Which postoperative complications should a nurse watch for?
NCLEX-RN topic: Complications of surgery and health alterations
- After surgery, the airway comes first, then breathing and circulation.
- Hemorrhage: fast pulse, falling blood pressure, site bleeding, dropping hemoglobin.
- For bleeding, apply pressure, stay with the client and call for help.
- PE: sudden dyspnea, chest pain, fast breathing; call rapid response, give oxygen.
- Urine output should be at least 30 mL/hr after surgery.
Key facts
- In the postanesthesia care unit, a stable airway is the priority of care.
- Vital signs in the PACU are checked about every 5 minutes for the first 15 minutes, then every 15 minutes if stable.
- Hemorrhage presents with hypotension, tachycardia, excessive bleeding at the site and falling hemoglobin and hematocrit; the nurse applies pressure, stays with the client and has the surgeon notified at once.
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- Pulmonary embolism presents with sudden shortness of breath, chest pain, tachypnea and tachycardia; the nurse activates the rapid response team and gives oxygen.
- Incentive spirometry, deep breathing, coughing, repositioning and early ambulation help prevent atelectasis and pneumonia.
- A DVT shows as swelling, pain, warmth and redness in one leg; untreated, it can become a pulmonary embolism.
- Urine output should be at least 30 mL/hr after surgery; a full bladder with no voiding suggests urinary retention.
Quick check1 question · 2 more at the end
A client had abdominal surgery 6 hours ago. Over the last 2 hours the heart rate has risen from 82 to 114/min and the blood pressure has fallen from 132/80 to 96/62 mm Hg. The abdominal dressing shows a spreading area of bright red drainage. Which action should the nurse take first?
Correct answer: D.
Rising heart rate, falling blood pressure and fresh bleeding at the site point to postoperative hemorrhage, a threat to circulation. The first action is to control bleeding with pressure while staying with the client and calling for help so the surgeon is notified at once. Circulation problems come before comfort and documentation.
A Waiting 30 minutes delays care for a client whose trend already shows hemorrhage.
B Removing the dressing delays bleeding control; the first step for active bleeding is pressure over the site.
C Pain relief matters, but it does not address the bleeding that threatens circulation.
D Correct: applying pressure is the first step for active postoperative bleeding, followed by calling for help and notifying the surgeon.
Full lesson
Each part starts with its main idea. Open a part when you want the details.
The short answer: After surgery, the airway comes first, then circulation. Hemorrhage shows as rising heart rate, falling blood pressure, bleeding at the site and a dropping hemoglobin; pulmonary embolism as sudden dyspnea, chest pain and tachypnea. Atelectasis, DVT, urinary retention, ileus, wound infection and dehiscence are prevented with breathing exercises, early ambulation and close monitoring.
1 What comes first right after surgery?In the first minutes after surgery, a stable airway is the top priority, then breathing and circulation. 1 min
In the first minutes after surgery, a stable airway is the top priority, then breathing and circulation. Anesthesia and pain medicines reduce breathing effort, so the nurse checks airway patency, respiratory rate and depth, breath sounds and oxygen saturation. In the PACU, vital signs are usually taken every 5 minutes for the first 15 minutes, then every 15 minutes if stable.
The nurse also checks the surgical site for bleeding and swelling, watches for nausea and vomiting, and manages pain.
2 Which complications can become emergencies within minutes?Hemorrhage and pulmonary embolism can turn deadly fast, so they take priority over the slower problems below. 1 min
Hemorrhage and pulmonary embolism can turn deadly fast, so they take priority over the slower problems below. Hemorrhage shows as a falling blood pressure, a rising heart rate, heavy bleeding at the site and a drop in hemoglobin and hematocrit. Restlessness and pale, cool skin are warning signs too.
For hemorrhage, apply pressure, stay with the client, have the surgeon notified at once, and prepare for a possible return to surgery. IV fluids and blood products are given as ordered.
Pulmonary embolism (PE) shows as sudden shortness of breath, chest pain, a fast breathing rate, a fast heart rate, cough and sometimes cyanosis or coughing up blood. The nurse activates the rapid response team and gives high-flow oxygen.
3 Which problems build up over hours to days?Most other complications develop more slowly, and nurses prevent many of them with simple routines. 1 min
Most other complications develop more slowly, and nurses prevent many of them with simple routines. Match each one with its clue and the nursing response.
| Complication | Clues | Nursing response |
|---|---|---|
| Atelectasis | Decreased breath sounds, low SpO2, dyspnea, tachypnea | Incentive spirometer, deep breathing, coughing, repositioning, walking |
| Pneumonia | Cough, fever, purulent sputum, crackles | Breathing exercises, head of bed up, antibiotics as ordered |
| Deep vein thrombosis | One leg swollen, painful, warm, red | Walking, leg exercises, SCDs or stockings, anticoagulant as ordered |
| Urinary retention | Cannot void, distended bladder | Bladder scan, catheterize if ordered |
| Paralytic ileus | Distended abdomen, absent bowel sounds, nausea, vomiting | Walking, IV fluids, NG tube if ordered |
| Wound infection | Redness, warmth, swelling, more pain, purulent drainage, fever | Sterile technique, hand hygiene, monitor temperature and WBC |
| Dehiscence | Wound edges separate, more drainage, tissue visible | Sterile dressing, notify surgeon, keep client calm, avoid strain |
4 How do you catch bleeding before shock sets in?Watch the trend, because early blood loss can hide behind a normal blood pressure. 1 min
Watch the trend, because early blood loss can hide behind a normal blood pressure. In early hypovolemic shock, the heart rate may be only slightly high and the blood pressure normal or slightly low, while anxiety is one of the first changes. Later, the blood pressure falls and urine output drops to 30 mL/hr or less.
Track intake and output and expect at least 30 mL/hr of urine. If blood pressure drops or breathing speeds up, do an ABC assessment right away.
5 What the nurse doesThe nurse assesses on a schedule, treats airway and bleeding first, and teaches prevention. 1 min
The nurse assesses on a schedule, treats airway and bleeding first, and teaches prevention.
- Assess: airway, breathing, vital-sign trends, the dressing and drains, urine output, bowel sounds, calves and level of consciousness.
- Priority action: treat airway and bleeding problems first; stay with an unstable client and call for help.
- Teach: use the incentive spirometer, splint the incision with a pillow when coughing, walk early, and report fever, redness or drainage after discharge.
Common mistakes
The traps students fall into most. Read these before you practice.
Watch out: Stay with a bleeding client and call for help, not leave the bedside to phone the surgeon yourself.
Watch out: Early ambulation prevents complications, not causes them; keeping a stable client in bed raises the risk of DVT and atelectasis.
Watch out: Tachycardia and restlessness can signal bleeding before blood pressure falls much, so a 'normal' blood pressure does not rule out hemorrhage.
Watch out: A distended abdomen with absent bowel sounds points to paralytic ileus, not to a normal recovery.
How to remember it
A quick head-to-toe scan helps you check every common complication in order.
Memory hook: scan from top to bottom. Airway and lungs (atelectasis, pneumonia, PE), belly (bleeding, ileus, wound), bladder (retention), legs (DVT).
Self-check:
- Name the four findings that suggest post-op hemorrhage.
- Say what you do first if a dressing is soaking with bright red blood.
- Name three routines that prevent atelectasis.