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Care of the Surgical Patient: Complications (Wonder Drugs (Preoperative…

- - - - INTERVENTIONS: deep breathing, deep coughing, orthosthatic position, turn q2h, spirometer, encourage fluids, mucous suctioning, oxygen therapy, medications such as bronchodilators per md order
  - - - INTERVENTIONS: Ambulation q4h, maintain hydration, nutrition (prevent gas producing foods, such as carbonated drinks),
- - - - dressings saturated with bright red drainage
      - bright red drainage occurring 24 to 48 hours after surgery warrants notifying the surgeon
        
        To accurately measure the amount of drainage, circle the shadowed drainage markings on the dressing and write the time and date
  - - - CBC count
  - - - Temperature
        
        Dihiscence
        
        Dehiscence (the separation of a surgical incision or rupture of a wound closure) may occur 3 days to more than 2 weeks postoperatively.
        
        Evaluate incision
      - Exudate
        
        Cachexia
        
        ill health, malnutrition, and wasting as a result of chronic disease
        
        Evisceration
        
        protrusion of an internal organ through a wound or surgical incision, especially in the abdominal wall
    - - tissue adhesives
        
        staples
      - sutures
      - transparent strips
- - - - Performing leg exercises every 2 hours and using intermittent pneumatic compression devices and compression stockings aid the circulatory system and help prevent deep-vein thrombosis.
      - Assessment of the feet and legs includes palpating for pedal pulse (i.e., pulse on upper surface of foot and noting the skin's color and temperature. If edema, aching or cramping, sensitivity, redness, inflammation, warmth, or pain occurs in the calf or leg, thrombophlebitis should be suspected.
  - - - Prevention of loss of muscle tone
      - Restoration of nitrogen balance
    - - • Prevention of atelectasis and hypostatic pneumonia
      - • Increased mental alertness from increased oxygenation to brain
  - - - Promotion of expulsion of flatus
      - Prevention of abdominal distention and gas pain
        
        . The health care provider may order a rectal tube to be inserted to relieve pain from intestinal gas
        
        patient who has difficulty with flatus, limiting iced beverages and offering warm liquids may help resolve the discomfort
      - Prevention of constipation
      - Prevention of paralytic ileus
      - Because anesthesia, surgical manipulation, administration of narcotics, and introduction of CO2 into the abdominal cavity during surgery slow peristalsis (i.e., the normal propulsion of food through the digestive tract), it may take 3 or 4 days for bowel activity to return.
        
        Normal peristalsis is indicated by hearing 5 to 30 gurgles per minute.
      - If bowel sounds are absent (each quadrant must be assessed for 3 to 5 minutes to determine absence of bowel sounds), paralytic ileus (a decrease in or absence of intestinal peristalsis that may occur after abdominal surgery, peritoneal trauma, severe metabolic disease, and other conditions) may have developed
    - - Increased kidney function
      - Prevention of urinary retention
        
        Usually I&O is measured while a Foley catheter is in place, while the patient is receiving IV therapy, and immediately after a Foley catheter has been removed. The urine measurement should continue until the patient is voiding without difficulty.
        
        A urinary output of 30 mL/hour is considered acceptable postoperatively. Unless the patient has had urinary tract surgery, urine should be clear and yellow and smell like ammonia.
        
        It routinely takes 6 to 8 hours for voiding to occur after surgery.
  - - - • Increased rate and depth of breathing
      - • Prevention of atelectasis and hypostatic pneumonia
      - • Increased mental alertness from increased oxygenation to brain
  - - - If vitals signs are within normal limits, have patient sit on side of bed (legs dangling) to adapt to the upright position before ambulating for the first time.
      - Be certain that the pulse has stabilized (returned to baseline) before patient attempts ambulation
- - - - Valium
        
        Decrease anxiety and produce sedation
    - - Morphine
        
        Decrease anxiety. Allow decreased anesthetics
        
        Narcan
        
        Morphine antagonist
    - - Famotidine
        
        Reduce gastric acid volume and concentration
  - - - Reduce oral and respiratory secretions to decrease risk of aspirations
  - - - Reduces intensity of pain
  - - - Produces anti coagulation
    - - vitamin K antagonist
      - PT/INR labs
    - - protamin sulfate Anatagonist
      - PTT labs
  - - - reduces risk of early occlusion of grafts
- - - - Fever
        
        Administer antibiotics
      - Prostate enlargement may increase risk of urinary tract infection.
  - - - SIGNS: Hypotension, Tachypnea, Tachycardia, restlessness, pale moist skin, weak thready pulse, cyanotic skin, hypothermia, decrease LOC may decrease as the patient loses oxygenation to the brain
      - NURSING INTERVENTIONS: fluid resuscitation(replenishing body fluids), monitor oxygenation and perfusion status, blood transfusions, may need oxygen and ventilatory support , patients may need to be taken to the OR to repair the injury or internal bleeding that caused the hypovolemia, monitor VS
  - - - Administer isotonic IV fluids (normal saline) as ordered