TABLE 7-22 Postoperative Complications

Condition and Etiology Assessment: Signs and Symptoms Nursing Care Plan/lmplementation
Respiratory Complications - Most Common Are Atelectasis, Pneumonias (Lobar, Bronchial, and Hypostatic), and Pleuritis;
Other Complications Are Hemothorax and Pneumothorax
Atelectasis - undetected preoperative upper respiratory infections, aspiration of vomitus: irritation of the tracheobronchial tree with increased secretions of mucus due to intubation and inhalation anesthesia, a history of heavy smoking, or chronic obstructive pulmonary disease; severe postoperative pain or high abdominal or thoracic surgery, which inhibits deep breathing; and debilitation or old age, which lowers the patient’s resistance Dyspnea; ↑ temperature; absent or diminished breath sounds over affected area, asymmetrical chest expansion, ↑ respirations and pulse rate; tracheal shift to affected side when severe; anxiety and restlessness
  1. Position: unaffected side
  2. Turn, cough, and deep breathe
  3. Postural drainage
  4. Nebulization
  5. Force fluids if not contraindicated
Pneumonia - see Atelectasis for etiology Rapid, shallow, painful respirations; crackles; diminished or absent breath sounds; asymmetrical lung expansion; chills and fever, productive cough, rust-colored sputum; and circumoral and nailbed cyanosis
  1. Position of comfort - semi-Fowler’s to high Fowler’s
  2. Force fluids to 3000 mL/day
  3. Provide humidification of air and oxygen therapy
  4. Oropharyngeal suction prn
  5. Assist during coughing
  6. Administer antibiotics and analgesics as ordered
  7. Diet: high calorie, as tolerated
  8. Cautious disposal of secretions; proper oral hygiene
Pleuritis - see Atelectasis for etiology Knifelike chest pain on inspiration; intercostal tenderness; splinting of chest by patient; rapid, shallow respirations; pleural friction rub; temperature; malaise
  1. Position: affected side to splint the chest
  2. Manually splint patient's chest during
  3. Apply binder or adhesive strapping as ordered
  4. Administer analgesics as ordered
Hemothorax - chest surgery, gunshot or knife wounds, and multiple fractures of chest wall Chest pain; increased respiratory rate; dyspnea, decreased or absent breath sounds; decreased blood pressure; tachycardia, and mediastinal shift may occur (heart, trachea, and esophagus great vessels are pushed toward unaffected side)
  1. Observe vital signs closely for signs of shock and respiratory distress
  2. Assist with thoracentesis (needle aspiration of fluid)
  3. Assist with insertion of thoracotomy tube to closed-chest drainage (see care of water-sealed drainage system)
Pneumothorax, closed or tension - thoracentesis (needle nicks the lung), rupture of alveoli or bronchi due to accidental injury, and chronic obstructive lung disease Marked dyspnea, sudden sharp chest pain, subcutaneous emphysema (air in chest wall tissue); cyanosis; tracheal shift to unaffected side; hyperresonance on percussion, decreased or absent breath sounds; increased respiratory rate, tachycardia; asymmetrical chest expansion, feeling of pressure within chest; mediastinal shift - severe dyspnea and cyanosis, deviation of larynx and trachea toward unaffected side, deviation either medially or laterally of apex of heart, decreased blood pressure; distended neck veins; increased pulse and respirations
  1. Remain with patient - keep as calm and quiet as possible
  2. Position: high Fowler’s (sitting)
  3. Notify physician through another nurse, and have thoracentesis equipment brought to bedside
  4. Administer oxygen as necessary
  5. Take vital signs to evaluate respiratory and cardiac function
  6. Assist with thoracentesis
  7. Assist with initiation and maintenance of closed-chest drainage