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POSTOPERATIVE COMPLICATIONS  Ligation of bleeders

 Pressure dressings
 SHOCK   Blood transfusion ; IV fluids
 Response of the body to a decrease  in the
circulating blood volume, which results to poor tissue perfusion
& inadequate tissue oxygenation

Impaired Tissue Metabolism  FEMORAL PHLEBITIS / DEEP THROMBOPHLEBITIS 


  Often occurs after operations on the lower abdomen or during
Cell / Organ Death the course of septic conditions as rupturered ulcer or peritonitis.
 CLINICAL
 CAUSES 
MANIFESTATION 
 Injury – damage to vein  Pain
 HEMORRHAGE   Hemorrhage  Redness
 COPIOUS ESCAPE OF BLOOD FROM THE BLOOD  Prolonged Immobility  Swelling
VESSEL  Heat /
 Obesity / Debilitation
 Capillary  slow, generalize oozing warmth
 Venous  dark in color & bubble out  +
 Arterial  spurts & bright red in color Homan’s Sign

 CLINICAL MANIFESTATION NURSING INTERVENTIONS 


 Apprehension; restlessness;  Prevention Active Intervention
thirst; cold, moist, pale skin  Hydrate adequately  Bed rest; elevate
 Deep rapid RR; low body to prevent the affected leg with pillow
temperature hemoconcentration. support.
 Low CO (cardiac output)  Wear antieembolilic
 Encourage leg
 Low BP, low Hgb support hose from the toes
exercise
 Circumoral pallor, spots to the groin.
before the eyes, ringing in the ears  Avoid any
 Avoid massage on
 Progressive weakness, then restricting devices that can
the calf of the leg.
death ensues constrict & impair circulation.
 Prevent use of bed
 Initiate
rolls, knee gatches, dangling
 MANAGEMENT anticoagulant therapy as
over the side of the bed with
 Vit. K ordered.
pressure on popliteal area.
enema is clear
 Shock, then death
 PULMONARY COMPLICATIONS  occurs
 NURSING
 Atelectasis
INTERVENTIONS 
 Reinforce deep
 Bronchitis breathing, coughing, turning  HICCUPS 
exercise (DBCT)  Intermittent spasms of the diaphragm causing a sound
 Encourage early (”hic’”) that result from the vibration of closed vocal cords as air
 Bronchopneumonia rushes suddenly into the lungs.
ambulation
 Incentive
 Lobar Pneumonia
spirometry  CAUSES 
 Hypostatic pulmonary  Irritation phrenic nerve between the
congestion sp9inal cord & terminal ramifications on ubdersurface of the
 Pleurisy diaphragm.

 NURSING INTERVENTIONS 
 Remove the cause
 E.q. abdominal distention – NGT insertion
 INTESTINAL OBSTRUCTION (3RD TO 5TH POSTOP DAY)   Hold breath while taking a large swallow of water
 Loop of intestine may kink due to inflammatory adhesions  Pressing on the eyeball through closed lids for several
minutes
 CLINICAL  NURSING  Breath in & out paper bag (CO2)
MANIFESTATION INTERVENTIONS   Plasil (Methochlorpramide) as ordered
 Intermittent sharp,
 NGT insertion
colicky abdominal pains
 Nausea & vomiting  Administer
( fecaloid) Electrolyte/IV as ordered
 Abdominal  Prepare for possible  URINARY DIFFICULTIES 
distention, hiccups surgical intervention  Retention  Incontenence
 Diarrhea  Occurs most  30 -60 ml. q°15 – 30
(incomplete obstruction), no frequently after operation mins.- over distended
bowel movement of the rectum, anus vagina, bladder – overflow
(complete) & lower abdomen. incontenence.
 Return flow of
 Cause by spasm of  Loss tone of the bladder
the bladder sphincter. sphincter.
NURSING INTERVENTIONS 
 Implement measures to induce voiding

 WOUND COMPLICATIONS 
 WOUND INFECTION   KINDS 
 CLINICAL  Hemorrhage / Hematoma
 CAUSES 
MANIFESTATION
MANIFESTATION  Wound Dehiscence – disruption in the coaptation of wound
 Redness, swelling, edges (wound breakdown)
 Staphylococcus aureus
pain, warmth  Wound Evisceration – dehiscense + outpouching of
 Pus or other abdominal organ
 Escherichia coli
discharge on the wound
 Foul smell from the  NURSING INTERVENTIONS 
 Proteus vulgaris
wound
 Apply abdominal binders
 Elevated
 Pseudomonas aeruginosa  Encourage proper nutrition – high CHON, Vit. C
temperature; chills
 Stay with patient, have someone call for doctor
 Tender lymph
 Keep in bed rest
 Anaerobic bacteria nodes on the axilla or groin
closest to wound  Supine or semis – Fowler’s position, bend knees to
relieve tension on abdominal muscles.
 Cover exposed intestine with sterile, moist saline
 Preventive dressing.
 Rule of Thumb
Interventions:  Reassure, keep patient quiet & relaxed.
 Fever 1st 24°  Prepare for surgery & repair of wound.
 Housekeepin
- disruption in the coaptation
g cleanliness in the surgical
of the wound edges (wound
environment
breakdown)
 Within 48° -  STRICT
UTI ASEPTIC TECHNIQUE
 Within 72° -  POSTOP PSYCHOLOGICAL DISTURBANCES 
 Wound care  Delirium
wound infection
 Antibiotic  ACS ( Acute Confusional State )
therapy.
 CAUSES   MANIFESTATION 
 Dehydrated  Poor memory
 Insufficient
 Restlessness
Oxygenation
 Anemia  Inattentiveness
 Hypotension  Inappropriate behavior
 Wild excitement,
 Hormonal
hallucinations, delusions,
Imbalances
depression
 Infection  Disoriented
 Trauma  Sleep disturbances

 NURSING INTERVENTIONS 
 Sedatives to keep patient quiet & comfortable.
 Explain reasons for interventions
 Listen & talk to patient & significant others
 Provide physical comfort
 Treat the underlying cause