Postoperative complications are a constant threat to the ...



Postoperative complications are a constant threat to the millions of people undergoing surgical interventions. Whether patients are managed in a hospital setting, an ambulatory care facility, or in a free-standing operating suite, the development of postoperative complications can lead to long-term disability and possibly death. Complications will be discussed utilizing an easy-to-decipher approach, beginning with detection and ending with appropriate steps to treat and/or reverse these untoward events. The underlying physiology will be presented to allow the reader to determine which patients would be at high risk for these developments. In addition, postoperative complications that are common to pediatric, geriatric, and obese patient populations will be addressed.

Upon completion of this course, you should be able to:

1. List the steps necessary to obtain an accurate and thorough assessment of patients prior to, during, and after surgery.

2. Identify information that should always be obtained during the assessment of the preoperative patient.

3. Review the common complications of patients undergoing abdominal, orthopedic, cardiovascular, respiratory, neurologic, obstetric/gynecologic, and genitourinary surgeries.

4. Describe the development, course, and management of postoperative nausea and vomiting (PONV).

5. Discuss the signs and symptoms as well as the treatment of malignant hyperthermia.

6. Review the implications of hypothermia, pain, and complications related to positioning in postsurgical patients.

7. List the most common respiratory complications following surgery and how to best identify and manage these complications in the postanesthesia care unit (PACU).

8. Describe the cardiovascular complications that may occur in the postoperative period and the appropriate interventions.

9. Discuss the development and management of postoperative neurologic complications.

10. List the steps to appropriately assess and manage the patient with a volume status complication in the postoperative period.

11. Outline the steps to managing postoperative ileus.

12. Identify the signs/symptoms, risk factors, and management of postsurgical renal insufficiency.

13. Describe the anatomic and physiologic differences between children and adults and how these differences impact postoperative care and complication development.

14. Identify the anatomic and physiologic differences between elderly and adult patients and the impact that these differences have on the development of postoperative complications.

15. Develop a plan for assessment and management to be instituted in the PACU to limit the development of postoperative complications in the morbidly obese patient.

ORTHOPEDIC SURGERY

Fracture repairs, total hip and/or knee replacements, and amputations are a few of the commonly performed orthopedic procedures. Slightly more women than men have these procedures; it is postulated that the bone loss that occurs in postmenopausal women puts them at increased risk of injury requiring surgical repair [9]. Patients who have orthopedic procedures require accurate assessment of their neurovascular status, including color, pulses, temperature, capillary refill, sensation, and movement of the affected area. Body alignment should be maintained, as ordered. Supplemental traction devices, casts, or braces should be assessed for pressure areas. Edema is common, and elevation of the affected limb can reduce this risk. DVT risk is higher in this group of patients than any other patient population [10,11]. Therefore, recommendations for DVT prophylaxis should be closely adhered to. Compartment syndrome may develop. The patient may be at risk for osteomyelitis, and hypovolemia is common in the postoperative phase. Patients undergoing amputation require close monitoring of their distal perfusion.

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