Explainers

Postoperative Complications – Clinical Guidelines for Nurses


Every time someone has a surgery, they are at risk of potential complications.

These can vary from the mild side effects of surgery, to major complications that can result in the death of a patient. This is why nursing care following surgery involves the close monitoring of the patient in order to identify early and prevent these complications from occurring. These complications vary according to the procedure being performed however many are common to a variety of different surgeries.

Nausea and Vomiting

Most people think of nausea and vomiting as something pretty insignificant, however it is a side effect that can delay someone’s discharge home if uncontrolled.

And postoperatively, expect about half of your patients to experience nausea and 30% to experience the vomiting with it (Koutoukidis et al. 2017; Gan et al. 2014).

Tools: Assessing Nausea and Vomiting

Abdominal Distension and Paralytic Ileus

These two complications are very similar. The patient will complain of abdominal pain and be unable to pass flatus, they may also have nausea and vomiting as well as a distended abdomen.

They are caused when the intestinal peristalsis slows down or stops so the bowel contents are stagnant. Sometimes it can be prevented with early mobilisation, however once it occurs, the patient is treated by being nil by mouth, and may also need their gastric contents emptied by insertion of a nasogastric tube (Koutoukidis et al. 2017).

Tools: Abdominal Assessment

Urinary Retention

There are many factors which can contribute to decreased urinary function following surgery, resulting in urinary retention. These include pain, anxiety and a depressed micturition reflex with certain anaesthetic agents or when a spinal anaesthetic or epidural is used.

Management of urinary retention includes encouraging ambulation, assuming a normal voiding position, ensuring adequate fluid intake, double voiding and providing sensory stimulation such as running water when trying to void, and as a last resort, catheterisation (Koutoukidis et al. 2017).

Related: Neurogenic Bladder Dysfunction

Constipation

Postoperative constipation is caused by the disruption of the patient’s normal diet, reduced mobility, reduced fluid intake, medications such as narcotics and the depressive effects of the anaesthetic agents. It is not something to be taken lightly; constipation can potentially lead to a bowel obstruction and the patient undergoing further surgery (Koutoukidis et al. 2017).

Tools: Common Constipation Treatments

Pain

Pain management can be a huge problem for some patients following surgery. People generally associate pain with surgery, however uncontrolled pain can have many negative impacts on the individual, including increasing their morbidity and mortality, delaying recovery and also potentially leading to chronic pain.

Patients with poor pain control have also been found to be 5 times more likely to experience an infection due to the stimulating effect pain has on the stress response impacting both cardiac and immune functions (Baratta et al. 2014; Koutoukidis et al. 2017).

Tools: Pain Assessment & Management

Shock

Shock is caused by the reduction in the volume of blood circulating through the body. Therefore the patient will present with hypotension, weak tachycardia, restlessness, be pale with cool and damp skin and have a diminished urinary output (Farrell & Dempsey 2013; Koutoukidis et al. 2017).

Tools: Signs and Symptoms of Hypotension

Haemorrhage

Postoperative haemorrhage can classed into 2 categories:

  • Reactionary haemorrhage occurs within the first 24 hours following the surgery from dislodgement of clots from vessels
  • Secondary haemorrhage results from infection that weaken these blood clots or the vessel walls causing the haemorrhage

(Koutoukidis et al. 2017)

Hypoxia

Hypoxia is the term for when your blood isn’t carrying enough oxygen for your body’s needs, and we all know that our tissues and organs need the oxygen from our blood to survive so it is a very significant complication following surgery.

The hypoxic patient will show signs and symptoms including:

  • Tachycardia
  • Tachypnea
  • Shortness of breath
  • Pallor or cyanosis
  • Lethargy
  • Decreased responsiveness
  • Confusion
  • Agitation

(Koutoukidis et al. 2017; Maity et al. 2012).

Pneumonia

Pneumonia can be a common complication following surgery and occurs in postoperative patients due to the accumulation of secretions in the lungs causing lung consolidation and consequently, infection.

The risk of pneumonia can be increased by a variety of factors including high body mass index, smoking status, respiratory status, any premorbid respiratory conditions such as COPD, if the patient needed mechanical ventilation during the postoperative period and the use of opioids. Opioids also have a depressive effect on the respiratory system and can place the individual at an increased risk of developing pneumonia (Akhtar et al. 2013; Farrell & Dempsey 2013; Koutoukidis et al. 2017).

Deep Vein Thrombosis (DVT)

DVTs can occur following surgery due to blood becoming stagnant in the veins, or venous stasis. This happens because the blood needs some help to flow back up your legs to your heart. Our calf muscles usually act as a pump to do this but after surgery when your patient is resting in bed for a prolonged period of time, this will not occur and can result in a DVT formation (Koutoukidis et al. 2017; Rothrock 2015).

Tools: Venous Thromboembolism: Symptoms and Prevention

Pulmonary Embolism

A pulmonary embolism (PE) occurs when one of the pulmonary arteries is blocked by a blood clot, air or fat. The patient will often complain of a sudden onset of dyspnea, chest pain, cyanosis and a PE can result in sudden circulatory collapse and death (Koutoukidis et al. 2017).

Tools: Chest Pain Assessment

Wound Infection

Wound infections can also occur in the surgical wound; therefore it is important that any dressing changes are completed using aseptic technique.

Surgical site infections have many implications including:

  • Increased length of stay
  • Increased cost of care
  • Placing the patient at risk of further complications
  • Patient pain and discomfort

(Farrell & Dempsey 2013).

Tools: Wound Care Guide

Wound Dehiscence

Wound dehiscence can be quite traumatic for the patient and also has been found to be associated with mortality rates as high as 45%!

It can occur due to a variety of factors including poor tissue healing from malnutrition, obesity, anaemia, infection, premature removal of wound closure or stress on the unhealed incision such as straining or coughing. (Koutoukidis et al. 2017; Van Ramshorst et al. 2010).

Tools: Wound Care Guide

Postoperative Delirium

This usually occurs in older adults. It is an acute change in cognition and is usually characterised by:

  • Confusion
  • Perceptual and cognitive deficits
  • Disturbed sleep
  • Fluctuating levels of consciousness
  • Disorganized thinking
  • Altered attention levels

Interestingly, the incidence of postoperative delirium is impacted by the type of surgery the patient has undergone, with surgery for hip fractures having a higher incidence of postoperative delirium than other surgeries. This could be due to the urgency often related to this surgery and often those who fracture their hips are elderly with multiple co-morbidities, increasing their risk of developing postoperative delirium (Rudolph & Marcantonio 2011).

There are many other potential complications which can occur following any surgery, however these are some of the common ones that are associated with a variety of operations, and as mentioned, can impact the patient in many different ways.

Show References

References

  • Akhtar, A, MacFarlane, RJ & Waseem, M 2013, ‘Pre-operative assessment and post-operative care in elective shoulder surgery’, The Open Orthopaedics Journal, vol. 7, no. 3, pp. 316-322 available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788190/
  • Baratta, JL, Schwenk, ES & Viscusi, E 2014, ‘Clinical consequences of inadequate pain relief: Barriers to optimal pain management’, Plastic and Reconstructive Surgery, vol. 134, no. 4S-2, pp. 15-21, available from: http://journals.lww.com/plasreconsurg/Abstract/2014/10002/Clinical_Consequences_of_Inadequate_Pain_Relief__.5.aspx
  • Farrell, M & Dempsey, J 2013, Smeltzer and Bare’s Textbook of Medical-Surgical Nursing, 3rd edn, Lippincott Williams & Wilkins, Broadway
  • Gan, TJ, Diemunsch, P, Habib, A, Kovac, A, Kranke, P, Meyer, T, Watcha, M, Chung, F, Angus, S, Apfe, C, Bergese, S, Candiotti, K, Chan, M, Davis, P, Hooper, V, Lafoo-Deenadayalan, S, Myles, P, Nezat, G, Philip, B & Tramer, M 2014, ‘Consensus guidelines for the management of postoperative nausea and vomiting’, Anesthesia & Analgesia, vol. 118, no. 1 pp. 85-113, available from: http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/01000/Consensus_Guidelines_for_the_Management_of.13.aspx
  • Koutoukidis, G, Stainton, K & Hughson, J (eds) 2017, Tabbner’s Nursing Care: Theory and Practice, 7th edn, Elsevier, Chatswood
  • Maity, A, Saha, D, Swaika, S, Maulik, SG, Choudhury, B & Sutradhar, M 2012, ‘Detection of hypoxia in the early postoperative period’, Anesthesia Essays and Researches, vol. 1, no. 1, pp. 34-37, available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173444/
  • Rothrock, JC (ed) 2015, Alexander’s Care of the Patient in Surgery, 15th edn, Elsiver, St Louis
  • Rudolph, JL & Marcantonio, ER 2011, ‘Postoperative delirium: Acute change with long-term implications’, Anesthesia and Analgesia, vol. 112, no. 5, pp. 1202-1211, available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3090222/
  • Van Ramshorst, GH, Nieuwenhuizen, J, Hop, MC, Arends, P, Boom, J, Jeekel, J & Lange, JF 2010, ‘Abdominal wound dehiscence in adults: Development and validation of a risk model’, World Journal of Surgery, vol. 34, no. 20, available from: http://link.springer.com/article/10.1007/s00268-009-0277-y

Hide References

Document this CPD

Comments

Explainers
How to Become a Better Listener
Explainers
Preventing Unnecessary Use of Antipsychotics in Dementia Care
Explainers
Can Life Continue to Get Better with Age? – How Health Professionals can Empower Ageing Clients