TABLE 7-22 Postoperative Complications-continued

Condition and Etiology Assessment: Signs and Symptoms Nursing Care Plan/Implementation
Urinary Complications - Retention and Infections
Urinary retention - obstruction in bladder or urethra; neurological disease; mechanical trauma as in childbirth or gynecological surgery; psychological conditioning that exhibits voiding in bed; prolonged bed rest; pain with lower abdominal surgery Inability to void within 8 hr postsurgery, despite adequate fluid replacement; palpable bladder, frequent voiding of small amounts of urine or dribbling; suprapubic pain
  1. Assist patient to stand, or use bedside commode if not contraindicated
  2. Provide privacy
  3. Reduce tension, provide support
  4. Use warm bedpan
  5. 5. Run tap water
  6. Place patient’s feet in warm water
  7. Pour warm water over perineum
  8. Catheterize if conservative measures fail
Urinary tract infections - urinary retention, bladder distention, repeated or prolonged catetherization Urinary: burning and frequency
Pain: low back or flank
Pyuria, hematuria; ↑ temperature, anorexia; positive urine culture
  1. Push fluids to 3000 mL daily, unless contraindicated
  2. Avoid stimulants such as caffeine
  3. 3. Give antibiotics, sulfonamides, or acidifying agents as ordered
  4. Give perianal care after each bowel movement
Gastrointestinal Complications - Gastric Distention, Paralytic Ileus, and Intestinal Obstruction
Gastric distention - depressed gastric motility due to sympathoadrenal stress response; idiosyncrasy to drugs: emotions, pain, shock; fluid and electrolyte imbalances Feeling of fullness, hiccups, overflow vomiting of dark, foul-smelling liquid; severe retention leads to decreased blood pressure (due to pressure on vagus nerve) and other symptoms of shock syndrome
  1. Report signs to physician immediately
  2. Insert or assist in insertion of NG tube; attach to intermittent suction
  3. Irrigate NG tube with saline (water will deplete electrolytes and result in metabolic alkalosis)
  4. Administer IV infusions with electrolytes as ordered
Paralytic ileus - see Gastric distention Severe, colicky abdominal pains, mild to severe abdominal distention, nausea and vomiting, anorexia and malaise; fever; lack of bowel movement; electrolyte imbalance; highpitched tinkling bowel sounds
  1. Assist with insertion of nasoenteric
  2. Maintain IV infusions with electrolytes
  3. Encourage nasal breathing to avoid air swallowing
  4. Check abdomen for distention and bowel sounds every 2 hr
  5. 5. Encourage verbalization
  6. Plan rest periods for patient
  7. Administer oral hygiene frequently
Transfusion Reactions - Allergic, Febrile, and Hemolytic
Allergic and febrile reactions - unidentified antigen or antigens in donor blood or transfusion equipment; previous reaction to transfusions; small thrombi; bacteria; lysed red blood cells Fever to 103°F, may have sudden onset; chills; itching; erythema; urticaria; nausea; vomiting; dyspnea and wheezing, occasionally
  1. Stop transfusion and notify physician
  2. Administer antihistamines, as ordered
  3. Send stat urine to lab for analysis
  4. Institute cooling measures if indicated
  5. Maintain strict input and output records
  6. Send remaining blood to lab for analysis, and order recipient blood sample for analysis