1. Identify common postoperative problems and their management.

 Shock - It is a serious reduction in blood pressure throughout the body caused by a severe drop
in blood pressure. Blood loss, infection, brain injury, or metabolic disorders can all induce shock.
Any or all of the following treatments may be used:

1) Stopping any blood loss

2) Helping with breathing (with mechanical ventilation if needed)
3) Reducing heat loss
4) Giving intravenous (IV) fluids or blood
5) Providing oxygen
6) Prescribing medicines, for example, to raise blood pressure

 Hemorrhage- Hemorrhage is the medical term for bleeding. Shock can result from a large
amount of blood loss at the operation site, for example. Treatment of rapid blood loss may
include:

1) IV Fluid or Blood plasma

2) Blood transfusion
3) More surgery to control the bleeding

 Wound Infection - Infection can occur when bacteria invade the surgical site. Infections might
slow down the healing process. Wound infections can spread through the bloodstream to
surrounding organs or tissue, as well as to distant locations. Infections in wounds can be treated
in a variety of ways, including:

1) Antibiotics
2) Surgery or procedure to clean or drain the infected area

 Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) - Are two types of thrombosis (PE).
These disorders are referred to as venous thromboembolism when they occur together (VTE).
Because the symptoms are so closely linked, this word is employed. Furthermore, their
prevention and treatment are intertwined. A blood clot in a major vein deep inside a leg, arm, or
other portion of the body is known as a deep vein thrombosis. Pain, swelling, and redness in a
leg, arm, or other location are symptoms. For management, call your healthcare provider if
you're experiencing any of these symptoms.
  Pulmonary Embolism - A clot in a vein can break free and migrate to the lungs. A pulmonary
embolism is the result of this. A blood clot in the lungs might stop blood flow. This is a medical
emergency that could result in death. Treatment is determined by the size and location of the
blood clot. It could include the following:

1) Anticoagulant medicines (blood thinners to prevent further clotting)

2) Thrombolytic medicines (to dissolve clots)
3) Surgery or other procedures

 Pulmonary Complications - Within 48 hours following surgery, lung problems can occur due to a
lack of deep breathing and coughing exercises. They can also happen as a result of pneumonia
or breathing food, water, or blood into the lungs. Wheezing, chest pain, fever, and cough are
some of the symptoms (among others).

 Urinary Retention - Urinary retention, or the inability to empty the bladder, is a common side
effect of surgery. Urinary retention, which is caused by anesthetics, is usually treated by
inserting a catheter into the bladder to drain it until the patient regains bladder control.
Medications that stimulate the bladder are sometimes prescribed.

 Reaction to Anesthesia - Allergies to anesthetics do exist, however they are uncommon. The
signs and symptoms might be modest to severe. Treatment of allergic reaction includes

1) Stopping specific medicines that may be causing the allergy

2) Administering other medicines to treat the allergy

2. Describe variables that affect wound healing

 Age - During the aging process, everything slows down, including wound healing phases.
As you become older, your skin thins out and your body's inflammatory response
decreases, which means your skin is more vulnerable to injury and heals more slowly.
 Nutrition - It is critical that the patient has adequate nutrition in order to heal. If the
patient lacks the necessary nutrition to sustain appropriate energy for collagen
formation, the wound will not heal adequately.
 Obesity - Anyone who is 20% or more over their optimal body weight has a higher risk
of infection when healing a wound.
 Repeated Trauma – The body's defense mechanisms will be limited and wound
regeneration will be delayed if you have several wounds or have suffered a severe
trauma.
 Skin Moisture - To be healthy, skin need a certain amount of fluid and moisture. If you
have dry skin (which is more frequent in the elderly), you're more likely to develop skin
lesions, infections, and thickness, all of which delay wound healing. On the other hand,
 if the skin is too wet, maceration and/or infections can occur, so maintaining an
adequate amount of skin moisture is critical for wound healing.
 Chronic Conditions - Chronic illnesses cause problems on the body's natural ability to
heal. Cardiovascular disease is one of the most dangerous, but diabetes and
immunodeficiency can significantly impede wound healing.
 Medication - Prescription drugs might have a negative impact on the healing process.
Aspirin and ibuprofen, for example, can obstruct the inflammatory stage of the healing
process. Anticoagulants can cause blood clotting to break down, whilst
immunosuppressants can weaken the immune system and increase the risk of infection.

3. Identify assessment parameters appropriate for the early detection of postoperative

complications.

Temperature, pulse rate, blood pressure, respiration rate, urine output, peripheral oxygen
saturation, and pain ratings are all common measures. Depending on the type of surgery, these variables
should be measured numerous times throughout the day. ECGs, arterial blood gas analysis (ABGs), and
central venous pressure (CVP) monitoring are all forms of monitoring. In addition, drainage and bleeding
should be assessed on a regular basis.

4. Demonstrate postoperative dressing technique.

A basic dressing technique that can be used to promote wound healing in people who are
unable to care for their own wounds:

1. Mupirocin ointment is applied to the surgical site, followed by bismuth tribromo phenate
gauze.The bismuth-impregnated gauze helps make the dressing nonadherent and moderately
occlusive.It also helps to keep the wound moist.

2. Excess mupirocin is then applied to the gauze. A non-adherent dressing is put to the wound.

3. To guarantee maximum adherence, the entire region is wrapped with gauze and cover-roll
nonlatex bandaging tape.

4. To prevent clothing from pulling the tape loose, the surgical site is covered in a self-adherent
wrap or bandage roll when it is on an extremity.

Once this dressing procedure has been completed, the bandage requires minimal wound care at
home other than keeping it dry. The dressing can be retained on the surgery site for up to 7 days
until the next checkup. It can also be used for a second week after bolster removal or for several
weeks after advanced flap repair if necessary.

What are the Nursing Considerations for Post-operative patient?

Nurses plays a vital role before, during, and after surgery. Surgical nurses, also known as perioperative
nurses, usually ensure that the patient is stable after the procedure and ready the room for the next
team. Monitoring vital signs, airway patency, and neurologic status; managing pain; assessing the
surgical site; assessing and maintaining fluid and electrolyte balance; and providing a detailed report of
the patient's condition to the receiving nurse on the unit and the patient's family are all examples of of
nursing considerations.

Preparing and Transferring Patients

The surgical nurse sutures the incision and administers dressings and bandages after the surgeon
finishes operating on the patient. The nurse also assesses the patient's condition by checking the vital
signs and determining whether the patient is stable enough to be sent to the recovery room. The nurse
observes the patient as the patient awakens from anesthesia after the nurse determined it's safe to
move him. Many hospitals offer a recovery department completely dedicated to ensuring that patients
recover properly from anesthesia. 

Monitoring Patients
After patients awaken from anesthesia, nurses continue to observe them. They check the incision site to
make sure the sutures are in place and the wound is healing properly. They also look for signs of
infection and, if necessary, provide medications. Because patients are more susceptible to sickness
following surgery, nurses must keep an eye out for signs of pneumonia or easily transmitted illnesses
like staph infections. They also check the patient's vital indicators, such as heart rate, pulse, breathing,
and temperature, on a frequent basis. They also keep an eye on the patient's IV and urine catheter.

Symptom Management
As a result of surgery, many patients experience pain, nausea, and other symptoms. Nurses look for
indicators of these side effects and treat them with pain or nausea medicine so that patients can heal. A
nurse must alter the dose or switch to a stronger drug if a patient does not respond to the medication.
Because patients are often cold after surgery, nurses may put more blankets on them to keep them
warm.

Question and Answer.

1. How often should surgical dressings be changed?

If the original dressing is not oozing, it should be left in place for up to two days (or as indicated by the
health care provider). For two days, the wound must be kept dry. The dressing must be changed
whenever it becomes moist from blood or any other liquid. Dressings should be changed as needed after
the primary bandage is removed to prevent wound drainage from soaking the gauze. This happens one
to four times every day on average. If the bandage is wet with drainage when you change it, you should
replace it more frequently. Dressings that have become soiled should be replaced.

2. What is the purpose of postoperative dressings?

The purpose of a postoperative dressings is to absorb any wound leakage, create ideal healing
conditions, protect the area until the wound heals, and keep stitches from sticking on clothing.
Based on the post-operative complications that you have learned:1. Identify major nursing diagnoses
to a patient recovering from surgery. Provide at least 2 nursing diagnoses.

1) Acute pain related to surgical incision and reflex muscle spasm

2) Nausea related to effects of anesthetic agents and gastrointestinal distention
3) Risk for imbalanced fluid volume related to stress
4) Risk for infection related to altered skin integrity, inadequate nutrition and fluid intake
References:
Akhtar, A., MacFarlane, R.J., Waseem, M. (2013). Pre-Operative Assessment and Post-Operative Care in
Elective Shoulder Surgery. NCBI Open Orthop J. 2013; 7: 316–322. Retrieved October 06, 2021 from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788190/

American Society for Surgery of the Hand. (n.d.). Patient Instructions: Taking care of your wounds. E-
Hand.Com The Electronic Textbook of Hand Surgery. Retrieved October 06, 2021, from
http://www.eatonhand.com/hdt/hdt005.htm
Edelman, A., Foley, M., McCall Michael. (2021). 24-7 Dressing Technique to Optimize Wound Healing
After Mohs Micrograhic Surgery. Cutis. Pearls 2021;107:149-150. Retrieved October 06, 2021 from
https://cdn.mdedge.com/files/s3fs-public/CT107003149.PDF
Hoch, C. (n.d.). Nursing Management: Postoperative Care. Nurse Key: Fastest Nurse Insight Engine
Chapter 20. Retrieved October 06, 2021 from https://nursekey.com/nursing-management-
postoperative-care/

John Hopkins Medicine. (n.d.). After Surgery: Discomforts and Complications. Retrieved October 06,
2021 from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/after-surgery-
discomforts-and-complications
Oxford University Hospitals. (2019). Caring for surgical wounds at home: Information for patients. NHS
Foundation Trust OMI 14109P. Retrieved October 06, 2021 from https://www.ouh.nhs.uk/patient-
guide/leaflets/files/14109Pwounds.pdf

The Hillingdon Hospitals. (2014). Caring for your surgical wounds at home. NHS Foundation Trust.
Retrieved October 06, 2021 from
https://www.thh.nhs.uk/documents/_Patients/PatientLeaflets/proceduresConditions/PIID185-
Caring_Surgical_Wounds_Oct12.pdf

Williams, E. (n.d.) The Postoperative Responsibilities of Nurses. CHRON. Retrieved October 06, 2021
from https://work.chron.com/postoperative-responsibilities-nurses-17262.html

Wound Care Solutions. (October 10, 2017). 7 Factors that Affect Wound Healing. Retrieved October 06,
2021 from https://www.woundcareinc.com/resources/factors-that-affect-wound-healing