Complications of Surgery

Learning Outcomes

• Recognise clinical manifestations of external & internal bleeding, post-op respiratory depression, shock, dysrhythmias, respiratory distress, uncontrolled pain, neurological depression.
• Plan immediate nursing care and identify required emergency equipment.

Overview of Post-operative Complications

• Early: haemorrhage, shock, respiratory depression/distress, dysrhythmias, pain, neuro-depression, urinary retention, hypovolemic shock, gastric dilation.
• Pulmonary: pneumonia, atelectasis, PE, ARDS.
• GI: paralytic ileus.
• Vascular: DVT → PE.
• Wound: infection, dehiscence/evisceration, secondary haemorrhage, keloid, adhesions.

Bleeding

External

• Visible bleeding through dressings / drains.
• Growing hematoma at op site.

Internal – Key Signs

• Pain (dull / stabbing) with swelling & tenderness.
• Weakness, fatigue → fainting / unconsciousness.
• Bruising or abdominal distention, nausea/vomiting.
• SOB, dizziness, confusion.
• Altered urine / stool colour.

Post-op Respiratory Depression

• Causes: airway obstruction (tongue), OIRD, residual anaesthesia/paralysis, other sedatives, poor pain control splinting, OSA.
• Adult/Child S&S: ↓ RR & depth, cyanosis, O2 sat ↓, confusion, restlessness.
• Nursing: monitor half-hourly, give 28\text{–}35\% O2 for 4\text{–}6 h, airway assessment, deep-breathing & cough.

Immediate Nursing Care

Shock & Haemorrhage

• VS 2-hourly (focus BP, HR).
• Inspect wound & drains; measure blood loss, urine output.
• Watch for restlessness, pallor, cold clammy skin, ↑ thirst.
• Equipment: emergency trolley, IV fluids, dynamap.

Cardiac Dysrhythmias

• Continuous ECG; VS every 30 min.
• Administer prescribed anti-arrhythmic/ electrolytes.
• Equipment: monitor, SpO2 probe, emergency trolley.

Respiratory Distress / ARDS

• Sudden severe dyspnoea 12\text{–}48 h after lung insult.
• Rapid, laboured breathing, cyanosis, cough, fatigue.
• Causes: direct (pneumonia, aspiration, trauma, toxins) / indirect (sepsis, pancreatitis, bypass).
• Nursing: high-flow O2, position, notify team.

Uncontrolled Pain

• Assess q 30 min.
• Give analgesia as prescribed for first 12 h even if no complaint.
• Support movement & comfort.

Neurological Depression

• On return: check alertness, Glasgow Coma Scale, glucose, VS.
• Promote mobility with passive/active exercises.

Specific Complication Care

Pneumonia & Atelectasis

• CXR, pain control, cough & deep-breath, early mobilise, O2, chest physio.

Paralytic Ileus

• Inspect abdomen, auscultate bowel sounds.
• Keep NPO; NGT with suction PRN; monitor vomiting & hiccups.

DVT & Pulmonary Embolism

• Early ambulation.
• Watch for chest pain, dyspnoea, hypotension, collapse; give O2.

Infection

• VS monitoring.
• Look for pyrexia, redness, swelling, persistent wound pain, heat, abscess, early temp rise.
• Treat with antibiotics, possible I&D.

Urinary Retention (8-10 h Post-op)

• Inability to void, palpable bladder, suprapubic pain; frequent small voids.
• Catheterise if necessary.

Emergency Equipment Checklist

• Haemorrhage: emergency trolley, IV fluids, pressure dressings, blood products.
• Respiratory distress: suction, O2 source & masks, airway adjuncts, bag-valve-mask.
• Dysrhythmias: cardiac monitor/defibrillator, emergency drugs, pacing leads.

Late Post-op Complications

• Infection: poor asepsis/cross-infection; S&S—pyrexia, pain, swelling, redness; treat with antibiotics, I&D for abscess.
• Secondary haemorrhage (day 7\text{–}10): bleeding due to infection, return to theatre.
• Wound dehiscence/evisceration: risk ↑ with infection, obesity, malnutrition; cover with sterile saline dressings, bedrest, monitor shock, theatre return.

Wound-healing Problems

• Keloid formation.
• Adhesions – mild → severe.