PERIOPERATIVE NURSING

Perioperative Nursing Practice- includes those activities performed by the registered nurse during the preoperative, intraoperative and postoperative phase of the patients surgical experience. It encompasses the patient¶s total experience when surgical intervention is accepted as the treatment of choice. Perioperative- refers to events during the entire surgical period, from preparation for surgery to recovery from the temporary effects of surgery and anesthesia. This period is divided into preoperative, intraoperative and postoperative phases. Preoperative phase- starts when the patient is admitted to the surgical floor and prepare him physically, psychologically, spiritually and legally for the surgical procedure until he is transported to the operating room. Intraoperative phase- is when the patient is transferred to the operating room where he is anesthetized and undergoes the scheduled surgical procedure. Postoperative phase- is the time during which the patient is transferred to the recovery room/post anesthesia unit where the nurse assist and observes the patient as he recovers from anesthesia and from the stress of surgery itself; to the time he is transferred back to the surgical floor, discharged from the hospital until the follow-up care. GENERAL CONSIDERATIONS: a) Basic Types of Pathologic Conditions Requiring Surgery  Obstruction  Perforation  Erosion  Tumors b) Major Categories of Surgical Procedures (according to:) 1) Purpose  Diagnostic  Exploratory  Curative y Ablative y Constructive y Reconstructive  Palliative 2) Degree of Risk  Major Surgery  Minor Surgery 3) Urgency  Emergency ± to be done immediately in order to; y save the life of the patient y save the function of an organ or limb y removed a damaged organ or limb as necessary y stop hemorrhage  Imperative or Urgent  Planned Required  Elective  Optional  Day (ambulatory surgery ESTIMATION OF SURGICAL RISKS General Risks factors:  Obesity  Aging  Fluid and Electrolyte and Nutritional problems  Presence of diseases  Concurrent or prior pharmacotherapy

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clinging  Anxiousness  Inability to concentrate  Bewilderment  Short attention span  Anger  Failure to carry out simple directions  Tendency to exaggerate  Nursing Interventions to Minimize Anxiety  Explore patient¶s feelings  Allow patient to speak openly about fears/concerns  Give accurate information regarding surgery  Give empathetic support  Consider the person¶s religious preferences and arrange for visit priest/minister as desired  Informed Consent (Operative Permit/Surgical Consent)  Purposes:  To ensure that the patient understands the nature of the treatment including the potential complications and disfigurement. PREOPERATIVE PHASE  Goals  Assessment & Correction of physiologic & psychological problems that may increase surgical risks.  To protect the client against unauthorized procedure.  To indicate that the patient¶s decision was made without pressure.  Body image may be disturbed.  Instructing & demonstrating exercises that will benefit the person during the postoperative period.Other 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 effects of surgery upon the patient:  Stress response is elicited.  Vascular system is disrupted.  Organ functions are disturbed.  Lifestyle might change. 2 .  Defense against infection is lowered. tearful.  Physiologic Assessment  Gastrointestinal Function  Age  Liver Function  Presence of pain  Endocrine Function  Nutritional Status  Neurologic Function  Fluid & Electrolyte Balance  Hematologic Function  Infection  Use of Medication  Cardiovascular Function  Presence of Trauma  Pulmonary Function  Liver Function  Psychosocial Assessment & Care  Causes of Fears of Preoperative Patients:  Fear of the unknown  Fear of death  Fear of Anesthesia  Fear of Disturbance of Body Image  Fear of pain  Worries  Manifestations of Fear  Sad.  Planning for discharge & any projected changes in lifestyle due to surgery. evasive.  To protect the surgeon and the hospital against legal action by a client who claims that an unauthorized procedure was performed.  Giving the person & significant others complete learning/teaching guidelines regarding surgery.

I. wedding ring ± tie with gauze and tie around the wrist.  Consent is obtained before sedation  Pt is not under the influence of drugs or alcohol  Secured without pressure or duress  A witness is desirable.  Preparing the patient on the day of surgery Early Morning Care:  Awaken one hour before preop medications  Morning bath. To allay anxiety 2. Reduce the amount of anesthesia given 4. suture. psychologically incapacitated. renal insufficiency  Halt or treat any infectious process  Treat an alcoholic person with vitamin supplementation.  Promoting sleep ± administer sedatives as ordered. The physician should document the nature of the emergency situation  For minor (below 18 years old).  Teaching preop exercises  Deep breathing exercises  Incentive spirometry  Coughing exercises  Turning exercises  Foot and leg exercises  Preparing the patient the evening before surgery  Preparing the skin ± have full bath to reduce microorganisms in the skin. contact lens. local anesthesia. hearing aid. permission via telephone or telefax is acceptable. permission is required from responsible family member (parent/legal guardian). cover hair with cap  Remove dentures. IVF or oral fluids if dehydrated. thermostats electro coagulation may be used.  Signature is obtained with the client¶s complete understanding of what is to occur.  Check ID band. IV line  Check NPO  Have patient void before preop medication  Check baseline V/S before preop medication  Continue to support emotionally  Accomplish ³preop care checklist´  Preoperative medication/preanestheic drugs A.  Preparing for anesthesia ± avoid alcohol and cigarette smoking for at least 24 hours before surgery. colored nail polish.  Physical Preparation  Before Surgery  Correct any dietary deficiencies  Reduce an obese person¶s weight  Correct fluid and electrolyte imbalances  Restore adequate blood volume with blood transfusion  Treat chronic diseases ± DM. braid long hairs.  Circumstances Requiring a Permit  Any surgical procedure where scalpel. foreign materials. skin prep  Check for special orders ± enema. Create amnesia for the events that precede surgery.  Entrance into a body cavity. Requisites for validity of informed consent  Written permission is best and is legally acceptable.  Preparing the G. heart disease. GI tube insertion. To decrease the flow of pharyngeal secretions 3. Goals: 1. mouth wash  Provide clean gown  Remove hairpins.  In an emergency. unconscious. tract ± NPO cleansing enema as required. scissors. local infiltration.  General anesthesia. 2 .

checks with circulating nurse When surgeon arrives after scrubbing  Perform assisted gowning and gloving to the surgeon and assistant surgeon as soon as they enter the operation suite  Assemble the drapes according to use. instruments and needle count. physical preparations for surgery. INTRAOPERATIVE PHASE  Goals     Asepsis Homeostasis Safe administration of Anesthesia Hemostasis  SURGICAL CONSCIENCE The Surgical team  The surgeon  The Anesthesiologist  The Circulating Nurse  The Scrub Nurse  Direct Assistant to the Surgeon DUTIES OF SCRUB NURSE       Before an operation Ensures that the circulating nurse has checked the equipment Ensures that the theater has been cleaned before the trolley is set Prepares the instruments and equipment needed in the operation Uses sterile technique for scrubbing. assemble suction tip and suction tube  Bring mayo stand and back table near the draped patient after draping is completed  Secure suction tube and cautery cord with towel clips or allis  Prepares sutures and needles according to use During an operation  Maintain sterility throughout the procedure  Awareness of the patient¶s safety  Adhere to the policy regarding sponge/ instruments count/ surgical needles  Arrange the instrument on the mayo table and on the back table 3 . Sedatives 3.  B. assist in draping the patient aseptically according to routine procedure  Place blade on the knife handle using needle holder. Anticholinergics 5. Recording ± all final preparation and emotional responses before surgery are noted down. Then. Analgesics / Opiates 4. draw sheet and then lap sheet. gowning and gloving Receives sterile equipment via circulating nurse using sterile technique Performs initial sponges. Types of preoperative medications: 1. towel clips. Histamine ± H2 Receptor Antagonist C. Start with towel. postoperative care and potential body image change. Transporting the patient to the Operating Room Patient¶s Family o Direct proper visiting room o Doctor informs the family immediate after surgery o Explain reason for long interval of waiting o Explain what to expect postoperatively *** Nursing Diagnosis for a Preoperative Patient*** Anxiety related to lack of knowledge about preoperative routines. Tranquilizers 2.

suction machine. OR light and OR table Make sure theater is clean Arrange furniture according to use Place a clean sheet. passing instruments. quick reaction and conscientious observation as well as knowledge of anatomy and of operative procedures DUTIES OF CIRCULATING NURSE                     Before an operation Checks all equipment for proper functioning such as cautery machine. arm board (arm strap) and a pillow on the OR table Provide a clean kick bucket and pail Collect necessary stock and equipment Turn on aircon unit Help scrub nurse with setting up the theater Assist with counts and records During the Induction of Anesthesia Turn on OR light Assist the anesthesiologist in positioning the patient Assist the patient in assuming the position for anesthesia Anticipate the anesthesiologist¶s needs If spinal anesthesia is contemplated: After the patient is anesthetized Reposition the patient per anesthesiologist¶s instruction Attached anesthesia screen and place the patient¶s arm on the arm boards Apply restraints on the patient Expose the area for skin preparation Catheterize the patient as indicated by the anesthesiologist Perform skin preparation 4 . sponges and other items needed during the procedure  Members of the surgical team who prepares and preserves a sterile field in which the operation can take place  Responsible for the sponge counts. the blades and needles and instruments check throughout the operation  Has a job requiring anticipation.Before the Incision Begins  Provide 2 sponges on the operative site prior to incision  Passes the 1st knife for the skin to the surgeon with blade facing downward and a hemostat to the assistant surgeon  Hand the retractor to the assistant surgeon  Watch the field/ procedure and anticipate the surgeon¶s needs  Pass the instrument in a decisive and positive manner  Watch out for hand signals to ask for instruments and keep instrument as clean as possible by wiping instrument with moist sponge  Always remove charred tissue from the cautery tip  Notify circulating nurse if you need additional instruments as clear as possible  Keep 2 sponges on the field  Save and care for tissue specimen according to the hospital policy  Remove excess instrument from the sterile field  Adhere and maintain sterile technique and watch for any breaks End of Operation  Undertake count of sponges and instruments with circulating nurse  Informs the surgeon of count result  Clears away instrument and equipment  After operation: helps to apply dressing  Removes and exposes of drapes  De-gown  Prepares the patient for recovery room  Completes documentation  Hand patient over to recover room ROLES OF SCRUB NURSE  Works directly with surgeon within the sterile field.

 Maintain good body alignment ANESTHESIA  Oliver Wendell Holmes.  Other position: Thyroidectomy ± head is hyperextended. Sr. hernia repair. explor lap.  Trendelenburg ± head and body are flexed by ³breaking the table´. mastectomy. pillow on neck and shoulders to provide exposure of thyroid gland. during and after the operation to ensure an optimal outcome for the patient  Must be able to anticipate the scrub nurse¶s needs and be able to open sterile packs. bowel resection. not only pain. etc. 5 . Position kick buckets on the operating side Replenishes and records sponge/ sutures Ensure the theater door remain closed and patient¶ s dignity is upheld Watch out for any break in aseptic technique End of Operation  Assist with final sponge and instruments count  Signs the theater register  Ensures specimen are properly labeled and signed      After an Operation Hands dressing to the scrub nurse Helps remove and dispose of drapes Helps to prepare the patient for the recovery room Assist the scrub nurse. etc. chest and hip surgeries. suction.g. dilatation and curretage and most abdomino-perineal resection. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. cholecystectomy. This position exposes the perineal area and is ideal for perineal repairs. taking the instrumentations to the service (washroom) Ensures that the theater is ready for the next case ROLE OF CIRCULATING NURSE  Responsible for managing the nursing care of the patient within the OR and coordinating the needs of the surgical team with other care provider necessary for completion of surgery  Observes the surgery and surgical team from broad perspective and assists the team to create and maintain a safe and comfortable environment for the patient  Asses the patient¶s condition before.  Laminectomy positions ± used during surgical procedures involving the spine.  Maintain adequate respiratory and circulatory function. in 1846  meant the condition of having sensation (including the feeling of pain) blocked.  Strap the patient to prevent falls.       During Operation Remain in theater throughout operation Focus the OR light every now and then Connect diatherapy.  Avoid undue exposure. Nursing Management:  Explain purpose of the position. (APR)  Lateral ± used in kidney.  a ³reversible lack of awareness´.  Lithotomy ± thighs and legs are flexed at right angles and then simultaneously placed to stirrup. a general anaesthestic) or a lack of awareness of a part of a the body such as a spinal anaesthetic or another nerve block would cause  Anesthesia differs from analgesia in blocking all sensation. a small sand bag. This position permits displacement of the intestines into the upper abdomen and is often used during surgery of the lower abdomen or pelvis.  Prone ± for back and rectal surgery. operate machinery and keep accurate records  Commonly Used Operative Positions  Dorsal Recumbent (Supine) ± coronary artery bypass.  Reverse Trendelenburg ± head is elevated and feet are lowered. whether this is a total lack of awareness (e.

Caudal block d. Major blocks involve multiple nerves or a plexus (e. Spinal block b. open skin surfaces. wounds. Topical anesthetics are  Topical Anesthesia readily absorbed and act rapidly.  Is a technique in which the anesthetic agent is injected into and around a nerve or small nerve group that supplies sensation to a small area of the body. Saddle block 5.  (Infiltration)is injected into a specific area and is used for minor surgical procedures such as suturing a small wound or performng a  Local Anesthesia biopsy. Regional anesthesia a. Epidural block c. the area inside the spinal column but outside the dura mater. Lidocaine or tetracaine 0. An occlusion tourniquet is applied to the extremity to prevent infiltration and absorption of the injected intravenous agent beyond the  Intravenous block (Bier block) involved extremity. Spinal anesthesia 6.1% may be used. Epidural anesthesia 7.  It requires a lumbar puncture through one of the interspaces between lumbar disc 2 (L2) and the sacrum (S1). a facial nerve)  Is used most often for procedures involving the arm.  Is an injection of an anesthetic agent into the epidural space. Deep sedation 3.g. Peripheral nerve blocks 6 . High Spinals (reaching the nipple line ± T4) can be used for surgeries such as cesarean sections. wrist and hand. General 2.  Epidural (peridural) anesthesia  Common Anesthetic Techniques 1. GA 4. Conscious sedation 2. and burns. Categorized into Low Spinals(saddle or caudal blocks) are primarily used for surgeries involving the perineal or rectal areas. minor blocks involve a  Nerve Block single nerve (e. Regional  Is applied directly to the skin and mucous membranes.g. the brachial plexus anesthetizes the arm).TYPES 1. Ananesthetic agent is injected into the subarachnoid space surrounding the spinal cord. Mild Spinals (below the level of the umbilicus ± T10) can be used for hernia repairs or  Spinal anesthesia (Subarachnoid block) appendectomies. The most common used topical agents are lidocaine (Xylocaine) and benzocaine.

Cardiac dysrrhytmias 5.  Continuous constant surveillance of the patient until completely out of anesthesia.  Recognize stress factors that may affect the patient and minimize these factor. ONSET or INDUCTION STAGE 2.able to breath deeply and cough freely with easy and noiseless breathing. A contaminated wound may be left open or partially open. and staples are usually removed after 7-10 days. attached to suction or self-contained drainage with suction.  Suction secretions.  CONSCIOUSNESS ± fully awake.pinkish skin and mucus membrane 1 . Hypoventilation 2. INTRAOPERATIVE COMPLICATIONS 1. responsive  COLOR. a dressing is applied:  To prevent wound contamination.BP is within + 20 mmHg of the preoperative level. serum and debris from the operative site.  Promote comfort and maintain safety. the sutures. 5 Physiologic Parameters in the Discharge of Patient from Recovery Room  ACTIVITY.  Administer humidified oxygen as ordered. EXCITEMENT or DELIRIUM 3. If healing progresses without complications.  RESPIRATION. The surgical wound is closed with:  Sutures  Staples  Skin closure strips  Retention sutures  Zipper-like devices After the incision is closed.  Observe signs and symptoms of shock and hemorrhage. coughing.  Keep airway in place until fully awake. Peripheral nerve damage 7.  Encourage deep breathing. SURGICAL STAGE 4. clips. Example: move four extremities voluntarily on commands.  CIRCULATION. deep breathing. Hypotension 4. Malignant hyperthermia  STAGES OF ANESTHESIA 1. Oral trauma 3.  To provide support for the incision. Hypothermia 6. Drains may be free draining.  Absorb drainage. ASSESSING DRAINAGE A drain is placed in the incision to drain blood. Nursing Interventions: y Maintenance of pulmonary ventilation (patent airway and adequate respiratory function)  Position patient to lateral position with neck extended. MEDULLARY or DANGER STAGE ASSISTING WITH SURGICAL WOUND CLOSURE Skin closure (sutures) are used to approximate wound edges until wound healing is complete or to occlude the lumen or a blood vessel.able to obey commands. y Maintenance of circulation  Monitor vital signs and report abnormalities.

 Perform safety checks. a. 1. and upon discharge (Recovery. o Restraints for IVF¶s.RR) Assist patient in returning to safe physiologic level by providing safe and individualized nursing care.  Avoid exposure. (CV status)  Examine operative site and check dressings.  Avoid rough handling.  Determine vital signs and skin temperature.  Assess neuro status. SCORING SYSTEMS Systemized methods of patient scoring help to provide an objective measurement for care. operative procedure and surgeon. o Side rails.  Ensure adequate discharge planning and teaching.  Restore homeostasis. with 6 representing complete recovery (Table 1). SIMPLIFIED SCORING SYSTEM The Simplified Scoring System is a straightforward system that lives up to its name by being relatively easy to use. 2005. o Position for good body alignment. Scoring systems aid in determining when an ambulatory surgery patient is ready to go home.) Get the baseline assessment of the patient.  Prevent postoperative complications. a total of 0 indicates still fully anesthetized and a total of 6 indicates that the patient is fully recovered. It is used as a quick method to assess objectively the progression from surgical anesthesia to recovery.) TABLE 1 SIMPLIFIED SCORING SYSTEM FOR POSTOPERATIVE RECOVERY PARAMETER FINDING Consciousness Awake Arouses and responds to stimulus Not responding to stimuli Airway Coughs on command or is crying Maintains a good airway and is breathing easily Airway requires maintenance Movement Moves limbs purposefully Nonpurposeful movements Not moving POINTS 2 1 0 2 1 0 2 1 0 SIMPLIFIED SCORING SYSTEM INTERPRETATION Minimum score 0 Maximum score 6 0 indicates still fully anesthetized 6 indicates fully recovered Using the Simplified System. or that an extended stay for observation is warranted.  Verify identity. 1. blood transfusion  Require briefing on problems encountered in OR. and 30-minute intervals. 2 . The time intervals set for recording scores are recommended for admission to PACU at 5-.  Alleviate pain and discomfort. Post Anesthetic Care Immediate post op (immediate post anesthesia recovery.POSTOPERATIVE PHASE  Goals  Maintain adequate body systems functions. Its scoring is on a scale of 0 through 6. 15-.  Avoid hurried movement and rapid changes in position.  Appraise air exchange status and skin color. Transport of the patient from the OR to RR.

and other factors indicative of post anesthesia complications (Table 2).2. hyperventilating. Pablo & Barone. emesis. A patient score of 9 in the operating room or PACU enables a satisfactory move to a lesser level of care (Barone. productive cough Rate over 20. as the drive to shorter procedure stays and observation periods makes a portion of this system unusable except in extreme instances TABLE 2. partial atelectasis Major atelectasis Pneumonia Amnesic. or 0 = No response Activity on command less.) MODIFIED ALDRETE SCORE (POSTANESTHESIA RECOVERY SCORE) Consciousness of pre-op level 1 = Blood pressure within 2 = Fully awake 50%±20% of pre-op level 1 = Responds to name 0 = Blood pressure 50%. breath holding more than 25 sec Rate 15±20. fifth. NOTRE DAME POST-ANESTHETIC SCORING SYSTEM The Post Anesthetic Scoring System of Notre Dame Hospital combines aspects of the Modified Aldrete System with an additional scoring system for the evaluation of postoperative pain. pulse always <100 (all blood pressure readings are systolic) Blood pressure change less than 30%. pulse 100±120 Vasopressors or digitalis therapy Blood pressure <100 despite treatment Decompensated Severe shock Rate under 15. Patients are scored in each area at the time of admission and at regular intervals during their stay in the PACU. observable criteria is based on the Apgar score and was developed by J. This system has the additional benefit of allowing patients to be scored on the second. It is extensively used because it can be applied immediately and repeatedly as a convenient means to evaluate progress in recovery from anesthesia. NOTRE DAME POST ANESTHETIC SCORING SYSTEM Organ System Finding Circulatory Blood pressure stable. obstructed breathing Total Score 0 = Apneic Circulation 10 = Score = 9 needed to leave PACU 2 = Blood pressure within 20% 3. satisfied Confused or recalls induction Dissatisfied with anesthesia for any reason Extrapyramidal signs Major neurologic complications Coma Points 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 Respiratory CNS 3 . MODIFIED ALDRETE SCORING SYSTEM Another scoring system that lists objective. and fifteenth days following surgery and their progress mapped. rales or temperature up to 100°F Temperature over 100°F. Antonio Aldrete. of pre-op level Oxygen saturation 2 = Moves all extremities 2 = SpO2 >92% on room air 1 = Moves two extremities 1 = Supplemental O2 required 0 = No movement Respiration to maintain SpO2 >92% 0 = SpO 2 <92% with O2 2 = Free deep breathing supplementation 1 = Dyspneic. 2004. This ability to follow a patient's progression over a longer course is a mixed blessing.

with at least one severe disease Status of underlying disease: poorly controlled or end-stage Limitations on activity: incapacitated Danger of death: possible American Society of Anesthesiologists Physical Status Classification System ASA V Patient's health: very poor. abdominal procedures. neonates.GI Renal (24-hr volumes) Nothing No more than 3 episodes of nausea Nausea. the better. reassessments several days after surgery have little meaning in all but the most serious cases (Recovery. and operations that require general anesthesia lasting for several hours are all candidates for extended observation in a skilled post anesthesia care setting. moribund Limitations on activity: incapacitated Danger of death: imminent 2 . vomited once only Vomiting Ileus Evisceration or perforation Voids over 800 mL Over 800 mL per catheter Voids 500±800 mL 500±800 mL per catheter Under 500 mL Anuria 0 1 2 3 4 5 0 1 2 3 4 5 NOTRE DAME POST ANESTHETIC SCORING SYSTEM The post anesthesia score for each organ system is designed to be evaluated separately: the lower the score in each organ system. Drawbacks to this system are its inherent complexity and²most important²that unless great care is taken to use the data achieved. emergency surgical procedures. 2005). premature infants. American Society of Anesthesiologists Physical Status Classification System ASA I Patient's health: excellent. Individuals identified as ASA III and above. PREOPERATIVE EVALUATION The American Society of Anesthesiologists (ASA) has developed a classification system that is used to identify patients preoperatively by degree of risk for complications. with no systemic disease Limitations on activity: none Danger of death: none Excluded: persons at extremes of age (very young. very old) American Society of Anesthesiologists Physical Status Classification System ASA II Patient's health: disease of one body system Status of underlying disease: well controlled Limitations on activity: none Danger of death: none American Society of Anesthesiologists Physical Status Classification System ASA III Patient's health: disease of more than one body system or one major system Status of underlying disease: controlled Limitations on activity: present but not incapacitated Danger of death: no immediate danger American Society of Anesthesiologists Physical Status Classification System ASA IV Patient's health: poor.

Causes of hypoventilation:  Medications  Pain  Chronic Lung Disease  Obesity Signs and Symptoms of Respiratory Obstruction and Hypoventilation  Restlessness  Attempt to sit up on bed  Fast.  Laryngospasm due to intubation.  2. apprehension.  Promote wound healing.  Maintain adequate fluid and electrolyte balance. NGT. Intermediate postop care When the patient returns from RR to the surgical unit.  Maintain adequate renal function. Causes of airway obstruction:  Mucus collection in the throat  Aspirated mucus/vomitus  Loss of swallowing reflex  Loss of control of the muscles of the jaw and tongue. Initial assessment  Respiratory Status. T-tube  Position Ongoing Assessment. Goals and Interventions. Extended Postop Period 2-3 days after surgery  Self care activities  Activity Limitation  Diet and Medication at Home  Possible Complications  Referrals.  Maintain adequate cardiovascular and tissue perfusion. comfort and safety. confusion  Stridor/ snoring/ wheezing  Cyanosis (late sign)  Interventions  Maintain adequate nutrition and elimination.  Promote adequate rest. directed towards prevention of complications and postoperative discomforts.  Provide adequate psychological support.  Maintain adequate respiratory function. follow up check-up Post Discomfort  Nausea and Vomiting  Restlessness and Sleeplessness  Thirst  Constipation  Pain 2 .  Promote and maintain activity and mobility. thready pulse (early sign)  Air hunger  Nausea.  Goals  Restore homeostasis and prevent complications.  Cardiovascular status  LOC ( Level of Consciousness)  Tubes ± Drainage.  Bronchospasm. 3.

rapid RR.  Initiate anticoagulant therapy as ordered.often occurs after operations on the lower abdomen or during the course of septic conditions as ruptured ulcer or peritonitis.  Capillary. dangling over the side of the bed with pressure on the popliteal area. Clinical Manifestations:  Apprehension  Deep. PULMONARY COMPLICATIONS  Atelectasis  Bronchitis  Bronchopneumonia  Lobar Pneumonia  Hypostatic Pneumonia  Pleurisy Nursing Interventions:  Reinforce deep breathing . (tissue hypoxia) Impaired Tissue Metabolism Cell/ Organ Death HEMORRHAGE. generalized oozing  Venous.  Arterial ± spurts and is bright red in color. Hemostan  Ligation of Bleeders  Pressure Dressings  Blood Transfusion. ringing in ears  Progressive weakness. turning exercises. Low Hgb  Circumoral pallor. y Active Interventions  Bed rest.POSTOPERATIVE COMPLICATIONS SHOCK.  Encourage leg exercises and ambulate early.slow. coughing. damage to vein  Hemorrhage  Prolonged Immobility  Obesity/ Debilitation Clinical Manifestations:  Pain  Redness  Swelling  Heat/ warmth  (+) homan¶s sign Nursing Interventions: y Prevention  Hydrate adequately to prevent hemoconcentration.dark in color and bubble out. low body temperature  Low BP.  Wear anti embolic support from the toes to the groin.  Encourage early ambulation.response of the body to a decrease in the circulating blood volume.  Avoid any restricting devices that can constrict and impair circulation. which results to poor tissue perfusion and inadequate tissue oxygenation.  Prevent use of bed rolls. IV fluids FEMORAL PHLEBITIS/ DEEP THROMBOPHLEBITIS. 3 .the copious escape of blood from the blood vessel. Causes:  Injury. elevate the affected leg with pillow support. the death ensues Management:  Vitamin K (Aquamephyton).  Avoid massage on the calf of the leg. knee gatches.

HICCUPS. bend knees to relieve tension on abdominal muscles.  Antibiotic therapy.  Breath in or out paper bag. WOUND COMPLICATIONS Kinds: Hemorrhage/Hematoma. have someone call for the doctor. moist saline dressing.  Keep on bed rest. anus.loop of intestine may kink due to inflammatory adhesions. Nursing Interventions: Implement measures to induce voiding. 4 . pain. URINARY DIFFICULTIES y Retention. colicky abdominal pains.  Supine or semi-fowlers position.  Pressing on the eyeball thru closed lids for several minutes. Nursing Interventions:  NGT insertion  Administer electrolyte/IV as ordered. swelling. Wound Dehiscence. Clinical Manifestations:  Intermittent sharp.  Wound care.  Plasil as ordered.occurs most frequently after operation of the rectum. vagina.  Elevated temperature. there is overflow incontinence caused by loss of tone of the bladder sphincter.caused by irritation of the phrenic nerve between the spinal cord and terminal ramifications on the undersurface of the diaphragm.  Abdominal distention. caused by the spasm of the bladder sphincter. y Incontinence ± 30-60 ml every 15-30 minutes. INTESTINAL OBSTRUCTION.intermittent spasms of the diaphragm causing a sound (³hic´) that result from the vibration of closed vocal cords as air rushes suddenly into the lungs-----.  Prepare for possible surgical intervention. WOUND INFECTIONS Clinical Manifestations:  Redness. Nursing Interventions:  Remove the cause.  Shock. e. Wound Evisceration Nursing Management:  Apply abdominal binders. lower abdomen.  Cover exposed intestine with sterile.  Stay with client. the bladder is over distended.  Nausea and vomiting. No bowel movement (complete obstruction)  Return flow of enema is clear. Preventive Measures:  Housekeeping cleanliness in the surgical environment.  Encourage proper nutrition.  Strict aseptic techniques.  Foul smell from the wound. warmth  Pus or other discharge on the wound.g abdominal distention  Hold breath by taking a large swallow of water. hiccups  Diarrhea (incomplete obstruction).  Prepare for surgery and repair of wound. then death occurs. chills  Tender lymph nodes on the axilla or groin closes to the wound. Incentive spirometry.

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