Definition of Terms:

• SURGERY: (Greek term cheirourgia, meaning to cut)

- the branch of medicine concerned with diseases and trauma
requiring operative procedure.
SURGICAL OPERATION:
- pertaining to the treatment of disease by manipulative and
operative methods.
SURGICAL ASISTANCE
- a nursing intervention (from Nursing Intervention Classifications
(NIC) )defined as assisting the surgeon with operative
procedures and care of the surgical patient.
General Considerations :
Conditions Requiring Surgery:
 Obstruction or blockage
 Perforation – rupture of an organ artery or bleb.
 Erosion – wearing away of the surface of a tissue.
 Tumor – abnormal growth
CATEGORIES OF SURGICAL
PROCEDURE (According to):
 PURPOSE:
 Diagnostic – to verify suspected diagnosis.
 Exploratory – to estimate the extent of the disease.
 Curative – to remove or repair damaged or diseased organs or
tissues.
a. Ablative - involves removal of diseased organs. e.g.nephrectomy,
spleenectomy.
b. Reconstructive – partial or complete restoration of a damaged
organ. e.g. plastic surgery following severe burn
c. Constructive – repair of a congenitally defective organ.
e.g. plastic surgery of cleft palate.
d. Palliative – relieves symtoms.
CATEGORIES FOR SURGICAL
PROCEDURE (cont…)
 Degree of risk to Patient
1.) Major Surgery – a surgical procedure that is extensive or life
threatening. It can be or often done under or other than
general anaesthesia.
2.) Minor Surgery – a surgical procedure for minor problems
and injuries that are not considered life threatening or
hazardous.
CATEGORIES FOR SURGICAL
PROCEDURE (cont….)
 According to Urgency:
2. Emergency – must be performed immediately. e.g. gunshot wound
3. Imperative/Urgent – must be performed as soon as possible
within 24-48 hours. e.g. severe bleeding
4. Planned Required – necessary for patient’s well being. e.g.
tonsillectomy
5. Optional Surgery – surgery that the patient request. e.g. face lift,
liposuction
6. Elective Surgery – should be performed for patient’s well-being but
which is not absolutely necessary. e.g. simple hernia repair.
CATEGORIES FOR SURGICAL
PROCEDURE (cont….)
 Effects of Surgery upon the person.
 Stress response is elicited. (increase HR, BP, blood
sugar, bronchial dilation).
 Defense against infection is lowered.
 Vascular system is disrupted.
 Organ functions are disturbed.
 Body image may be disturbed.
 Lifestyle may change.
CATEGORIES FOR SURGICAL
PROCEDURE (cont…..)

 Factors in the Estimation of Surgical Risk

2. Physical and mental conditions of client:
• Factors that may affect:
d) Age: premature and elderly person are at risk.
e) Nutritional status: malnourished and obese are at risk.
f) State of fluid and electrolyte imbalance: dehydration and
hypovolemia predispose client to complications.
g) General Health: infectious process increases operative risk.
h) Type of medications taken regularly:
 Steroids – may improve the body’s ability to respond to the
stress of anesthesia and surgery
CATEGORIES FOR SURGICAL
PROCEDURE (cont…..)
 Anticoagulants and salicylates – may increased bleeding during
surgery
 Anitbiotics – may be incompatible with or potentiate anesthetic
agents
 tranquilizer – potentiate the effect of narcotics and cause
hypotension
 Antihypertensive – may predispose to shock by the combined effect
of blood pressure reduction and anesthetic vasodilation
 Diuretics – may increase the potassium loss already begun by the
body’s response to stress
CATEGORIES FOR SURGICAL
PROCEDURE (cont…..)

 Alcohol – will place the surgical client at risk when

used chronically.
f.) Mental Health
g.) Economic and occupational status
2.) The extent of disease
3.) The magnitude of the required operation
4.) Resources and preparation of the surgeon, nurses, and
hospital
PERIOPERATIVE CARE

• Perioperative Nursing
-(Gk-peri-around + L operari-to
work + nutrix- nurse)
- Nursing care provided to
surgery patients during the
entire inpatient period
( preoperative, intraoperative &
postoperative) from admission
to date of discharge.
PREOPERATIVE CARE

• Preoperative Care
- the preparation and
management of patient
before surgery. Begins
at the time of the
decision for surgery.
 PREOPERATIVE CARE (cont…)
• Psychologic Preparation for Surgery:
 Preparation for hospital admission: includes
explanation of procedures to be done, probable
outcome, expected duration of hospitalization, cost,
length of absence from work and residual effects.
 Preoperative visits.
PREOPERATIVE CARE
(cont…)
• LEGAL ASPECTS:
INFORMED CONSENT: permission
obtained from the patient to
perform specific test or procedure.
1.This is to protect the surgeon and
the hospital against claims that
unauthorized surgery has been
performed and that the patient was
unaware of the potential risks of
complications involved.
2.Protects the patient from undergoing
unauthorized surgery.
PREOPERATIVE CARE
(cont…)
• PHYSIOLOGIC PREPARATIONS:
2. Respiratory preparation – includes x-ray
ordered by the surgeon.
3. Cardiovascular preparation – ECG, Blood
test: CBC, Hgt, and others
4. Renal preparation – routine urinalysis
PREOPERATIVE CARE (cont…)

• INSTRUCTIONAL AND PREVENTIVE ASPECTS:

note: The best time to instruct the client is relatively close to
the time of the surgery.
3. Deep breathing exercise – use of diaphragmatic abdominal
breathing. Done 5-10 times every hour in post-op period.
4. Coughing exercise – deep breathing, exhale to the mouth
and then follow with a short breath while coughing.
5. Turning Exercise – every 1-2 hours post-op.
6. Extremity exercise – prevents circulatory problems and
post-op gas pains or flatus.
PREOPERATIVE CARE
(CONT..)
• PHYSICAL PREPARATION
2. On the night of the surgery:
c. Preparing patient’s skin. Shave against the grain of
hair shaft to insure clean, close shave.
d. Preparing the GIT:
 Patient is on NPO after midnight: note: the age of
the client should always be taken into
consideration. Infant and children has a higher
metabolic rate than adult, this makes it essential for
the child or infant to receive carbohydrate regularly
to prevent acidosis from occurring.
 Administration of enema.
 Insertion of gastric or intestinal tubes.
PREOPERATIVE CARE (cont…)

c.Preparing for anesthesia:

 Promoting rest and sleep: use of drugs.
- Barbiturates – sedative or hypnotic that depresses
RR, BP, and CNS.
secobarbital Na (seconal), pentobarbital Na
(nembutal).
-Non-barbiturates – chloral hydrate, flurazefam
(dalmane)
*given after all preoperative treatment have been
completed. If a second barbiturate is needed, it must
be given at least 4 hours before the pre- op
medication is due.
PREOPERATIVE CARE
(cont…)
2. The patient on the day of the surgery:
b. Early morning care ( about 1 hour before
the preoperative medication is schedule)
 Vital signs taken and recorded promptly.
 Provide oral hygiene
 Remove jewelry and dentures
 Remove nail polish
 Make sure that the patient has not taken
food for the last 10 hours by asking the
patient.
 PREOPRATIVE CARE
(cont…)
b. Pre-operative medication: generally administered 60-90 minutes
before induction of anesthesia.
1. Purposes:
 To allay anxiety
 To decrease the flow of pharyngeal secretions.
 Reduce the amount of anesthesia to be given
 Create amnesia for the events that precede surgery.
2. Types of pre-operative medications:
 Sedatives – given to decrease the patient’s anxiety, to
lower BP and PR and to reduce the amount of general
anesthesia. An overdose can lead to respiratory
depression. ex. Dormicum, Nubain
 Tranquilizer – lowers the patient’s anxiety level. ex. Valium,
phenergan
 Narcotic Analgesia – given to reduce anxiety and the
amount of narcotics given during surgery. ex. Morphine
Sulfate.
PREOPERATIVE CARE
(cont…)
 Vagolytic or Drying Agent: ex. Atropine Sulfate
Given:
 To reduce he amount of tracheobronchial secretions
which can clog the pulmonary tree and result in
atelectasis or pneumonia.
 To interrupt vagal nerve impulses which acts to slow
the heart.
3. Recording – all final preparation and emotional response
before surgery are noted down.
4. Transportation to the OR woollen or synthetic blankets
must never be sent to the OR because they are sources of
static electricity.
• Nursing diagnosis for Preoperative client:
Anxiety related to: lack of knowledge about preoperative
routines, physical preparation for surgery, post operative care
and potential body image change.
INTRAOPERATIVE NURSING CARE

• INTRAOPERATIVE CARE
pertaining to the period during
a surgical procedure. Begins
at the moment when the
patient is anesthetized and
ends when the last stitch and
dressing is in place.
INTRAOPERATIVE CARE (CONT…)

• ANALGESIA – pain relief by insensibility

production without loss of consciousness.

• ANESTHESIA – loss of sensation, usually

produced in order to permit a painless
surgical operation.
INTRAOPERATIVE CARE (CONT…)
• 1. Anesthesia:
Stages of Anesthesia:
 Stage I: Stage of Analgesia – this stage extends from the beginning of
administration of an anaesthetics to the beginning of the loss of
consciousness, the sensation of pain is not lost.
 Stage II: Stage of Delirium or Excitement – extends from the loss of
consciousness to the loss of eyelid reflexes. Any stimulation has the
potential to cause the client to become difficult to control. Characterized by
increased muscle tone, irregular respiration, REM.
 Stage III: Stage of Surgical Anesthesia – extends from the loss of eyelid
reflexes to cessation of respiratory effort. Characterized by completely
dilated and unresponsive pupils and absence of reflexes.
 Stage IV: Stage of Danger/ Medullary Stage – vital functions become too
depressed and respiratory failure occurs due to high concentration of
anaesthetic in the CNS.
INTRAOPERATIVE CARE (CONT…)

• 2 Types of Anesthesia:
Main Classification:
c. General Anesthesia – it is a state of analgesia, amnesia and
unconsciousness characterized by the loss of reflexes and muscle
tone.
Types: Inhalation Anesthesia : surgical narcosis achieved by the
inhalation of an anesthetic gas or vapor.
Endotracheal: G.A. administered through a tube, placed
through the mouth or nose, directly into the trachea or windpipe.
 Advantage: prevention of pain and anxiety.
 Disadvantage: circulatory and respiratory depression. Highly
inflammable and explosive.
INTRAOPERATIVE CARE (CONT…)

 Safety Rules:
b. Do not wear slips, nylons,
wool, or any material which
can set-off sparks.
c. Minimized use of cautery.
d. Do not touch the vicinity of
the breathing area to prevent
sparks.
e. Do not use bed materials that
are not conductive.
INTRAOPERATIVE CARE
(cont…)

b. Intravenous Anesthesia : usually employed as an induction prior to

administration of more potent inhalation anesthetic agents. Commonly
use in minor procedure.
 Advantage:
 Rapid pleasant induction.
 Absence of explosive hazards.
 Low incidence of nausea and vomiting.
 Disadvantage:
 Laryngeal spasm and bronchospasm
 Hypotension
 Respiratory arrest
 Examples: Thiopental Na pentothal Na), Ketamine (ketalar), Fentanyl
(sublimaze)
INTRAOPERATIVE CARE
(cont…)
c. Rectal Anesthesia : rarely used today,
useful during the induction of anesthesia
for pediatric patient, e.g. pentothal Na.
d. Regional Anesthesia: it is the injection or
application of a local anesthetic agent to
produce loss of painful sensation in only
one region of the body and does not result
to unconsciousness.
INTRAOPERATIVE CARE
(cont…)
 Types of Regional Anesthesia:
2. Topical Anesthesia – application of an anesthetic agent on a body surface; as with
a spray or a cotton swab. e.g. cocaine, lidocaine, novocaine
3. Infiltration Anesthesia
 Nerve block – injection of an anesthetic agent into or around the nerve to produce loss of
sensation to the area supplied by the nerve.
 Epidural block – injection of anesthetic agent into the space just outside of the spinal
canal.
 Caudal block – injection of an anesthetic agent into the lower caudal (spinal) canal near
the end of the vertebral column.
 Pudendal block – injection of an anesthetic agent into the perineum.
 Field block – applied directly to the area to be operated upon.
3. Spinal Anesthesia – injection of an anesthetic agent directly into the spinal fluid within
the spinal canal (between the spaces of L3 & L4 or L4 & L5).
 Saddle block – spinal anesthesia given so as to affect only the genital region, buttocks
and thighs.
INTRAOPERATIVE CARE
(cont…)
• 3. Specialized Methods of Producing Anesthesia:
Types:
 Muscle Relaxants - a neuromuscular blocking agent used to provide
muscle relaxation. Used in Endotracheal intubation. e.g. Tracrium,
pancronium
 Hypothermia – refers to the deliberate reduction of the patient’s body
temperature between 28-30 degree Celsius.
Uses:
 Heart surgery, brain surgery, surgery on large vessels supplying major
organs.
Methods:
 Ice water immersion, Icebags, cooling blanket, Extracorporeal cooling
devices.
Complications: Cardiac arrest, respiratory depression.
INTRAOPERATIVE CARE (CONT…)
• 4. Positioning the Patient:
Commonly used Operative Positions:
 Supine – for hernia repair, explore lap, cholecystectomy, mastectomy, etc.
 Prone – for back supine and rectal surgery.
note: After surgery, the patient will be returned to supine position. This should be done
gradually and slowly to adjust cardiovascular system in position. Rapid turning can
cause drop in BP.
 Trendelenberg – head and body are flexed by breaking the table.
 Reverse Trendelenberg – head is elevated and feet are lowered.
 Lithotomy Position – thighs and legs are flexed at right angle then simultaneously
placed in stirrups.
 Lateral Position – used in kidney and chest surgery.
 Thyroidectomy Position – head hyperextended, with small sand bag , pillow on the
neck and shoulders to provide exposure of the thyroid gland.
POSTOPERATIVE NURSING CARE

Postoperative Care: pertaining to the period

of time after surgery. Begins with the
patient’s emergence from anesthesia and
continues through the time required for the
acute effects of anesthetic and surgical
procedures to abate ( begins when the
client returns from the Recovery
Room/Surgery Suite to the nursing limit
and ends when the client is discharged.)
POSTOPERATIVE CARE
(cont…)

• Post Anesthesia Care (P.A.C.):

monitoring and management of
the patient who has recently
undergone general or regional
anesthesia.
• Nursing priorities:
 Get the baseline assessment of
the patient.
 Vital Signs (PR, T, RR, BP)
 Level of consciousness
POSTOPERATIVE CARE
cont…)
• Nursing Responsibilities during P.A.C.:
2. Maintenance of Pulmonary Ventilation:
 Position the patient to side lying or semi-prone position to
prevent aspiration.
 Oropharyngeal or nasopharyngeal airway is left on place
following administration of G.A. until pharyngeal reflexes
have returned. Airway should be removed as soon as the
patient begins to regain consciousness and coughing and
swallowing reflexes returned.
 All patients should receive O2 at least until they are
conscious and are able to take deep breaths on command.
 Shivering of the patient must be avoided to prevent an
increase in O2 demand. O2 should be administerd until
shivering ceased.
POSTOPERATIVE CARE
(cont..)
2. Maintenance of Circulation: most common
complication during post anesthetic period:
 Hypotension:
Causes:
d. Moving the patient fro OR to bed, jarring during
transport.
e. Reaction to drug and anesthesia.
f. Loss of blood and other body fluids.
g. Cardiac arrhythmias and cardiac failure.
h. Inadequate ventilation
i. Pain.
POSTOPERATIVE CARE
(cont…)
Assessment:
b. Weak thready pulse with a significant drop in BP may indicate hemorrhage or circulatory
failure.
c. Skin: cold, moist, pale, or cyanotic.
d. Restlessness or apprehension.
Nursing Responsibilities:
 Monitor v/s every 15 minutes for the first 4 hours or until stable.
 Cardiac Arrhythmias:
Causes:
i. Hypoxemia – abnormal deficiency in the concentration of oxygen in the arterial blood.
j. Hypercapnea – excess carbon dioxide in the arterial blood.
(common causes of premature beats and sinus tachycardia)
Management:
m. Oxygen Therapy
n. Drug Administration: lidocaine,procainamide, prostigmine
POSTOPERATIVE CARE
(cont…)
3. Protection from Injury and Promotion of
Comfort:
2. Provide side rails, placed up until the patient
is fully awake.
3. Patient is turned frequently and placed in
good body alignment to prevent nerve
damage from pressure.
4. Administration of narcotic analgesic to relieve
incisional pain. Post operative dose usually
reduced to half until the patient is fully
recovered from anesthesia.
POSTOPERATIVE CARE
(cont…)
• Dismissal of client from the Recovery
Room:
Five (5) Physiological Parameters:
3. Activity – able to move extremities
voluntarily on command.
4. Respiration – able to breath deeply and
cough freely.
5. Circulation – BP is +20% or -20% of
pre-anesthetic level.
6. Consciousness – fully awake.
7. Color - pinkish
POSTOPERATIVE CARE
(cont…)
• Prevention of Postoperative Complications:
2. Respiratory complication: e.g. atelectasis, pneumonia
 Atelectasis is suspected whenever there is sudden rise
in temperature 24-48 hours after surgery. Collapsed
lung are highly susceptible to infection.
 Pneumonia occurs usually in high abdominal surgery
when prolonged inhalation anesthesia ha s been
necessary and vomiting has occurred during the
operation or while the patient is recovering from
anesthesia.
POSTOPERATIVE CARE
(cont…)
 Nursing Management for respiratory complication:
2. Measures to prevent polling of secretions:
a. Includes changing of position.
b. Altering height of bed from low to high fowlers
c. Moving out of bed or walking activity stimulates deeper
breathing and prevents pooling of secretions.
3. Measures to liquefy and remove secretions:
a. Encourage patient to increase fluid intake.
b. Breathing in moist air provided by moist tents or
ultrasonic mist.
c. Deep breathing followed by coughing may be contra
indicated in cases of brain surgery, spinal or eye surgery.
Administer analgesic before coughing is attempted after
thoracic or abdominal surgery.
d. Splint operative area with a draw sheet or towel to
promote comfort while coughing.
POSTOPERATIVE CARE
(cont…)
(Nursing mgt. for resp. complication cont…)
3. Other measures to increase pulmonary ventilation:
a. Blow bottle exercise.
b. Incentive spirometer – designed to encouraged sustained
maximal inspiration (SMI).
c. Rebreathing tubes – increase CO2 stimulates the respiratory
center to increase the depth of breathing thus increasing the
amount of inspired air.
d. Intermittent Positive-Pressure Breathing (IPPB) – a form of
assisted or controlled respiration produced by a ventilatory
apparatus in which compressed gas is delivered under positive
pressure into a person’s airway until a preset pressure is
reached.
POSTOPERATIVE CARE
(cont…)
2. Circulatory Complication: e.g. venous stasis: a disorder in which the
normal flow of blood through a vein is slowed or halted.
 Causes of venous stasis:
1. Muscular inactivity.
2. Respiratory and circulatory depression
3. Increased pressure on blood vessels due to tight dressing.
4. Intestinal distension.
5. Prolonged maintenance of sitting position.
6. Contributing factors:
a) Obesity
b) Cardiovascular disease
c) Debility
d) Malnutrition
e) Old age
POSTOPERATIVE CARE
(cont…)
 Most common circulatory complications:
1. Phlebothrombosis: a clot forms within the vein
2. Thrombophlebitis: inflammation of a vein accompanied by the
formation of blood clot. (positive homan’s sign: pain on dorsiflexion of
the foot).
 Nursing Measures:
1. Limbs must never be massage for a post operative patient.
2. If possible patient should lie on the abdomen for 30 mins, 2-3 times a
day to prevent pooling of blood on pelvic cavity.
3. Do not allow patient to stand unless pulse has returned close to
baseline to prevent orthostatic hypotension.
4. Wear elastic bandage or support stockings when in bed and when
walking for the first time. Remove at least once daily to permit washing
of the legs.
POSTOPERATIVE CARE
(cont…)

3. Fluid and Electrolyte Imbalance: Particularly Na & K imbalance as a

result of blood loss. Stress of surgery increases adrenal hormonal
activity resulting to increase aldosterone and glucocortioids
resulting to Increase Na reabsorpstion by the kidney and as Na is
reabsorbed, K is excreted. Increase K loss from tissue breakdown.
 Causes:
Blood loss
Increase insensible fluid loss through skin, after surgery through
vomiting, copious wound, drainage from tubes like NGT.
Since surgery is a stressor, there is increase production of ADH for 1st
12-24 hours following surgery which results to fluid retained by the
kidney. The potential for over hydrating therefore exist since fluid being
given IV may exceed fluid output by the kidney.
 Action: IV of D5W alternated with D5NSS or PNSS to prevent Na
excess.
POSTOPERATIVE CARE
(cont…)

4. Gastrointestinal Complications:
 Paralytic Ileus – cessation of peristalsis due to extensive handling of GI
organs.
Nursing Management: No fluids or food are given until peristalsis has returned as
evidenced by auscultation of bowel sounds or by passing of flatus.
 Vomiting – usually a result of certain anesthetics on the stomach or eating
food or drinking H2O before peristalsis returns. Psychologic factors also
contribute to vomiting.
Nursing Management:
1. Position the patient on his side to prevent aspiration.
2. When vomiting has subsided, give ice chips, sips of ginger ale, or hot tea or eating
small amounts of dry solid foods may relieve nausea.
3. Anti-emetic Drugs: Metochlopromide HCl (Pasil),
POSTOPERATIVE CARE
(cont…)

• GI complications (cont…)
 Abdominal Distention: results from the accumulation of
non- absorbable gas in the intestine.
Causes:
1. Reaction to the handling of bowel during surgery.
2. Swallowing of air during recovery from anesthesia.
3. Passes of gases from the blood stream to the atonic portion of
the bowel.
4. Gas pain: results from contraction of unaffected portion of the
bowel in order to move accumulated gas in intestinal tract..
POSTOPERATIVE CARE
(cont…)

Management:
1. Aspiration of fluid or gas with a NGT.
2. Ambulation stimulates the return of peristalsis and expulsion of flatus.
3. Rectal tube insertion- inserted just past the rectal sphincter and
removal after approximately 20 mins (2-4 inches for adult, 1-3 inches
for children) prolonged stimulation of the anal sphincter may result in a
loss of neuromuscular response. It may cause pressure necrosis of the
mucous surface.
4. Fleet enema.
 Constipation : due to decrease food intake and decrease activity.
Management: Drinking adequate amounts of fluid and ambulating will
have a bowel movement within 3-4 days after surgery.
POSTOPERATIVE CARE
(CONT…)
5. Urinary Complications:
 Return of Urinary Function: usually after 6-8 hours. 1st voiding may not
be more than 200ml and total output may not be more than 1500ml. This
is due to the loss of fluids during surgery and to perspiration,
hyperventilation, vomiting and increase secretion of ADH.
 Complications:
4. Urinary retention
Causes:
a) Prolonged recumbent position
b) Nervous tension.
c) Effect of anesthetic that interfere with bladder sensation and the ability to
void.
d) Use of narcotics that reduce the sensation of bladder distention.
e) Pain at the site or by movement.
POSTOPERATIVE CARE
(cont…)
 Management (Urinary retention)
1. Force fluid intake.
2. Place patient on bed pan at regular interval.
3. Pouring warm H2O over the perineum.
4. Assuring patient’s privacy
5. Assuming proper position.
6. Catheterization if bladder is palpable over the
suprapubic bone, because pressure causes
discomfort, this is done to prevent stretching of
the vesical wall.
POSTOPERATIVE CARE
(cont…)
Complications (Urinary comp…cont….)
2. Urinary Tract Infection:
 Management:
1. Instruct the patient to empty the bladder
completely each voiding.
2. Use sterile non-traumatic technique in
catheterization if necessary.
POSTOPERATIVE CARE
(cont…)

6. Post-operative discomforts:
 Post-operative pain:
Management: narcotics can be given every 3-4 hours during the 1st 48
hours post-op for severe pain without the danger of addiction.
 Hiccoughs: brought about by the dilation of the stomach, irritation
of the diaphragm, peritonitis and uremia cause either reflex or
CNS stimulation of the phrenic nerve.
Management:
1. Paper bag blowing.
2. CO2 inhalation, 5% CO2 and 95% O2, 5 mins every hour.
POSTOPERATIVE CARE
(cont…)

7. Wound Complications:
sutures are usually removed
about the 5-7th day post-op
with the exception of wire
retention sutures placed deep
in muscles and removed
usually 14-21 days after.
POSTOPERATIVE CARE
(cont…)
 Wound complications:
 Hemorrhage from the wound: most likely to occurs within the
1st hours post-op or as late as 6th or 7th post-op day.
Causes:
a. Hemorrhage occurring soon after operation: slipping of
ligature or mechanical dislodging of a blood clot or
caused by the re-established blood flow through vessel.
b. Hemorrhage after a few days: sloughing of a clot or tissue,
infection, erosion of blood vessel by a drainage tube.
Assessment:
a. Bright red blood
b. Decrease BP
c. Increase PR & RR
d. Restlessness
e. Pallor
f. Weakness
g. Cold, moist skin
POSTOPERATIVE CARE
(cont…)
2. Infection:
Causes: streptococcus, staphylococcus
Assessment:
a. From 3- 6 days after surgery, the patient begins to have low
grade fever and the wound becomes painful and swollen.
There maybe purulent drainage on dressing.
3. Dehiscence and Evisceration:
a. Dehiscence- (wound disruption) refers to a partial to complete
the separation of the wound edges.
b. Evisceration- refers to the protrusion of the abdominal viscera
through the incision and onto the abdominal wall.
POSTOPERATIVE CARE
(cont…)
Assessment:
a. Complaint of giving sensation in the incision
b. Sudden, profuse leakage of fluid from the incision
c. Dressing saturated with clear , pink drainage.
Management:
a. Position the patient to low fowler’s position; instruct not to cough,
sneeze , eat or drink, and remain quiet until the surgeon arrives.
b. Protruding viscera should be covered with warm, sterile saline
dressing.
c. Apply slight pressure on the bleeding site.
d. Dressing should be change frequently
e. Administer antibiotic as ordered