Postoperative Discomfort Management

• Discomfort after surgery is triggered by both internal and external factors.

Types of Postoperative Discomfort

• Pain
• Nausea/vomiting
• Thirst
• Hiccups
• Abdominal distension

Pain Causes After Surgery

• Incision
• Tissue/organ manipulation
• Chemical activation of nerve endings
• Muscle spasms
• Pressure
• Edema

Pain Characteristics After Surgery

• Intensity ranges from mild to severe, or sudden to gradual.
• Duration can be persistent or intermittent.
• Types include superficial, deep, localized, referred, projected, phantom, acute, dull, colicky, throbbing, or fixed.

Clinical Signs of Pain

• Tachycardia
• Tachypnea
• Hypertension
• Increased perspiration
• Irritability
• Apprehension
• Anxiety
• Diaphoresis

Interventions for Postoperative Pain

• Administer strong analgesics such as tramadol, morphine, fentanyl.
• Monitor respiratory function (two breaths per minute or less).
• Give emotional support.
• Provide comfort measures.
• Use non-pharmacological measures (local ice, change of position).
• Give oxygen therapy if caused by medications.
• Evaluate effectiveness and any side effects of pain relievers.
• Assess pain.

Definitions of Nausea and Vomiting

• Nausea is the sensation of unease with an impending need to vomit.
• Vomiting is the forceful expulsion of gastric contents from the mouth due to gastrointestinal muscle/thoracic wall contractions.

Causes of Nausea and Vomiting

• Inhaled anesthetics
• Abdominal distension following organ manipulation
• Narcotic side effects
• Fluid/food accumulation in the stomach prevents the digestive tract or peristalsis from being re-established.
• Psychological trigger

Interventions for Nausea/Vomiting

• Encourage deep breathing to eliminate anesthetic.
• Protect the wound during vomiting.
• Position the patient on their side to prevent aspiration.
• Remove vomit.
• Rinse the mouth.
• Administer antiemetics as prescribed.

Constipation and Flatulence

• Constipation is a symptom characterized by an increase in the number of bowel movements or excessive straining/difficulty in passing stool.
• Flatulence is discomfort/indisposition resulting from excessive gas accumulation in the digestive system.

Causes of Constipation and Flatulence

• Intestinal trauma/manipulation
• Narcotics
• Delayed peristalsis
• Local inflammation (peritonitis/abscess)
• Prolonged intestinal issues cause fecal impaction

Interventions for Constipation and Flatulence

• Early ambulation
• Fluid intake to hydrate/soften stool
• Diet to stimulate peristalsis
• Non-narcotic analgesics
• Listen and assess bowel sounds
• Perform rectal exam PRN

Thirst Definition and Causes

• Thirst is described as real and general overall discomfort resulting from great suffering.
• NPO status (nothing by mouth) or prolonged fasting
• Atropine usage (dries mucous membranes of the upper intestinal tract), nitrous oxide, isoflurane, and inhaled anesthetics

Nursing Care for Thirst

• Administer IV fluids as prescribed.
• Auscultate bowel sounds.
• Apply moist gauze to the lips.
• Perform oral rinses if necessary.
• Give ice chips.
• Give moist gauze with warm tea.

Hiccups and Interventions

• Hiccups are subsequent to gastrointestinal surgeries. Irritation of the phrenic nerve, spinal cord, and nerve branches below the upper diaphragm happens, accompanied by sounds and vocal cord vibrations.
• Determination can be be caused by trigger and deep breathing.
• Solutions may include eliminating the cause, encouraging the patient to hold their breath, paper bag breathing, covering the nose/mouth, pressure on the eyeballs for a few minutes.
• Position patient in Fowler or Semi-Fowler position and administer water as tolerated.

Abdominal Distension Definition and Interventions

• Abdominal distension is a build-up of gas in the intestine that cannot be absorbed. Air is swallowed during recovery when the patient attempts to vomit or because of nausea. Gases pass from the blood to the weakened areas of the intestine.
• Interventions and/or assessment include measuring the abdominal perimeter and checking for abdominal percussion - tympanic sound/cool/sweaty skin.

Additional Recommendations

• Walking, nursing care (position changes, early ambulation, suctioning liquid/gas via nasogastric tube).
• Rectal tube for 20 minutes every four hours.
• Passing of anal sphincter dilator and helping gas liberation.
• Pelvis movements/applying heat to the abdomen.

Paralytic Ileus Definition and Causes After Abdominal Surgery

• Paralytic ileus is pain response via the eardrum’s nervous system where utilization of narcotics can increases sphincter tone. Defecation will not take place from from the lack or decrease of peristalsis.
• Underling causes can be neuroendocrine response due to stress.
• Agents such as anesthetics/narcotics, inactivity, or lowered fiber intake.

Paralytic Ileus Assessment

• Bowel sounds
• Absence of flatulence
• Defecation (present/absent)
• Taking into account narcotics dosage/prolonged inactivity
• Fluid intake (<1200 mL daily)
• Previous incidents with constipation

Signs and Symptoms of Paralytic Ileus

• Abdominal discomfort/distension
• Absence of gas/feces
• Vomiting/Nausea
• Anxiety

Preventative Precautions and Care

• Correcting hydroelectrolytic equilibrium
• Mitigating any pre or post-operation anxieties
• Usage of a nasogastric tube along with minimizing any intestinal brain commotion

Interventions

• Feeding through the mouth depends on the surgery (NPO and NPT).
• Prescribed drugs/Free flowing nasogastric tube
• Managing intake and excreta, & maintain hydroelectrolytic equilibrium.

Urinary Retention

• Urinary retention is a surgical procedure increases aldosterone production. This leads to sodium preservation and water retention; the level of urine is decreased.
• Causes can stem from surgery type/duration, age and overall fluids given.
• Closely monitor those with trauma near specified area/adopted positioning as well in nervous people as well as painkiller use.
• Signs can show distension (bladder shape) with feelings of disquiet in suprapubic space.
• Nursing involves checking hourly diuresis to equalize fluid ingestion levels along with implementing physical stimulation.
• If there’s still no urination/discomfort/ heightened temperature around 6-8 hours after last void, catheter must be considered/administered and a blood culture for antibiotics done.

Postoperative complications

• Respiratory such as atelectasis, pulmonary aspiration/embolism, & pneumonia may happen.
• Vascular complications might be hemorrhage due to shock or deep venous thrombosis while complications with hydroelectrolytes can be urinary retention along with intestinal/wound infection (dehiscence & evisceration).
• Preoperative factors of potential surgical complications of preexisting pathology are being POC positive, using preoperative medications and weight - along with age.

Transoperative and Postoperative Factors

• Placement/length of nasogastric tube, low cough effectiveness, intense pain, top abdominal factors, mobility, type of anesthesia.

Classifications of Factors

• Obstructive conditions: blocking of airway via the base of tongue, salivary fluids and other matter.
• Hypoventilation: residual paralysis from nerve block or medication.
• Atelectasis shows the incomplete lung expansion.

Prevention

• Ensuring airway flow guaranteed from anesthesia patient through via oropharyngeal tube (endotracheal).
• Look for skin discoloration, signs involving uneasiness in verbal/nonverbal states, panic manifestations and vitals.
• Nurses should look respiration rates/ depths/accessory muscle usage/intercostal flare with auscultations for noises throughout lungs.
• Promote Fowler/semi-Fowler Positions and be observant of side lying, and use Guedel cannulas.

Additional Steps

• Suction secretions when needed, humidify O2, take vitals (15 minutes for 2 hours and 30 minutes for an additional 2 later on); promote sighing if able.

Hemorrhage Definition and Origin

• Hemorrhage is defined as copious blood leakage out of vessel after or during surgery.
• Blood vessel origin can range from leaking capillary (small), borborygmic/darkening venous, to spraying arterial type with bright red coloring.

Location and Signs of Hemorrhage

• Can be external or visible and internal; its manifestations cause worry, thirst, cool-clammy pale skin, heart/breathing difficulties.

Treatment of Hemorrhage

• Use hospital protocols/compression bandages while supplying fluids and possibly blood transfusions.

Deep Vein Thrombosis

• Deep Vein Thrombosis is when a blood clot develops in veins found in pelvic or lower legs. It is a common find due to abdominal surgeries, operations, and hip/ prostate/thoracic procedures.
• Lesions within linings vessels causes issues. Common symptoms include slight fever, swelling, cramping, perspiration.

Nursing for Deep Vein Thrombosis

• Includes encouraging enough liquids and pressure stockings while limiting the patient wearing tight, comfortable clothes. Friction and rubbing must be kept to minimal/avoided during movement. Assess peripheral pulses alongside general symptoms.

Treatment

• Using devices that support circulation, medication and circulation assistance throughout pre and post- operational stages are important.

Fluid Volume Disorders

• Fluid Volume Disorders are desensitization regarding imbalances involving overall liquid counts that also includes electrolytes, hypovolemia and other conditions. imbalances related in sodium/potassium levels might occur during the procedures.

Urinary Obstruction

• Urinary Obstruction is when the process/ability to completely (or partially) eliminate urine becomes obstructed which can cause abnormal structural/functional issues.

Classifications of Urinary Obstructions

• Can be acute/chronic or intrinsic/extrinsic - renal colic/tumors.

Pathophysiology of Urinary Obstructions

• Intraluminal pressures increase with glomerular flow decreases - this leads urethral complications along with renal area deterioration. Opposite (polyuria production) occurs with the release of pressure.

Causes, Signs and Symptoms and Additional Points for Urinary Obstructions

• Obesity, poor eating habits, tumors with hormonal complications and urinary calculus. May be related to irritating infections causing increased/ decreased urine flow and pain within the flanks.
• Labs can diagnose (analyzing of urine/metabolic markers), further check mineral levels if needed.

Benign Prostatic Hyperplasia (BPH)

• Benign Prostatic Hyperplasia is a non-cancerous condition with prostate growth that occurs as a male ages - often occurs as tissue puts stress/ blocks areas, leading various symptoms related in the inability of control to the urethra.
• Testing functions require secretion of fluid along to production PSA levels.

BPH Points

• 35 to 50 is considered normal for production of PSA
• 20% men in ages ranging 41 - 50 are at risk
• 96% risk above 80 years old
• Risk may heighten and the increased presence of certain chemicals that regulates testosterone due to aging processes.

Benign Prostatic Hyperplasia Risk Factors and Diagnoses

• Risk Factors involving such complications might consist (but not limited to ): Tobacco intake, diet and fat problems. testing/diagnosing require evaluating (but also limited to ) urine components + ultrasound/PSA levels.
• Treatment strategies for the symptoms largely dependent on the obstruction degree - pharmaceutical/surgical routes are also possible option alongside those needing prompt management with catheterization/cystostomy.

Soft Tissue Injuries

• Soft Tissue Injuries are contusions (non penetrating impact wounds without external cuts) stemming from hits/ repeated force that leads vessel breakage- creating mild symptoms. RICE method should be applied alongside administering medicine that reduces inflammation for more assistance.
• Distension happens through tendons/ connecting muscles being forced due movement , leads some rupture/ hemorrhaging occurrences - management also lies through RICE with some physiotherapeutic work involved. Sprains happen across strained ligaments through direct hits , leads grades symptoms and must dealt through ice compressions - plus further support.
• Dislocations result because bones may dislodge and cut a structure which might lead paralysis. Reduction via manual methods performed, if applicable.. Management after each one largely contains some kind physical/ rehab measures.

Central Venous Catheter

• Central Venous Catheter are tools that access the central circulation flowing through a vein within the chest - and terminates near to heart (atrium or right ventricle). Objective is the provision (but may not limit to) medication and sustenance, hemodynamic control and dialysis assistance.
• Construction lies a device that contains 2 - 3 pathways involving distal (NPT related things), proximal (for administering medications + taking out blood if needing as well analgesic support.)
• Indication for this is because of the inability to reach peripheral access or infusion concerns when needed to be able place line for drugs being taken along with various procedures (such intervention actions to monitor) , as example

Classifications, Contraindications and Complications of Central Venous Catheter

• Short /medium and long. There 3 points for insert -central/peripheral . contraindications includes blood clotting problems and low platelets amount with possible risks involves infection, bleeding, air causing blocks along with arrhythmias .
• Routine check/ monitoring regarding wounds + observing for infection signals is imperative , including cleansing, lighting + making compatibility tests when comes time handle catheter- use sterile practices/wear gloves. . When remove place patients the decubitus position and use a bandage after applying solution.

Total Parenteral Nutrition (TPN)

• TPN uses large vein, such as the superior vena cava and is done under/with a strict process when dealing with the G.I tract isn’t applicable. Components comprises some important things - such as proteins and electrolyte and may include glucose as part of liquid inclusion (depending what’s needed).
• It is 60% glucose , 30% fat, 10 % proteins - The source comes from carbs (glucose ) which vital to brain/blood cells, lipids and (of) proteins , for tissue control . signs of needing use would because complications within the digest tract/ileus conditions.

Complications and Care for Total Parenteral Nutrition (TPN)

• Should be done under a laminar environment alongside with the technique - that helps monitor zone for infection . Clean after 7 days and check lines - washing off the line so should never contain substance should complications includes thrombi/air in the system and also potential infection factors.
• When administering make clear aseptic manner using prescribed rate - do not suddenly change speeds or take down - doing reverse the action put 10 % dextrose into IV and be careful in checking tube connections as well evaluate how the skin looks . Perform frequent check of blood and sugar levels.