Hi, I am Joanna Jackson and this lesson is
about the potential for complications
from surgical procedures and health alterations.
This portion of learning is
dedicated to the nurses ability to lessen
the effects of complications
following surgical or other procedures. The
focus for the nurse is on the reduction
of risks. A quick overview of our contents.
We'll review key terms, warning signs, specific
complications, and review the nursing
process. Some key
terms include aspiration, dehiscence, evisceration,
hematoma, seroma, and hypoxia. It is the nurses'
responsibility to do the following things.
Educate the clients on the
reduction of post procedure complications.
Give the medications as
ordered. The nurse should know the signs and
symptoms of complications. Perform
nursing assessments to identify any risks
and respond appropriately to any
complications. Immediately following procedures,
the nurse should conduct complete
and frequent physical assessments and
monitor the patient's vital signs.
Promote physical health and well-being
by providing care and comfort to the
patient, and manage pain and prevent risks
through medication administration such
as antibiotics. Now let's talk about what
is normal? Following any surgical
procedure, it's perfectly normal for patients
to have altered mental status due
to any sedating medications that may have been
given. It is also normal and expected for a
patient to be pain or discomfort.
You should expect the patient to have
the gradual return to baseline behavior and
mobility. The ability for the patient
to follow simple commands.
Urinary retention affected by the
medication or the procedures is also
possible. Initial inability to move
bowels is expected and impaired gas
exchanges including the respirations
is also expected.
Nausea and vomiting can also be a side
effect of medication, and changes in
color, amount, and consistency of drainage
is expected depending on the procedure
given. Many complications following procedures
are related to medications
given before and after the procedures.
Think about common side effects of opioids,
sedatives, IV fluids, and
antibiotics. The signs and symptoms related
to those medications may appear
as complications. But they could resolve
depending on the medication given.
Common side effects of opioids include
bowel function, sedation, respiratory
depression and urinary retention.
Side effects of sedatives include drowsiness,
slowed bowel function and sedation. IV fluids
can come with fluid overload
or electrolyte imbalances. And
come with nausea, vomiting and frequently diarrhea.
Some post procedure complications
include aspirations, infections, hemorrhage,
hypoxia, pain, shock, and falls and injury
due to sedatives. This is not an inclusive list.
The nurse should always consider
the procedure received and possible specific
risks. Aspirations. This is
when food, liquid or other secretions are
breathed into the airway. Ensure the
patient remains NPO for the required time
that means nothing by mouth. Review the
patient's positioning. Elevate the head or
put them in the side-lying position. Use
sedatives sparingly. Assess feeding tubes
for proper placement, and assess
swallowing function before advancing
their diet back to regular.
Another potential complication is an infection.
Anytime a procedure is performed from
blood collection to major surgery, there
is a potential risk for an infection.
Use standard precautions or sterile procedure.
Monitor vital signs and
report an elevated temperatures immediately.
Assess wound drainage
regularly, monitor pain, swelling, and condition
of any wounds or surgical
sites, and administer medications like
antibiotics as ordered.
Clinical signs of infections include elevated
patient's temperature, excessive or unusual
bleeding or drainage, wound breakdown, an
unusual smell, and increased pain.
Some common wound complications following
surgical procedures include dehiscence.
This is a partial or total disruption of the
layers causing surgical wounds to
rupture along the sutures. Evisceration, this
is a very serious complication when
a wound opens known as dehiscence and internal
organs protrude through opening.
This is the emergency situation and the
provider needs to be notified
immediately. Hematomas are collection of blood
that can cause the incision to
separate and increase the risk of infection.
And finally seroma. This is the collection
of serous fluid that can cause the incision
to separate and also increase
risk of infection. Now let's put it all
together. This section requires you
to apply all of the nursing information you
have learned. Take it slow. Reread the
question, and pull out any important information.
Break the question down. What was the procedure?
What are the vital signs? What
Think about any medications that may have
been administered and the side
effects of those medications. Always consider
what you should do first,
that is what is the most immediate need.
Immediately eliminate answers that are
inappropriate in any situation.
Let's practice putting in all together.
A nurse is caring for a patient who recently
had an abdominal surgery. The patient's
temperature is 102.2 F. Which of
the following is an
appropriate action by the nurse?
1. Prepare the client for his scheduled
discharge. 2. Educate the patient on signs
and symptoms to monitor following discharge.
3. Inform the provider of the
elevated temperature and 4. Encourage the
patient to increase fluid intake.
What are the normal findings following an
abdominal surgery? Eliminate answers that
are inappropriate responses and always consider
what you should do first. We can
immediately eliminate number 1, preparing the client
for his scheduled discharge. It is always
inappropriate to ignore any abnormal findings.
We can also eliminate number 2,
educating the patient on signs and symptoms
to monitor. While education is an
important response, I don't think you
can do this first. Number 3,
informing the provider of the elevated temperature
is always inappropriate. We do
not ignore abnormal findings. We can eliminate
number 4, encouraging the
patient to increase the fluid intake. This is not
appropriate because it is not the
most immediate need and the patient may need
to be NPO for any corrective
procedure. Tips for Success. Always assess,
diagnosis, plan, and then implement. Always
assess before taking any action. If two
answers feel correct, do your very best
to pick the one that is most correct.
And opposites attract,
if two answers are complete opposites,
one is usually the correct answer.