterized by respiratory/cardiac
depression or arrest. It is due to overdose of
anesthesia. Resuscitation must be done
Regional
Reduce all painful sensations in one region of
the body without inducing unconsciousness

Topical, local infiltration, epidural, spinal

Client receiving regional anesthesia is awake
and aware of his/her surroundings unless
medications are given to produce mild sedation
or to relieve anxiety


Nurse must avoid careless conversation,
unnecessary noise, and unpleasant odors

Diagnosis must not be stated allowed if the
client is not to know it at this time

A postdural puncture headache may occur after
spinal and epidural blocks caused by leakage of
CSF. Small-gauge spinal needle (less than
gauge 25) helps prevent headaches. Position
the client flat and force fluids to relieve
headache. A blood patch treatment can be done
if headache continues
TRANSFER FROM SURGERY
After surgery client is stabilized for transfer

After local anesthesia, the client may return
directly to a nursing unit

After general and spinal anesthesia, the
client goes to the PACU or in some cases,
the intensive care unit
SAFETY is always a priority at this time!

Never leave client alone

Ensure patent airways and prevent falls an
injury

Continuous monitoring of client
POSTOPERATIVE PHASE

Extends from the time the client is admitted
to the recovery room, to the time he is
transported back into the surgical unit,
discharged from the hospital, until the follow-
up care

Begins when the client is admitted to the
PACU or a nursing unit and ends with the
clients postoperative evaluation in the
physicians office

GOALS:

Maintain adequate body system functions

Restore homeostasis

Alleviate pain and discomfort

Prevent postoperative complications

Ensure adequate discharge planning and
teaching

ADMISSION TO PACU
Goal is to promote safe recovery from
anesthesia

Administer oxygen by nasal cannula or mask
as ordered

Continuous monitoring is done for ECG,
pulse oximetry, and BP measurements


Assess surgical site and dressing

Check for patency of catheter, drains and
tubes

Measure body temperature

Provide warming blanket

Control shivering by administering
Meperidine (Demerol) when anesthesia is
the cause

Provide supplemental oxygen during
shivering

Perform hand washing between clients

VS taking every 5 to 15 minutes

GENERAL INTERVENTIONS
Avoid exposure

Avoid rough handling

Avoid hurried movement and rapid changes
Assessment
Appraise air exchange status and note skin color

Verify identity, operative procedure, surgeon

Assess neurologic status

Determine VS

Perform safety checks

Ensure maintenance of patent airway and
adequate respiratory function
Lateral position with neck extended

Keep airway in place until fully awake

Suction secretions

Encourage deep breathing

Administer humidified oxygen as ordered
TRANSFER FROM RECOVERY ROOM TO
SURGICAL UNIT
Parameters for Discharge from Recovery
Room
Activity: able to obey commands

Respiration: easy, noiseless breathing

Circulation: BP is within +/-20 mmHg of the
preop level


Consciousness: responsive

Color: pinkish skin and mucus membrane
NURSING CARE OF CLIENT DURING THE
EXTENDED POSTOPERATIVE PERIOD
2-3 days after surgery (discharge
planning/teaching)

Self-care activities
Activity limitation
Diet and medications
Complications
Referrals, follow-up check up
Postoperative discomforts
Nausea and vomiting

Restlessness & sleeplessness

Thirst

Constipation

Pain
POSTOPERATIVE
COMPLICATIONS
SHOCK
Response of the body to a decrease in the
circulating blood volume, which results to
poor tissue perfusion and inadequate tissue
oxygenation
HEMORRHAGE
Copious escape of blood from the blood
vessel
Capillary slow, generalized oozing
Venous dark in color and bubble out
Arterial spurts and is bright red in color
Manifestations
Apprehension, restlessness, thirst, cold, moist,
pale skin

Deep rapid respiration, low body temperature

Low blood pressure, low hemoglobin

Circumoral pallor

Progressive weakness
Management
Administer Vitamin K as ordered

Pressure dressings

Blood transfusion

IV fluids
FEMORAL PHLEBITIS/ DEEP
THROMBOPHLEBITIS
Often occurs after operations on the lower
abdomen or during the course of septic
conditions as rupture ulcer or peritonitis

Causes
Injury damage to vein
Hemorrhage
Prolonged immobility
Obesity/ debilitation
Manifestations
Pain
Redness
Swelling
Heat/warmth
Positive Homans sign
Nursing Interventions (prevention)
Hydrate adequately to prevent
hemoconcentration

Encourage leg exercises and ambulate early

Avoid any restricting devices that can constrict
and impair circulation

Prevent use of bed rolls or dangling over the side
of the bed with pressure on popliteal area

Nursing Interventions (Active)
Bed rest, elevate the affected leg with pillow
support

Wear antiembolic support hose from the toes to
the groin

Avoid massage on the calf of the leg

Initiate anticoagulant therapy as ordered
PULMONARY COMPLICATIONS
Atelectasis
Bronchitis
Bronchopneumonia
Lobar pneumonia
Pleurisy
Nursing Interventions

Reinforce deep breathing, coughing, and turning
exercises

Encourage early ambulation

Incentive spirometry
INTESTINAL OBSTRUCTION
Loop of intestine may kink due to inflamatory
adhesions

Manifestations
Intermittent, sharp, colicky abdominal pains

Nausea and vomiting
Abdominal distention

Diarrhea(incomplete obstruction), no bowel
movement (complete)

Return flow of enema is clear
Nursing Interventions
NGT insertion

Administer electrolyte/ IV as ordered

Prepare for possible surgical intervention
WOUND INFECTIONS
Causes
Staphylococcus aureus

Escherichia coli

Proteus vulgaris

Pseudomonas aeruginosa

Anaerobic bacteria
Clinical manifestations
Redness, swelling, pain, warmth

Pus or other discharge on the wound

Foul smell from the wound

Elevated temperature; chills

Tender lymph nodes
Rule of thumb:
Fever within first 24 hours pulmonary infection

Within 48 hours urinary tract infection

Within 72 hours wound infection
Preventive interventions
Strict aseptic technique

Wound care

Keep unit clean

Antibiotic therapy as ordered
WOUND COMPLICATIONS
Hemorrhage

Wound dehiscence disruption in the
coaptation of wound edges (wound
breakdown)

Wound evisceration dehiscence +
outpouching of abdominal organs

Nursing interventions
Apply abdominal binders

Encourage proper nutrition (high protein, vitamin
C)

Stay with client, have someone call for the doctor

Keep in bed rest

Supine or Semi-Fowlers position, bend knees to
relieve
Cover exposed intestine with sterile, moist
saline dressing

Reassure, keep him/her quiet and relaxed

Prepare for surgery and repair of wound