Question

Doris Bowman is a 39-year-old female patient who underwent a total abdominal hysterectomy with bilateral salpingo-oopherectomy with general anesthesia. Patient tolerated the procedure without complications. She has an abdominal incision covered with a 4 × 4 gauze dressing with no drainage noted. IV of potassium chloride in 5% dextrose and normal saline is infusing at 125 mL/hr. Estimated blood loss was 400 mL. She was extubated in the operating room and is breathing spontaneously at 21 breaths per minute. Blood pressure is stable at 154/92. She has a Foley catheter placed with 200 mL urine output and compression stockings have been applied.

1.   What are you on alert for today with this patient?

2.    Why is this important?

3.    What are the important assessments to make?

4.    Why are these assessments important

5.    What complications may occur? What could go wrong

6.    Relate the assessment data to the potential complications that may occur.

7.    What interventions will prevent complications?

8.How will the interventions prevent complications?

Answer 1

1. We should be alert for the development of post operative complications as well as adequate analgesia, iv fluid administration, control of hypertension, early initiation of enteral feed and early initiation of movement.

2. The post operative short term complications that can occur in this patient includes

• infections- pevic cellulitis, surgical wound infections
• Hemorrhage- post op bleeding can occur, Clots
• Deep vein thrombosis and pulmonary embolism- Risks are greater in malignancies
• Ureter or bladder injuries
• This patient has hypertension – can lead to bleeding, other medical events like stroke if not controlled
• Pain
• Breathing difficulties related to general anaesthesia

Early recognition of signs of complications is life saving

3. The important assessments to be made include:

· Monitoring of vitals regularly- Heart rate, Blood pressure, Respiratory rate,SpO2, Urine output

· Checking of surgical drain

· Noting the frequency of change of pads

· Checking soakage of surgical dressing

· Ensuring proper placement of compression stockings

· Monitoring input -output status

· Pasiing of flatus or stools

4. These assessments can lead to early recognition of complications. Tachycardia can indicate blood loss, inadequate analgesia, dehydration, pulmonary embolism etc. Normal urine output assures against bladder and ureteral injuries to an extent. Watching of drains helps in assessing blood loss and requirement of resuscitation. Normal respiratory mechanics helps in eliminating complications like DVT and pulmonary embolism

5. The post operative short term complications that can occur in this patient includes

• infections- pevic cellulitis, surgical wound infections
• Hemorrhage- post op bleeding can occur, Clots
• Deep vein thrombosis and pulmonary embolism- Risks are greater in malignancies
• Ureter or bladder injuries
• This patient has hypertension – can lead to bleeding, other medical events like stroke if not controlled
• Abnormal GI functions

Long term complications include early menopause, sexual dysfunction

6. As explained in 4

7. The interventions that can be done:

· Prophylactic antibiotics preop and continuation 24-48 hours postoperatively

· Compression stockings and LMW heparin for DVT prevention

· Early mobilisation

· Early initiation of enteral feeds

· Adequate fluid resuscitation

· Adequate analgesia

8. Prophylactic antibiotics prevent infections. Compression stockings, heparin, early mobilization prevent DVT. Adequate analgesia helps in initiation of early mobilazation and helps with breathing.