oncology fluids & electrolytes perioperative

8/3/2019 Oncology Fluids & Electrolytes Perioperative

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G0Mitosis

G1

G2

S

Cell Cycle a series of events within the cell thatprepare the cell for dividing into two

daughter cells


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WARNING SIGNS

(C.A.U.T.I.O.N.A.L)(C.A.U.T.I.O.N.U.S)


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CHANGE IN BOWELOR BLADDER HABITS


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A SORE THAT DOES NOTHEAL


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UNUSUAL BLEEDINGOR DISCHARGE


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THICKENING OR LUMP INBREAST OR ELSEWHERE


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Indigestion or difficulty swallowing


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OBVIOUS CHANGE IN WARTOR MOLE


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NAGGING COUGHOR

HOARSENESS


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UNEXPLAINED WEIGHT LOSS


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SEVERE ANEMIA


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EARLY DETECTION: main goalof treatment of breast cancer

BSE: MONTHLY self examination; age 20-40:breast exam every 2-3 years by a physician; 40 years =

annual

Mammogram: baseline 35-40 years; mammogram everyyear or very other year fro ages 40-50; mammogramyearly after age 50


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hard irregular mass felt in the

superior medial quadrant ofthe breast at the 2 oclock

position approximately 2.5 cmfrom the margin of the areola


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Breast SELF EXAMINATION

1. Start from age 20

2. Done after menstruation3. One week after menstrual

period4. During standing position,

note symmetry of breast5. Lying position, elevate

shoulders on side examinedwith pillow support

6. Palpate the breast fromperiphery to the center incircular motion


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STAGE 1

Breast tumors are very small and measure less than 2 cm. in

size; early breast cancer


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STAGE 2

Breast tumors measure between 2 and 5 cm. and the lymph nodes mayhave become affected. There is no sign of spread of breast cancer to

any other part of the body; still termed early breast cancer


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STAGE 3

Breast tumors are larger than 5 cm. and the lymph nodes are usuallyaffected, but there is still no sign that the disease has spread any further

throughout the body. locally-advanced breast cancer


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STAGE 4

Breast tumors are of any size, but in addition the lymphnodes are affected and the cancer has spread to other

parts of the body. advanced or metastatic breast cancer


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SUMMARY

1. Biopsy (FNAB)

2. Surgery (lumpectomy; simple mastectomy, MRM)

3. Chemotherapy

4. Radiation

5. Hormone therapy1. Tamoxifen2. Oophorectomy3. Corticosteroids4. Adrenalectomy and hypophysectomy


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NURSING CARE

Preoperative:

HISTORY AND P.E.

Tetanus prophylaxis and prophylactic antibiotic forulcerated tumors

Rehabilitation medicine

Intraoperative

DECISION Suction drain


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Post operative

Analgesics

Arm rehabilitation exercises

Discharge after 48 hours with tube drains and withinstructions:

Care of tube drain

Intake of analgesics

Arm rehabilitation exercises Follow up visit 5-7 days after discharge


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Post operative

Prevent lymphedema

ARM ADDUCTED, JP drain present

Instruct JP system After discharge, teach abduction, elevation 7-10

days to prevent contractures

Finger, hand, wrist, elbow, shoulder movement

throughout No venipuncture, injections, parenteral fluids

No shaving or deodorant to affected side


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Post operative

Post mastectomy arm exercises

1-2 days: focus on elbow, wrist and hand ofaffected side (extends, flexes elbow, gentlysqueezes a soft rubber ball and does DB tofacilitate lymph flow)

2nd day: add shoulder shrugs and ROM includingflexion and abduction; self care activities; not raisethe arm above shoulder height until drains areremoved


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Post operative

Post mastectomy arm exercises

10th day: active assisted ROM 2x a day; pain meds30 min prior = lymphedema and loss of shouldermobility

6th week: water aerobics; avoid using weights toprevent edema and subsequent swelling


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Post operative Arm precautions after mastectomy

Affected arm never used for BP, venipuncture,injection

No constricting clothing or jewelry including wristwatch on affected arm

Do not carry heavy objects in affected arm

Wear rubber gloves when washing dishes

Use unaffected arm when removing food from hotoven or wear padded glove pot holder

Use a thimble when sewing

Use cream or lotion to keep the skin soft


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Post operative Outdoor activities

Wear gloves when gardening

Wear protective clothing or use sunscreen to

prevent sunburn

Use insect repellant fro insect bits

Immediately wash cuts and scratches


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Follow up

Second follow up is 30 days after operation

Adjuvant therapy started within 6 weeks of operation

Frequency of follow up

First 2 years: every 6 months; earlier if with symptoms

After 2 years: yearly

Routine annual contralateral breast mammography

Symptom directed metastatic work up

Gynecological evaluation annually if on tamoxifen


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Early detection methods

SBE monthly Clinical breast exam every 3 years @ 20-39 and annually

thereafter

Annual PSA and DRE for men > 50 y.o.; annual testing for

men age 40 and over who are at high risk PE every 3 years, ages 20-39 and yearly over 40 y.o.

Pelvic exam every 3 years until 40, then yearly

Pap smear

Yearly fecal occult blood at 50; sigmoidoscopy q5y; doublecontrast enema q5y or colonoscopy q10y

TSE monthly (testes smooth, firm, oval shaped; rightlarger and higher; left smaller and lower)


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CHEMOTHERAPY

may or may not include Hormone Therapy

adjuvant treatment

can be taken by mouth, by injection, by intravenous

injection or by intravenous pump at set cycles or rounds

cause the fast growing cancer cells to stop dividing, stopgrowing and die

can be given before surgery to shrink a tumor or aftersurgery to reduce the chances of recurrence


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Side Effects mouth sores

nausea and vomiting

loss or thinning of hair

loss of appetite tiredness; loss of energy

sleep disturbances

temporary or permanent menopause (and sideeffects)

hot flashes

low red blood cell count; low white blood cell count


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1. Report side effects of chemotherapy2. Take medicines prescribed for side effects3. Severe side effects might improve with treatment

changes or dose reduction

4. Restrict activities5. Ask for help with chores6. If necessary cut back on hours at work7. Rest when tired8. Plan meals ahead for day of treatment and a couple of

days after


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9. Arrange for help with young children at treatment time10. Nibble dry crackers to help nausea11. If you are unable to eat, drink lots of liquids (juice,

peppermint tea, soup, Boost etc.)

12. Meditation and visualization can help reduce sideeffects13. Reward yourself with a small gift after each treatment

(flower, perfume, bubble bath etc)


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Woman in position for radiation treatment, from the side.Side radiation treatment beam is shown.

A bright yellow indicates breast being treatedB light yellow part of the beam, beam in air, not touching womanC opening of the linear acceleratorD arm holder


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Woman in position for radiation treatment, from the front. Middleradiation beam is shown.

A bright yellow indicates breast being treatedB light yellow part of the beam, beam in air, not touching woman

C opening of the linear acceleratorD arm holder supports woman's right arm


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INTERNAL RADIOTHERAPY

brachytherapy radiotherapy with implants thin tubes, seeds or rods containing radioactive material

are placed either directly into the cancer or close to it

alone, or combined with external radiotherapy

Temporary (one to six days) Permanent (remain in the body but are no longer

radioactive after being in place for some weeks or

months)


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INTERNAL RADIOTHERAPY

may send some radiation outside your body into thesurrounding area

Once the implant is removed, all radioactivity is removedfrom youthat is, you are not radioactive and there is nodanger to anyone else


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EXTERNAL RADIOTHERAPY

a machine directs radiation onto the cancer andsurrounding tissue

the length of treatment depends on many things, such asthe type of cancer, its location, and whether it is intendedto cure the cancer or to provide palliative treatment

a special x-ray machine called a simulator is often usedto pinpoint, very precisely, the area of the body to betreated


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EXTERNAL RADIOTHERAPY

permanent marks, which are fine dots, may be used toensure the radiation is delivered to the same site on adaily basis. These small, black 'tattoos' are about thesize of a pinhead.

external radiotherapy does not make you radioactive. Itis quite safe for you to be with other people when youare having treatments and after.


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SIDE EFFECTS tiredness inflamed, dry, itchy skin

peeling or darkening skin wet, moist, blistering skin surface (like a bad sunburn) swelling, heaviness, tenderness of the breast pinching or mild jabbing sensations thickening of the breast skin or tissue change in size of the breast lump in the throat during treatment heartburn during treatment difficulty swallowing during treatment


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1. Do not remove colored ink marks on the skin unless toldto do so

2. Wash with lukewarm water only and blot dry

3. Avoid soap, lotion, ointment or perfume on treatment

area

4. Do not shave or use deodorant in armpit on thetreatment side

5. You can dust your armpit with cornstarch

6. Avoid exposing treatment area to sun or hair dryers


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7. Wear a very loose fitting bra or camisole. If you havehad a mastectomy ask you doctor if you can wear yourprosthesis.

8. Do not scratch when itchy

9. If side effects persist or are aggressive ask your doctorfor special treatment products.

10.Continue doing post surgery exercises

11.Maintain a well balanced diet


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ORAL

CANCER

Tobacco use; mouth

sore that doesnt heal,

sore throat,

dysphagia,hgoarseness;

LEUKOPLAKIA;

ERYTHROPLAKIA

Clinical 1. SURGERY;

RADIATION

2. SOFT DIET TO

ALLOW AREATO HEAL

3. TUBE

FEEDINGS;

TRACHEOSTO

MY CARE

LUNG

CANCER

SMOKING

Chronic cough,

hoarseness,

hemoptysis, weightloss, loss of appetite,

fever, wheezing,

repeated bouts of

pneumonia, chest pain

CT scan; PET

scan; cytologic

analysis of

sputum; fiberopticbronchoscopy;

lymph node

biopsy; chest x-ray

Surgery


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ESOPAHGEAL

CARCINOMA

1. Ingestion of

corrosive

substance

like acids or

alkali

2. Esophagealstasis, like

muscular

problem of

esophagus

3. Alcohol

4. Smoking

Progressive

dysphagia

Anorexia

and weightloss; Back

and

substernal

pain

Hoarseness

of voice

Chronic

cough

Barium

swallow

Endoscopy

with biopsy

CT scan

Endoscopic

ultrasound

1. Nutrition

2. Palliative

3. Supportive


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LARYNGEAL

CANCERPROGRESSIVE

hoarseness;

dysphagia; lump

in the throat;burning

sensation when

drinking hot

liquids;persistent sore

throat

1. Laryngectomy (partial - clients

voice preserved; or total loss of

smell and speech; permanent

stoma needed)PRE-OP: routine; communication

mode; post op teaching before

procedure

POST-OP: routine post op care; checkfor hemorrhage, Atelectasis and

pneumonia; stoma care (avoid

water, aerosols, sprays; suction,

DBCT; humidified air, oralhygiene, hemovac make sure

deflated; establish

communication; speech therapist

consulted


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GASTRIC CANCER

1. Excess intake of

nitrate - cured,

salt cured andsmoke cured

foods

2. Smoking

3. Chronic

achlorhydria4. Pernicious

anemia

5. (+) family history

6. Excess intake of

raw foods

7. Drinking large,

volume of hot tea

8. Atrophic gastritis

Progressive loss

of appetite

Gastric fullness

(early satiety)Dyspepsia

(+) Guaiac stool

N & V

Hematemesis;

melenaPain induced by

eating relieved by

vomiting

Palpable mass

Anemia, pallor,weight loss

Occult blood

test

UGI series

UGI endoscopyBlood chemistry

1. Gastrectomy

Dumping

syndrome

Hemorrhage orbleeding

Pernicious

anemia

HODGKINSA EARLY 20S; Presence of 1 Radiation (1& 2)


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HODGKIN SA

LYMPHOMA

(malignancies of

lymphoid tissue; Blymphocytes; due to

Epstein Barr virus;

UNKNOWN CAUSE)

Most common in the

cervical, axillary,

inguinal nodes

EARLY 20 S;

55-75 Y.O.;

MEN

NIGHT

SWEATS,

WEIGHT

LOSS, FEVER,

FATIGUE,

PAINLESS

ENLARGEMENT

OF ONE OR

MORE LYMPH

NODES ON

ONE SIDE OF

THE NECK

Presence of

Reed Sternberg

cells

Test to stage:

1. Chest x-

rays; CT

scans of

head,neck,

chest,

abdomen,

pelvis;

PET of

entire

body;

CBC, Bone

marrow

biopsy

1. Radiation (1& 2)

2. Chemotherapy

(3 & 4)


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Staging

STAGE I single LN region, lymphoid

structure or extralymphatic site STAGE II 2 or more LN on same side of

diaphragm, localized extra

lymphatic involvement

STAGE III LN regions or structures on both

sides of the diaphragm, involve

the spleen or localized extranodal

disease STAGE IV diffuse or disseminated extra

lymphatic disease


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Chemotherapy

Depends on clients age, general condition

ABVD REGIMEN (DOXORUBICIN, BLEOMYCIN,

VINBALSTINE, DEACARBAZINE)

MOPP REGIMEN (NITROGEN MUSTARD,

VINCRISTINE, PROCARBAZINE, PREDNISONE

Radiation therapy(EARLY STAGE OF Hodgkinsdisease)


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Subtype Incidence Prognosis

Lymphocytepredominant Adults and males Localized atdiagnosis;

excellent

prognosis

Nodularsclerosing

MOST COMMON Good if diagnosedearly

Mixed cellularity Adults and males Poorer prognosis

Lymphocytedepleted

LEAST COMMON Poor prognosis

Manifestation HODGKINS NON HODGKINS


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Manifestation HODGKIN S NON HODGKIN S

LAD Localized, single

(cervical,

subclavicular)

Multiple peripheral

(mesentery)

SPREAD Orderly &

continuous

Diffuse & unpredictable

EXTRANODAL

INVOLVEMENT

RARE EARLY & COMMON

BONE MARROW UNCOMMON COMMON

FEVER, night

sweats, wt. loss

COMMON UNCOMMON

Other

manifestations

Fatigue, pruritus,

splenomegaly,

anemia, neutrophilia

Abdominal pain,

nausea, vomiting,

dyspnea, cough, CNS

symptoms


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COLORECTAL Change in FECAL OCCULT BLOOD


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COLORECTAL

CANCER

FAMILY HISTORY;ethnic

background;

colorectal

polyps; chronic

inflammatorybowel diseases;

> 50 y.o.;

smoking;

alcohol intake;

high fat; low

fiber; obesity;

DM

Change in

bowels:

tarry,

pencil or

ribbonshaped,

bloody

stools

Abdominal pain;diarrhea,

vomiting,

obstipation

, rectal

pressure;bleeding

FECAL OCCULT BLOOD,

SIGMOIDOSCOPY,

COLONOSCOPY, BARIUM

ENEMA, DRE

SURGERY, CHEMOTHERAPY


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ASCENDING (RIGHT) COLON CANCER

Occult blood in stool; Anemia; anorexia andweight loss; abdominal pain above umbilicus;palpable mass

DISTAL COLON/RECTAL CANCER

Rectal bleeding; changed bowel habits;constipation or diarrhea; pencil or ribbon shapedstool; tenesmus; sensation of incomplete bowelemptying


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Barium Enema

apple core Polypoid or plaque-like

lesion

Colonoscopy

Access to biopsy


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DUKES CLASSIFICATION

Stage A

confined to bowelmucosa; 80-90% survival

rate

Stage B

invading muscle wall

Stage C

lymph node involvement

Stage D metastases or locally

unresectable tumor;


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MANAGEMENT

Surgery

Hemicolectomy for ascending and transversecolon CA

Abdomino perineal resection (APR) forrectosigmoid cancer

There are 2 incisions: lower abdomenincision to remove sigmoid and perinealincision to rev\move the rectum

T- binder is used to secure perinealdressing

Necessitates permanent colostomy Chemotherapy (Fluouracil)

Radiation (adjuvant therapy for rectal CA)

RADIATION THERAPY


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RADIATION THERAPY

Internal BRACHYTHERAPY

1. Implanted into affectedtissue or body cavity

2. Ingested as a solution3. Injected as a solution

into the bloodstream orbody cavity

4. Introduced through acatheter into the tumor

SEALED OR UNSEALED Sealed

(temporary/permanent) Bed rest Use long handled

forceps Unsealed

Flush toilet 2x ormore

External TELETHERAPY

TIME, DISTANCE,SHIELDING 10 30 MINUTES 6 FEET PRIVATE ROOM

NO PREGNANT NURSE ROTATE NURSE(minimize exposure)

Lead apron Mark No deodorant, irritants to

skin etc. Avoid rubbing

Three step analgesic ladder for cancer pain


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Three step analgesic ladder for cancer paincontrol (WHO 1986)

1. BY THE MOUTH oral medication if possible

2. BY THE CLOCK regularly not as required

3. BY THE LADDER increasing potency of analgesiafor increasing severity of pain

Three step analgesic ladder for cancer pain


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Three step analgesic ladder for cancer paincontrol (WHO 1986)

Strong opioid

+/- non opioid

+/- adjuvant

Weak opioid

+/- non opioid

+/- adjuvant

Non opioid

+/- adjuvantNON OPIOID ANALGESICS

Paracetamol, Aspirin, NSAIDs

WEAK OPIOID ANALGESICSCodeine, Codeine paracetamolmixtures; dextropropoxyphene

STRONG OPIOID ANALGESICS

Morphine and related compounds

Prostate cancer Frequency, 1. Dx: DRE, needle biopsy, PSA;


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Etiology: Unknown

nocturia,

hesitancy,

urinary retention

, p y, ;

increase in acid and alkaline

phosphatases

2. Tx: radical prostatectomy;

radiation, hormone

manipulation; bilateral

orchiectomy

Bone metastasis: spinal cord

compression, pathologicfractures

Bladder Cancer

Chronic bladderinfection, smoking

Painless

hematuria,

dysuria and

frequency

1. Dx: cystoscopy

2. Cystectomy with one type of

urinary diversion: ILEAL

CONDUIT

Bladder Cancer 1. Pre op: routine; bowel prep


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p ; p p

2. Post op: routine; stoma care

3. Stoma care:

1. Check color; increase stomalheight is normal; monitor

excessive edema and

bleeding, monitor for

obstruction (decrease UO);

empty pouch when half full;

cleans periostomal skin with

mild soap and water; check

appliance in AM; maintain

urine acidity; report s/Sx of UTI


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Peri operative Nursing

PREOPERATIVE


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Assess STRESS (vaso vagal response)

Diagnose FEARS


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Fears of surgery at different developmental stages

AGE GROUP SPECIFIC FEARS NURSING considerations

Toddler SEPARATION TEACH parent to expectregression

Preschooler MUTILATION Allow child to play with models;encourage expression of feelings

School ager LOSS OF CONTROL Explain procedures in simpleterms; allow choices whenpossible

Adolescent LOSS OFINDEPENDENCE,

being different frompeers, e.g. alteration inbody image

Involve adolescent in proceduresand therapies; expect resistance;

express understanding ofconcerns; point out strengths

PREOPERATIVE


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Plan/Implementation

Age appropriate preparation for health care proceduresAGE SPECIAL NEEDS Typical fears

Newborn Include parents

Mummy restraints

Loud noises

Sudden movements

6-12 month Model desiredbehavior

Strangers, heights

Toddler Simple explanations;use distractions; allow

choices

Separation from parents;animals, strangers; change in

environment

Preschooler Encourageunderstanding by

playing with puppets,dolls; demo equipment;talk at childs eye level

Separation from parentsGhosts

Scary people

PREOPERATIVE


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Plan/Implementation

Age appropriate preparation for health care proceduresAGE SPECIAL NEEDS Typical fears

School ager Allow questions

Explain why

Allow to handleequipment

Dark, injury

Being alone

Death

Adolescent Explain long termbenefit

Accept regression

Provide privacy

Social incompetence

War, accdietns

Death

PREOPERATIVE


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Plan/Implementation

Promote safe environment PARENTAL INVOLVEMENT SAME NURSE TO CARE FOR THE CHILD (CONSISTENCY)

PROVIDE OBKJECTS THAT RECREATE FAMILIARSURROUNDINGS

Preparation for surgery Pre op check list: Informed consent; lab tests; skin prep; bowel

prep

IVs

NPO

Pre op meds, sedation and antibiotics

Removal of dentures, jewelry and nail polish

Nutrition (may need TPN or tube feedings pre op

PREOP TEACHING GUIDE


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FACTORS FOR NURSE TO ASSESS BEFORE TEACHING

History of illness

Rationale for surgeryNature of Surgery

Factors related for patients readiness for learning (age, mental status, pre

existing knowledge about condition)

CONTENT AREAS TO COVER DURING TEACHING

Elicit patients concerns

Provide info to clear up misconceptions

Explain preop procedures; remove jewelry and nail polish

Lab tests; skin prep

Rationale for withholding food and fluids (NPO)

Preop meds and IV line

Teach preop procedure (DBCT, leg exercises, moving in bed, incentivespirometry, equipment to expect post op)

Explain importance of reporting pain after surgery; relieve pain

PREOPERATIVE


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Evaluation

Is the preop checklist complete? Is the patient able to demonstrate post op exercises?


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PREOPERATIVE


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PREOPERATIVE

History Allergies Present medications Past medical illness Alcohol and drug use

Female patients: ask about pregnancy (LMP) Others:

Any loose teeth, dentures Glasses or contact lenses Hearing aid Jewelry Joint implants, metal implants, pacemaker Body piercing

PREOPERATIVE


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PREOPERATIVE

Surgical risks Age Obesity Medical illness Fluid and electrolyte status

Present medication Nature and location of present condition Magnitude and urgency of surgical procedure Mental attitude of the patient towards surgery

Caliber of the professional health team and ORfacilities

PREOPERATIVE


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PREOPERATIVE

Patient teaching

Diagnostic tests Concerns about anesthesia Diet; OR procedure IV therapy What to expect in the PACU

Pain control

Informed consent

Pre op exercises DBCT Incentive spirometry Foot and leg exercises Getting out of bed

PREOPERATIVE


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PREOPERATIVE

Skin preparation

Reduce number of microorganism near the incisionsite

Full bath the evening or morning of surgery Document

Bowel preparation AFTER 3 make the call

Pre op DRUGS

ANTI cholinergics; sedatives; anti anxiety; narcoticanalgesics; H2 receptor antagonists

FINAL CHECK


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INTRAOPERATIVE


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INTRAOPERATIVE

Role of the nurse

Positions during surgery

Types of anesthesia


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ANESTHESIA

MEDICATION SIDE EFFECTS Nursing considerations

Generalanesthesia via

inhalation(halothane)

Resp, circ depressionDelirium during

induction and recoveryNausea and vomiting,

aspiration during

induction, myocardialdepression and hepatic

toxicity

Check history of sensitizationMaintain airway

Protect and orient client

Monitor vital signs and labs

Prevent aspiration post op byelevating hear of bead andturning head to side unless

contraindicated

Nitrous oxide Hypotension, post op

nausea and vomiting

Monitor VS

Adequate oxygenation,especially during emergence

ANESTHESIA



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IV thiopentalsodium

(Pentothal)

Resp depression, lowBP, laryngospasm;

poor musclecontraction, irritating toskin and subQ tissue

Monitor VS, esp. airway andbreathing

Straps for operative table, properpositioning

Protect IV site, check placementperiodically

Spinalanesthesia,

saddle

Hypotension,headache

Monitor Vs, encourage fluids

Conductionblocks

(epiduralcaudal)

Hypotension,respiratory depression

Headache not experienced

Monitor VS

Localanesthesia

Excitability, toxicreaction (resp difficulty,

vasoconstriction)

Monitor patient

Do not use with epinephrine onfingers (circulation is less

optimal)

ANESTHESIA



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Conscioussedation

(Valium)

Respiratorydepression, apnea,

hypotension,bradycardia

Never leave the client alone

Constantly monitor airway, LOC,

pulse oximetry, ECG

VS q15-30 minutes

Assess clients ability to maintain

patent airway an respond toverbal commands

Plan/Implementation


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1. Monitor effects of anesthesia post induction2. Continuously monitor VS

3. Aseptic technique4. Appropriate grounding devices5. Fluid balance6. Perform sponge/instrument count

Potential complications1. Nausea and vomiting2. Hypoxia3. Hypothermia

4. Malignant hyperthermia Inherited muscle disorder chemically induced by

anesthesia; stop surgery, treated with 100% oxygen,skeletal muscle relaxant, sodium bicarbonate

POST - OPERATIVE


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OS O

Respiratory

Check breath sounds Turn, cough and deep breath (C/I: brain, spinal and eye

surgery)

Assess pain level

Teach how to use incentive spirometer

PCA

Get out of bed as soon as possible

Cardiovascular

VS q15min x 4; q30min x 2, q1H x 2 then as needed Monitor I & O

Check potassium levels

Monitor CVP

POST - OPERATIVE


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Neuropsychological

Stimulate patient post anesthesia Monitor LOC

GIT Check bowel sounds in 4 quadrants for 5 minutes

Keep NPO until bowel sounds are present Provide good mouth care while NPO Provide anti emetics for nausea and vomiting Check abdomen for distention Check for passage of flatus and stool

GUT Monitor I & O Encourage to void Notify physician if unable to void within 8 hours Catheterize if needed

POST - OPERATIVE


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Extremities

Check pulses

Assess color, edema, temperature

Inform patient not to cross legs

Apply anti embolic stockings before getting out of bed

Monitor for Homans sign

Wounds

Dressing

Document amount and character of drainage

Physician changes first post op dressing

Use aseptic technique

Note presence of drains

POST - OPERATIVE


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Wounds

Incision

Assess site (edematous, inflamed, excoriated)

Assess drainage (serous, serosanguinous, purulent)

Note type of sutures

Note if edges of wound are well approximated Anticipate infection 3-5 days post op

Debride wound if needed to reduce inflammation

Change dressing frequently to prevent skin breakdown andminimize bacterial growth

Drains

GI tubes

POST - OPERATIVE


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Prevent post op complications

Septicemia

Paralytic ileus

Urine retention

Wound infection; dehiscence; evisceration

Intestinal obstruction Hiccups

Post of psychosis

POST - OPERATIVE


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Prevent post op complications

Atelectasis Hypostatic pneumonia Constipation Abdominal distention Venous pooling

Thrombophlebitis

RULE OF THUMB Fever 1st 24 hours PULMONARY INFECTION Fever within 48 hours UTI Fever within 72 hours WOUND INFECTION

POTENTIAL COMPLICATIONS OF SURGERY

COMPLICATION ASSESSMENT Nursing considerations


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g

Hemorrhage Decreased BP,increased pulse, cold,

clammy skin

Replace blood volume; monitorVS

Shock Decreased BP,increased pulse, cold,

clammy skin

Treat cause, oxygen, IV fluids

Atelectasis and

pneumonia

Dyspnea, cyanosis,

cough, tachycardia,elevated temp, pain

on affected side

Experienced second day post op;

suctioning, postural drainage,antibiotics, cough and turn

Embolism Dyspnea, pain,hemoptysis,

restlessness, ABGlow, high CO2

Experienced second day post op;Oxygen, anticoagulants, IV fluids

DVT Positive homans sign Experienced 6-14 days up to 1year later; anti coagulant

POTENTIAL COMPLICATIONS OF SURGERY

COMPLICATION ASSESSMENT Nursing considerations


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Paralytic ileus Absent bowelsounds, no flatus or

stool

Nasogastric suction

IV fluids

Decompression tubesInfection of

woundElevated WBC,temperature;

positive cultures

3-5 days post op

Antibiotics, aseptic technique

Good nutrition

Dehiscence Disruption ofsurgical incision or

wound

5-6 days post opLow fowlers position, no

coughing, NPO, notify AP

Evsiceration Protrusion of woundcontents

5-6 days post op

Low fowlers position, no coughing

NPO, cover viscera with sterilesaline dressing; notify AP

Urinaryretention

Unable to void;bladder distention

8-12 day post op

Catheterize as needed


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POTENTIAL COMPLICATIONS OF SURGERYCOMPLICATION ASSESSMENT Nursing considerations

Urinary infection Foul smelling urine

Elevated WBC

5-8 days post op

Antibiotics

Force fluids

Psychosis Inappropriate affect Therapeutic communication

Medication

POST - OPERATIVE


105/106

DISCHARGE PLANNING

Medication Diet Activity Home care procedures and referrals

Potential complications Return appointments


106/106

oncology fluids & electrolytes perioperative

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