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Preventative Measures to avoid early Postoperative Complications…
Preventative
Measures to
avoid early
Postoperative Complications
Assessement
Level of Consciousness
Assess patient for orientation ( name, time, place, location and date), consciousness and awareness
Ability to move fingers, toes, hands etc.
Color and temperature of skin
Assess skin for color( pallor, cyanosis) skin temperature and excessive sweating
Vital Signs and Oxygen saturation
Frequent vital signs: Check temperature, oxygen saturation, blood pressure, respiration, pulse every 15 minutes until stable, then every 1 to 2 hours, then every 4 hours . Note, report, and document any deviations from preoperative and post-anesthesia care unit data any other symptoms(vomiting etc.)
Intravenous Fluids
Note the type of intravenous solution ( dextrose 5 %, normal saline etc.) , flow rate, infusion site patency ( ensure heplock is not blocked) signs of infiltration ( redness, swelling, temperature
Surgical site
Assess dressing for color (bright red, light, clear) , amount , consistent (heavy, light flow).Assess drains (e.g Jackson pratt, penrose) intact, patency and connection . Assess for approximation of wound, sutures and dressing
Other tubes
Assess urinary catheters, gastrointestinal suction ( colostomy)and other tubes for patency, amount of output and attachment .
If patient is order oxygen, ensure placement pf order and application
Comfort
Assess for pain use pain scale, location, intensity, duration
Assess for vomiting and nausea
Reorient patient to the room/ward.
Allow family to stay will patient for initial assessment. Assess for allergic reaction of medications such as antibiotics
Position and Safety
Asses patient for safety risk for falls, side lying position if unconscious. Asses for patient for risk of pressure ulcer, using the braden scale
Assess for bladder distention
Help Cope with Surgery
Assess patient's facial expression, posture, signs of depression, no family visits etc.
Assess wound for drainage, color, odor, dehiscence, evisceration, infection ,hydration, overhydration, infection, trauma, edema, exudates, eschar, inflammation granulation tissue
Intervention
Monitor for thrombophlebitis in extremities. Monitor temperature, swelling, pain and cramping of the calf or thigh and increase diameter of extremities.
Administer medication as ordered like anti coagulant, analgesics.
If extremities are swollen ( leg)allow patient to maintain bedrest . Apply external heat, ant antiembolic stocking. Assess peripheral pulse and measure diameter of extremities
Monitor for pulomonary embolus
Monitor patient for shortness of breath, cough, bluish color (around eyes, lips, finger nails, toe nail), rapid breathing, chest pain, anxiety and increase heart rate.
Notify physician and maintain bed rest, place patient in semi- fowler's position. Administer oxygen and medications. Caution patient to strain
Have patient do cough exercise taught in preoperative teaching
Monitor patient for atelectasis
Monitor lung sounds for crackles. Monitor patient for restlessness, bluish color ( eyes, finger nails, lips, toe nails)
Position patient in semi -fowler's position , administer oxygen, pain medication
Preventing Cardiovascular Complications
Monitor for hemorrhage
Assess vitals signs for deviation from preoperative and PACU data. Monitor for dressing for sanguineous drainage. Do not remove gauze rather pack with additional gauze
Monitor signs of restless, anxiety, clammy skin, hypotension , decrease urine, thirst, rapid respiration , rapid pulse and cold clammy skin
Monitor for shock . Assess for signs like hemorrhage . Report findings to physician. Patient will do deep breathing exercise, spirometer taught preoperatively. Administer oxygen
Promote ambulation. Encourage patient to sit in bedside chair and slow progress to slow walking
Monitor input and output, document of fluid balance chart
Palpate pubis symphysis if patient hasn't void in 8 hours
Fluid and Nutrition
Encourage patient to increase oral intake like fluids, fruits, vegetable if prescribed
Encourage elimination
Provide commode, urinal and provide privacy
Administer enema, suppository if ordered
Help patient Cope with surgery
Allow time for patient and family to verbalize their feelings about alteration of surgery.
Work along with members of health team for referrals( community clinic), physical ( physiotherapy ), psychological ( support group)and spiritual(church )
Promote rest comfort
Prevent nausea and vomiting
Avoid large amounts of water or food at one time
Maintain clean environment
Avoid strong smelling food
Assess for possible allergic reaction to medication especially antibiotics and analgesics
Avoid thirst
Offer sips of water or ice when NPO (if permitted ). Maintain oral hygiene
Hiccups
Have take several swallows of water while holding the breath (if not NPO)
Rebreathe in a paper bag
Eat a teaspoon of granulated sugar
Surgical pain management
Assess pain frequently administer prescribed analgesic every 2 to 4 hours on a regular schedule during the first 24 to 36 hours after surgery
Reinforce preoperative reaching for pain ( deep breathing exercise)for pain management
Offer massage, positions( side lying) changes relaxation ( diming light, reading material, meditation , music
Respiration
Wound Care
Preform surgical hand washing
Administer analgesic 30 minutes before cleaning wound site and changing dressing
Use surgical asepsis
Check wound care prescribe for patient
When removing dressing note approximation of wound
Note color, odor, drainage, depth, and diameter
After changing dressing label it with time of dress change and nurse's initials
Document location and dressing of the wound. Document assessment approximation, sutures, staples, condition of wound, what was use to clean wound and dressing.Note if any redeness, drainage, edema