Mitosis

G0

G2
G1 S

Cell Cycle a series of events within the cell that prepare the cell for dividing into two daughter cells

WARNING SIGNS
(C.A.U.T.I.O.N.A.L) (C.A.U.T.I.O.N.U.S)

CHANGE IN BOWEL OR BLADDER HABITS

A SORE THAT DOES NOT HEAL

UNUSUAL BLEEDING OR DISCHARGE

THICKENING OR LUMP IN BREAST OR ELSEWHERE

Indigestion or difficulty swallowing

OBVIOUS CHANGE IN WART OR MOLE

NAGGING COUGH OR HOARSENESS

UNEXPLAINED WEIGHT LOSS

SEVERE ANEMIA

EARLY DETECTION: main goal

of treatment of breast cancer
BSE: MONTHLY self examination; age 20-40: breast exam every 2-3 years by a physician; 40 years = annual
Mammogram: baseline 35-40 years; mammogram every year or very other year fro ages 40-50; mammogram yearly after age 50

hard irregular mass felt in the superior medial quadrant of the breast at the 2 oclock position approximately 2.5 cm from the margin of the areola

Breast SELF EXAMINATION

1. Start from age 20 2. Done after menstruation 3. One week after menstrual period 4. During standing position, note symmetry of breast 5. Lying position, elevate shoulders on side examined with pillow support 6. Palpate the breast from periphery to the center in circular motion

STAGE 1

Breast tumors are very small and measure less than 2 cm. in size; early breast cancer

STAGE 2

Breast tumors measure between 2 and 5 cm. and the lymph nodes may have become affected. There is no sign of spread of breast cancer to any other part of the body; still termed early breast cancer

STAGE 3

Breast tumors are larger than 5 cm. and the lymph nodes are usually affected, but there is still no sign that the disease has spread any further throughout the body. locally-advanced breast cancer

Breast tumors are of any size, but in addition the lymph nodes are affected and the cancer has spread to other parts of the body. advanced or metastatic breast cancer

STAGE 4

SUMMARY
1. Biopsy (FNAB) 2. Surgery (lumpectomy; simple mastectomy, MRM) 3. Chemotherapy 4. Radiation 5. Hormone therapy
1. Tamoxifen 2. Oophorectomy 3. Corticosteroids 4. Adrenalectomy and hypophysectomy

NURSING CARE
Preoperative: HISTORY AND P.E. Tetanus prophylaxis and prophylactic antibiotic for ulcerated tumors Rehabilitation medicine Intraoperative
DECISION Suction drain

 Post operative Analgesics Arm rehabilitation exercises Discharge after 48 hours with tube drains and with instructions: Care of tube drain Intake of analgesics Arm rehabilitation exercises Follow up visit 5-7 days after discharge

 Post operative Prevent lymphedema ARM ADDUCTED, JP drain present Instruct JP system After discharge, teach abduction, elevation 7-10 days to prevent contractures Finger, hand, wrist, elbow, shoulder movement throughout No venipuncture, injections, parenteral fluids No shaving or deodorant to affected side

 Post operative Post mastectomy arm exercises 1-2 days: focus on elbow, wrist and hand of affected side (extends, flexes elbow, gently squeezes a soft rubber ball and does DB to facilitate lymph flow) 2nd day: add shoulder shrugs and ROM including flexion and abduction; self care activities; not raise the arm above shoulder height until drains are removed

 Post operative Post mastectomy arm exercises 10th day: active assisted ROM 2x a day; pain meds 30 min prior = lymphedema and loss of shoulder mobility 6th week: water aerobics; avoid using weights to prevent edema and subsequent swelling

 Post operative Arm precautions after mastectomy Affected arm never used for BP, venipuncture, injection No constricting clothing or jewelry including wrist watch on affected arm Do not carry heavy objects in affected arm Wear rubber gloves when washing dishes Use unaffected arm when removing food from hot oven or wear padded glove pot holder Use a thimble when sewing Use cream or lotion to keep the skin soft

 Post operative Outdoor activities Wear gloves when gardening Wear protective clothing or use sunscreen to prevent sunburn Use insect repellant fro insect bits Immediately wash cuts and scratches

 Follow up Second follow up is 30 days after operation Adjuvant therapy started within 6 weeks of operation Frequency of follow up First 2 years: every 6 months; earlier if with symptoms After 2 years: yearly Routine annual contralateral breast mammography Symptom directed metastatic work up Gynecological evaluation annually if on tamoxifen

Early detection methods

SBE monthly Clinical breast exam every 3 years @ 20-39 and annually thereafter Annual PSA and DRE for men > 50 y.o.; annual testing for men age 40 and over who are at high risk PE every 3 years, ages 20-39 and yearly over 40 y.o. Pelvic exam every 3 years until 40, then yearly Pap smear Yearly fecal occult blood at 50; sigmoidoscopy q5y; double contrast enema q5y or colonoscopy q10y TSE monthly (testes smooth, firm, oval shaped; right larger and higher; left smaller and lower)

CHEMOTHERAPY
may or may not include Hormone Therapy adjuvant treatment can be taken by mouth, by injection, by intravenous injection or by intravenous pump at set cycles or rounds cause the fast growing cancer cells to stop dividing, stop growing and die can be given before surgery to shrink a tumor or after surgery to reduce the chances of recurrence

 Side Effects mouth sores nausea and vomiting loss or thinning of hair loss of appetite tiredness; loss of energy sleep disturbances temporary or permanent menopause (and side effects) hot flashes low red blood cell count; low white blood cell count

1. 2. 3. 4. 5. 6. 7. 8.

Report side effects of chemotherapy Take medicines prescribed for side effects Severe side effects might improve with treatment changes or dose reduction Restrict activities Ask for help with chores If necessary cut back on hours at work Rest when tired Plan meals ahead for day of treatment and a couple of days after

9. Arrange for help with young children at treatment time 10. Nibble dry crackers to help nausea 11. If you are unable to eat, drink lots of liquids (juice, peppermint tea, soup, Boost etc.) 12. Meditation and visualization can help reduce side effects 13. Reward yourself with a small gift after each treatment (flower, perfume, bubble bath etc)

Woman in position for radiation treatment, from the side. Side radiation treatment beam is shown.

A bright yellow indicates breast being treated B light yellow part of the beam, beam in air, not touching woman C opening of the linear accelerator D arm holder

Woman in position for radiation treatment, from the front. Middle radiation beam is shown. A bright yellow indicates breast being treated B light yellow part of the beam, beam in air, not touching woman C opening of the linear accelerator D arm holder supports woman's right arm

INTERNAL RADIOTHERAPY
brachytherapy radiotherapy with implants thin tubes, seeds or rods containing radioactive material are placed either directly into the cancer or close to it alone, or combined with external radiotherapy Temporary (one to six days) Permanent (remain in the body but are no longer radioactive after being in place for some weeks or months)

INTERNAL RADIOTHERAPY
may send some radiation outside your body into the surrounding area Once the implant is removed, all radioactivity is removed from youthat is, you are not radioactive and there is no danger to anyone else

EXTERNAL RADIOTHERAPY
a machine directs radiation onto the cancer and surrounding tissue the length of treatment depends on many things, such as the type of cancer, its location, and whether it is intended to cure the cancer or to provide palliative treatment a special x-ray machine called a simulator is often used to pinpoint, very precisely, the area of the body to be treated

EXTERNAL RADIOTHERAPY
permanent marks, which are fine dots, may be used to ensure the radiation is delivered to the same site on a daily basis. These small, black 'tattoos' are about the size of a pinhead. external radiotherapy does not make you radioactive. It is quite safe for you to be with other people when you are having treatments and after.

 SIDE EFFECTS
tiredness inflamed, dry, itchy skin peeling or darkening skin wet, moist, blistering skin surface (like a bad sunburn) swelling, heaviness, tenderness of the breast pinching or mild jabbing sensations thickening of the breast skin or tissue change in size of the breast lump in the throat during treatment heartburn during treatment difficulty swallowing during treatment

1. Do not remove colored ink marks on the skin unless told to do so

2. Wash with lukewarm water only and blot dry

3. Avoid soap, lotion, ointment or perfume on treatment area 4. Do not shave or use deodorant in armpit on the treatment side

5. You can dust your armpit with cornstarch

6. Avoid exposing treatment area to sun or hair dryers

7. Wear a very loose fitting bra or camisole. If you have had a mastectomy ask you doctor if you can wear your prosthesis. 8. Do not scratch when itchy

9. If side effects persist or are aggressive ask your doctor for special treatment products.
10.Continue doing post surgery exercises 11.Maintain a well balanced diet

ORAL Tobacco use; mouth CANCER sore that doesnt heal, sore throat, dysphagia, hgoarseness; LEUKOPLAKIA; ERYTHROPLAKIA

Clinical

1.
2.

3.

SURGERY; RADIATION SOFT DIET TO ALLOW AREA TO HEAL TUBE FEEDINGS; TRACHEOSTO MY CARE
Surgery

LUNG CANCER

SMOKING CT scan; PET scan; cytologic Chronic cough, analysis of hoarseness, hemoptysis, weight sputum; fiberoptic bronchoscopy; loss, loss of appetite, lymph node fever, wheezing, biopsy; chest x-ray repeated bouts of pneumonia, chest pain

ESOPAHGEAL CARCINOMA
1. Ingestion of corrosive substance like acids or alkali Esophageal stasis, like muscular problem of esophagus Alcohol Smoking

2.

Progressive dysphagia Anorexia and weight loss; Back and substernal pain Hoarseness of voice Chronic cough

Barium swallow Endoscopy with biopsy CT scan Endoscopic ultrasound

1. 2. 3.

Nutrition Palliative Supportive

3. 4.

LARYNGEAL CANCER

PROGRESSIVE 1. Laryngectomy (partial - clients hoarseness; voice preserved; or total loss of dysphagia; lump smell and speech; permanent in the throat; stoma needed) burning PRE-OP: routine; communication sensation when mode; post op teaching before drinking hot procedure liquids; POST-OP: routine post op care; check persistent sore for hemorrhage, Atelectasis and throat pneumonia; stoma care (avoid
water, aerosols, sprays; suction, DBCT; humidified air, oral hygiene, hemovac make sure deflated; establish communication; speech therapist consulted

GASTRIC CANCER 1. Excess intake of nitrate - cured, salt cured and smoke cured foods 2. Smoking 3. Chronic achlorhydria 4. Pernicious anemia 5. (+) family history 6. Excess intake of raw foods 7. Drinking large, volume of hot tea 8. Atrophic gastritis

Progressive loss of appetite Gastric fullness (early satiety) Dyspepsia (+) Guaiac stool N&V Hematemesis; melena Pain induced by eating relieved by vomiting Palpable mass Anemia, pallor, weight loss

Occult blood 1. test UGI series UGI endoscopy Blood chemistry

Gastrectomy Dumping syndrome Hemorrhage or bleeding Pernicious anemia

HODGKINSA LYMPHOMA (malignancies of lymphoid tissue; B lymphocytes; due to Epstein Barr virus; UNKNOWN CAUSE) Most common in the cervical, axillary, inguinal nodes

EARLY 20S; 55-75 Y.O.; MEN

Presence of 1. Reed Sternberg 2. cells

Radiation (1& 2) Chemotherapy (3 & 4)

Test to stage: NIGHT 1. Chest xSWEATS, rays; CT WEIGHT scans of LOSS, FEVER, head, neck, FATIGUE, chest, PAINLESS abdomen, ENLARGEMENT pelvis; OF ONE OR PET of MORE LYMPH entire body; NODES ON CBC, Bone ONE SIDE OF marrow THE NECK biopsy

 Staging STAGE I STAGE II

STAGE III

STAGE IV

single LN region, lymphoid structure or extralymphatic site 2 or more LN on same side of diaphragm, localized extra lymphatic involvement LN regions or structures on both sides of the diaphragm, involve the spleen or localized extranodal disease diffuse or disseminated extra lymphatic disease

 Chemotherapy
Depends on clients age, general condition ABVD REGIMEN (DOXORUBICIN, BLEOMYCIN, VINBALSTINE, DEACARBAZINE) MOPP REGIMEN (NITROGEN MUSTARD, VINCRISTINE, PROCARBAZINE, PREDNISONE

Radiation therapy (EARLY STAGE OF Hodgkins disease)

Subtype Lymphocyte predominant

Incidence Adults and males

Prognosis

Nodular sclerosing Mixed cellularity Lymphocyte depleted

Localized at diagnosis; excellent prognosis MOST COMMON Good if diagnosed early Adults and males Poorer prognosis LEAST COMMON Poor prognosis

Manifestation LAD

HODGKINS Localized, single (cervical, subclavicular) Orderly & continuous RARE UNCOMMON COMMON Fatigue, pruritus, splenomegaly, anemia, neutrophilia

NON HODGKINS Multiple peripheral (mesentery) Diffuse & unpredictable EARLY & COMMON COMMON UNCOMMON Abdominal pain, nausea, vomiting, dyspnea, cough, CNS symptoms

SPREAD EXTRANODAL INVOLVEMENT BONE MARROW FEVER, night sweats, wt. loss Other manifestations

Change in bowels: tarry, pencil or FAMILY HISTORY; ribbon ethnic shaped, background; bloody colorectal stools polyps; chronic Abdominal pain; inflammatory diarrhea, bowel diseases; vomiting, > 50 y.o.; obstipation smoking; , rectal alcohol intake; pressure; high fat; low bleeding fiber; obesity; DM

COLORECTAL CANCER

FECAL OCCULT BLOOD, SIGMOIDOSCOPY, COLONOSCOPY, BARIUM ENEMA, DRE SURGERY, CHEMOTHERAPY

 ASCENDING (RIGHT) COLON CANCER Occult blood in stool; Anemia; anorexia and weight loss; abdominal pain above umbilicus; palpable mass DISTAL COLON/RECTAL CANCER Rectal bleeding; changed bowel habits; constipation or diarrhea; pencil or ribbon shaped stool; tenesmus; sensation of incomplete bowel emptying

 Barium Enema apple core Polypoid or plaque-like lesion Colonoscopy Access to biopsy

 DUKES CLASSIFICATION Stage A confined to bowel mucosa; 80-90% survival rate Stage B invading muscle wall Stage C lymph node involvement Stage D metastases or locally unresectable tumor; <5% 5 year survival rate

 MANAGEMENT Surgery Hemicolectomy for ascending and transverse colon CA Abdomino perineal resection (APR) for rectosigmoid cancer There are 2 incisions: lower abdomen incision to remove sigmoid and perineal incision to rev\move the rectum T- binder is used to secure perineal dressing Necessitates permanent colostomy Chemotherapy (Fluouracil) Radiation (adjuvant therapy for rectal CA)

RADIATION THERAPY
Internal BRACHYTHERAPY 1. Implanted into affected tissue or body cavity 2. Ingested as a solution 3. Injected as a solution into the bloodstream or body cavity 4. Introduced through a catheter into the tumor SEALED OR UNSEALED Sealed (temporary/permanent) Bed rest Use long handled forceps Unsealed Flush toilet 2x or more External TELETHERAPY TIME, DISTANCE, SHIELDING 10 30 MINUTES 6 FEET PRIVATE ROOM NO PREGNANT NURSE ROTATE NURSE (minimize exposure) Lead apron Mark No deodorant, irritants to skin etc. Avoid rubbing

Three step analgesic ladder for cancer pain control (WHO 1986)
1. 2. 3. BY THE MOUTH oral medication if possible BY THE CLOCK regularly not as required BY THE LADDER increasing potency of analgesia for increasing severity of pain

Three step analgesic ladder for cancer pain control (WHO 1986)
Strong opioid +/- non opioid +/- adjuvant Weak opioid +/- non opioid +/- adjuvant Non opioid +/- adjuvant

STRONG OPIOID ANALGESICS Morphine and related compounds

WEAK OPIOID ANALGESICS Codeine, Codeine paracetamol mixtures; dextropropoxyphene NON OPIOID ANALGESICS Paracetamol, Aspirin, NSAIDs

Prostate cancer Etiology: Unknown

Frequency, nocturia, hesitancy, urinary retention

1.

Dx: DRE, needle biopsy, PSA; increase in acid and alkaline phosphatases 2. Tx: radical prostatectomy; radiation, hormone manipulation; bilateral orchiectomy Bone metastasis: spinal cord compression, pathologic fractures 1. 2. Dx: cystoscopy Cystectomy with one type of urinary diversion: ILEAL CONDUIT

Bladder Cancer Chronic bladder infection, smoking

Painless hematuria, dysuria and frequency

Bladder Cancer

1. 2. 3.

Pre op: routine; bowel prep Post op: routine; stoma care Stoma care:
1. Check color; increase stomal height is normal; monitor excessive edema and bleeding, monitor for obstruction (decrease UO); empty pouch when half full; cleans periostomal skin with mild soap and water; check appliance in AM; maintain urine acidity; report s/Sx of UTI

Peri operative Nursing

PREOPERATIVE Assess STRESS (vaso vagal response)

Diagnose

FEARS

Fears of surgery at different developmental stages

AGE GROUP Toddler SPECIFIC FEARS SEPARATION NURSING considerations TEACH parent to expect regression

Preschooler
School ager

MUTILATION
LOSS OF CONTROL

Allow child to play with models; encourage expression of feelings

Explain procedures in simple terms; allow choices when possible

Adolescent

LOSS OF Involve adolescent in procedures INDEPENDENCE, and therapies; expect resistance; being different from express understanding of peers, e.g. alteration in concerns; point out strengths body image

PREOPERATIVE Plan/Implementation
Age appropriate preparation for health care procedures AGE Newborn 6-12 month Toddler SPECIAL NEEDS Include parents Mummy restraints Model desired behavior Simple explanations; use distractions; allow choices Encourage understanding by playing with puppets, dolls; demo equipment; talk at childs eye level Typical fears Loud noises Sudden movements Strangers, heights Separation from parents; animals, strangers; change in environment Separation from parents Ghosts Scary people

Preschooler

PREOPERATIVE Plan/Implementation
Age appropriate preparation for health care procedures AGE SPECIAL NEEDS Typical fears

School ager

Allow questions Explain why Allow to handle equipment Explain long term benefit Accept regression Provide privacy

Dark, injury Being alone Death Social incompetence War, accdietns Death

Adolescent

PREOPERATIVE Plan/Implementation
Promote safe environment
PARENTAL INVOLVEMENT SAME NURSE TO CARE FOR THE CHILD (CONSISTENCY) PROVIDE OBKJECTS THAT RECREATE FAMILIAR SURROUNDINGS

Preparation for surgery

Pre op check list: Informed consent; lab tests; skin prep; bowel prep

IVs NPO Pre op meds, sedation and antibiotics Removal of dentures, jewelry and nail polish Nutrition (may need TPN or tube feedings pre op

PREOP TEACHING GUIDE FACTORS FOR NURSE TO ASSESS BEFORE TEACHING History of illness Rationale for surgery Nature of Surgery Factors related for patients readiness for learning (age, mental status, pre existing knowledge about condition) CONTENT AREAS TO COVER DURING TEACHING Elicit patients concerns Provide info to clear up misconceptions Explain preop procedures; remove jewelry and nail polish Lab tests; skin prep Rationale for withholding food and fluids (NPO) Preop meds and IV line Teach preop procedure (DBCT, leg exercises, moving in bed, incentive spirometry, equipment to expect post op) Explain importance of reporting pain after surgery; relieve pain

PREOPERATIVE Evaluation
Is the preop checklist complete? Is the patient able to demonstrate post op exercises?

PREOPERATIVE
History Allergies Present medications Past medical illness Alcohol and drug use Female patients: ask about pregnancy (LMP) Others:
Any loose teeth, dentures Glasses or contact lenses Hearing aid Jewelry Joint implants, metal implants, pacemaker Body piercing

PREOPERATIVE
Surgical risks Age Obesity Medical illness Fluid and electrolyte status Present medication Nature and location of present condition Magnitude and urgency of surgical procedure Mental attitude of the patient towards surgery Caliber of the professional health team and OR facilities

PREOPERATIVE
Patient teaching
Diagnostic tests Concerns about anesthesia Diet; OR procedure IV therapy What to expect in the PACU Pain control

Informed consent Pre op exercises

DBCT Incentive spirometry Foot and leg exercises Getting out of bed

PREOPERATIVE
Skin preparation Reduce number of microorganism near the incision site Full bath the evening or morning of surgery Document

Bowel preparation AFTER 3 make the call

Pre op DRUGS ANTI cholinergics; sedatives; anti anxiety; narcotic analgesics; H2 receptor antagonists FINAL CHECK

INTRAOPERATIVE
Role of the nurse

Positions during surgery

Types of anesthesia

ANESTHESIA
MEDICATION General anesthesia via inhalation (halothane) SIDE EFFECTS Resp, circ depression Delirium during induction and recovery Nausea and vomiting, aspiration during induction, myocardial depression and hepatic toxicity Hypotension, post op nausea and vomiting Nursing considerations Check history of sensitization Maintain airway Protect and orient client Monitor vital signs and labs Prevent aspiration post op by elevating hear of bead and turning head to side unless contraindicated Monitor VS Adequate oxygenation, especially during emergence

Nitrous oxide

ANESTHESIA

MEDICATION
IV thiopental sodium (Pentothal)

SIDE EFFECTS

Nursing considerations

Resp depression, low Monitor VS, esp. airway and BP, laryngospasm; breathing poor muscle Straps for operative table, proper contraction, irritating to positioning skin and subQ tissue Protect IV site, check placement periodically Hypotension, headache Hypotension, respiratory depression Monitor Vs, encourage fluids

Spinal anesthesia, saddle Conduction blocks (epidural caudal) Local anesthesia

Headache not experienced Monitor VS

Excitability, toxic reaction (resp difficulty, vasoconstriction)

Monitor patient Do not use with epinephrine on fingers (circulation is less optimal)

ANESTHESIA

MEDICATION
Conscious sedation (Valium)

SIDE EFFECTS
Respiratory depression, apnea, hypotension, bradycardia

Nursing considerations
Never leave the client alone Constantly monitor airway, LOC, pulse oximetry, ECG VS q15-30 minutes Assess clients ability to maintain patent airway an respond to verbal commands

Plan/Implementation 1. Monitor effects of anesthesia post induction 2. Continuously monitor VS 3. Aseptic technique 4. Appropriate grounding devices 5. Fluid balance 6. Perform sponge/instrument count Potential complications 1. Nausea and vomiting 2. Hypoxia 3. Hypothermia 4. Malignant hyperthermia
Inherited muscle disorder chemically induced by anesthesia; stop surgery, treated with 100% oxygen, skeletal muscle relaxant, sodium bicarbonate

POST - OPERATIVE
Respiratory
Check breath sounds Turn, cough and deep breath (C/I: brain, spinal and eye surgery) Assess pain level Teach how to use incentive spirometer PCA Get out of bed as soon as possible

Cardiovascular
VS q15min x 4; q30min x 2, q1H x 2 then as needed Monitor I & O Check potassium levels Monitor CVP

POST - OPERATIVE
Neuropsychological Stimulate patient post anesthesia Monitor LOC GIT Check bowel sounds in 4 quadrants for 5 minutes Keep NPO until bowel sounds are present Provide good mouth care while NPO Provide anti emetics for nausea and vomiting Check abdomen for distention Check for passage of flatus and stool

GUT

Monitor I & O Encourage to void Notify physician if unable to void within 8 hours Catheterize if needed

POST - OPERATIVE
Extremities Check pulses Assess color, edema, temperature Inform patient not to cross legs Apply anti embolic stockings before getting out of bed Monitor for Homans sign Wounds Dressing Document amount and character of drainage Physician changes first post op dressing Use aseptic technique Note presence of drains

POST - OPERATIVE
Wounds Incision Assess site (edematous, inflamed, excoriated) Assess drainage (serous, serosanguinous, purulent) Note type of sutures Note if edges of wound are well approximated Anticipate infection 3-5 days post op Debride wound if needed to reduce inflammation Change dressing frequently to prevent skin breakdown and minimize bacterial growth Drains GI tubes

POST - OPERATIVE
Prevent post op complications Septicemia Paralytic ileus Urine retention Wound infection; dehiscence; evisceration Intestinal obstruction Hiccups Post of psychosis

POST - OPERATIVE
Prevent post op complications Atelectasis Hypostatic pneumonia Constipation Abdominal distention Venous pooling Thrombophlebitis RULE OF THUMB Fever 1st 24 hours Fever within 48 hours Fever within 72 hours

PULMONARY INFECTION UTI WOUND INFECTION

POTENTIAL COMPLICATIONS OF SURGERY

COMPLICATION ASSESSMENT Nursing considerations

Hemorrhage

Decreased BP, increased pulse, cold, clammy skin Decreased BP, increased pulse, cold, clammy skin Dyspnea, cyanosis, cough, tachycardia, elevated temp, pain on affected side Dyspnea, pain, hemoptysis, restlessness, ABG low, high CO2 Positive homans sign

Replace blood volume; monitor VS Treat cause, oxygen, IV fluids

Shock

Atelectasis and pneumonia

Experienced second day post op; suctioning, postural drainage, antibiotics, cough and turn Experienced second day post op; Oxygen, anticoagulants, IV fluids

Embolism

DVT

Experienced 6-14 days up to 1 year later; anti coagulant

POTENTIAL COMPLICATIONS OF SURGERY

COMPLICATION ASSESSMENT Nursing considerations

Paralytic ileus

Absent bowel sounds, no flatus or stool

Nasogastric suction IV fluids Decompression tubes

Infection of wound
Dehiscence

Elevated WBC, temperature; positive cultures

Disruption of surgical incision or wound

3-5 days post op Antibiotics, aseptic technique Good nutrition

5-6 days post op Low fowlers position, no coughing, NPO, notify AP

Evsiceration

Protrusion of wound 5-6 days post op contents Low fowlers position, no coughing NPO, cover viscera with sterile saline dressing; notify AP Unable to void; bladder distention 8-12 day post op Catheterize as needed

Urinary retention

POTENTIAL COMPLICATIONS OF SURGERY

COMPLICATION ASSESSMENT Nursing considerations

Urinary infection

Foul smelling urine Elevated WBC Inappropriate affect

5-8 days post op Antibiotics Force fluids Therapeutic communication Medication

Psychosis

POST - OPERATIVE
DISCHARGE PLANNING Medication Diet Activity Home care procedures and referrals Potential complications Return appointments