TABLE 7-22 Postoperative Complications-continued

Condition and Etiology Assessment: Signs and Symptoms Nursing Care Plan/Implementation
Circulatory Complications - Shock, Thrombophlebitis, Pulmonary Embolism, and Disseminated Intravascular Coagulation (DIC)
Shock - hemorrhage, sepsis, decreased cardiac contractility (myocardial infarction, cardiac failure, tamponade), drug sensitivities, transfusion reactions, pulmonary embolism, and emotional reaction to pain or deep fear Dizziness; fainting; restlessness; anxiety BP: ↓ or falling
Pulse: weak, thready
Respirations: ↑, shallow
Skin: pale, cool, clammy, cyanotic
↓ temperature; oliguria; CVP < 5 cm H2O; thirst
  1. Position: foot of bed raised 20 degrees, knees straight, trunk horizontal, head slightly elevated; avoid Trendelenburg’s position
  2. Administer blood transfusions, plasma expanders, and intravenous infusions as ordered; medications specific to type of shock
  3. Check: vital signs, CVP, temperature
  4. Insert urinary catheter to monitor hourly urine output
  5. Administer oxygen as ordered
Thrombophlebitis - injury to vein wall by tight leg straps or leg holders during gynecological surgery; hemoconcentration due to dehydration or fluid loss; stasis of blood in extremities due to postoperative circulatory depression. Calf pain or cramping, redness and swelling (the left leg is affected more frequently than the right); slight fever, chills; Homans' sign and tenderness over the anteromedian surface of thigh
  1. Maintain complete bed rest, avoiding positions that restrict venous return
  2. Apply elastic stockings to prevent :swelling and pooling of venous blood
  3. Apply warm, moist soaks to area as or-
  4. Administer anticoagulants as ordered 5. Use bed cradle over affected limb
  5. Use bed cradle over affected limb
  6. Provide active and passive ROM exercises in unaffected limb
Pulmonary embolism - obstruction of a pulmonary artery by a foreign body in bloodstream, usually a blood clot that has been dislodged from its original site Sudden, severe stabbing chest pain; severe dyspnea; cyanosis; rapid pulse; anxiety and apprehension; pupillary dilation: profuse diaphoresis; loss of consciousness
  1. Administer oxygen and inhalants while paitient is sitting upright
  2. Maintain bed rest and frequent reassurance
  3. Administer heparin sodium, as ordered
  4. Administer analgesics, such as morphine SO4 to reduce pain and apprehension
Disseminated Intravascular Coagulation (DIC)
Wound dehiscence and evisceration— obesity and undernutrition, particularly protein and vitamin C deficiencies; immunosuppression; metabolic disorders; cancer; liver disease; common site is midline abdominal incision, frequently about 7 days postoperatively; precipitating factors include: abdominal distention, vomiting, coughing, hiccups, and uncontrolled motor activity Slow parting of wound edges with a gush of pinkish serous drainage; or rapid parting with coils of intestines escaping onto the abdomi- nal wall: the latter accompanied by pain and often by vomiting. Patient reports “giving”
  1. Position: bed rest, low Fowler’s or horizontal position
  2. Notify physician stat
  3. Cover exposed coils of intestines with sterile towels or dressing and keep moist with sterile normal saline
  4. Monitor vital signs frequently
  5. Remain with patient; reassure that physician is coming
  6. Prepare for physician’s arrival; set up IV, suction equipment, and nasogastric tube; obtain sterile gown, mask, gloves, towels, and warmed normal
  7. Notify surgery that patient will be returning to operating room
Continued